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

             <h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES</h1>

          DEPARTMENT OF HEALTH AND HUMAN SERVICES
             Food and Drug AdministrationFederal Funds
             Salaries and expensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
                of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration
                which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
                and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
                on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $5,833,942,000: Provided, That of the amount provided under this heading, $1,062,367,000 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; $219,527,000 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; $511,682,000 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; $39,618,000 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; $30,524,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account
                   and remain available until expended; $18,700,000 shall be derived from generic new animal drug user fees authorized by 21
                   U.S.C. 379j-21, 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,  biosimilar biological product user fees, animal drug user fees, and generic animal drug user fees that exceed the respective fiscal year 2020 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,  biosimilar biological product, animal drug, and generic animal drug assessments for fiscal year 2020, including any such fees collected prior to fiscal year 2020 but credited for fiscal year 2020, shall be subject to the fiscal year 2020 limitations: Provided further, That the Secretary may accept payment during fiscal year 2020 of user fees specified under this heading and authorized for fiscal year 2021, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2021 for which the Secretary accepts payment in fiscal year 2020 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C.
                9701: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided
                for, as determined by the Commissioner: Provided further, That funds may be transferred from one specified activity to another with the prior notification of the Committees on Appropriations
                of both Houses of Congress.
          In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381,
                priority review user fees authorized by 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, and voluntary
                qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C. 379j-62,
                prescription drug wholesale distributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics
                provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C.
                384d(c)(8), and Medical Countermeasure Priority Review Voucher User Fees authorized by 21 U.S.C. 360bbb-4a, shall be credited
                to this account, to remain available until expended.

             Buildings and facilitiesFor plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities
                of or used by the Food and Drug Administration, where not otherwise provided, $11,788,000, to remain available until expended.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      1
                      1
                      2

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, FDA
                      1
                      3
                      3

                      2000
                      Total: Balances and receipts
                      2
                      4
                      5

                      Appropriations:

                      Current law:

                      2101
                      Salaries and Expenses
                      –1
                      –2
                      –2

                      5099
                      Balance, end of year
                      1
                      2
                      3

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Foods
                      1,041
                      1,042
                      1,083

                      0002
                      Human Drugs
                      496
                      496
                      716

                      0003
                      Devices and Radiological Health
                      330
                      330
                      424

                      0004
                      National Center for Toxicological Research
                      63
                      63
                      67

                      0005
                      FDA Other Activities (FDA Headquaters)
                      194
                      196
                      180

                      0006
                      FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)
                      115
                      115
                      144

                      0007
                      FDA GSA Rental Payments
                      170
                      170
                      172

                      0008
                      FDA Buildings and Facilities
                      15
                      12
                      12

                      0009
                      Cooperative Research and Development (CRADA)
                      2
                      2
                      2

                      0010
                      Animal Drugs and Feed
                      172
                      173
                      192

                      0011
                      Biologics
                      215
                      215
                      262

                      0012
                      Food and Drug Safety (no-year)
                      1

                      0014
                      Zika Activities
                      1

                      0015
                      CURES Activities

                      60
                      75

                      0016
                      Emerging Health Threats
                      4

                      0017
                      Opioids - IMF
                      13
                      94

                      0799
                      Total direct obligations
                      2,832
                      2,968
                      3,329

                      0801
                      FDA Reimbursable program (User fees)
                      2,488
                      2,535
                      2,656

                      0802
                      FDA Reimbursable program (Federal sources)
                      37

                      0899
                      Total reimbursable obligations
                      2,525
                      2,535
                      2,656

                      0900
                      Total new obligations, unexpired accounts
                      5,357
                      5,503
                      5,985

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      927
                      926
                      910

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      927
                      926

                      1021
                      Recoveries of prior year unpaid obligations
                      54

                      1050
                      Unobligated balance (total)
                      981
                      926
                      910

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,913
                      2,906
                      3,251

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

                      1120
                      Appropriations transferred to other acct [075–4613]

                      –5
                      –5

                      1121
                      Appropriations transferred from other acct [075–5629]

                      60
                      75

                      1160
                      Appropriation, discretionary (total)
                      2,911
                      2,959
                      3,321

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      1
                      2
                      2

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      2,932
                      2,526
                      2,650

                      1700
                      Collected
                      12
                      31

                      1701
                      Change in uncollected payments, Federal sources
                      31
                      –31

                      1702
                      Offsetting collections (previously unavailable)
                      197

                      1710
                      Spending authority from offsetting collections transferred to other accounts [075–4613]
                      –5

                      1725
                      Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                      –772

                      1750
                      Spending auth from offsetting collections, disc (total)
                      2,395
                      2,526
                      2,650

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1

                      1900
                      Budget authority (total)
                      5,308
                      5,487
                      5,973

                      1930
                      Total budgetary resources available
                      6,289
                      6,413
                      6,883

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –6

                      1941
                      Unexpired unobligated balance, end of year
                      926
                      910
                      898

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      2,723
                      2,978
                      3,178

                      3010
                      New obligations, unexpired accounts
                      5,357
                      5,503
                      5,985

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      32

                      3020
                      Outlays (gross)
                      –5,001
                      –5,303
                      –5,483

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –54

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –79

                      3050
                      Unpaid obligations, end of year
                      2,978
                      3,178
                      3,680

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –65
                      –70
                      –39

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –31
                      31

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      26

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –70
                      –39
                      –39

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2,658
                      2,908
                      3,139

                      3200
                      Obligated balance, end of year
                      2,908
                      3,139
                      3,641

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,306
                      5,485
                      5,971

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,908
                      4,404
                      4,760

                      4011
                      Outlays from discretionary balances
                      2,091
                      895
                      721

                      4020
                      Outlays, gross (total)
                      4,999
                      5,299
                      5,481

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –33
                      –31

                      4033
                      Non-Federal sources:
                      –2,933
                      –2,526
                      –2,650

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –2,966
                      –2,557
                      –2,650

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –31
                      31

                      4052
                      Offsetting collections credited to expired accounts
                      22

                      4060
                      Additional offsets against budget authority only (total)
                      –9
                      31

                      4070
                      Budget authority, net (discretionary)
                      2,331
                      2,959
                      3,321

                      4080
                      Outlays, net (discretionary)
                      2,033
                      2,742
                      2,831

                      Mandatory:

                      4090
                      Budget authority, gross
                      2
                      2
                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      2
                      2

                      4101
                      Outlays from mandatory balances
                      2
                      2

                      4110
                      Outlays, gross (total)
                      2
                      4
                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources:
                      –1

                      4180
                      Budget authority, net (total)
                      2,332
                      2,961
                      3,323

                      4190
                      Outlays, net (total)
                      2,034
                      2,746
                      2,833

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      229
                      804
                      804

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      804
                      804
                      804

             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 advance 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 2020 Budget includes $6.1 billion in total resources for FDA. The Budget
                invests in priority activities including: modernizing food safety, strengthening foodborne illness response, helping fight
                the opioid crisis, promoting the development of innovative medical products, investing in blood pathogen reduction technology,
                and supporting the preparedness infrastructure.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      931
                      940
                      964

                      11.3
                      Other than full-time permanent
                      85
                      86
                      89

                      11.5
                      Other personnel compensation
                      42
                      44
                      45

                      11.7
                      Military personnel
                      58
                      60
                      62

                      11.8
                      Special personal services payments
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      1,117
                      1,131
                      1,161

                      12.1
                      Civilian personnel benefits
                      351
                      354
                      363

                      12.2
                      Military personnel benefits
                      31
                      32
                      33

                      21.0
                      Travel and transportation of persons
                      56
                      60
                      75

                      22.0
                      Transportation of things
                      3
                      4
                      5

                      23.1
                      Rental payments to GSA
                      170
                      170
                      172

                      23.2
                      Rental payments to others
                      3
                      3
                      4

                      23.3
                      Communications, utilities, and miscellaneous charges
                      21
                      23
                      28

                      24.0
                      Printing and reproduction
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      54
                      58
                      72

                      25.2
                      Other services from non-Federal sources
                      407
                      455
                      569

                      25.3
                      Other goods and services from Federal sources
                      159
                      170
                      213

                      25.4
                      Operation and maintenance of facilities
                      95
                      102
                      128

                      25.5
                      Research and development contracts
                      28
                      30
                      37

                      25.7
                      Operation and maintenance of equipment
                      63
                      68
                      85

                      26.0
                      Supplies and materials
                      47
                      50
                      63

                      31.0
                      Equipment
                      47
                      52
                      65

                      32.0
                      Land and structures
                      3
                      4
                      4

                      41.0
                      Grants, subsidies, and contributions
                      173
                      198
                      247

                      42.0
                      Insurance claims and indemnities
                      1
                      1
                      2

                      99.0
                      Direct obligations
                      2,832
                      2,968
                      3,329

                      99.0
                      Reimbursable obligations
                      2,525
                      2,535
                      2,656

                      99.9
                      Total new obligations, unexpired accounts
                      5,357
                      5,503
                      5,985

          Employment Summary

                      Identification code 075–9911–0–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      9,220
                      9,215
                      9,454

                      1101
                      Direct military average strength employment
                      668
                      668
                      668

                      2001
                      Reimbursable civilian full-time equivalent employment
                      6,602
                      7,191
                      7,355

                      2101
                      Reimbursable military average strength employment
                      479
                      479
                      479

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

                      3101
                      Allocation account military average strength employment
                      1
                      1
                      1

             Salaries and Expenses
             (Legislative proposal, not subject to PAYGO)Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for  innovative food products activities and over-the-counter monograph drug activities: Provided, That fees of  $28,000,000 for innovative food products shall be credited to this account and remain available until expended; $28,400,000 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   innovative food products and over-the-counter monograph drug user fees that exceed the respective fiscal year   2020 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from innovative food products and over-the-counter monograph drug reviews for fiscal year  2020 received during fiscal year 2020, including any such fees assessed prior to fiscal year  2020 but credited for fiscal year 2020, shall be subject to the fiscal year   2020 limitations: Provided further, That the Secretary may accept payment during fiscal year  2020 of user fees specified in this paragraph and authorized for fiscal year 2021, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year   2021 for which the Secretary accepts payment in fiscal year   2020 shall not be included in amounts in this paragraph.
          In addition, contingent upon the enactment of authorizing legislation establishing fees under 21 U.S.C. 387s with respect
                   to products deemed under 21 U.S.C. 387a(b) but not specified in 21 U.S.C. 387s(b)(2)(B), the Secretary shall assess and collect
                   such fees: Provided, That $100,000,000 shall be derived from such fees, which shall be credited to this account and remain
                   available until expended, in addition to amounts otherwise derived from fees authorized under 21 U.S.C. 387s.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      FDA Reimbursable program (Tobacco)

                      156

                      0899
                      Total reimbursable obligations

                      156

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected

                      156

                      1900
                      Budget authority (total)

                      156

                      1930
                      Total budgetary resources available

                      156

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      156

                      3020
                      Outlays (gross)

                      –156

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      156

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      156

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources:

                      –156

                      4040
                      Offsets against gross budget authority  and outlays (total)

                      –156

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The FY 2020 Budget proposes reforms to the Over-the-Counter Monograph program and includes a total of $28 million in new over-the-counter
                drug fees. The Budget proposes a new user fee program to support innovative food activities totaling $28 million. The Budget
                also includes a legislative proposal to increase the user fee collected in support of the tobacco program by $100 million
                and adds electronic nicotine delivery system manufacturers and importers as entities subject to the user fees.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      5

                      11.3
                      Other than full-time permanent

                      1

                      11.5
                      Other personnel compensation

                      1

                      11.9
                      Total personnel compensation

                      7

                      12.1
                      Civilian personnel benefits

                      2

                      21.0
                      Travel and transportation of persons

                      3

                      25.1
                      Advisory and assistance services

                      12

                      25.2
                      Other services from non-Federal sources

                      91

                      25.3
                      Other goods and services from Federal sources

                      41

                      99.0
                      Reimbursable obligations

                      156

                      99.9
                      Total new obligations, unexpired accounts

                      156

          Employment Summary

                      Identification code 075–9911–2–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      2001
                      Reimbursable civilian full-time equivalent employment

                      52

             FDA Working Capital FundProgram and Financing (in millions of dollars)

                      Identification code 075–4613–0–4–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Direct program activity

                      15

                      0900
                      Total new obligations, unexpired accounts (object class 25.3)

                      15

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      5
                      10

                      Budget authority:

                      Appropriations, discretionary:

                      1121
                      Appropriations transferred from other acct [075–9911]

                      5
                      5

                      Spending authority from offsetting collections, discretionary:

                      1711
                      Spending authority from offsetting collections transferred from other accounts [075–9911]
                      5

                      1900
                      Budget authority (total)
                      5
                      5
                      5

                      1930
                      Total budgetary resources available
                      5
                      10
                      15

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      5
                      10

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      15

                      3020
                      Outlays (gross)

                      –3

                      3050
                      Unpaid obligations, end of year

                      12

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      12

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5
                      5
                      5

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances

                      3

                      4180
                      Budget authority, net (total)
                      5
                      5
                      5

                      4190
                      Outlays, net (total)

                      3

             Payment to the FDA Innovation Account, CURES ActProgram and Financing (in millions of dollars)

                      Identification code 075–0148–0–1–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Direct program activity
                      60
                      60
                      75

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      60
                      60
                      75

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      60
                      60
                      75

                      1930
                      Total budgetary resources available
                      60
                      60
                      75

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      60
                      60
                      75

                      3020
                      Outlays (gross)
                      –60
                      –60
                      –75

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      60
                      60
                      75

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      60
                      60
                      75

                      4180
                      Budget authority, net (total)
                      60
                      60
                      75

                      4190
                      Outlays, net (total)
                      60
                      60
                      75

             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", $75,000,000, 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.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      10

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, FDA Innovation, CURES Act
                      60
                      70
                      75

                      2000
                      Total: Balances and receipts
                      60
                      70
                      85

                      Appropriations:

                      Current law:

                      2101
                      FDA Innovation, Cures Act
                      –60
                      –60
                      –75

                      5099
                      Balance, end of year

                      10
                      10

          Program and Financing (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      New Obligations for CURES Activities
                      41

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      8
                      27
                      27

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      60
                      60
                      75

                      1120
                      Appropriations transferred to other acct [075–9911]

                      –60
                      –75

                      1160
                      Appropriation, discretionary (total)
                      60

                      1930
                      Total budgetary resources available
                      68
                      27
                      27

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      27
                      27
                      27

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      8
                      26

                      3010
                      New obligations, unexpired accounts
                      41

                      3020
                      Outlays (gross)
                      –23
                      –26

                      3050
                      Unpaid obligations, end of year
                      26

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      8
                      26

                      3200
                      Obligated balance, end of year
                      26

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      60

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      15

                      4011
                      Outlays from discretionary balances
                      8
                      26

                      4020
                      Outlays, gross (total)
                      23
                      26

                      4180
                      Budget authority, net (total)
                      60

                      4190
                      Outlays, net (total)
                      23
                      26

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

          Object Classification (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      10

                      11.3
                      Other than full-time permanent
                      2

                      11.5
                      Other personnel compensation
                      1

                      11.9
                      Total personnel compensation
                      13

                      12.1
                      Civilian personnel benefits
                      4

                      25.2
                      Other services from non-Federal sources
                      12

                      31.0
                      Equipment
                      1

                      41.0
                      Grants, subsidies, and contributions
                      11

                      99.9
                      Total new obligations, unexpired accounts
                      41

          Employment Summary

                      Identification code 075–5629–0–2–554
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      100

             Revolving Fund for Certification and Other ServicesProgram and Financing (in millions of dollars)

                      Identification code 075–4309–0–3–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      Revolving Fund for Certification and Other Services (Reimbursable)
                      10
                      10
                      11

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      4
                      3
                      3

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      9
                      10
                      10

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      9
                      10
                      11

                      1900
                      Budget authority (total)
                      9
                      10
                      11

                      1930
                      Total budgetary resources available
                      13
                      13
                      14

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3
                      3
                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3
                      4

                      3010
                      New obligations, unexpired accounts
                      10
                      10
                      11

                      3020
                      Outlays (gross)
                      –9
                      –14
                      –11

                      3050
                      Unpaid obligations, end of year
                      4

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3
                      4

                      3200
                      Obligated balance, end of year
                      4

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      9
                      10
                      11

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6
                      10
                      11

                      4101
                      Outlays from mandatory balances
                      3
                      4

                      4110
                      Outlays, gross (total)
                      9
                      14
                      11

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –9
                      –10
                      –10

                      4180
                      Budget authority, net (total)

                      1

                      4190
                      Outlays, net (total)

                      4
                      1

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1

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

          Object Classification (in millions of dollars)

                      Identification code 075–4309–0–3–554
                      2018 actual
                      2019 est.
                      2020 est.

                      Reimbursable obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      4
                      4
                      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

                      25.4
                      Operation and maintenance of facilities
                      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
                      11

          Employment Summary

                      Identification code 075–4309–0–3–554
                      2018 actual
                      2019 est.
                      2020 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      36
                      37
                      37

             Health Resources and Services AdministrationFederal 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, $1,626,522,000 : 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 $120,000,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of
                section 224 of the PHS Act, and for expenses incurred by the Department of Health and Human Services (referred to in this
                Act as "HHS") pertaining to administrative claims made under such law .

             Health workforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of
                the Social Security Act, and the Health Care Quality Improvement Act of 1986,  $304,714,000: Provided, That sections 751  and 762(k) of the PHS Act and the proportional funding amounts in paragraphs (1) through (4) of section 756(f) 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 section and subpart: Provided further, That $105,000,000 shall remain available until expended for the purposes of providing primary health services, assigning
                National Health Service Corps ("NHSC") members to expand the delivery of substance use disorder treatment services, notwithstanding
                the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS Act, and making
                payments under the NHSC Loan Repayment Program under section 338B of such Act:  Provided further, That for purposes of the previous  proviso, section 331(a)(3)(D) of the PHS Act shall be applied as if the term "primary health services" includes clinical substance
                use disorder treatment services, including those provided by masters level, licensed substance use disorder treatment counselors.

             Maternal and child healthFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, and title V of the Social Security Act,  $783,200,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than  $92,593,000 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,  $2,388,781,000  ; of which $1,970,881,000 shall remain available to the Secretary through September 30,  2022, for parts A and B of title XXVI of the PHS Act,  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; and of which $70,000,000, to remain available until expended, shall be available to the Secretary for carrying out a program
                   of grants and contracts under title XXVI or section 311(c) of such Act focused on ending the nationwide epidemic, with any
                   grants issued under such section 311(c) administered in conjunction with title XXVI of the PHS Act, including the limitation
                   on administrative expenses.

             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,  $111,018,000 : 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 for 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 appropriation and 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 sections 711 and 1820 of the Social Security Act,  $188,645,000 .

             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".
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0005
                      Primary Health Care (Health Centers, Free Clinics)
                      1,668
                      1,626
                      1,626

                      0010
                      Primary Health Care (Mandatory)
                      3,894
                      4,016

                      0015
                      Health Workforce
                      915
                      1,139
                      305

                      0020
                      Health Workforce (Mandatory)
                      464
                      439

                      0025
                      Maternal and Child Health
                      883
                      927
                      783

                      0030
                      Maternal and Child Health (Mandatory)
                      6
                      6

                      0035
                      Ryan White HIV/AIDS
                      2,355
                      2,326
                      2,389

                      0040
                      Health Care Systems
                      111
                      115
                      111

                      0045
                      Rural Health
                      200
                      374
                      189

                      0050
                      Family Planning
                      286
                      286
                      286

                      0055
                      HRSA Program Management
                      155
                      155
                      152

                      0091
                      Direct program activities, subtotal
                      10,937
                      11,409
                      5,841

                      0300
                      Total direct programs
                      10,937
                      11,409
                      5,841

                      Credit program obligations:

                      0702
                      Loan guarantee subsidy

                      2

                      0799
                      Total direct obligations
                      10,937
                      11,409
                      5,843

                      0801
                      Health Resources and Services (Reimbursable)
                      65
                      63
                      82

                      0899
                      Total reimbursable obligations
                      65
                      63
                      82

                      0900
                      Total new obligations, unexpired accounts
                      11,002
                      11,472
                      5,925

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      309
                      454
                      315

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      167
                      335

                      1010
                      Unobligated balance transfer to other accts [075–1503]
                      –17

                      1010
                      Unobligated balance transfer to other accts [015–5606]
                      –5
                      –5
                      –5

                      1021
                      Recoveries of prior year unpaid obligations
                      61

                      1050
                      Unobligated balance (total)
                      348
                      449
                      310

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      6,737
                      6,844
                      5,841

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –16

                      1121
                      Appropriations transferred from other acct [075–0140]
                      60

                      1160
                      Appropriation, discretionary (total)
                      6,781
                      6,844
                      5,841

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      4,268
                      4,443

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      20
                      30
                      49

                      1701
                      Change in uncollected payments, Federal sources
                      10

                      1750
                      Spending auth from offsetting collections, disc (total)
                      30
                      30
                      49

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Offsetting collections (cash)(HPSL&NSL)
                      32
                      20
                      20

                      1802
                      Offsetting collections (previously unavailable)
                      2
                      2
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      32
                      21
                      21

                      1900
                      Budget authority (total)
                      11,111
                      11,338
                      5,911

                      1930
                      Total budgetary resources available
                      11,459
                      11,787
                      6,221

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –3

                      1941
                      Unexpired unobligated balance, end of year
                      454
                      315
                      296

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,627
                      7,968
                      8,613

                      3010
                      New obligations, unexpired accounts
                      11,002
                      11,472
                      5,925

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      26

                      3020
                      Outlays (gross)
                      –10,519
                      –10,827
                      –9,281

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –61

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –107

                      3050
                      Unpaid obligations, end of year
                      7,968
                      8,613
                      5,257

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –16
                      –16
                      –16

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

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      10

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –16
                      –16
                      –16

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,611
                      7,952
                      8,597

                      3200
                      Obligated balance, end of year
                      7,952
                      8,597
                      5,241

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      6,811
                      6,874
                      5,890

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,088
                      2,233
                      1,878

                      4011
                      Outlays from discretionary balances
                      4,121
                      4,150
                      4,893

                      4020
                      Outlays, gross (total)
                      6,209
                      6,383
                      6,771

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –11
                      –12
                      –12

                      4033
                      Non-Federal sources
                      –26
                      –18
                      –18

                      4033
                      Non-Federal sources

                      –19

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –37
                      –30
                      –49

                      Additional offsets against gross budget authority only:

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

                      4052
                      Offsetting collections credited to expired accounts
                      17

                      4060
                      Additional offsets against budget authority only (total)
                      7

                      4070
                      Budget authority, net (discretionary)
                      6,781
                      6,844
                      5,841

                      4080
                      Outlays, net (discretionary)
                      6,172
                      6,353
                      6,722

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,300
                      4,464
                      21

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,907
                      1,958
                      21

                      4101
                      Outlays from mandatory balances
                      2,403
                      2,486
                      2,489

                      4110
                      Outlays, gross (total)
                      4,310
                      4,444
                      2,510

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –32
                      –20
                      –20

                      4180
                      Budget authority, net (total)
                      11,049
                      11,288
                      5,842

                      4190
                      Outlays, net (total)
                      10,450
                      10,777
                      9,212

                      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)

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      11,049
                      11,288
                      5,842

                      Outlays
                      10,450
                      10,777
                      9,212

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      4,443

                      Outlays

                      1,937

                      Total:

                      Budget Authority
                      11,049
                      11,288
                      10,285

                      Outlays
                      10,450
                      10,777
                      11,149

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

                      Identification code 075–0350–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Guaranteed loan levels supportable by subsidy budget authority:

                      215001
                      Health centers: Facilities renovation loan guarantee levels
                      7
                      3
                      60

                      215999
                      Total loan guarantee levels
                      7
                      3
                      60

                      Guaranteed loan subsidy (in percent):

                      232001
                      Health centers: Facilities renovation loan guarantee levels
                      2.69
                      2.71
                      2.57

                      232999
                      Weighted average subsidy rate
                      2.69
                      2.71
                      2.57

                      Guaranteed loan subsidy budget authority:

                      233001
                      Health centers: Facilities renovation loan guarantee levels

                      2

                      233999
                      Total subsidy budget authority

                      2

                      Guaranteed loan reestimates:

                      235001
                      Health centers: Facilities renovation loan guarantee levels

                      –1

                      235999
                      Total guaranteed loan reestimates

                      –1

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

             HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL),
                Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts
                (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are
                awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the program's 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 2017–2018 data reported in the Annual Operating Report.

             Health Professions Revolving Loan Programs Federal Capital Contribution

                         Program
                         Account Balance

                         HPSL
                         424,598,650

                         NSL
                         195,287,497

                         PCL
                         225,828,416

                         LDS
                         181,920,522

                         Total
                         1,027,635,085

          Object Classification (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      197
                      201
                      152

                      11.3
                      Other than full-time permanent
                      6
                      6
                      5

                      11.5
                      Other personnel compensation
                      5
                      5
                      3

                      11.7
                      Military personnel
                      21
                      21
                      16

                      11.9
                      Total personnel compensation
                      229
                      233
                      176

                      12.1
                      Civilian personnel benefits
                      65
                      65
                      50

                      12.2
                      Military personnel benefits
                      11
                      11
                      9

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      23.1
                      Rental payments to GSA
                      30
                      30
                      16

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      5
                      5
                      5

                      25.1
                      Advisory and assistance services
                      16
                      16
                      11

                      25.2
                      Other services from non-Federal sources
                      251
                      258
                      188

                      25.3
                      Other goods and services from Federal sources
                      295
                      415
                      155

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.6
                      Medical care
                      3
                      3
                      2

                      25.7
                      Operation and maintenance of equipment
                      7
                      6
                      4

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      4
                      4
                      4

                      41.0
                      Grants, subsidies, and contributions
                      9,905
                      10,248
                      5,108

                      42.0
                      Insurance claims and indemnities
                      110
                      109
                      109

                      99.0
                      Direct obligations
                      10,937
                      11,409
                      5,843

                      99.0
                      Reimbursable obligations
                      65
                      63
                      82

                      99.9
                      Total new obligations, unexpired accounts
                      11,002
                      11,472
                      5,925

          Employment Summary

                      Identification code 075–0350–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,788
                      1,810
                      1,404

                      1101
                      Direct military average strength employment
                      201
                      201
                      154

                      2001
                      Reimbursable civilian full-time equivalent employment
                      51
                      51
                      67

                      2101
                      Reimbursable military average strength employment
                      2
                      2
                      2

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

                      Identification code 075–0350–4–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0010
                      Primary Health Care (Mandatory)

                      4,000

                      0020
                      Health Workforce (Mandatory)

                      437

                      0030
                      Maternal and Child Health (Mandatory)

                      6

                      0300
                      Total direct programs

                      4,443

                      0900
                      Total new obligations, unexpired accounts

                      4,443

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      4,443

                      1900
                      Budget authority (total)

                      4,443

                      1930
                      Total budgetary resources available

                      4,443

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      4,443

                      3020
                      Outlays (gross)

                      –1,937

                      3050
                      Unpaid obligations, end of year

                      2,506

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      2,506

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      4,443

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1,937

                      4180
                      Budget authority, net (total)

                      4,443

                      4190
                      Outlays, net (total)

                      1,937

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

          Object Classification (in millions of dollars)

                      Identification code 075–0350–4–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      45

                      11.3
                      Other than full-time permanent

                      1

                      11.5
                      Other personnel compensation

                      1

                      11.7
                      Military personnel

                      5

                      11.9
                      Total personnel compensation

                      52

                      12.1
                      Civilian personnel benefits

                      15

                      12.2
                      Military personnel benefits

                      3

                      23.1
                      Rental payments to GSA

                      8

                      23.3
                      Communications, utilities, and miscellaneous charges

                      2

                      25.2
                      Other services from non-Federal sources

                      34

                      25.3
                      Other goods and services from Federal sources

                      114

                      41.0
                      Grants, subsidies, and contributions

                      4,215

                      99.9
                      Total new obligations, unexpired accounts

                      4,443

          Employment Summary

                      Identification code 075–0350–4–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment

                      364

                      1101
                      Direct military average strength employment

                      36

             Vaccine Injury CompensationProgram and Financing (in millions of dollars)

                      Identification code 075–0320–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      31
                      33
                      33

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      33
                      33
                      33

                      1930
                      Total budgetary resources available
                      33
                      33
                      33

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      33
                      33
                      33

                      Budget authority and outlays, net:

                      Mandatory:

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4170
                      Outlays, net (mandatory)
                      –2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –2

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

             Covered Countermeasure Process FundProgram and Financing (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Claims
                      2
                      1
                      1

                      0103
                      Admin Expense

                      2
                      2

                      0900
                      Total new obligations, unexpired accounts
                      2
                      3
                      3

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      1

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

                      1050
                      Unobligated balance (total)
                      3
                      3
                      3

                      1930
                      Total budgetary resources available
                      3
                      3
                      3

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1

                      Change in obligated balance:

                      Unpaid obligations:

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

                      3010
                      New obligations, unexpired accounts
                      2
                      3
                      3

                      3020
                      Outlays (gross)
                      –2
                      –3
                      –3

                      3050
                      Unpaid obligations, end of year
                      1
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1
                      1
                      1

                      3200
                      Obligated balance, end of year
                      1
                      1
                      1

                      Budget authority and outlays, net:

                      Discretionary:

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances
                      2
                      3
                      3

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      2
                      3
                      3

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

          Object Classification (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      1
                      1
                      1

                      42.0
                      Insurance claims and indemnities

                      1
                      1

                      99.0
                      Direct obligations
                      2
                      3
                      3

                      99.9
                      Total new obligations, unexpired accounts
                      2
                      3
                      3

          Employment Summary

                      Identification code 075–0343–0–1–551
                      2018 actual
                      2019 est.
                      2020 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 ProgramsProgram and Financing (in millions of dollars)

                      Identification code 075–0321–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0010
                      Maternal, Infant, and Early Childhood Home Visiting Programs
                      411
                      404
                      400

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      14
                      20
                      16

                      1021
                      Recoveries of prior year unpaid obligations
                      17

                      1050
                      Unobligated balance (total)
                      31
                      20
                      16

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      400
                      400
                      400

                      1930
                      Total budgetary resources available
                      431
                      420
                      416

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      20
                      16
                      16

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      720
                      748
                      769

                      3010
                      New obligations, unexpired accounts
                      411
                      404
                      400

                      3020
                      Outlays (gross)
                      –366
                      –383
                      –393

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –17

                      3050
                      Unpaid obligations, end of year
                      748
                      769
                      776

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      720
                      748
                      769

                      3200
                      Obligated balance, end of year
                      748
                      769
                      776

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      400
                      400
                      400

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      4
                      16
                      16

                      4101
                      Outlays from mandatory balances
                      362
                      367
                      377

                      4110
                      Outlays, gross (total)
                      366
                      383
                      393

                      4180
                      Budget authority, net (total)
                      400
                      400
                      400

                      4190
                      Outlays, net (total)
                      366
                      383
                      393

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

          Object Classification (in millions of dollars)

                      Identification code 075–0321–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      11.1
                      Direct obligations: Personnel compensation: Full-time permanent
                      5
                      5
                      5

                      11.9
                      Total personnel compensation
                      5
                      5
                      5

                      12.1
                      Civilian personnel benefits
                      2
                      2
                      2

                      25.1
                      Advisory and assistance services
                      11
                      11
                      11

                      41.0
                      Grants, subsidies, and contributions
                      393
                      386
                      382

                      99.9
                      Total new obligations, unexpired accounts
                      411
                      404
                      400

          Employment Summary

                      Identification code 075–0321–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      39
                      39
                      39

                      1101
                      Direct military average strength employment
                      3
                      3
                      3

             Health Center Guaranteed Loan Financing AccountProgram and Financing (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2018 actual
                      2019 est.
                      2020 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)

          Status of Guaranteed Loans (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Position with respect to appropriations act limitation on commitments:

                      2111
                      Guaranteed loan commitments from current-year authority
                      889

                      2121
                      Limitation available from carry-forward
                      6
                      888
                      885

                      2143
                      Uncommitted limitation carried forward
                      –888
                      –885
                      –825

                      2150
                      Total guaranteed loan commitments
                      7
                      3
                      60

                      2199
                      Guaranteed amount of guaranteed loan commitments
                      6
                      2
                      48

                      Cumulative balance of guaranteed loans outstanding:

                      2210
                      Outstanding, start of year
                      69
                      60
                      52

                      2231
                      Disbursements of new guaranteed loans
                      7
                      3
                      60

                      2251
                      Repayments and prepayments
                      –16
                      –10
                      –10

                      Adjustments:

                      2263
                      Terminations for default that result in claim payments

                      –1
                      –1

                      2264
                      Other adjustments, net

                      2290
                      Outstanding, end of year
                      60
                      52
                      101

                      Memorandum:

                      2299
                      Guaranteed amount of guaranteed loans outstanding, end of year
                      45
                      39
                      78

             Public Law 104–299, Public Law 104–208, and Public Law 115–141 authorize Health Resources and Services Administration (HRSA)
                to guarantee up to $1 billion in private loans to health centers for the costs of developing and operating managed care networks
                or plans and for the construction, renovation, and modernization of medical facilities. The program account for this activity
                is displayed in the Health Resources and Services account (75–0350) as a line in the program and financing schedule.

          Balance Sheet (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2017 actual
                      2018 actual

                      ASSETS:

                      1101
                      Federal assets: Fund balances with Treasury
                      2
                      1

                      1999
                      Total assets
                      2
                      1

                      LIABILITIES:

                      2204
                      Non-Federal liabilities: Liabilities for loan guarantees
                      2
                      1

                      NET POSITION:

                      3300
                      Cumulative results of operations

                      4999
                      Total liabilities and net position
                      2
                      1

             Medical Facilities Guarantee and Loan FundStatus of Direct Loans (in millions of dollars)

                      Identification code 075–9931–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      5
                      5
                      5

                      1290
                      Outstanding, end of year
                      5
                      5
                      5

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

          Balance Sheet (in millions of dollars)

                      Identification code 075–9931–0–3–551
                      2017 actual
                      2018 actual

                      ASSETS:

                      1601
                      Direct loans, gross
                      5
                      5

                      1999
                      Total assets
                      5
                      5

                      LIABILITIES:

                      2201
                      Non-Federal liabilities: Accounts payable
                      5
                      5

                      NET POSITION:

                      3100
                      Unexpended appropriations

                      3300
                      Cumulative results of operations

                      3999
                      Total net position

                      4999
                      Total liabilities and net position
                      5
                      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 $11,200,000 shall be available from the Trust Fund to the Secretary.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      3,619
                      3,684
                      3,812

                      0198
                      Reconciliation adjustment
                      5

                      0199
                      Balance, start of year
                      3,624
                      3,684
                      3,812

                      Receipts:

                      Current law:

                      1110
                      Deposits, Vaccine Injury Compensation Trust Fund
                      309
                      305
                      310

                      1140
                      Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                      10
                      130
                      146

                      1199
                      Total current law receipts
                      319
                      435
                      456

                      1999
                      Total receipts
                      319
                      435
                      456

                      2000
                      Total: Balances and receipts
                      3,943
                      4,119
                      4,268

                      Appropriations:

                      Current law:

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –27
                      –27
                      –33

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –227
                      –280
                      –286

                      2199
                      Total current law appropriations
                      –254
                      –307
                      –319

                      2999
                      Total appropriations
                      –254
                      –307
                      –319

                      4030
                      Vaccine Injury Compensation Program Trust Fund
                      5

                      5098
                      Reconciliation adjustment
                      –10

                      5099
                      Balance, end of year
                      3,684
                      3,812
                      3,949

          Program and Financing (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Compensation: Claims for post - FY 1989 injuries
                      227
                      280
                      286

                      0103
                      Claims processing (Claims Court)
                      8
                      8
                      9

                      0104
                      Claims processing (HRSA)
                      9
                      9
                      11

                      0105
                      Claims processing (Dept. of Justice)
                      10
                      10
                      13

                      0191
                      Direct program activities, subtotal
                      27
                      27
                      33

                      0900
                      Total new obligations, unexpired accounts
                      254
                      307
                      319

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1033
                      Recoveries of prior year paid obligations
                      4

                      1035
                      Unobligated balance of appropriations withdrawn
                      –5

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      27
                      27
                      33

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      227
                      280
                      286

                      1900
                      Budget authority (total)
                      254
                      307
                      319

                      1930
                      Total budgetary resources available
                      254
                      307
                      319

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      11
                      18

                      3010
                      New obligations, unexpired accounts
                      254
                      307
                      319

                      3020
                      Outlays (gross)
                      –246
                      –325
                      –319

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      18

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      11
                      18

                      3200
                      Obligated balance, end of year
                      18

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      27
                      27
                      33

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      15
                      27
                      33

                      4011
                      Outlays from discretionary balances
                      4

                      4020
                      Outlays, gross (total)
                      19
                      27
                      33

                      Mandatory:

                      4090
                      Budget authority, gross
                      227
                      280
                      286

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      227
                      280
                      286

                      4101
                      Outlays from mandatory balances

                      18

                      4110
                      Outlays, gross (total)

                      298
                      286

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –4

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      4

                      4160
                      Budget authority, net (mandatory)
                      227
                      280
                      286

                      4170
                      Outlays, net (mandatory)
                      223
                      298
                      286

                      4180
                      Budget authority, net (total)
                      254
                      307
                      319

                      4190
                      Outlays, net (total)
                      242
                      325
                      319

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      3,595
                      3,750
                      3,905

                      5001
                      Total investments, EOY: Federal securities: Par value
                      3,750
                      3,905
                      4,075

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

          Object Classification (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      2
                      2
                      3

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      25.3
                      Other goods and services from Federal sources
                      4
                      22
                      29

                      42.0
                      Insurance claims and indemnities
                      247
                      282
                      286

                      99.9
                      Total new obligations, unexpired accounts
                      254
                      307
                      319

          Employment Summary

                      Identification code 075–8175–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      14
                      14
                      20

                      1101
                      Direct military average strength employment
                      4
                      4
                      4

             Indian Health ServiceFederal 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, $4,286,541,000, 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$968,177,000 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, for the Zero Suicide Initiative, for Aftercare
                Pilot Program at Youth Regional Treatment Centers, for transformation and modernization costs of the IHS Electronic Health Record system, for an initiative to improve the recruitment
                   and retention of health care providers and certain other critical professions, for national quality and oversight activities,
                   for initiatives to treat or reduce the transmission of Hepatitis-C and HIV-AIDs or both in high priority areas, to improve collections from public and private insurance at Indian Health Service and tribally operated facilities, and for
                accreditation emergencies shall be allocated at the discretion of the Director of the Indian Health Service and shall remain
                available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the
                total obligation is recorded in the year the funds are appropriated: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health
                Care Improvement Act shall remain available until expended for the purpose of achieving compliance with the applicable conditions
                and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or
                construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall
                remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall
                be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating
                health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children
                as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
                U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
                Indian Health Facilities account.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Clinical services
                      3,603
                      3,615
                      3,997

                      0002
                      Preventive health
                      170
                      171
                      118

                      0003
                      Urban health
                      49
                      49
                      49

                      0004
                      Indian health professions
                      49
                      49
                      44

                      0005
                      Tribal management
                      2
                      2

                      0006
                      Direct operations
                      72
                      72
                      74

                      0007
                      Self-governance
                      6
                      6
                      5

                      0009
                      Diabetes funds
                      150
                      150

                      0799
                      Total direct obligations
                      4,101
                      4,114
                      4,287

                      0801
                      Indian Health Services (Reimbursable)
                      1,610
                      1,634
                      1,634

                      0900
                      Total new obligations, unexpired accounts
                      5,711
                      5,748
                      5,921

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,006
                      1,220
                      1,222

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1,006
                      1,006

                      1021
                      Recoveries of prior year unpaid obligations
                      185

                      1050
                      Unobligated balance (total)
                      1,191
                      1,220
                      1,222

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,952
                      3,966
                      4,287

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      150
                      150

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,647
                      1,634
                      1,634

                      1701
                      Change in uncollected payments, Federal sources
                      7

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,654
                      1,634
                      1,634

                      1900
                      Budget authority (total)
                      5,756
                      5,750
                      5,921

                      1930
                      Total budgetary resources available
                      6,947
                      6,970
                      7,143

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –16

                      1941
                      Unexpired unobligated balance, end of year
                      1,220
                      1,222
                      1,222

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,034
                      1,139
                      553

                      3010
                      New obligations, unexpired accounts
                      5,711
                      5,748
                      5,921

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      34

                      3020
                      Outlays (gross)
                      –5,431
                      –6,334
                      –5,796

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –185

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –24

                      3050
                      Unpaid obligations, end of year
                      1,139
                      553
                      678

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –100
                      –106
                      –106

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –7

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –106
                      –106
                      –106

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      934
                      1,033
                      447

                      3200
                      Obligated balance, end of year
                      1,033
                      447
                      572

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,606
                      5,600
                      5,921

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,423
                      4,886
                      5,149

                      4011
                      Outlays from discretionary balances
                      862
                      1,298
                      641

                      4020
                      Outlays, gross (total)
                      5,285
                      6,184
                      5,790

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –441
                      –441
                      –441

                      4033
                      Non-Federal sources
                      –1,210
                      –1,193
                      –1,193

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,651
                      –1,634
                      –1,634

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –7

                      4052
                      Offsetting collections credited to expired accounts
                      4

                      4060
                      Additional offsets against budget authority only (total)
                      –3

                      4070
                      Budget authority, net (discretionary)
                      3,952
                      3,966
                      4,287

                      4080
                      Outlays, net (discretionary)
                      3,634
                      4,550
                      4,156

                      Mandatory:

                      4090
                      Budget authority, gross
                      150
                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      47
                      144

                      4101
                      Outlays from mandatory balances
                      99
                      6
                      6

                      4110
                      Outlays, gross (total)
                      146
                      150
                      6

                      4180
                      Budget authority, net (total)
                      4,102
                      4,116
                      4,287

                      4190
                      Outlays, net (total)
                      3,780
                      4,700
                      4,162

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      4,102
                      4,116
                      4,287

                      Outlays
                      3,780
                      4,700
                      4,162

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      150

                      Outlays

                      144

                      Total:

                      Budget Authority
                      4,102
                      4,116
                      4,437

                      Outlays
                      3,780
                      4,700
                      4,306

             The Indian Health Services account provides medical care, public health services, and health professions training opportunities
                to American Indians and Alaska Natives. More than $2.5. billion, primarily through self-determination contracts and compacts,
                will be administered by tribal governments in 2020.

          Object Classification (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      420
                      421
                      450

                      11.3
                      Other than full-time permanent
                      18
                      18
                      19

                      11.5
                      Other personnel compensation
                      66
                      66
                      69

                      11.7
                      Military personnel
                      54
                      54
                      57

                      11.9
                      Total personnel compensation
                      558
                      559
                      595

                      12.1
                      Civilian personnel benefits
                      167
                      168
                      186

                      12.2
                      Military personnel benefits
                      24
                      24
                      25

                      13.0
                      Benefits for former personnel
                      12
                      12
                      13

                      21.0
                      Travel and transportation of persons

                      1

                      21.0
                      Patient travel
                      45
                      45
                      45

                      22.0
                      Transportation of things
                      6
                      6
                      5

                      23.1
                      Rental payments to GSA
                      15
                      15
                      16

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      17
                      17
                      18

                      25.1
                      Advisory and assistance services
                      6
                      6
                      6

                      25.2
                      Other services from non-Federal sources
                      153
                      154
                      184

                      25.3
                      Other goods and services from Federal sources
                      88
                      88
                      93

                      25.4
                      Operation and maintenance of facilities
                      2
                      2

                      25.6
                      Medical care
                      360
                      361
                      361

                      25.7
                      Operation and maintenance of equipment
                      19
                      19
                      19

                      25.8
                      Subsistence and support of persons
                      8
                      8
                      8

                      26.0
                      Supplies and materials
                      97
                      97
                      119

                      31.0
                      Equipment
                      7
                      7
                      7

                      32.0
                      Land and structures
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      2,505
                      2,514
                      2,573

                      42.0
                      Insurance claims and indemnities
                      10
                      10
                      11

                      99.0
                      Direct obligations
                      4,101
                      4,114
                      4,287

                      99.0
                      Reimbursable obligations
                      1,610
                      1,634
                      1,634

                      99.9
                      Total new obligations, unexpired accounts
                      5,711
                      5,748
                      5,921

          Employment Summary

                      Identification code 075–0390–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      6,676
                      6,676
                      6,785

                      1101
                      Direct military average strength employment
                      922
                      922
                      922

                      2001
                      Reimbursable civilian full-time equivalent employment
                      5,701
                      5,701
                      5,701

                      2101
                      Reimbursable military average strength employment
                      785
                      785
                      785

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

                      Identification code 075–0390–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0009
                      Diabetes funds

                      150

                      0799
                      Total direct obligations

                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      150

                      1930
                      Total budgetary resources available

                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      150

                      3020
                      Outlays (gross)

                      –144

                      3050
                      Unpaid obligations, end of year

                      6

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      6

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      144

                      4180
                      Budget authority, net (total)

                      150

                      4190
                      Outlays, net (total)

                      144

             The Budget proposes to extend the Special Diabetes Program for Indians through fiscal year 2021.

          Object Classification (in millions of dollars)

                      Identification code 075–0390–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      21.0
                      Patient travel

                      2

                      22.0
                      Transportation of things

                      1

                      25.2
                      Other services from non-Federal sources

                      5

                      25.4
                      Operation and maintenance of facilities

                      3

                      25.6
                      Medical care

                      20

                      25.7
                      Operation and maintenance of equipment

                      1

                      26.0
                      Supplies and materials

                      5

                      31.0
                      Equipment

                      1

                      41.0
                      Grants, subsidies, and contributions

                      112

                      99.9
                      Total new obligations, unexpired accounts

                      150

             Special Diabetes Program for Indians
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

             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 2020, such sums as may be necessary: Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements
                for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal
                years: Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
                to another budget account.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0344–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Contract Support Costs
                      763
                      822
                      855

                      0900
                      Total new obligations, unexpired accounts (object class 25.3)
                      763
                      822
                      855

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      763
                      822
                      855

                      1930
                      Total budgetary resources available
                      763
                      822
                      855

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      48
                      63
                      3

                      3010
                      New obligations, unexpired accounts
                      763
                      822
                      855

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

                      3020
                      Outlays (gross)
                      –754
                      –882
                      –855

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –14

                      3050
                      Unpaid obligations, end of year
                      63
                      3
                      3

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      48
                      63
                      3

                      3200
                      Obligated balance, end of year
                      63
                      3
                      3

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      763
                      822
                      855

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      723
                      822
                      855

                      4011
                      Outlays from discretionary balances
                      31
                      60

                      4020
                      Outlays, gross (total)
                      754
                      882
                      855

                      4180
                      Budget authority, net (total)
                      763
                      822
                      855

                      4190
                      Outlays, net (total)
                      754
                      882
                      855

             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 $855 million in contract support
                costs funds will be provided to tribal governments and tribal organizations in 2020.

             Indian health facilitiesFor construction, repair, maintenance, improvement, demolition, 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,  $803,026,000, 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.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

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

                      2000
                      Total: Balances and receipts
                      8
                      9
                      9

                      Appropriations:

                      Current law:

                      2101
                      Indian Health Facilities
                      –8
                      –9
                      –9

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Maintenance
                      168
                      168
                      169

                      0002
                      Sanitation Facilities Construction
                      192
                      192
                      193

                      0003
                      Facilities and environmental health
                      251
                      251
                      251

                      0004
                      Equipment
                      24
                      24
                      24

                      0100
                      Total direct program
                      635
                      635
                      637

                      0799
                      Total direct obligations
                      635
                      635
                      637

                      0801
                      Indian Health Facilities (Reimbursable)
                      9
                      9
                      9

                      0900
                      Total new obligations, unexpired accounts
                      644
                      644
                      646

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      309
                      620
                      912

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      309
                      620

                      1021
                      Recoveries of prior year unpaid obligations
                      11

                      1050
                      Unobligated balance (total)
                      320
                      620
                      912

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      868
                      868
                      803

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      8
                      9
                      9

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      59
                      59
                      59

                      1701
                      Change in uncollected payments, Federal sources
                      9

                      1750
                      Spending auth from offsetting collections, disc (total)
                      68
                      59
                      59

                      1900
                      Budget authority (total)
                      944
                      936
                      871

                      1930
                      Total budgetary resources available
                      1,264
                      1,556
                      1,783

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      620
                      912
                      1,137

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      574
                      679
                      488

                      3010
                      New obligations, unexpired accounts
                      644
                      644
                      646

                      3020
                      Outlays (gross)
                      –528
                      –835
                      –868

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –11

                      3050
                      Unpaid obligations, end of year
                      679
                      488
                      266

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –9
                      –18
                      –18

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –9

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –18
                      –18
                      –18

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      565
                      661
                      470

                      3200
                      Obligated balance, end of year
                      661
                      470
                      248

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      936
                      927
                      862

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      326
                      319
                      300

                      4011
                      Outlays from discretionary balances
                      195
                      507
                      559

                      4020
                      Outlays, gross (total)
                      521
                      826
                      859

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –59
                      –59
                      –59

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –59
                      –59
                      –59

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –9

                      4070
                      Budget authority, net (discretionary)
                      868
                      868
                      803

                      4080
                      Outlays, net (discretionary)
                      462
                      767
                      800

                      Mandatory:

                      4090
                      Budget authority, gross
                      8
                      9
                      9

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3
                      9
                      9

                      4101
                      Outlays from mandatory balances
                      4

                      4110
                      Outlays, gross (total)
                      7
                      9
                      9

                      4180
                      Budget authority, net (total)
                      876
                      877
                      812

                      4190
                      Outlays, net (total)
                      469
                      776
                      809

             The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
                facilities support for the Indian Health Service. More than $340 million, primarily through self-determination contracts and
                compacts, will be administered by tribal governments in 2020.

          Object Classification (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      51
                      51
                      51

                      11.3
                      Other than full-time permanent
                      2
                      2
                      2

                      11.5
                      Other personnel compensation
                      3
                      3
                      3

                      11.7
                      Military personnel
                      22
                      22
                      22

                      11.9
                      Total personnel compensation
                      78
                      78
                      78

                      12.1
                      Civilian personnel benefits
                      18
                      18
                      18

                      12.2
                      Military personnel benefits
                      8
                      8
                      8

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      22.0
                      Transportation of things
                      4
                      4
                      4

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      15
                      15
                      15

                      25.1
                      Advisory and assistance services
                      2
                      2
                      2

                      25.2
                      Other services from non-Federal sources
                      163
                      163
                      165

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      25.4
                      Operation and maintenance of facilities
                      24
                      24
                      24

                      25.7
                      Operation and maintenance of equipment
                      4
                      4
                      4

                      25.8
                      Subsistence and support of persons
                      64
                      64
                      64

                      26.0
                      Supplies and materials
                      11
                      11
                      11

                      31.0
                      Equipment
                      8
                      8
                      8

                      32.0
                      Land and structures
                      6
                      6
                      6

                      41.0
                      Grants, subsidies, and contributions
                      225
                      225
                      225

                      99.0
                      Direct obligations
                      635
                      635
                      637

                      99.0
                      Reimbursable obligations
                      9
                      9
                      9

                      99.9
                      Total new obligations, unexpired accounts
                      644
                      644
                      646

          Employment Summary

                      Identification code 075–0391–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,010
                      1,010
                      1,015

                      1101
                      Direct military average strength employment
                      151
                      151
                      151

                      2001
                      Reimbursable civilian full-time equivalent employment
                      40
                      40
                      40

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

             Centers for Disease Control and PreventionFederal 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,  $577,386,000.

             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,  $1,318,056,000, of which $140,000,000 shall remain available through September 30, 2021.

             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,  $372,472,000: Provided, That of the amounts made available under this heading 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,  $347,145,000: Provided, That such amounts and any amounts transferred to this account shall be 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 this program, the Director may 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  made available under this heading 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,  $112,000,000.

             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,  $45,000,000: Provided, That in addition to amounts provided herein, $423,000,000 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,  $628,839,000.

             National Institute for Occupational Safety and HealthFor carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal
                Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22
                of the Occupational Safety and Health Act, with respect to occupational safety and health,  $190,000,000.

             Energy employees occupational illness compensation programFor necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act,  $55,358,000, to remain available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of
                division B, title I of Public Law 106–554.

             Global healthFor carrying out titles II, III, and XVII of the PHS Act with respect to global health,  $456,984,000, of which: (1)  $69,547,000 shall remain available through September 30,  2021 for international HIV/AIDS; and (2)  $99,762,000 shall  be available  for  global public health protection: 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,  $825,000,000: Provided, That the Director of the Centers for Disease Control and Prevention (referred to in this title as "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,
                 $155,000,000, of which up to $10,000,000 may be transferred to the reserve of the Working Capital Fund authorized under this heading in
                division F of Public Law 112–74: 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 of the amounts made available under this heading, $50,000,000 shall be transferred to and merged with
                   the Infectious Diseases Rapid Response Reserve Fund established by section 231 of division B of Public Law 115–245: Provided
                   further, That any funds made available by this Act to the Centers for Disease Control and Prevention may be used to support
                   the purchase, hire, maintenance, and operation of an 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,  2021.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      1

                      Receipts:

                      Current law:

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

                      2000
                      Total: Balances and receipts
                      1
                      2
                      3

                      Appropriations:

                      Current law:

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

                      5099
                      Balance, end of year

                      1
                      2

          Program and Financing (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Birth Defects, Developmental Disabilities, Disability and Health (0958)
                      140
                      156
                      112

                      0002
                      CDC-Wide Activities and Program Support (0943)
                      564
                      327
                      105

                      0004
                      Chronic Disease Prevention and Health Promotion (0948)
                      1,166
                      1,188
                      951

                      0005
                      Emerging and Zoonotic Infectious Diseases (0949)
                      611
                      620
                      509

                      0006
                      Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                      52
                      51
                      55

                      0007
                      Environmental Health (0947)
                      218
                      209
                      157

                      0008
                      Global Health (0955)
                      442
                      489
                      457

                      0012
                      HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                      1,122
                      1,132
                      1,318

                      0013
                      Immunization and Respiratory Diseases (0951)
                      769
                      798
                      727

                      0015
                      Injury Prevention and Control (0952)
                      593
                      649
                      629

                      0016
                      Occupational Safety and Health (0953)
                      334
                      336
                      190

                      0019
                      Public Health Preparedness and Response (0956)
                      1,168
                      858
                      825

                      0020
                      Public Health Scientific Services (0959)
                      488
                      496
                      468

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

                      0799
                      Total direct obligations
                      7,668
                      7,310
                      6,504

                      0802
                      CDC-Wide Activities and Program Support (Reimbursable)
                      269
                      297
                      331

                      0809
                      Reimbursable program activities, subtotal
                      269
                      297
                      331

                      0900
                      Total new obligations, unexpired accounts
                      7,937
                      7,607
                      6,835

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      469
                      933
                      467

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      334
                      664

                      1010
                      Unobligated balance transfer to other accts [075–0960]
                      –1

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

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

                      –406

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

                      –23

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      7

                      1021
                      Recoveries of prior year unpaid obligations
                      148

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      621
                      504
                      467

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      7,135
                      7,058
                      5,185

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –17

                      1120
                      Appropriations transferred to other acct [075–0960]
                      –6

                      1120
                      Appropriations transferred to other acct [075–0140]

                      –604

                      1120
                      Appropriations transferred to other acct [075–0945]

                      –50
                      –50

                      1160
                      Appropriation, discretionary (total)
                      7,112
                      6,404
                      5,135

                      Appropriations, mandatory:

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

                      1200
                      Appropriation (Childhood Obesity 075–0943)
                      30

                      1201
                      Appropriation (075–5146 CRADA)
                      1
                      1
                      1

                      1221
                      Appropriations transferred from other acct PPHF [075–0116]
                      801
                      805
                      894

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

                      1260
                      Appropriations, mandatory (total)
                      882
                      861
                      950

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      267
                      301
                      331

                      1701
                      Change in uncollected payments, Federal sources
                      –7

                      1750
                      Spending auth from offsetting collections, disc (total)
                      260
                      301
                      331

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      4
                      4
                      4

                      1900
                      Budget authority (total)
                      8,258
                      7,570
                      6,420

                      1930
                      Total budgetary resources available
                      8,879
                      8,074
                      6,887

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –9

                      1941
                      Unexpired unobligated balance, end of year
                      933
                      467
                      52

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,137
                      6,935
                      7,135

                      3010
                      New obligations, unexpired accounts
                      7,937
                      7,607
                      6,835

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      48

                      3020
                      Outlays (gross)
                      –7,884
                      –7,407
                      –7,637

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –148

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –155

                      3050
                      Unpaid obligations, end of year
                      6,935
                      7,135
                      6,333

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –190
                      –127
                      –127

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      7

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      56

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –127
                      –127
                      –127

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      6,947
                      6,808
                      7,008

                      3200
                      Obligated balance, end of year
                      6,808
                      7,008
                      6,206

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      7,372
                      6,705
                      5,466

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,629
                      2,860
                      2,368

                      4011
                      Outlays from discretionary balances
                      4,364
                      3,772
                      4,397

                      4020
                      Outlays, gross (total)
                      6,993
                      6,632
                      6,765

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –310
                      –301
                      –331

                      4033
                      Non-Federal sources
                      –20

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –330
                      –301
                      –331

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      7

                      4052
                      Offsetting collections credited to expired accounts
                      63

                      4060
                      Additional offsets against budget authority only (total)
                      70

                      4070
                      Budget authority, net (discretionary)
                      7,112
                      6,404
                      5,135

                      4080
                      Outlays, net (discretionary)
                      6,663
                      6,331
                      6,434

                      Mandatory:

                      4090
                      Budget authority, gross
                      886
                      865
                      954

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      147
                      206
                      224

                      4101
                      Outlays from mandatory balances
                      744
                      569
                      648

                      4110
                      Outlays, gross (total)
                      891
                      775
                      872

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –5
                      –4
                      –4

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4160
                      Budget authority, net (mandatory)
                      882
                      861
                      950

                      4170
                      Outlays, net (mandatory)
                      886
                      771
                      868

                      4180
                      Budget authority, net (total)
                      7,994
                      7,265
                      6,085

                      4190
                      Outlays, net (total)
                      7,549
                      7,102
                      7,302

             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 2020 Budget provides $140 million for CDC to begin a new initiative to end the HIV
                epidemic in America. The FY 2020 Budget maintains the proposal to establish a new block grant, proposed at $500 million, to
                increase flexibility for States to address their population's unique public health needs. The FY 2020 Budget provides $100
                million for global health security activities to protect Americans through partnerships and other activities that support
                public health capacity improvements in countries at risk for uncontrolled outbreaks of infectious diseases.

          Object Classification (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      770
                      642
                      642

                      11.3
                      Other than full-time permanent
                      115
                      100
                      100

                      11.5
                      Other personnel compensation
                      40
                      34
                      34

                      11.7
                      Military personnel
                      76
                      70
                      72

                      11.8
                      Special personal services payments
                      8
                      7
                      7

                      11.9
                      Total personnel compensation
                      1,009
                      853
                      855

                      12.1
                      Civilian personnel benefits
                      309
                      255
                      255

                      12.2
                      Military personnel benefits
                      46
                      47
                      49

                      13.0
                      Benefits for former personnel
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      55
                      50
                      50

                      22.0
                      Transportation of things
                      12
                      13
                      14

                      23.1
                      Rental payments to GSA
                      7
                      6
                      6

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      9
                      18
                      19

                      24.0
                      Printing and reproduction
                      2
                      3
                      3

                      25.1
                      Advisory and assistance services
                      814
                      625
                      737

                      25.2
                      Other services from non-Federal sources
                      180
                      155
                      183

                      25.3
                      Other goods and services from Federal sources
                      883
                      855
                      315

                      25.4
                      Operation and maintenance of facilities
                      12
                      22
                      25

                      25.5
                      Research and development contracts
                      38
                      24
                      28

                      25.6
                      Medical care
                      28
                      37
                      44

                      25.7
                      Operation and maintenance of equipment
                      41
                      44
                      52

                      26.0
                      Supplies and materials
                      260
                      401
                      406

                      31.0
                      Equipment
                      70
                      52
                      52

                      32.0
                      Land and structures
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      3,889
                      3,846
                      3,407

                      42.0
                      Insurance claims and indemnities
                      1
                      1
                      1

                      99.0
                      Direct obligations
                      7,668
                      7,310
                      6,504

                      99.0
                      Reimbursable obligations
                      269
                      297
                      331

                      99.9
                      Total new obligations, unexpired accounts
                      7,937
                      7,607
                      6,835

          Employment Summary

                      Identification code 075–0943–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      8,970
                      8,784
                      8,808

                      1101
                      Direct military average strength employment
                      820
                      810
                      808

                      2001
                      Reimbursable civilian full-time equivalent employment
                      187
                      178
                      178

                      2101
                      Reimbursable military average strength employment
                      31
                      5
                      5

             Buildings and facilities
             (including transfer of funds)For any cost related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities,  $30,000,000, which shall remain available until September 30,  2024 .
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      CDC Buildings and Facilities (0960)
                      25
                      25
                      25

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      7
                      499
                      504

                      1011
                      Unobligated balance transfer from other acct [075–0125]
                      240

                      1011
                      Unobligated balance transfer from other acct [075–0943]
                      1

                      1050
                      Unobligated balance (total)
                      248
                      499
                      504

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      270
                      30
                      30

                      1121
                      Appropriations transferred from other acct [075–0943]
                      6

                      1160
                      Appropriation, discretionary (total)
                      276
                      30
                      30

                      1930
                      Total budgetary resources available
                      524
                      529
                      534

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      499
                      504
                      509

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      10
                      27
                      25

                      3010
                      New obligations, unexpired accounts
                      25
                      25
                      25

                      3020
                      Outlays (gross)
                      –8
                      –27
                      –43

                      3050
                      Unpaid obligations, end of year
                      27
                      25
                      7

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      10
                      27
                      25

                      3200
                      Obligated balance, end of year
                      27
                      25
                      7

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      276
                      30
                      30

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1
                      12
                      12

                      4011
                      Outlays from discretionary balances
                      7
                      15
                      31

                      4020
                      Outlays, gross (total)
                      8
                      27
                      43

                      4180
                      Budget authority, net (total)
                      276
                      30
                      30

                      4190
                      Outlays, net (total)
                      8
                      27
                      43

          Object Classification (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      1
                      1
                      1

                      25.4
                      Operation and maintenance of facilities
                      11
                      11
                      11

                      32.0
                      Land and structures
                      13
                      13
                      13

                      99.9
                      Total new obligations, unexpired accounts
                      25
                      25
                      25

             CDC Working Capital FundProgram and Financing (in millions of dollars)

                      Identification code 075–4553–0–4–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      CDC Working Capital Fund (Reimbursable)
                      576
                      569
                      569

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      54
                      48
                      55

                      1021
                      Recoveries of prior year unpaid obligations
                      6

                      1050
                      Unobligated balance (total)
                      60
                      48
                      55

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      564
                      576
                      532

                      1900
                      Budget authority (total)
                      564
                      576
                      532

                      1930
                      Total budgetary resources available
                      624
                      624
                      587

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      48
                      55
                      18

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      195
                      199
                      207

                      3010
                      New obligations, unexpired accounts
                      576
                      569
                      569

                      3020
                      Outlays (gross)
                      –566
                      –561
                      –545

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –6

                      3050
                      Unpaid obligations, end of year
                      199
                      207
                      231

                      Uncollected payments:

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

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      193
                      197
                      205

                      3200
                      Obligated balance, end of year
                      197
                      205
                      229

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      564
                      576
                      532

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      399
                      380
                      351

                      4011
                      Outlays from discretionary balances
                      167
                      181
                      194

                      4020
                      Outlays, gross (total)
                      566
                      561
                      545

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –564
                      –576
                      –532

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      2
                      –15
                      13

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

          Object Classification (in millions of dollars)

                      Identification code 075–4553–0–4–551
                      2018 actual
                      2019 est.
                      2020 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
                      77
                      77
                      77

                      25.3
                      Other goods and services from Federal sources
                      68
                      68
                      68

                      25.4
                      Operation and maintenance of facilities
                      10
                      10
                      10

                      25.7
                      Operation and maintenance of equipment
                      57
                      52
                      52

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      12
                      12
                      12

                      32.0
                      Land and structures
                      52
                      50
                      50

                      99.9
                      Total new obligations, unexpired accounts
                      576
                      569
                      569

          Employment Summary

                      Identification code 075–4553–0–4–551
                      2018 actual
                      2019 est.
                      2020 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,268
                      1,551
                      1,551

                      2101
                      Reimbursable military average strength employment
                      21
                      79
                      79

             Infectious Diseases Rapid Response Reserve FundProgram and Financing (in millions of dollars)

                      Identification code 075–0945–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Direct program activity

                      50

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

                      50

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      50

                      Budget authority:

                      Appropriations, discretionary:

                      1121
                      Appropriations transferred from other acct [075–0943]

                      50
                      50

                      1930
                      Total budgetary resources available

                      50
                      100

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      50
                      50

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      50

                      3020
                      Outlays (gross)

                      –50

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      50
                      50

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances

                      50

                      4180
                      Budget authority, net (total)

                      50
                      50

                      4190
                      Outlays, net (total)

                      50

             The FY 2020 Budget provides $50 million for the Infectious Diseases Rapid Response Reserve Fund within the Centers for Disease
                Control and Prevention. This Fund will provide the ability to respond efficiently and rapidly to emerging infectious disease
                threats or outbreaks.

             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 2020, and existing profiles may be updated as necessary.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Agency for Toxic Substances and Disease Registry, Toxic Substance (Direct)
                      87
                      75
                      62

                      0801
                      Agency for Toxic Substances and Disease Registry, Toxic Substance (Reimbursable)
                      16

                      0900
                      Total new obligations, unexpired accounts
                      103
                      75
                      62

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      23
                      21
                      24

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      75
                      75
                      62

                      1121
                      Appropriations transferred from other acct [097–0100]
                      10

                      1160
                      Appropriation, discretionary (total)
                      85
                      75
                      62

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3
                      3
                      3

                      1701
                      Change in uncollected payments, Federal sources
                      13

                      1750
                      Spending auth from offsetting collections, disc (total)
                      16
                      3
                      3

                      1900
                      Budget authority (total)
                      101
                      78
                      65

                      1930
                      Total budgetary resources available
                      124
                      99
                      89

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      21
                      24
                      27

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      41
                      64
                      42

                      3010
                      New obligations, unexpired accounts
                      103
                      75
                      62

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

                      3020
                      Outlays (gross)
                      –79
                      –97
                      –71

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      64
                      42
                      33

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –4
                      –15
                      –15

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –13

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      37
                      49
                      27

                      3200
                      Obligated balance, end of year
                      49
                      27
                      18

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      101
                      78
                      65

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      51
                      51
                      42

                      4011
                      Outlays from discretionary balances
                      25
                      46
                      29

                      4020
                      Outlays, gross (total)
                      76
                      97
                      71

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –5
                      –3
                      –3

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –5
                      –3
                      –3

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –13

                      4052
                      Offsetting collections credited to expired accounts
                      2

                      4060
                      Additional offsets against budget authority only (total)
                      –11

                      4070
                      Budget authority, net (discretionary)
                      85
                      75
                      62

                      4080
                      Outlays, net (discretionary)
                      71
                      94
                      68

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      3

                      4180
                      Budget authority, net (total)
                      85
                      75
                      62

                      4190
                      Outlays, net (total)
                      74
                      94
                      68

          Object Classification (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      21
                      20
                      16

                      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
                      27
                      26
                      22

                      12.1
                      Civilian personnel benefits
                      8
                      7
                      6

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      1
                      1

                      25.1
                      Advisory and assistance services
                      3
                      7
                      9

                      25.2
                      Other services from non-Federal sources
                      5
                      5
                      3

                      25.3
                      Other goods and services from Federal sources
                      22
                      14
                      14

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1

                      31.0
                      Equipment
                      2

                      1

                      41.0
                      Grants, subsidies, and contributions
                      16
                      13
                      5

                      99.0
                      Direct obligations
                      87
                      75
                      62

                      99.0
                      Reimbursable obligations
                      16

                      99.9
                      Total new obligations, unexpired accounts
                      103
                      75
                      62

          Employment Summary

                      Identification code 075–0944–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      214
                      212
                      212

                      1101
                      Direct military average strength employment
                      33
                      33
                      33

                      2001
                      Reimbursable civilian full-time equivalent employment

                      2
                      2

             World Trade Center Health Program FundProgram and Financing (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      World Trade Center Health Program—Federal Share (CDC/NIOSH)
                      432
                      517
                      541

                      0002
                      World Trade Center Health Program—NYC
                      48
                      57
                      60

                      0900
                      Total new obligations, unexpired accounts
                      480
                      574
                      601

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      869
                      872
                      812

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      25
                      25
                      25

                      1021
                      Recoveries of prior year unpaid obligations
                      25

                      1033
                      Recoveries of prior year paid obligations
                      11

                      1050
                      Unobligated balance (total)
                      930
                      897
                      837

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (WTC (CDC Direct))
                      347
                      440
                      487

                      1200
                      Appropriation (WTC—NYC DHSS—CDC)
                      39
                      49
                      54

                      1260
                      Appropriations, mandatory (total)
                      386
                      489
                      541

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      36

                      1900
                      Budget authority (total)
                      422
                      489
                      541

                      1930
                      Total budgetary resources available
                      1,352
                      1,386
                      1,378

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      872
                      812
                      777

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      186
                      225
                      412

                      3010
                      New obligations, unexpired accounts
                      480
                      574
                      601

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

                      3020
                      Outlays (gross)
                      –393
                      –387
                      –401

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –25

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –25

                      3050
                      Unpaid obligations, end of year
                      225
                      412
                      612

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      186
                      225
                      412

                      3200
                      Obligated balance, end of year
                      225
                      412
                      612

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      422
                      489
                      541

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      225
                      249

                      4101
                      Outlays from mandatory balances
                      393
                      162
                      152

                      4110
                      Outlays, gross (total)
                      393
                      387
                      401

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –50

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      3

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      11

                      4150
                      Additional offsets against budget authority only (total)
                      14

                      4160
                      Budget authority, net (mandatory)
                      386
                      489
                      541

                      4170
                      Outlays, net (mandatory)
                      343
                      387
                      401

                      4180
                      Budget authority, net (total)
                      386
                      489
                      541

                      4190
                      Outlays, net (total)
                      343
                      387
                      401

             HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347)
                on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
                Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
                health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
                2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
                Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2019 and 2020 in
                the Budget reflect estimated Federal obligations for the WTC Health Program.

          Object Classification (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2018 actual
                      2019 est.
                      2020 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
                      35
                      39
                      39

                      25.2
                      Other services from non-Federal sources
                      128
                      157
                      179

                      25.3
                      Other goods and services from Federal sources
                      10
                      4
                      4

                      31.0
                      Equipment
                      4
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      23
                      27
                      27

                      42.0
                      Insurance claims and indemnities
                      274
                      340
                      345

                      99.9
                      Total new obligations, unexpired accounts
                      480
                      574
                      601

          Employment Summary

                      Identification code 075–0946–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      30
                      32
                      32

                      1101
                      Direct military average strength employment
                      9
                      7
                      7

             National Institutes of HealthFederal Funds
             national cancer instituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer,  $5,051,737,000, of which up to  $30,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research
                and Development Center in Frederick, Maryland.

             national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
                and blood products,  $3,002,696,000.

             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,  $397,493,000.

             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,  $1,746,493,000.

             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,  $1,956,031,000.

             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,  $4,754,379,000.

             national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences,  $2,472,838,000, of which  $741,000,000 shall be from funds available under section 241 of the PHS Act: Provided, That not less than  $311,236,000 is provided for the Institutional Development Awards program.

             eunice kennedy shriver national institute of child health and human developmentFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development,  $1,296,732,000.

             national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders,  $685,644,000.

             national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences,  $666,854,000.
          (Department of Health and Human Services Appropriations Act, 2019.)
             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,  $66,581,000.
          Note.—A full-year 2019 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, 2019 (Division C of P.L. 115–245, as amended).
             The amounts included for 2019 reflect the annualized level provided by the continuing resolution.

             national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging,  $2,654,144,000.

             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,
                 $520,829,000.

             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,  $408,358,000.

             national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research,  $140,301,000.

             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,  $452,419,000.

             National institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse,  $1,296,379,000.

             national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health,  $1,560,422,000.

             national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research,  $495,448,000.

             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,  $335,986,000.

             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,  $126,081,000.

             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,
                 $270,870,000.

             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),  $67,235,000.

             national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications,  $380,463,000: Provided, That of the amounts available for improvement of information systems,  $4,000,000 shall be available until September 30,  2021: Provided further, That in fiscal year  2020, 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,  $694,112,000: Provided, That up to  10 percent of the amounts made available under this heading shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network .

             office of the director
             For carrying out the responsibilities of the Office of the Director, NIH,  $1,756,544,000: 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  $157,065,000 shall be for the Environmental Influences on Child Health Outcomes study: Provided further, That  $520,367,000 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 of, 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,  2024.
             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 2020: 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9915–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, NIH
                      45
                      42
                      42

                      2000
                      Total: Balances and receipts
                      45
                      42
                      42

                      Appropriations:

                      Current law:

                      2101
                      National Institutes of Health
                      –45
                      –42
                      –42

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–9915–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      National Cancer Institute (0849)
                      5,951
                      6,170
                      5,248

                      0002
                      National Heart, Lung, and Blood Institute (0872)
                      3,374
                      3,487
                      3,003

                      0003
                      National Institute of Dental and Craniofacial Research (0873)
                      447
                      462
                      397

                      0004
                      National Institute of Diabetes and Digestive and Kidney Disease (0884)
                      1,963
                      2,030
                      1,746

                      0005
                      National Institute of Neurological Disorders and Stroke (0886)
                      1,949
                      2,469
                      2,027

                      0006
                      National Institute of Allergy and Infectious Diseases (0885)
                      5,263
                      5,528
                      4,755

                      0007
                      National Institute of General Medical Sciences (0851)
                      1,858
                      1,726
                      1,732

                      0008
                      National Institute of Child Health and Human Development (0844)
                      1,450
                      1,514
                      1,297

                      0009
                      National Eye Institute (0887)
                      770
                      797
                      686

                      0010
                      National Institute of Environmental Health Sciences (0862)
                      830
                      852
                      733

                      0011
                      National Institute on Aging (0843)
                      2,571
                      3,082
                      2,655

                      0012
                      National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                      585
                      605
                      521

                      0013
                      National Institute on Deafness and Other Communication Disorder (0890)
                      459
                      474
                      408

                      0014
                      National Institute of Mental Health (0892)
                      1,754
                      1,870
                      1,630

                      0015
                      National Institute on Drug Abuse (0893)
                      1,161
                      1,633
                      1,296

                      0016
                      National Institute on Alcohol Abuse and Alcoholism (0894)
                      508
                      526
                      452

                      0017
                      National Institute of Nursing Research (0889)
                      158
                      163
                      140

                      0018
                      National Human Genome Research Institute (0891)
                      557
                      576
                      495

                      0019
                      National Institute of Biomedical Imaging and Bioengineering (0898)
                      377
                      389
                      336

                      0021
                      National Center for Complementary and Integrative Health (0896)
                      142
                      146
                      126

                      0022
                      National Institute on Minority Health and Health Disparities (0897)
                      304
                      315
                      271

                      0023
                      John E. Fogarty International Center (0819)
                      76
                      78
                      67

                      0024
                      National Library of Medicine (0807)
                      427
                      442
                      380

                      0025
                      NIH Office of the Director (0846)
                      1,806
                      1,922
                      1,769

                      0026
                      NIH Buildings and facilities (0838)
                      169
                      200
                      200

                      0027
                      NIH Cooperative Research and Development Agreements
                      37
                      42
                      42

                      0028
                      National Center for Advancing Translational Sciences (0875)
                      754
                      813
                      694

                      0029
                      National Institute for Research on Safety and Quality

                      256

                      0031
                      Type 1 Diabetes
                      26
                      274
                      150

                      0799
                      Total direct obligations
                      35,726
                      38,585
                      33,512

                      0801
                      NIH Reimbursable - Other
                      3,958
                      4,408
                      3,730

                      0802
                      NIH Royalties
                      146
                      145
                      145

                      0809
                      Reimbursable program activities, subtotal
                      4,104
                      4,553
                      3,875

                      0899
                      Total reimbursable obligations
                      4,104
                      4,553
                      3,875

                      0900
                      Total new obligations, unexpired accounts
                      39,830
                      43,138
                      37,387

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      992
                      1,476
                      782

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      992
                      1,277

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

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

                      22

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      6

                      1021
                      Recoveries of prior year unpaid obligations
                      88

                      1033
                      Recoveries of prior year paid obligations
                      9

                      1050
                      Unobligated balance (total)
                      1,098
                      1,476
                      804

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      35,792
                      37,290
                      32,972

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –87

                      1120
                      Appropriations transferred to other acct [075–0128]

                      –5

                      1121
                      Appropriations transferred from other acct [075–5628]
                      386
                      515
                      335

                      1121
                      Appropriations transferred from other acct [075–5736]

                      13
                      13

                      1160
                      Appropriation, discretionary (total)
                      36,091
                      37,813
                      33,320

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      150
                      150

                      1201
                      Appropriation (special or trust fund)
                      45
                      42
                      42

                      1260
                      Appropriations, mandatory (total)
                      195
                      192
                      42

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3,784
                      4,439
                      4,439

                      1701
                      Change in uncollected payments, Federal sources
                      137

                      1750
                      Spending auth from offsetting collections, disc (total)
                      3,921
                      4,439
                      4,439

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      4

                      1900
                      Budget authority (total)
                      40,211
                      42,444
                      37,801

                      1930
                      Total budgetary resources available
                      41,309
                      43,920
                      38,605

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –3

                      1941
                      Unexpired unobligated balance, end of year
                      1,476
                      782
                      1,218

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      34,682
                      37,408
                      40,758

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1
                      –10

                      3010
                      New obligations, unexpired accounts
                      39,830
                      43,138
                      37,387

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      493

                      3020
                      Outlays (gross)
                      –36,720
                      –39,788
                      –40,881

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –88

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –779

                      3050
                      Unpaid obligations, end of year
                      37,408
                      40,758
                      37,264

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –671
                      –565
                      –565

                      3061
                      Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                      51

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –137

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      192

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –565
                      –565
                      –565

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      34,052
                      36,843
                      40,193

                      3200
                      Obligated balance, end of year
                      36,843
                      40,193
                      36,699

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      40,012
                      42,252
                      37,759

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      11,786
                      14,161
                      12,961

                      4011
                      Outlays from discretionary balances
                      24,748
                      25,489
                      27,729

                      4020
                      Outlays, gross (total)
                      36,534
                      39,650
                      40,690

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –3,654
                      –4,439
                      –4,439

                      4033
                      Non-Federal sources
                      –366

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,020
                      –4,439
                      –4,439

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –137

                      4052
                      Offsetting collections credited to expired accounts
                      227

                      4053
                      Recoveries of prior year paid obligations, unexpired accounts
                      9

                      4060
                      Additional offsets against budget authority only (total)
                      99

                      4070
                      Budget authority, net (discretionary)
                      36,091
                      37,813
                      33,320

                      4080
                      Outlays, net (discretionary)
                      32,514
                      35,211
                      36,251

                      Mandatory:

                      4090
                      Budget authority, gross
                      199
                      192
                      42

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      17
                      44
                      10

                      4101
                      Outlays from mandatory balances
                      169
                      94
                      181

                      4110
                      Outlays, gross (total)
                      186
                      138
                      191

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –4

                      4180
                      Budget authority, net (total)
                      36,286
                      38,005
                      33,362

                      4190
                      Outlays, net (total)
                      32,696
                      35,349
                      36,442

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      36,286
                      38,005
                      33,362

                      Outlays
                      32,696
                      35,349
                      36,442

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      150

                      Outlays

                      35

                      Total:

                      Budget Authority
                      36,286
                      38,005
                      33,512

                      Outlays
                      32,696
                      35,349
                      36,477

             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 2020 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. Detailed information is available through the Department of Health and Human Services.

          Object Classification (in millions of dollars)

                      Identification code 075–9915–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      985
                      1,015
                      1,044

                      11.3
                      Other than full-time permanent
                      515
                      527
                      531

                      11.5
                      Other personnel compensation
                      48
                      49
                      50

                      11.7
                      Military personnel
                      18
                      19
                      20

                      11.8
                      Special personal services payments
                      194
                      197
                      189

                      11.9
                      Total personnel compensation
                      1,760
                      1,807
                      1,834

                      12.1
                      Civilian personnel benefits
                      514
                      529
                      546

                      12.2
                      Military personnel benefits
                      12
                      12
                      13

                      13.0
                      Benefits for former personnel

                      2

                      21.0
                      Travel and transportation of persons
                      54
                      56
                      43

                      22.0
                      Transportation of things
                      5
                      6
                      5

                      23.1
                      Rental payments to GSA
                      23
                      21
                      18

                      23.2
                      Rental payments to others
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      38
                      36
                      25

                      25.1
                      Advisory and assistance services
                      264
                      268
                      194

                      25.2
                      Other services from non-Federal sources
                      1,327
                      1,393
                      974

                      25.3
                      Other goods and services from Federal sources
                      3,374
                      3,519
                      3,214

                      25.4
                      Operation and maintenance of facilities
                      213
                      282
                      268

                      25.5
                      Research and development contracts
                      1,577
                      1,663
                      1,467

                      25.6
                      Medical care
                      29
                      29
                      25

                      25.7
                      Operation and maintenance of equipment
                      143
                      146
                      120

                      25.8
                      Subsistence and support of persons
                      2
                      2
                      2

                      26.0
                      Supplies and materials
                      240
                      247
                      191

                      31.0
                      Equipment
                      192
                      204
                      159

                      41.0
                      Grants, subsidies, and contributions
                      25,958
                      28,364
                      24,412

                      99.0
                      Direct obligations
                      35,726
                      38,585
                      33,512

                      99.0
                      Reimbursable obligations
                      4,104
                      4,553
                      3,875

                      99.9
                      Total new obligations, unexpired accounts
                      39,830
                      43,138
                      37,387

          Employment Summary

                      Identification code 075–9915–0–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      12,799
                      13,193
                      13,412

                      1101
                      Direct military average strength employment
                      172
                      177
                      181

                      2001
                      Reimbursable civilian full-time equivalent employment
                      4,435
                      4,572
                      4,573

                      2101
                      Reimbursable military average strength employment
                      96
                      99
                      99

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

                      Identification code 075–9915–4–1–999
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Type 1 Diabetes

                      150

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

                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      150

                      1930
                      Total budgetary resources available

                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      150

                      3020
                      Outlays (gross)

                      –35

                      3050
                      Unpaid obligations, end of year

                      115

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      115

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      35

                      4180
                      Budget authority, net (total)

                      150

                      4190
                      Outlays, net (total)

                      35

             The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through fiscal year 2021.

             Payment to the NIH Innovation Account, CURES ActProgram and Financing (in millions of dollars)

                      Identification code 075–0147–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Payment to NIH Innovation (object class 94.0)
                      496
                      711
                      492

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      496
                      711
                      492

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      496
                      711
                      492

                      1930
                      Total budgetary resources available
                      496
                      711
                      492

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      496
                      711
                      492

                      3020
                      Outlays (gross)
                      –496
                      –711
                      –492

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      496
                      711
                      492

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      496
                      711
                      492

                      4180
                      Budget authority, net (total)
                      496
                      711
                      492

                      4190
                      Outlays, net (total)
                      496
                      711
                      492

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

             NIH Innovation Account, CURES Act
             (including transfer of funds)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 NIH in this Act,  $492,000,000, to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act, are to be derived from amounts transferred
                under section 1001(b)(2)(A) of such Act, and may be transferred by the Director of the National Institutes of Health to other
                accounts of the National Institutes of Health solely for the purposes provided in such Act: Provided further, That upon a determination by the Director that funds transferred pursuant to the previous proviso are not necessary for
                the purposes provided, such amounts may be transferred back to the Account: Provided further, That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, NIH Innovation, CURES Act
                      496
                      711
                      492

                      2000
                      Total: Balances and receipts
                      496
                      711
                      492

                      Appropriations:

                      Current law:

                      2101
                      NIH Innovation, Cures Act
                      –496
                      –711
                      –492

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      CURES obligations
                      102
                      244
                      157

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      40
                      48

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      496
                      711
                      492

                      1120
                      Appropriations transferred to other acct [075–9915]
                      –386
                      –515
                      –335

                      1160
                      Appropriation, discretionary (total)
                      110
                      196
                      157

                      1930
                      Total budgetary resources available
                      150
                      244
                      157

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      48

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      12
                      94
                      233

                      3010
                      New obligations, unexpired accounts
                      102
                      244
                      157

                      3020
                      Outlays (gross)
                      –20
                      –105
                      –175

                      3050
                      Unpaid obligations, end of year
                      94
                      233
                      215

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      12
                      94
                      233

                      3200
                      Obligated balance, end of year
                      94
                      233
                      215

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      110
                      196
                      157

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      12
                      39
                      33

                      4011
                      Outlays from discretionary balances
                      8
                      66
                      142

                      4020
                      Outlays, gross (total)
                      20
                      105
                      175

                      4180
                      Budget authority, net (total)
                      110
                      196
                      157

                      4190
                      Outlays, net (total)
                      20
                      105
                      175

             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. Amounts appropriated into the NIH Innovation Account are either transferred to the individual institutes and
                centers or obligated directly in the NIH Innovation Account.

          Object Classification (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      3
                      6
                      7

                      11.3
                      Other than full-time permanent
                      1
                      2
                      2

                      11.9
                      Total personnel compensation
                      4
                      8
                      9

                      12.1
                      Civilian personnel benefits
                      1
                      2
                      3

                      25.3
                      Other goods and services from Federal sources
                      1

                      25.5
                      Research and development contracts
                      2
                      1

                      41.0
                      Grants, subsidies, and contributions
                      94
                      233
                      145

                      99.9
                      Total new obligations, unexpired accounts
                      102
                      244
                      157

          Employment Summary

                      Identification code 075–5628–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      30
                      59
                      73

                      1101
                      Direct military average strength employment

                      1
                      1

             10-Year Pediatric Research Initiative FundSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      Transfers from Presidential Election Campaign Fund

                      13
                      13

                      2000
                      Total: Balances and receipts

                      13
                      13

                      Appropriations:

                      Current law:

                      2101
                      10-Year Pediatric Research Initiative Fund

                      –13
                      –13

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)

                      13
                      13

                      1120
                      Appropriations transferred to other accts [075–9915]

                      –13
                      –13

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This special fund was created by the Gabriella Miller Kids First Research Act, enacted on April 3, 2014. This fund receives
                transfers from the Presidential Election Campaign Fund, which are then appropriated to the NIH Common Fund to support pediatric
                research.

             Substance Abuse and Mental Health Services AdministrationFederal 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,  $1,485,047,000:  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 $150,000,000 shall be available until September 30,  2022 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics
                pursuant to section 223(a) of Public Law 113–93: 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 available to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 note).

             SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
                respect to substance abuse treatment and prevention and the SUPPORT for Patients and Communities Act,  $3,708,767,000: Provided, That $1,500,000,000 shall be for State Opioid Response Grants for carrying out activities pertaining to opioids undertaken
                by the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II
                of part B of title XIX of the PHS Act (42 U.S.C. 300x-21 et seq.): Provided further, That of such amount $50,000,000 shall be made available to Indian Tribes or tribal organizations: Provided further, That 15 percent of the remaining amount shall be for the States with the highest mortality rate related to opioid use disorders:
                Provided further, That of the amounts provided for State Opioid Response Grants not more than 2 percent shall be available for Federal administrative
                expenses, training, technical assistance, and evaluation: Provided further, That of the amount not reserved by the previous three provisos, the Secretary shall make allocations to States, territories,
                and the District of Columbia according to a formula using national survey results that the Secretary determines are the most
                objective and reliable measure of drug use and drug-related deaths:  Provided further, That prevention and treatment activities funded through such grants may include education, treatment (including the provision
                of medication), behavioral health services for individuals in treatment programs, referral to treatment services, recovery
                support, and medical screening associated with such treatment: Provided further, That each State, as well as the District of Columbia, shall receive not less than $4,000,000: Provided further, 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 of the funds made available under this heading, $4,000,000 shall be available to carry out section
                   3203 of the SUPPORT for Patients and Communities Act: Provided further, That none of the funds provided for section 1921 of the PHS Act or State Opioid Response Grants 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 National Narcotics Leadership Act of 1988, as amended,  $244,090,000, of which $2,000,000 shall be made available as directed by section 4 of Public Law 107–82, as amended by Public
                   Law 115–271, and $3,000,000, to remain available until expended, shall be for activities authorized by section 103 of Public
                   Law 114–198.

             HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
                Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act and the Protection
                and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration,  $97,004,000: Provided, That in addition to amounts provided herein,  $42,453,000 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,  2021: 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".
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1362–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0006
                      Mental Health
                      1,454
                      1,525
                      1,485

                      0007
                      Substance Abuse Treatment
                      3,683
                      3,738
                      3,708

                      0008
                      Substance Abuse Prevention
                      248
                      205
                      244

                      0009
                      Health Surveillance and Program Support
                      129
                      129
                      98

                      0011
                      SAMHSA Prevention Fund
                      12
                      12

                      0100
                      Total, direct program
                      5,526
                      5,609
                      5,535

                      0799
                      Total direct obligations
                      5,526
                      5,609
                      5,535

                      0802
                      SAMHSA Reimbursables
                      146
                      148
                      30

                      0810
                      SAMHSA Reimbursable:  PHS Evaluation
                      134
                      134
                      143

                      0899
                      Total reimbursable obligations
                      280
                      282
                      173

                      0900
                      Total new obligations, unexpired accounts
                      5,806
                      5,891
                      5,708

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      19
                      19

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      6

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      10

                      1050
                      Unobligated balance (total)
                      12
                      19
                      19

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      5,013
                      5,597
                      5,535

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –6

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

                      1121
                      Appropriations transferred from other acct [075–0140]
                      20

                      1160
                      Appropriation, discretionary (total)
                      5,527
                      5,597
                      5,535

                      Appropriations, mandatory:

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

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      163
                      282
                      173

                      1701
                      Change in uncollected payments, Federal sources
                      115

                      1750
                      Spending auth from offsetting collections, disc (total)
                      278
                      282
                      173

                      1900
                      Budget authority (total)
                      5,817
                      5,891
                      5,708

                      1930
                      Total budgetary resources available
                      5,829
                      5,910
                      5,727

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –4

                      1941
                      Unexpired unobligated balance, end of year
                      19
                      19
                      19

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      4,506
                      6,127
                      6,824

                      3010
                      New obligations, unexpired accounts
                      5,806
                      5,891
                      5,708

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      24

                      3020
                      Outlays (gross)
                      –4,085
                      –5,194
                      –5,857

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –124

                      3050
                      Unpaid obligations, end of year
                      6,127
                      6,824
                      6,675

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –143
                      –165
                      –165

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –115

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      93

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –165
                      –165
                      –165

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      4,363
                      5,962
                      6,659

                      3200
                      Obligated balance, end of year
                      5,962
                      6,659
                      6,510

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,805
                      5,879
                      5,708

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,155
                      1,636
                      1,593

                      4011
                      Outlays from discretionary balances
                      2,913
                      3,553
                      4,258

                      4020
                      Outlays, gross (total)
                      4,068
                      5,189
                      5,851

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –250
                      –280
                      –171

                      4033
                      Non-Federal sources
                      –2
                      –2
                      –2

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –252
                      –282
                      –173

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –115

                      4052
                      Offsetting collections credited to expired accounts
                      89

                      4060
                      Additional offsets against budget authority only (total)
                      –26

                      4070
                      Budget authority, net (discretionary)
                      5,527
                      5,597
                      5,535

                      4080
                      Outlays, net (discretionary)
                      3,816
                      4,907
                      5,678

                      Mandatory:

                      4090
                      Budget authority, gross
                      12
                      12

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4

                      4101
                      Outlays from mandatory balances
                      17
                      1
                      6

                      4110
                      Outlays, gross (total)
                      17
                      5
                      6

                      4180
                      Budget authority, net (total)
                      5,539
                      5,609
                      5,535

                      4190
                      Outlays, net (total)
                      3,833
                      4,912
                      5,684

             This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective
                substance abuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance
                abuse or mental illness. SAMHSA builds partnerships with States, communities, tribal organizations, and private not-for-profit
                organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.

          Object Classification (in millions of dollars)

                      Identification code 075–1362–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      47
                      48
                      49

                      11.3
                      Other than full-time permanent
                      2
                      3
                      2

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      53
                      55
                      55

                      12.1
                      Civilian personnel benefits
                      15
                      16
                      17

                      12.2
                      Military personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      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
                      32
                      33
                      34

                      25.2
                      Other services from non-Federal sources
                      132
                      146
                      146

                      25.3
                      Other goods and services from Federal sources
                      36
                      40
                      37

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      5,244
                      5,306
                      5,232

                      99.0
                      Direct obligations
                      5,526
                      5,610
                      5,535

                      99.0
                      Reimbursable obligations
                      280
                      281
                      173

                      99.9
                      Total new obligations, unexpired accounts
                      5,806
                      5,891
                      5,708

          Employment Summary

                      Identification code 075–1362–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      424
                      474
                      479

                      1101
                      Direct military average strength employment
                      31
                      31
                      31

                      2001
                      Reimbursable civilian full-time equivalent employment
                      101
                      101
                      91

                      2101
                      Reimbursable military average strength employment
                      5
                      5
                      5

             Agency for Healthcare Research and QualityFederal Funds
             Healthcare research and quality
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Research on Health Costs, Quality and Outcomes
                      192
                      197

                      0002
                      Medical Expenditure Panel Survey
                      70
                      70

                      0003
                      AHRQ Program Support
                      71
                      71

                      0799
                      Total direct obligations
                      333
                      338

                      0803
                      Research on Health Costs, Quality and Outcomes (Reimbursable)
                      26
                      26

                      0899
                      Total reimbursable obligations
                      26
                      26

                      0900
                      Total new obligations, unexpired accounts
                      359
                      364

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      22
                      21
                      22

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      1

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

                      –22

                      1021
                      Recoveries of prior year unpaid obligations
                      1
                      1

                      1050
                      Unobligated balance (total)
                      23
                      22

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      334
                      338

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

                      1160
                      Appropriation, discretionary (total)
                      333
                      338

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1
                      1

                      1701
                      Change in uncollected payments, Federal sources
                      17
                      17

                      1750
                      Spending auth from offsetting collections, disc (total)
                      18
                      18

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      6
                      8

                      1900
                      Budget authority (total)
                      357
                      364

                      1930
                      Total budgetary resources available
                      380
                      386

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      21
                      22

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      346
                      335
                      432

                      3010
                      New obligations, unexpired accounts
                      359
                      364

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

                      3020
                      Outlays (gross)
                      –358
                      –266
                      –299

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –12

                      3050
                      Unpaid obligations, end of year
                      335
                      432
                      133

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –52
                      –35
                      –18

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –17
                      –17

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      34
                      34

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –35
                      –18
                      –18

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      294
                      300
                      414

                      3200
                      Obligated balance, end of year
                      300
                      414
                      115

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      351
                      356

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      130
                      136

                      4011
                      Outlays from discretionary balances
                      222
                      114
                      299

                      4020
                      Outlays, gross (total)
                      352
                      250
                      299

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –28
                      –28

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –28
                      –28

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –17
                      –17

                      4052
                      Offsetting collections credited to expired accounts
                      27
                      27

                      4060
                      Additional offsets against budget authority only (total)
                      10
                      10

                      4070
                      Budget authority, net (discretionary)
                      333
                      338

                      4080
                      Outlays, net (discretionary)
                      324
                      222
                      299

                      Mandatory:

                      4090
                      Budget authority, gross
                      6
                      8

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      8

                      4101
                      Outlays from mandatory balances
                      6
                      8

                      4110
                      Outlays, gross (total)

                      16

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –6
                      –8

                      4180
                      Budget authority, net (total)
                      333
                      338

                      4190
                      Outlays, net (total)
                      324
                      230
                      299

             The FY 2020 Budget consolidates the activities of the Agency for Healthcare Research and Quality within the National Institutes
                of Health as the National Institute for Research on Safety and Quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      30
                      31

                      11.3
                      Other than full-time permanent
                      4
                      4

                      11.5
                      Other personnel compensation
                      1

                      11.7
                      Military personnel
                      1
                      1

                      11.9
                      Total personnel compensation
                      36
                      36

                      12.1
                      Civilian personnel benefits
                      11
                      11

                      23.1
                      Rental payments to GSA
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      10
                      11

                      25.3
                      Other goods and services from Federal sources
                      21
                      21

                      25.5
                      Research and development contracts
                      142
                      144

                      31.0
                      Equipment
                      1
                      2

                      41.0
                      Grants, subsidies, and contributions
                      109
                      110

                      99.0
                      Direct obligations
                      333
                      338

                      99.0
                      Reimbursable obligations
                      26
                      26

                      99.9
                      Total new obligations, unexpired accounts
                      359
                      364

          Employment Summary

                      Identification code 075–1700–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      263
                      270

                      1101
                      Direct military average strength employment
                      6
                      6

                      2001
                      Reimbursable civilian full-time equivalent employment
                      4
                      1

                      3001
                      Allocation account civilian full-time equivalent employment
                      8
                      7

             Centers for Medicare and Medicaid ServicesFederal Funds
             Grants to states for medicaidFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act,  $273,188,478,000, to remain available until expended.
           In addition, for carrying out such titles after May 31,  2020,  for the last quarter of fiscal year  2020 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  2021,  $139,903,075,000, 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0512–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments
                      414,870
                      420,268
                      438,844

                      0002
                      State and local administration
                      22,133
                      21,861
                      22,527

                      0003
                      Vaccines for Children
                      4,389
                      4,176
                      4,761

                      0799
                      Total direct obligations
                      441,392
                      446,305
                      466,132

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      441,392
                      446,305
                      466,132

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      310
                      15,402
                      16,784

                      1021
                      Recoveries of prior year unpaid obligations
                      29,936
                      35,570
                      37,100

                      1033
                      Recoveries of prior year paid obligations
                      15,114

                      1050
                      Unobligated balance (total)
                      45,360
                      50,972
                      53,884

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      284,798
                      276,236
                      273,188

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      125,219
                      134,848
                      137,932

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1,087
                      1,033
                      1,128

                      1801
                      Change in uncollected payments, Federal sources
                      330

                      1850
                      Spending auth from offsetting collections, mand (total)
                      1,417
                      1,033
                      1,128

                      1900
                      Budget authority (total)
                      411,434
                      412,117
                      412,248

                      1930
                      Total budgetary resources available
                      456,794
                      463,089
                      466,132

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      15,402
                      16,784

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      39,981
                      46,079
                      37,100

                      3010
                      New obligations, unexpired accounts
                      441,392
                      446,305
                      466,132

                      3020
                      Outlays (gross)
                      –405,358
                      –419,714
                      –427,114

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –29,936
                      –35,570
                      –37,100

                      3050
                      Unpaid obligations, end of year
                      46,079
                      37,100
                      39,018

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –393
                      –723
                      –723

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –330

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –723
                      –723
                      –723

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      39,588
                      45,356
                      36,377

                      3200
                      Obligated balance, end of year
                      45,356
                      36,377
                      38,295

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      411,434
                      412,117
                      412,248

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      404,451
                      404,672
                      410,329

                      4101
                      Outlays from mandatory balances
                      907
                      15,042
                      16,785

                      4110
                      Outlays, gross (total)
                      405,358
                      419,714
                      427,114

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –1,087
                      –1,033
                      –1,128

                      4123
                      Non-Federal sources
                      –15,114

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –16,201
                      –1,033
                      –1,128

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –330

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      15,114

                      4150
                      Additional offsets against budget authority only (total)
                      14,784

                      4160
                      Budget authority, net (mandatory)
                      410,017
                      411,084
                      411,120

                      4170
                      Outlays, net (mandatory)
                      389,157
                      418,681
                      425,986

                      4180
                      Budget authority, net (total)
                      410,017
                      411,084
                      411,120

                      4190
                      Outlays, net (total)
                      389,157
                      418,681
                      425,986

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      410,017
                      411,084
                      411,120

                      Outlays
                      389,157
                      418,681
                      425,986

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –7,835

                      Outlays

                      –7,835

                      Total:

                      Budget Authority
                      410,017
                      411,084
                      403,285

                      Outlays
                      389,157
                      418,681
                      418,151

             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
                         2018
                         2019
                         2020

                         Vaccine Purchase
                         4,191
                         3,964
                         4,467

                         Vaccine Stockpile
                         25
                         24
                         98

                         Ordering, Distribution, and Operations
                         122
                         136
                         142

                         Vaccine Management Contract Support
                         0
                         0
                         0

                         Evaluation Activities
                         51
                         52
                         54

                         Total Obligations
                         4,389
                         4,176
                         4,761

             Grants to States for Medicaid
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0512–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments

                      –7,835

                      0799
                      Total direct obligations

                      –7,835

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

                      –7,835

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –7,835

                      1900
                      Budget authority (total)

                      –7,835

                      1930
                      Total budgetary resources available

                      –7,835

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –7,835

                      3020
                      Outlays (gross)

                      7,835

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –7,835

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –7,835

                      4180
                      Budget authority, net (total)

                      –7,835

                      4190
                      Outlays, net (total)

                      –7,835

             This schedule reflects the Administration's Medicaid proposals.

             State Grants and DemonstrationsProgram and Financing (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0012
                      Medicaid integrity program
                      84
                      102
                      90

                      0018
                      Money follows the person (MFP) demonstration

                      112
                      76

                      0019
                      MFP evaluations and technical support

                      1

                      0021
                      Katrina Relief
                      2

                      0023
                      Grants to improve outreach and enrollment
                      1
                      58

                      0028
                      Demo to increase substance use provider under the Medicaid Program

                      51
                      1

                      0799
                      Total direct obligations
                      87
                      324
                      167

                      0900
                      Total new obligations, unexpired accounts
                      87
                      324
                      167

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      244
                      368
                      293

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1033
                      Recoveries of prior year paid obligations
                      10

                      1050
                      Unobligated balance (total)
                      255
                      368
                      293

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      206
                      254
                      90

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –6
                      –5

                      1260
                      Appropriations, mandatory (total)
                      200
                      249
                      90

                      1900
                      Budget authority (total)
                      200
                      249
                      90

                      1930
                      Total budgetary resources available
                      455
                      617
                      383

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      368
                      293
                      216

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,297
                      901
                      749

                      3010
                      New obligations, unexpired accounts
                      87
                      324
                      167

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

                      3020
                      Outlays (gross)
                      –482
                      –476
                      –610

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      901
                      749
                      306

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,297
                      901
                      749

                      3200
                      Obligated balance, end of year
                      901
                      749
                      306

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      200
                      249
                      90

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      20
                      39
                      15

                      4101
                      Outlays from mandatory balances
                      462
                      437
                      595

                      4110
                      Outlays, gross (total)
                      482
                      476
                      610

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –10

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      10

                      4160
                      Budget authority, net (mandatory)
                      200
                      249
                      90

                      4170
                      Outlays, net (mandatory)
                      472
                      476
                      610

                      4180
                      Budget authority, net (total)
                      200
                      249
                      90

                      4190
                      Outlays, net (total)
                      472
                      476
                      610

             State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including
                the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement,
                and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance
                Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), the Health
                Care and Education Reconciliation Act of 2010 (P.L. 111–152), the Protecting Access to Medicare Act of 2014 (P.L. 113–93),
                and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10). The account also includes funding for grant programs
                enacted in the HEALTHY KIDS Act (P.L. 115–120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123),
                the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115–271),
                and the Medicaid Extenders Act of 2019 (P.L. 116–3).

          Object Classification (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      11.1
                      Direct obligations: Personnel compensation: Full-time permanent - Medicaid Integrity Program
                      19
                      27
                      27

                      11.9
                      Total personnel compensation

                      27
                      27

                      12.1
                      Civilian personnel benefits - Medicaid Integrity Program
                      9
                      13
                      13

                      41.0
                      Grants, subsidies, and contributions - Medicaid Integrity Program
                      56
                      62
                      50

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

                      112
                      76

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

                      1

                      41.0
                      Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                      1
                      58

                      41.0
                      Grants, subsidies, and contributions - Katrina Relief
                      2

                      41.0
                      Grants, subsidies, and contributions - Demo to increase substance use provider capacity under Medicaid

                      51
                      1

                      99.0
                      Direct obligations
                      87
                      324
                      167

                      99.9
                      Total new obligations, unexpired accounts
                      87
                      324
                      167

          Employment Summary

                      Identification code 075–0516–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      188
                      200
                      200

                      1101
                      Direct military average strength employment

                      5
                      5

             Payments to the health care trust fundsFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
                under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
                of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the
                Social Security Act,  $410,796,100,000.
          In addition, for making adjustments to the allocation of administrative expenses incurred in prior fiscal years pursuant to
                   section 201(g) of the Social Security Act, such sums as may be necessary: Provided, That such amounts shall not be available
                   for obligation until the Office of Management and Budget approves a justification of the adjustments to the allocation of
                   administrative expenses between the Social Security Administration, Railroad Retirement Board, and the CMS Trust Funds.
          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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0580–0–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)
                      249,921
                      284,288
                      296,515

                      0002
                      Part D benefits (Rx Drug)
                      69,563
                      92,070
                      98,431

                      0003
                      Part D Federal administration (Rx Drug)
                      422
                      642
                      861

                      0004
                      General Fund Transfers to HI
                      1,543
                      1,332
                      1,323

                      0006
                      Federal Bureau of Investigation (HCFAC)
                      135
                      135
                      138

                      0007
                      Federal payments from taxation of OASDI benefits (HI)
                      24,192
                      23,882
                      26,472

                      0008
                      Criminal fines (HCFAC)
                      2
                      88
                      36

                      0009
                      Civil penalties and damages (HCFAC—DOJ and CMS administration)
                      16
                      52
                      52

                      0010
                      Asset Forfeiture
                      22
                      31
                      32

                      0011
                      State Low Income Determinations
                      3
                      4
                      5

                      0900
                      Total new obligations, unexpired accounts
                      345,819
                      402,524
                      423,865

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)
                      327,124
                      378,336
                      397,135

                      1200
                      Appropriation (indefinite, permanent)
                      24,723
                      23,882
                      26,472

                      1200
                      Appropriation (HCFAC for FBI)
                      135
                      135
                      138

                      1200
                      Appropriation (indefinite for HCFAC)
                      307
                      171
                      120

                      1260
                      Appropriations, mandatory (total)
                      352,289
                      402,524
                      423,865

                      1930
                      Total budgetary resources available
                      352,289
                      402,524
                      423,865

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –6,470

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      18,743
                      10,525
                      54,052

                      3010
                      New obligations, unexpired accounts
                      345,819
                      402,524
                      423,865

                      3020
                      Outlays (gross)
                      –348,189
                      –358,997
                      –401,440

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –5,848

                      3050
                      Unpaid obligations, end of year
                      10,525
                      54,052
                      76,477

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      18,743
                      10,525
                      54,052

                      3200
                      Obligated balance, end of year
                      10,525
                      54,052
                      76,477

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      352,289
                      402,524
                      423,865

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      339,880
                      348,473
                      360,406

                      4101
                      Outlays from mandatory balances
                      8,309
                      10,524
                      41,034

                      4110
                      Outlays, gross (total)
                      348,189
                      358,997
                      401,440

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –3,980

                      4123
                      Non-Federal sources
                      –228

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –4,208

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      4,208

                      4160
                      Budget authority, net (mandatory)
                      352,289
                      402,524
                      423,865

                      4170
                      Outlays, net (mandatory)
                      343,981
                      358,997
                      401,440

                      4180
                      Budget authority, net (total)
                      352,289
                      402,524
                      423,865

                      4190
                      Outlays, net (total)
                      343,981
                      358,997
                      401,440

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      352,289
                      402,524
                      423,865

                      Outlays
                      343,981
                      358,997
                      401,440

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –7,786

                      Outlays

                      –7,786

                      Total:

                      Budget Authority
                      352,289
                      402,524
                      416,079

                      Outlays
                      343,981
                      358,997
                      393,654

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

          Object Classification (in millions of dollars)

                      Identification code 075–0580–0–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      41.0
                      Grants, subsidies, and contributions
                      343,722
                      400,542
                      421,676

                      42.0
                      Insurance claims and indemnities (HI Uninsured Federal)
                      132
                      127
                      102

                      94.0
                      Financial transfers (Federal admin)
                      1,965
                      1,855
                      2,087

                      99.9
                      Total new obligations, unexpired accounts
                      345,819
                      402,524
                      423,865

             Payments to Health Care Trust Funds
             (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0580–2–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)

                      –7,696

                      0002
                      Part D benefits (Rx Drug)

                      –90

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

                      –7,786

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)

                      –7,786

                      1930
                      Total budgetary resources available

                      –7,786

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –7,786

                      3020
                      Outlays (gross)

                      7,786

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –7,786

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –7,786

                      4180
                      Budget authority, net (total)

                      –7,786

                      4190
                      Outlays, net (total)

                      –7,786

             Quality Improvement OrganizationsProgram and Financing (in millions of dollars)

                      Identification code 075–0519–0–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      QIO contracts
                      478
                      445
                      226

                      0002
                      QIO support contracts
                      157
                      875
                      444

                      0900
                      Total new obligations, unexpired accounts
                      635
                      1,320
                      670

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      172
                      1,320
                      670

                      1801
                      Change in uncollected payments, Federal sources
                      607

                      1850
                      Spending auth from offsetting collections, mand (total)
                      779
                      1,320
                      670

                      1930
                      Total budgetary resources available
                      779
                      1,320
                      670

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –144

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,188
                      867
                      867

                      3010
                      New obligations, unexpired accounts
                      635
                      1,320
                      670

                      3020
                      Outlays (gross)
                      –934
                      –1,320
                      –670

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –22

                      3050
                      Unpaid obligations, end of year
                      867
                      867
                      867

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –1,982
                      –1,616
                      –1,616

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –607

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      973

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –1,616
                      –1,616
                      –1,616

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –794
                      –749
                      –749

                      3200
                      Obligated balance, end of year
                      –749
                      –749
                      –749

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      779
                      1,320
                      670

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      167
                      720
                      416

                      4101
                      Outlays from mandatory balances
                      767
                      600
                      254

                      4110
                      Outlays, gross (total)
                      934
                      1,320
                      670

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –1,040
                      –1,320
                      –670

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –607

                      4142
                      Offsetting collections credited to expired accounts
                      868

                      4150
                      Additional offsets against budget authority only (total)
                      261

                      4170
                      Outlays, net (mandatory)
                      –106

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –106

                      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 (P.L. 97–248), provides
                the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to
                promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure
                that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance
                Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO
                Program was established to improve budgetary operations.

          Object Classification (in millions of dollars)

                      Identification code 075–0519–0–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      27
                      29
                      58

                      11.7
                      Military personnel

                      1
                      1

                      11.9
                      Total personnel compensation

                      30
                      59

                      12.1
                      Civilian personnel benefits
                      9
                      9
                      9

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      598
                      1,280
                      601

                      99.9
                      Total new obligations, unexpired accounts
                      635
                      1,320
                      670

          Employment Summary

                      Identification code 075–0519–0–1–571
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      236
                      220
                      168

                      1101
                      Direct military average strength employment

                      10
                      10

             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 & Medicaid Services, not to exceed  $3,579,427,000, 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  2020 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: Provided further, That of the funds made available under this heading, $442,192,000, to remain available until September
                   30, 2021, shall be available for the Survey and Certification Program.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0511–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Program operations
                      3,106
                      2,886
                      2,446

                      0002
                      Federal administration
                      749
                      733
                      748

                      0003
                      State survey and certification
                      409
                      403
                      447

                      0004
                      Research, demonstrations, and evaluation projects
                      20
                      20

                      0007
                      ARRA Medicare/Medicaid HIT
                      37
                      36
                      23

                      0100
                      Total direct program
                      4,321
                      4,078
                      3,664

                      0799
                      Total direct obligations
                      4,321
                      4,078
                      3,664

                      0801
                      Clinical laboratory improvement amendments
                      62
                      35
                      40

                      0802
                      Sale of data
                      18
                      21
                      20

                      0803
                      Coordination of benefits
                      32
                      35
                      35

                      0804
                      Medicare advantage/Prescription drug plan
                      58
                      88
                      89

                      0805
                      Provider enrollment
                      10
                      31
                      32

                      0806
                      Recovery audit contractors
                      90
                      80
                      85

                      0808
                      Marketplace User Fees
                      1,272
                      1,422
                      1,235

                      0810
                      Risk Adjustment Administrative Expenses
                      32
                      49
                      39

                      0813
                      Other reimbursable program activity
                      13

                      0899
                      Total reimbursable obligations
                      1,587
                      1,761
                      1,575

                      0900
                      Total new obligations, unexpired accounts
                      5,908
                      5,839
                      5,239

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      –9,240
                      3,123
                      3,838

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –162

                      1021
                      Recoveries of prior year unpaid obligations
                      12,330

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      2,929
                      3,123
                      3,838

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3
                      3
                      3

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,832
                      4,035
                      3,629

                      1701
                      Change in uncollected payments, Federal sources
                      2,204

                      1750
                      Spending auth from offsetting collections, disc (total)
                      4,036
                      4,035
                      3,629

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      2,232
                      2,560
                      2,491

                      1801
                      Change in uncollected payments, Federal sources
                      –88

                      1802
                      Offsetting collections (previously unavailable)
                      101
                      116

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –145
                      –160

                      1850
                      Spending auth from offsetting collections, mand (total)
                      2,100
                      2,516
                      2,491

                      1900
                      Budget authority (total)
                      6,139
                      6,554
                      6,123

                      1930
                      Total budgetary resources available
                      9,068
                      9,677
                      9,961

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –37

                      1941
                      Unexpired unobligated balance, end of year
                      3,123
                      3,838
                      4,722

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      16,606
                      4,599
                      4,568

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

                      3010
                      New obligations, unexpired accounts
                      5,908
                      5,839
                      5,239

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      164

                      3020
                      Outlays (gross)
                      –5,553
                      –5,870
                      –6,691

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –12,330

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –221

                      3050
                      Unpaid obligations, end of year
                      4,599
                      4,568
                      3,116

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –6,082
                      –5,839
                      –5,839

                      3061
                      Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                      –10

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,116

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2,369

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –5,839
                      –5,839
                      –5,839

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      10,539
                      –1,240
                      –1,271

                      3200
                      Obligated balance, end of year
                      –1,240
                      –1,271
                      –2,723

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,036
                      4,035
                      3,629

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,774
                      2,042
                      1,840

                      4011
                      Outlays from discretionary balances
                      2,249
                      1,192
                      1,991

                      4020
                      Outlays, gross (total)
                      4,023
                      3,234
                      3,831

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –4,056
                      –3,985
                      –3,579

                      4033
                      Non-Federal sources
                      –54
                      –50
                      –50

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,110
                      –4,035
                      –3,629

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,204

                      4052
                      Offsetting collections credited to expired accounts
                      2,278

                      4060
                      Additional offsets against budget authority only (total)
                      74

                      4080
                      Outlays, net (discretionary)
                      –87
                      –801
                      202

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,103
                      2,519
                      2,494

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      172
                      1,399
                      1,283

                      4101
                      Outlays from mandatory balances
                      1,358
                      1,237
                      1,577

                      4110
                      Outlays, gross (total)
                      1,530
                      2,636
                      2,860

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –314
                      –159
                      –36

                      4123
                      Non-Federal sources
                      –1,935
                      –2,401
                      –2,455

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –2,249
                      –2,560
                      –2,491

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      88

                      4142
                      Offsetting collections credited to expired accounts
                      16

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)
                      105

                      4160
                      Budget authority, net (mandatory)
                      –41
                      –41
                      3

                      4170
                      Outlays, net (mandatory)
                      –719
                      76
                      369

                      4180
                      Budget authority, net (total)
                      –41
                      –41
                      3

                      4190
                      Outlays, net (total)
                      –806
                      –725
                      571

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      476
                      515
                      559

                      5091
                      Expiring unavailable balance: Offsetting collections
                      –5

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      515
                      559
                      559

                      5093
                      Expired unavailable balance, SOY: Offsetting collections
                      1
                      6
                      6

                      5095
                      Expired unavailable balance, EOY: Offsetting collections
                      1
                      6
                      6

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      –41
                      –41
                      3

                      Outlays
                      –806
                      –725
                      571

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      12

                      Outlays

                      2

                      Total:

                      Budget Authority
                      –41
                      –41
                      15

                      Outlays
                      –806
                      –725
                      573

             Program management activities include funding for program operations, survey and certification, the Clinical Laboratory Improvement
                Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts, and other administrative
                costs.

          Object Classification (in millions of dollars)

                      Identification code 075–0511–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      473
                      489
                      490

                      11.3
                      Other than full-time permanent
                      11
                      11
                      15

                      11.5
                      Other personnel compensation
                      8
                      8
                      9

                      11.7
                      Military personnel
                      15
                      15
                      15

                      11.9
                      Total personnel compensation
                      507
                      523
                      529

                      12.1
                      Civilian personnel benefits
                      157
                      154
                      157

                      12.2
                      Military personnel benefits
                      8
                      8
                      8

                      21.0
                      Travel and transportation of persons
                      5
                      5
                      5

                      22.0
                      Transportation of things
                      2
                      2
                      2

                      23.1
                      Rental payments to GSA
                      23
                      23
                      23

                      23.3
                      Communications, utilities, and miscellaneous charges
                      73
                      73
                      73

                      24.0
                      Printing and reproduction
                      63
                      63
                      63

                      25.2
                      Other services from non-Federal sources
                      3,030
                      2,765
                      2,298

                      25.6
                      Medical care
                      394
                      403
                      447

                      26.0
                      Supplies and materials
                      2
                      2
                      2

                      31.0
                      Equipment
                      4
                      4
                      4

                      41.0
                      Grants, subsidies, and contributions
                      33
                      33
                      33

                      42.0
                      Insurance claims and indemnities
                      20
                      20
                      20

                      99.0
                      Direct obligations
                      4,321
                      4,078
                      3,664

                      99.0
                      Reimbursable obligations
                      1,587
                      1,761
                      1,575

                      99.9
                      Total new obligations, unexpired accounts
                      5,908
                      5,839
                      5,239

          Employment Summary

                      Identification code 075–0511–0–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4,206
                      4,167
                      4,195

                      1001
                      Direct civilian full-time equivalent employment
                      149
                      142
                      142

                      1101
                      Direct military average strength employment
                      135
                      146
                      146

                      2001
                      Reimbursable civilian full-time equivalent employment
                      252
                      300
                      380

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

                      Identification code 075–0511–4–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Program operations

                      12

                      0100
                      Total direct program

                      12

                      0799
                      Total direct obligations

                      12

                      0801
                      ACL SHIPs

                      13

                      0899
                      Total reimbursable obligations

                      13

                      0900
                      Total new obligations, unexpired accounts

                      25

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      12

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      13

                      1900
                      Budget authority (total)

                      25

                      1930
                      Total budgetary resources available

                      25

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      25

                      3020
                      Outlays (gross)

                      –15

                      3050
                      Unpaid obligations, end of year

                      10

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      10

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –13

                      4180
                      Budget authority, net (total)

                      12

                      4190
                      Outlays, net (total)

                      2

             This display includes the effects of proposals related to mandatory funding for the State Health Insurance Assistance Program,
                resources to implement HHS's legislative proposals in the FY 2020 Budget, and the National Medicare and You Education Program
                user fee increase.

          Object Classification (in millions of dollars)

                      Identification code 075–0511–4–1–550
                      2018 actual
                      2019 est.
                      2020 est.

                      25.3
                      Direct obligations: Other goods and services from Federal sources

                      12

                      99.0
                      Direct obligations

                      12

                      99.0
                      Reimbursable obligations

                      13

                      99.9
                      Total new obligations, unexpired accounts

                      25

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

                      Identification code 075–0514–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Direct program activity

                      15,290

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

                      15,290

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      15,290

                      1930
                      Total budgetary resources available

                      15,290

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      15,290

                      3020
                      Outlays (gross)

                      –15,290

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      15,290

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      15,290

                      4180
                      Budget authority, net (total)

                      15,290

                      4190
                      Outlays, net (total)

                      15,290

             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 FundProgram and Financing (in millions of dollars)

                      Identification code 075–0515–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Grants to states and US territories
                      17,310
                      17,881
                      18,366

                      0002
                      CHIP Redistribution Funds
                      171

                      0003
                      Child health quality
                      8
                      22
                      21

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      17,489
                      17,903
                      18,387

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      6,442
                      8,251
                      10,887

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

                      4,632

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      101

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –170

                      1021
                      Recoveries of prior year unpaid obligations
                      2,041

                      1050
                      Unobligated balance (total)
                      8,414
                      8,251
                      15,519

                      Budget authority:

                      Appropriations, discretionary:

                      1130
                      Appropriations permanently reduced

                      –15,352

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      21,590
                      22,600
                      23,700

                      1221
                      Appropriations transferred from other acct [075–5551]

                      5,604

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –3,645
                      –2,061

                      1260
                      Appropriations, mandatory (total)
                      17,945
                      20,539
                      29,304

                      1900
                      Budget authority (total)
                      17,945
                      20,539
                      13,952

                      1930
                      Total budgetary resources available
                      26,359
                      28,790
                      29,471

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –619

                      1941
                      Unexpired unobligated balance, end of year
                      8,251
                      10,887
                      11,084

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,803
                      5,789
                      5,258

                      3010
                      New obligations, unexpired accounts
                      17,489
                      17,903
                      18,387

                      3020
                      Outlays (gross)
                      –17,282
                      –18,434
                      –16,882

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2,041

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –180

                      3050
                      Unpaid obligations, end of year
                      5,789
                      5,258
                      6,763

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,803
                      5,789
                      5,258

                      3200
                      Obligated balance, end of year
                      5,789
                      5,258
                      6,763

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –15,352

                      Mandatory:

                      4090
                      Budget authority, gross
                      17,945
                      20,539
                      29,304

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11,703
                      12,301
                      11,653

                      4101
                      Outlays from mandatory balances
                      5,579
                      6,133
                      5,229

                      4110
                      Outlays, gross (total)
                      17,282
                      18,434
                      16,882

                      4180
                      Budget authority, net (total)
                      17,945
                      20,539
                      13,952

                      4190
                      Outlays, net (total)
                      17,282
                      18,434
                      16,882

             The Balanced Budget Act of 1997 (P.L. 105–33) established the Children's Health Insurance Program (CHIP) under title XXI of
                the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured
                children from low-income families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured
                children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health
                Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding
                for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and
                territories, and support for child health quality and outreach activities. A contingency fund to assist States who project
                spending above their available allocated CHIP funds was also created by CHIPRA, and funding is included in a separate account.
                The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Medicare Access and CHIP Reauthorization Act
                of 2015 (P.L. 114–10) extended CHIP funding through fiscal year 2015 and 2017, respectively.  The HEALTHY KIDS Act (P.L. 115–120)
                and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123) extended CHIP funding through fiscal year
                2023 and 2027, respectively.

             Center for Medicare and Medicaid InnovationProgram and Financing (in millions of dollars)

                      Identification code 075–0522–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Administration
                      320
                      420
                      397

                      0002
                      Innovation Activities
                      611
                      602
                      1,003

                      0900
                      Total new obligations, unexpired accounts
                      931
                      1,022
                      1,400

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3,483
                      2,619
                      1,597

                      1021
                      Recoveries of prior year unpaid obligations
                      66

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      3,550
                      2,619
                      1,597

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      10,000

                      1930
                      Total budgetary resources available
                      3,550
                      2,619
                      11,597

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      2,619
                      1,597
                      10,197

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,376
                      1,228
                      1,161

                      3010
                      New obligations, unexpired accounts
                      931
                      1,022
                      1,400

                      3020
                      Outlays (gross)
                      –1,013
                      –1,089
                      –1,226

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –66

                      3050
                      Unpaid obligations, end of year
                      1,228
                      1,161
                      1,335

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,376
                      1,228
                      1,161

                      3200
                      Obligated balance, end of year
                      1,228
                      1,161
                      1,335

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      10,000

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      413

                      4101
                      Outlays from mandatory balances
                      1,013
                      1,089
                      813

                      4110
                      Outlays, gross (total)
                      1,013
                      1,089
                      1,226

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4160
                      Budget authority, net (mandatory)

                      10,000

                      4170
                      Outlays, net (mandatory)
                      1,012
                      1,089
                      1,226

                      4180
                      Budget authority, net (total)

                      10,000

                      4190
                      Outlays, net (total)
                      1,012
                      1,089
                      1,226

             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 for fiscal years 2011 through 2019 and each subsequent 10-year fiscal
                period (beginning with the 10-year fiscal period beginning with fiscal year 2020).

          Object Classification (in millions of dollars)

                      Identification code 075–0522–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      62
                      60
                      67

                      11.7
                      Military personnel

                      3
                      3

                      11.9
                      Total personnel compensation

                      63
                      70

                      12.1
                      Civilian personnel benefits
                      20
                      20
                      21

                      12.2
                      Military personnel benefits

                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      3
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      512
                      418
                      777

                      41.0
                      Grants, subsidies, and contributions
                      310
                      448
                      457

                      42.0
                      Insurance claims and indemnities
                      24
                      69
                      71

                      99.9
                      Total new obligations, unexpired accounts
                      931
                      1,022
                      1,400

          Employment Summary

                      Identification code 075–0522–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      540
                      578
                      578

                      1101
                      Direct military average strength employment

                      22
                      22

             Child Enrollment Contingency FundSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      570
                      3,132
                      5,604

                      0198
                      Rounding adjustment
                      2

                      0198
                      Earnings on investment adjustment

                      –4

                      0199
                      Balance, start of year
                      572
                      3,128
                      5,604

                      Receipts:

                      Current law:

                      1140
                      Interest, Child Enrollment Contingency Fund
                      27
                      246
                      156

                      2000
                      Total: Balances and receipts
                      599
                      3,374
                      5,760

                      Appropriations:

                      Current law:

                      2101
                      Child Enrollment Contingency Fund
                      –27
                      –246
                      –156

                      2103
                      Child Enrollment Contingency Fund
                      –572
                      –3,128
                      –5,604

                      2134
                      Child Enrollment Contingency Fund
                      2,562
                      3,262

                      2199
                      Total current law appropriations
                      1,963
                      –112
                      –5,760

                      2999
                      Total appropriations
                      1,963
                      –112
                      –5,760

                      4030
                      Child Enrollment Contingency Fund
                      570
                      2,342

                      5099
                      Balance, end of year
                      3,132
                      5,604

          Program and Financing (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      573
                      2,338
                      4,632

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

                      –4,632

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –2
                      4

                      1035
                      Unobligated balance precluded from obligation (limitation on obligations)
                      –570
                      –2,342

                      1050
                      Unobligated balance (total)
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1131
                      Unobligated balance of appropriations permanently reduced

                      –4,396

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      4,300
                      4,520
                      4,740

                      1201
                      Appropriation (special or trust fund)
                      27
                      246
                      156

                      1203
                      Appropriation (previously unavailable)
                      572
                      3,128
                      5,604

                      1220
                      Appropriations transferred to other acct [075–0515]

                      –5,604

                      1234
                      Appropriations precluded from obligation
                      –2,562
                      –3,262

                      1260
                      Appropriations, mandatory (total)
                      2,337
                      4,632
                      4,896

                      1900
                      Budget authority (total)
                      2,337
                      4,632
                      500

                      1930
                      Total budgetary resources available
                      2,338
                      4,632
                      500

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      2,338
                      4,632
                      500

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      200
                      200

                      3020
                      Outlays (gross)

                      –200

                      3050
                      Unpaid obligations, end of year
                      200

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      200
                      200

                      3200
                      Obligated balance, end of year
                      200

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –4,396

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,337
                      4,632
                      4,896

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      200

                      4180
                      Budget authority, net (total)
                      2,337
                      4,632
                      500

                      4190
                      Outlays, net (total)

                      200

                      Memorandum (non-add) entries:

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

                      10,236

                      5001
                      Total investments, EOY: Federal securities: Par value

                      10,236
                      500

             The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3) established the Child Enrollment Contingency
                Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
                it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
                number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Medicare
                Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended the Contingency Fund through fiscal years 2015 and 2017,
                respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L.
                115–123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.

             The Fund receives an appropriation equal to 20 percent of the CHIP national allotment appropriation under section 2104(a)
                of 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, subject to PAYGO)
             The Budget proposes to repeal the Child Enrollment Contingency Fund, because few states can meet the restrictive eligibility
                criteria to qualify for a payment, and when States do qualify, funds do not need to be spent on children's health. Instead,
                the Budget proposes funding for a restructured Shortfall Fund, which will be a more accessible safety net for States.

             Medicare Health Information Technology Incentive Payments, Recovery ActProgram and Financing (in millions of dollars)

                      Identification code 075–0508–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      Incentive payments to hospitals
                      60
                      20
                      15

                      0900
                      Total new obligations, unexpired accounts (object class 42.0)
                      60
                      20
                      15

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      7

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected from the HI Trust Fund
                      71
                      20
                      15

                      1801
                      Change in uncollected payments, Federal sources
                      –10

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      53
                      20
                      15

                      1930
                      Total budgetary resources available
                      60
                      20
                      15

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      18
                      25

                      3010
                      New obligations, unexpired accounts
                      60
                      20
                      15

                      3020
                      Outlays (gross)
                      –53
                      –45
                      –15

                      3050
                      Unpaid obligations, end of year
                      25

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –171
                      –161
                      –161

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      10

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –161
                      –161
                      –161

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –153
                      –136
                      –161

                      3200
                      Obligated balance, end of year
                      –136
                      –161
                      –161

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      53
                      20
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      35
                      20
                      15

                      4101
                      Outlays from mandatory balances
                      18
                      25

                      4110
                      Outlays, gross (total)
                      53
                      45
                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –71
                      –20
                      –15

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      10

                      4160
                      Budget authority, net (mandatory)
                      –8

                      4170
                      Outlays, net (mandatory)
                      –18
                      25

                      4180
                      Budget authority, net (total)
                      –8

                      4190
                      Outlays, net (total)
                      –18
                      25

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      133
                      141
                      141

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      141
                      141
                      141

             Rate Review GrantsProgram and Financing (in millions of dollars)

                      Identification code 075–0112–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Premium rate review grants
                      9

                      19

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      9

                      19

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3
                      4
                      19

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      10

                      1021
                      Recoveries of prior year unpaid obligations

                      15

                      1050
                      Unobligated balance (total)
                      13
                      19
                      19

                      1930
                      Total budgetary resources available
                      13
                      19
                      19

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      4
                      19

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      69
                      53
                      5

                      3010
                      New obligations, unexpired accounts
                      9

                      19

                      3020
                      Outlays (gross)
                      –19
                      –33
                      –4

                      3040
                      Recoveries of prior year unpaid obligations, unexpired

                      –15

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –6

                      3050
                      Unpaid obligations, end of year
                      53
                      5
                      20

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      69
                      53
                      5

                      3200
                      Obligated balance, end of year
                      53
                      5
                      20

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      19
                      33
                      4

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      19
                      33
                      4

             The Patient Protection and Affordable Care Act (P.L. 111–148) added section 2794 to 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 ProgramProgram and Financing (in millions of dollars)

                      Identification code 075–0113–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Pre-Existing Condition Insurance Plan Program (Direct)
                      87

                      0002
                      Administration

                      81
                      60

                      0799
                      Total direct obligations
                      87
                      81
                      60

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)
                      87
                      81
                      60

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      332
                      246
                      165

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      333
                      246
                      165

                      1930
                      Total budgetary resources available
                      333
                      246
                      165

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      246
                      165
                      105

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      38
                      69
                      94

                      3010
                      New obligations, unexpired accounts
                      87
                      81
                      60

                      3020
                      Outlays (gross)
                      –55
                      –56
                      –43

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      69
                      94
                      111

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      38
                      69
                      94

                      3200
                      Obligated balance, end of year
                      69
                      94
                      111

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      55
                      56
                      43

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      55
                      56
                      43

             This account funded 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 paid for remaining costs that exceeded enrollee contributions.
                The funding for this program, including operating costs, was provided in the Patient Protection and Affordable Care Act (P.L.
                111–148). The PCIP program ended in fiscal year 2014, and outlays 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 ProgramProgram and Financing (in millions of dollars)

                      Identification code 075–0114–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      26
                      26
                      26

                      1930
                      Total budgetary resources available
                      26
                      26
                      26

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      26
                      26
                      26

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      11
                      11

                      3020
                      Outlays (gross)

                      –11

                      3050
                      Unpaid obligations, end of year
                      11

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      11
                      11

                      3200
                      Obligated balance, end of year
                      11

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      11

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      11

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

             Affordable Insurance Exchange GrantsProgram and Financing (in millions of dollars)

                      Identification code 075–0115–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0002
                      Administration
                      12

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      13

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –1

                      1260
                      Appropriations, mandatory (total)
                      12

                      1930
                      Total budgetary resources available
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      147
                      8
                      1

                      3010
                      New obligations, unexpired accounts
                      12

                      3020
                      Outlays (gross)
                      –48
                      –7

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –103

                      3050
                      Unpaid obligations, end of year
                      8
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      147
                      8
                      1

                      3200
                      Obligated balance, end of year
                      8
                      1
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      12

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      7

                      4101
                      Outlays from mandatory balances
                      41
                      7

                      4110
                      Outlays, gross (total)
                      48
                      7

                      4180
                      Budget authority, net (total)
                      12

                      4190
                      Outlays, net (total)
                      48
                      7

             This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
                Exchanges. The Exchanges facilitated the purchase of qualified health plans in the individual market and allowed small businesses
                to offer qualified health plans to their employees through the Small Business Health Options Program (SHOP). Section 1311
                of the Patient Protection and Affordable Care Act (P.L. 111–148) provided amounts necessary to enable the Secretary to award
                grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
                round of grants was awarded to States in December 2014.

          Object Classification (in millions of dollars)

                      Identification code 075–0115–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      3

                      25.2
                      Other services from non-Federal sources
                      9

                      99.9
                      Total new obligations, unexpired accounts
                      12

          Employment Summary

                      Identification code 075–0115–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      24

             Cost-sharing ReductionsProgram and Financing (in millions of dollars)

                      Identification code 075–0126–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Cost Sharing Reductions

                      6,263
                      6,601

                      0002
                      Basic Health Program

                      1,312
                      1,374

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

                      7,575
                      7,975

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      8,076
                      7,975

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      –501

                      1260
                      Appropriations, mandatory (total)

                      7,575
                      7,975

                      1930
                      Total budgetary resources available

                      7,575
                      7,975

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      7,575
                      7,975

                      3020
                      Outlays (gross)

                      –7,575
                      –7,975

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      7,575
                      7,975

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      7,575
                      7,975

                      4180
                      Budget authority, net (total)

                      7,575
                      7,975

                      4190
                      Outlays, net (total)

                      7,575
                      7,975

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority

                      7,575
                      7,975

                      Outlays

                      7,575
                      7,975

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –6,301
                      479

                      Outlays

                      –6,301
                      479

                      Total:

                      Budget Authority

                      1,274
                      8,454

                      Outlays

                      1,274
                      8,454

             Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers. The FY 2020 Budget
                requests a mandatory appropriation for Cost Sharing Reduction (CSR) payments. The classification of CSRs as an entitlement
                pursuant to BBEDCA does not determine legal entitlement to a payment or benefit or availability of funding.

             Cost-sharing Reductions
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0126–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Cost Sharing Reductions

                      –5,070
                      397

                      0002
                      Basic Health Program

                      –1,231
                      82

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

                      –6,301
                      479

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –6,802

                      1200
                      Appropriation

                      501
                      479

                      1260
                      Appropriations, mandatory (total)

                      –6,301
                      479

                      1930
                      Total budgetary resources available

                      –6,301
                      479

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –6,301
                      479

                      3020
                      Outlays (gross)

                      6,301
                      –479

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –6,301
                      479

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –6,301
                      479

                      4180
                      Budget authority, net (total)

                      –6,301
                      479

                      4190
                      Outlays, net (total)

                      –6,301
                      479

             This proposal would fully fund cost-sharing reduction (CSR) payments through calendar year 2020 only for those qualified health
                plans that did not increase their premium rates to account for the non-payment of CSRs.

             Risk Adjustment Program PaymentsSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      371
                      311
                      297

                      Receipts:

                      Current law:

                      1110
                      Receipts, Risk Adjustment Program
                      4,705
                      4,786
                      4,022

                      2000
                      Total: Balances and receipts
                      5,076
                      5,097
                      4,319

                      Appropriations:

                      Current law:

                      2101
                      Risk Adjustment Program Payments
                      –4,705
                      –4,786
                      –4,022

                      2103
                      Risk Adjustment Program Payments
                      –371
                      –311
                      –297

                      2132
                      Risk Adjustment Program Payments
                      311
                      297

                      2199
                      Total current law appropriations
                      –4,765
                      –4,800
                      –4,319

                      2999
                      Total appropriations
                      –4,765
                      –4,800
                      –4,319

                      5099
                      Balance, end of year
                      311
                      297

          Program and Financing (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Risk Adjustment Program Payments (Direct)
                      3,875
                      4,800
                      4,319

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      3,875
                      4,800
                      4,319

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,336
                      2,226
                      2,226

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      4,705
                      4,786
                      4,022

                      1203
                      Appropriation (previously unavailable)
                      371
                      311
                      297

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –311
                      –297

                      1260
                      Appropriations, mandatory (total)
                      4,765
                      4,800
                      4,319

                      1930
                      Total budgetary resources available
                      6,101
                      7,026
                      6,545

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      2,226
                      2,226
                      2,226

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      915
                      2,191

                      3010
                      New obligations, unexpired accounts
                      3,875
                      4,800
                      4,319

                      3020
                      Outlays (gross)
                      –2,599
                      –6,991
                      –4,319

                      3050
                      Unpaid obligations, end of year
                      2,191

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      915
                      2,191

                      3200
                      Obligated balance, end of year
                      2,191

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,765
                      4,800
                      4,319

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      348
                      4,800
                      4,319

                      4101
                      Outlays from mandatory balances
                      2,251
                      2,191

                      4110
                      Outlays, gross (total)
                      2,599
                      6,991
                      4,319

                      4180
                      Budget authority, net (total)
                      4,765
                      4,800
                      4,319

                      4190
                      Outlays, net (total)
                      2,599
                      6,991
                      4,319

             Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a permanent risk adjustment program
                for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
                and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
                with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
                a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
                they are calculated.

             Transitional Reinsurance ProgramSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      285
                      25

                      0198
                      Rounding adjustment
                      1

                      0199
                      Balance, start of year
                      286
                      25

                      Receipts:

                      Current law:

                      1110
                      Contributions, Transitional Reinsurance Program
                      383

                      2000
                      Total: Balances and receipts
                      669
                      25

                      Appropriations:

                      Current law:

                      2101
                      Transitional Reinsurance Program
                      –383

                      2103
                      Transitional Reinsurance Program
                      –286
                      –25

                      2132
                      Transitional Reinsurance Program
                      25

                      2199
                      Total current law appropriations
                      –644
                      –25

                      2999
                      Total appropriations
                      –644
                      –25

                      5099
                      Balance, end of year
                      25

          Program and Financing (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Transitional reinsurance payments
                      428
                      241

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      428
                      241

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      216

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      383

                      1203
                      Appropriation (previously unavailable)
                      286
                      25

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –25

                      1260
                      Appropriations, mandatory (total)
                      644
                      25

                      1930
                      Total budgetary resources available
                      644
                      241

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      216

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      248
                      10
                      10

                      3010
                      New obligations, unexpired accounts
                      428
                      241

                      3020
                      Outlays (gross)
                      –666
                      –241

                      3050
                      Unpaid obligations, end of year
                      10
                      10
                      10

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      248
                      10
                      10

                      3200
                      Obligated balance, end of year
                      10
                      10
                      10

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      644
                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      419
                      25

                      4101
                      Outlays from mandatory balances
                      247
                      216

                      4110
                      Outlays, gross (total)
                      666
                      241

                      4180
                      Budget authority, net (total)
                      644
                      25

                      4190
                      Outlays, net (total)
                      666
                      241

             Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a transitional 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 assessed contributing entities a per enrollee fee to fund the reinsurance program
                and made 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 were made in the year following the plan year for which they were
                applicable. Reinsurance collections ended in FY 2018 and outlays in subsequent fiscal years reflect remaining payments, refunds,
                and allowable administrative activities.

             Consumer Operated and Oriented Plan Program Contingency FundProgram and Financing (in millions of dollars)

                      Identification code 075–0524–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      124
                      4

                      0706
                      Interest on reestimates of direct loan subsidy
                      11

                      0709
                      Administrative expenses

                      1

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      135
                      5

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      1
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      135
                      4

                      1930
                      Total budgetary resources available
                      136
                      5

                      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
                      4
                      2
                      1

                      3010
                      New obligations, unexpired accounts
                      135
                      5

                      3020
                      Outlays (gross)
                      –136
                      –6

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      2
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      4
                      2
                      1

                      3200
                      Obligated balance, end of year
                      2
                      1
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      135
                      4

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      135
                      4

                      4101
                      Outlays from mandatory balances
                      1
                      2

                      4110
                      Outlays, gross (total)
                      136
                      6

                      4180
                      Budget authority, net (total)
                      135
                      4

                      4190
                      Outlays, net (total)
                      136
                      6

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

                      Identification code 075–0524–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct loan reestimates:

                      135001
                      Startup Loans
                      17
                      5

                      135002
                      Solvency Loans
                      117

                      135999
                      Total direct loan reestimates
                      134
                      5

                      Administrative expense data:

                      3580
                      Outlays from balances
                      2

             The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
                112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
                loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148).

             Consumer Operated and Oriented Plan Program AccountProgram and Financing (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      226
                      231

                      0706
                      Interest on reestimates of direct loan subsidy
                      33
                      28

                      0709
                      Administrative expenses

                      1

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      259
                      260

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      1
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      259
                      259

                      1900
                      Budget authority (total)
                      259
                      259

                      1930
                      Total budgetary resources available
                      260
                      260

                      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
                      4
                      2

                      3010
                      New obligations, unexpired accounts
                      259
                      260

                      3020
                      Outlays (gross)
                      –260
                      –262

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      4
                      2

                      3200
                      Obligated balance, end of year
                      2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      259
                      259

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      259
                      259

                      4101
                      Outlays from mandatory balances
                      1
                      3

                      4110
                      Outlays, gross (total)
                      260
                      262

                      4180
                      Budget authority, net (total)
                      259
                      259

                      4190
                      Outlays, net (total)
                      260
                      262

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

                      Identification code 075–0118–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct loan reestimates:

                      135002
                      Startup Loans
                      –8
                      116

                      135003
                      Solvency  Loans
                      252
                      143

                      135999
                      Total direct loan reestimates
                      244
                      259

                      Administrative expense data:

                      3580
                      Outlays from balances
                      1

             Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the
                Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
                insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
                markets in the States. The Secretary awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which
                enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.

             Consumer Operated and Oriented Plan Financing AccountProgram and Financing (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      13
                      7
                      7

                      0742
                      Downward reestimates paid to receipt accounts
                      14

                      0743
                      Interest on downward reestimates
                      1

                      0900
                      Total new obligations, unexpired accounts
                      28
                      7
                      7

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      143
                      22
                      24

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –127

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1023
                      Unobligated balances applied to repay debt
                      –4

                      1050
                      Unobligated balance (total)
                      15
                      22
                      24

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      22
                      2
                      2

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      265
                      301
                      565

                      1801
                      Change in uncollected payments, Federal sources
                      –1

                      1825
                      Spending authority from offsetting collections applied to repay debt
                      –251
                      –294
                      –565

                      1850
                      Spending auth from offsetting collections, mand (total)
                      13
                      7

                      1900
                      Budget authority (total)
                      35
                      9
                      2

                      1930
                      Total budgetary resources available
                      50
                      31
                      26

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      22
                      24
                      19

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3

                      3010
                      New obligations, unexpired accounts
                      28
                      7
                      7

                      3020
                      Outlays (gross)
                      –28
                      –7
                      –7

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      Uncollected payments:

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

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      35
                      9
                      2

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      28
                      7
                      7

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –259
                      –259

                      4122
                      Interest on uninvested funds
                      –6
                      –5
                      –5

                      4123
                      Non-Federal sources

                      –37
                      –560

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –265
                      –301
                      –565

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      4160
                      Budget authority, net (mandatory)
                      –229
                      –292
                      –563

                      4170
                      Outlays, net (mandatory)
                      –237
                      –294
                      –558

                      4180
                      Budget authority, net (total)
                      –229
                      –292
                      –563

                      4190
                      Outlays, net (total)
                      –237
                      –294
                      –558

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      1,893
                      1,893
                      1,858

                      1251
                      Repayments: Repayments and prepayments

                      –35
                      –11

                      1263
                      Write-offs for default: Direct loans

                      –582

                      1290
                      Outstanding, end of year
                      1,893
                      1,858
                      1,265

          Balance Sheet (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2017 actual
                      2018 actual

                      ASSETS:

                      Federal assets:

                      1101
                      Fund balances with Treasury
                      16
                      9

                      Investments in U.S. securities:

                      1106
                      Receivables, net

                      259

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      1,893
                      1,893

                      1402
                      Interest receivable
                      20
                      25

                      1405
                      Allowance for subsidy cost (-)
                      –1,278
                      –1,778

                      1499
                      Net present value of assets related to direct loans
                      635
                      140

                      1999
                      Total assets
                      651
                      408

                      LIABILITIES:

                      2103
                      Federal liabilities: Debt
                      651
                      408

                      NET POSITION:

                      3300
                      Cumulative results of operations

                      4999
                      Total liabilities and net position
                      651
                      408

             Consumer Operated and Oriented Plan Program Contingency Fund Financing AccountProgram and Financing (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      4
                      1
                      1

                      0900
                      Total new obligations, unexpired accounts
                      4
                      1
                      1

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      34
                      9
                      12

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –24

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1023
                      Unobligated balances applied to repay debt
                      –4

                      1050
                      Unobligated balance (total)
                      9
                      9
                      12

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      1
                      2
                      1

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      137
                      5
                      164

                      1801
                      Change in uncollected payments, Federal sources
                      –1

                      1825
                      Spending authority from offsetting collections applied to repay debt
                      –133
                      –3
                      –164

                      1850
                      Spending auth from offsetting collections, mand (total)
                      3
                      2

                      1900
                      Budget authority (total)
                      4
                      4
                      1

                      1930
                      Total budgetary resources available
                      13
                      13
                      13

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      9
                      12
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3

                      3010
                      New obligations, unexpired accounts
                      4
                      1
                      1

                      3020
                      Outlays (gross)
                      –4
                      –1
                      –1

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      Uncollected payments:

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

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

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4
                      4
                      1

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      4
                      1
                      1

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –134
                      –5

                      4122
                      Interest on uninvested funds
                      –3

                      –164

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –137
                      –5
                      –164

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      4160
                      Budget authority, net (mandatory)
                      –132
                      –1
                      –163

                      4170
                      Outlays, net (mandatory)
                      –133
                      –4
                      –163

                      4180
                      Budget authority, net (total)
                      –132
                      –1
                      –163

                      4190
                      Outlays, net (total)
                      –133
                      –4
                      –163

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      480
                      480
                      480

                      1263
                      Write-offs for default: Direct loans

                      –139

                      1290
                      Outstanding, end of year
                      480
                      480
                      341

          Balance Sheet (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2017 actual
                      2018 actual

                      ASSETS:

                      Federal assets:

                      1101
                      Fund balances with Treasury
                      9
                      5

                      Investments in U.S. securities:

                      1106
                      Receivables, net

                      5

                      1206
                      Non-Federal assets: Receivables, net
                      4

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      480
                      480

                      1402
                      Interest receivable

                      5

                      1405
                      Allowance for subsidy cost (-)
                      –291
                      –429

                      1499
                      Net present value of assets related to direct loans
                      189
                      56

                      1999
                      Total assets
                      202
                      66

                      LIABILITIES:

                      Federal liabilities:

                      2103
                      Debt

                      65

                      2104
                      Resources payable to Treasury
                      202

                      2207
                      Non-Federal liabilities: Other

                      2999
                      Total liabilities
                      202
                      65

                      NET POSITION:

                      3300
                      Cumulative results of operations

                      1

                      4999
                      Total liabilities and net position
                      202
                      66

          Trust Funds
             Federal Hospital Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      160,218
                      164,161
                      156,887

                      Receipts:

                      Current law:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      241,572
                      256,909
                      268,244

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      571
                      593
                      607

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      18,516
                      18,751
                      20,087

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      507
                      614
                      575

                      1130
                      FHI Trust Fund, Other Proprietary Interest from the Public

                      2
                      2

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      393
                      462
                      502

                      1130
                      FHI Trust Fund, Medicare Refunds
                      6,051
                      6,100
                      6,150

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      17
                      118
                      3

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,533
                      3,931
                      4,194

                      1140
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,839
                      3,816
                      3,821

                      1140
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      639
                      660
                      675

                      1140
                      FHI Trust Fund, Interest Received by Trust Funds
                      7,328
                      7,039
                      6,640

                      1140
                      FHI Trust Fund, Taxation on OASDI Benefits
                      24,192
                      23,882
                      26,472

                      1140
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      135
                      135
                      138

                      1140
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      2
                      88
                      36

                      1140
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      49
                      52
                      52

                      1140
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      22
                      31
                      32

                      1140
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      26
                      26
                      28

                      1140
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      1,498
                      1,307
                      1,316

                      1199
                      Total current law receipts
                      308,890
                      324,516
                      339,574

                      Proposed:

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –8

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –5

                      1230
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible

                      –223

                      1240
                      FHI Trust Fund, Interest Received by Trust Funds

                      14
                      301

                      1240
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)

                      2

                      1299
                      Total proposed receipts

                      14
                      67

                      1999
                      Total receipts
                      308,890
                      324,530
                      339,641

                      2000
                      Total: Balances and receipts
                      469,108
                      488,691
                      496,528

                      Appropriations:

                      Current law:

                      2101
                      Federal Hospital Insurance Trust Fund
                      –3,247
                      –3,039
                      –2,878

                      2101
                      Federal Hospital Insurance Trust Fund
                      –303,458
                      –319,485
                      –334,568

                      2101
                      Health Care Fraud and Abuse Control Account
                      –745
                      –765
                      –792

                      2101
                      Health Care Fraud and Abuse Control Account
                      –1,348
                      –1,354
                      –1,229

                      2103
                      Federal Hospital Insurance Trust Fund

                      –7,210
                      –12,886

                      2132
                      Federal Hospital Insurance Trust Fund
                      8

                      2132
                      Health Care Fraud and Abuse Control Account
                      50
                      49

                      2134
                      Federal Hospital Insurance Trust Fund
                      3,996

                      2199
                      Total current law appropriations
                      –304,744
                      –331,804
                      –352,353

                      Proposed:

                      2201
                      Federal Hospital Insurance Trust Fund

                      –14
                      –301

                      2201
                      Federal Hospital Insurance Trust Fund

                      230

                      2234
                      Federal Hospital Insurance Trust Fund

                      14
                      301

                      2234
                      Federal Hospital Insurance Trust Fund

                      15,455

                      2299
                      Total proposed appropriations

                      15,685

                      2999
                      Total appropriations
                      –304,744
                      –331,804
                      –336,668

                      3098
                      Federal Hospital Insurance Trust Fund
                      –203

                      5099
                      Balance, end of year
                      164,161
                      156,887
                      159,860

          Program and Financing (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI
                      298,824
                      325,232
                      346,847

                      0002
                      HIT Incentive Payments
                      44
                      20
                      15

                      0003
                      Administration, HI
                      3,536
                      3,297
                      2,868

                      0004
                      Quality improvement organizations, HI
                      522
                      891
                      452

                      0799
                      Total direct obligations
                      302,926
                      329,440
                      350,182

                      0900
                      Total new obligations, unexpired accounts
                      302,926
                      329,440
                      350,182

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      294

                      1021
                      Recoveries of prior year unpaid obligations
                      4

                      1026
                      Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                      203

                      1033
                      Recoveries of prior year paid obligations
                      18

                      1050
                      Unobligated balance (total)
                      225

                      294

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      3,247
                      3,039
                      2,878

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      303,458
                      319,485
                      334,568

                      1203
                      Appropriation (previously unavailable)

                      7,210
                      12,886

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                      –8

                      1234
                      Appropriations precluded from obligation
                      –3,996

                      1260
                      Appropriations, mandatory (total)
                      299,454
                      326,695
                      347,454

                      1900
                      Budget authority (total)
                      302,701
                      329,734
                      350,332

                      1930
                      Total budgetary resources available
                      302,926
                      329,734
                      350,626

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      294
                      444

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      35,193
                      36,685
                      36,823

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      5

                      3010
                      New obligations, unexpired accounts
                      302,926
                      329,440
                      350,182

                      3020
                      Outlays (gross)
                      –301,430
                      –329,307
                      –350,596

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –4

                      3050
                      Unpaid obligations, end of year
                      36,685
                      36,823
                      36,409

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      35,193
                      36,690
                      36,823

                      3200
                      Obligated balance, end of year
                      36,685
                      36,823
                      36,409

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,247
                      3,039
                      2,878

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,014
                      1,898
                      1,850

                      4011
                      Outlays from discretionary balances
                      981
                      746
                      1,182

                      4020
                      Outlays, gross (total)
                      2,995
                      2,644
                      3,032

                      Mandatory:

                      4090
                      Budget authority, gross
                      299,454
                      326,695
                      347,454

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      267,704
                      293,886
                      315,282

                      4101
                      Outlays from mandatory balances
                      30,731
                      32,777
                      32,282

                      4110
                      Outlays, gross (total)
                      298,435
                      326,663
                      347,564

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –18

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      18

                      4160
                      Budget authority, net (mandatory)
                      299,454
                      326,695
                      347,454

                      4170
                      Outlays, net (mandatory)
                      298,417
                      326,663
                      347,564

                      4180
                      Budget authority, net (total)
                      302,701
                      329,734
                      350,332

                      4190
                      Outlays, net (total)
                      301,412
                      329,307
                      350,596

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      197,835
                      202,805
                      195,595

                      5001
                      Total investments, EOY: Federal securities: Par value
                      202,805
                      195,595
                      182,709

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      302,701
                      329,734
                      350,332

                      Outlays
                      301,412
                      329,307
                      350,596

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –15,685

                      Outlays

                      –15,685

                      Total:

                      Budget Authority
                      302,701
                      329,734
                      334,647

                      Outlays
                      301,412
                      329,307
                      334,911

             The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
                disabled persons.

          Status of Funds (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      197,520
                      203,227
                      196,153

                      0999
                      Total balance, start of year
                      197,520
                      203,227
                      196,153

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      241,572
                      256,909
                      268,244

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      571
                      593
                      607

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      18,516
                      18,751
                      20,087

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      507
                      614
                      575

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      393
                      462
                      502

                      1130
                      FHI Trust Fund, Medicare Refunds
                      6,051
                      6,100
                      6,150

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      17
                      118
                      3

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,533
                      3,931
                      4,194

                      1130
                      Federal Hospital Insurance Trust Fund
                      18

                      1150
                      FHI Trust Fund, Interest Received by Trust Funds
                      7,328
                      7,039
                      6,640

                      1150
                      FHI Trust Fund, Other Proprietary Interest from the Public

                      2
                      2

                      1150
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      26
                      26
                      28

                      1160
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,839
                      3,816
                      3,821

                      1160
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      639
                      660
                      675

                      1160
                      FHI Trust Fund, Taxation on OASDI Benefits
                      24,192
                      23,882
                      26,472

                      1160
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      135
                      135
                      138

                      1160
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      2
                      88
                      36

                      1160
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      49
                      52
                      52

                      1160
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      22
                      31
                      32

                      1160
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      1,498
                      1,307
                      1,316

                      1199
                      Income under present law
                      308,908
                      324,516
                      339,574

                      Proposed:

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –8

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –5

                      Offsetting receipts (proprietary):

                      1230
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible

                      –223

                      1250
                      FHI Trust Fund, Interest Received by Trust Funds

                      14
                      301

                      Offsetting governmental receipts:

                      1260
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)

                      2

                      1299
                      Income proposed

                      14
                      67

                      1999
                      Total cash income
                      308,908
                      324,530
                      339,641

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Hospital Insurance Trust Fund [009–38–8005–0]
                      –301,430
                      –329,307
                      –350,596

                      2100
                      Health Care Fraud and Abuse Control Account [009–38–8393–0]
                      –1,771
                      –2,297
                      –1,909

                      2199
                      Outgo under current law
                      –303,201
                      –331,604
                      –352,505

                      Proposed:

                      2200
                      Federal Hospital Insurance Trust Fund

                      15,685

                      2299
                      Outgo under proposed legislation

                      15,685

                      2999
                      Total cash outgo (-)
                      –303,201
                      –331,604
                      –336,820

                      Surplus or deficit:

                      3110
                      Excluding interest
                      –1,647
                      –14,155
                      –4,150

                      3120
                      Interest
                      7,354
                      7,081
                      6,971

                      3199
                      Subtotal, surplus or deficit
                      5,707
                      –7,074
                      2,821

                      3999
                      Total change in fund balance
                      5,707
                      –7,074
                      2,821

                      Unexpended balance, end of year:

                      4100
                      Uninvested balance (net), end of year
                      422
                      558
                      16,265

                      4200
                      Federal Hospital Insurance Trust Fund
                      202,805
                      195,595
                      182,709

                      4999
                      Total balance, end of year
                      203,227
                      196,153
                      198,974

          Object Classification (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      41.0
                      Payment for Quality Improvement Organization (QIO) activities
                      522
                      891
                      452

                      42.0
                      Insurance claims and indemnities (benefits)
                      298,868
                      325,232
                      346,862

                      94.0
                      Financial transfers
                      3,536
                      3,317
                      2,868

                      99.9
                      Total new obligations, unexpired accounts
                      302,926
                      329,440
                      350,182

          Employment Summary

                      Identification code 075–8005–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1
                      2
                      2

             Federal Hospital Insurance Trust Fund
             (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8005–2–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      14
                      301

                      1234
                      Appropriations precluded from obligation

                      –14
                      –301

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Federal Hospital Insurance Trust Fund
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8005–4–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI

                      –15,703

                      0003
                      Administration, HI

                      18

                      0799
                      Total direct obligations

                      –15,685

                      0900
                      Total new obligations, unexpired accounts

                      –15,685

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –230

                      1234
                      Appropriations precluded from obligation

                      –15,455

                      1260
                      Appropriations, mandatory (total)

                      –15,685

                      1900
                      Budget authority (total)

                      –15,685

                      1930
                      Total budgetary resources available

                      –15,685

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –15,685

                      3020
                      Outlays (gross)

                      15,685

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –15,685

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –15,685

                      4180
                      Budget authority, net (total)

                      –15,685

                      4190
                      Outlays, net (total)

                      –15,685

             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.

          Object Classification (in millions of dollars)

                      Identification code 075–8005–4–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities (benefits)

                      –15,703

                      94.0
                      Financial transfers

                      18

                      99.9
                      Total new obligations, unexpired accounts

                      –15,685

             Health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management,  $792,000,000, to remain available through September 30,  2021, 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  $614,000,000 shall be for the Centers for Medicare & Medicaid Services program integrity activities, of which  $98,000,000 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  $80,000,000 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  2020 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  $475,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That  amounts made available under this heading and amounts made available for fiscal year 2020 in section 1817(k)(3)(A) of the
                   Social Security Act shall also be available for the Senior Medicare Patrol program to combat health care fraud and abuse.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–8393–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Medicare integrity program
                      864
                      898
                      939

                      0002
                      FBI fraud and abuse control
                      135
                      138
                      151

                      0003
                      Other fraud and abuse control
                      282
                      294
                      320

                      0005
                      Undistributed Savings, HCFAC and SSA

                      –26
                      –181

                      0091
                      Total Mandatory
                      1,281
                      1,304
                      1,229

                      0101
                      CMS discretionary
                      576
                      599
                      614

                      0102
                      Other discretionary
                      160
                      166
                      178

                      0191
                      Total Discretionary
                      736
                      765
                      792

                      0900
                      Total new obligations, unexpired accounts
                      2,017
                      2,069
                      2,021

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      430
                      471
                      472

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      198
                      201

                      1021
                      Recoveries of prior year unpaid obligations
                      23

                      1050
                      Unobligated balance (total)
                      453
                      471
                      472

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      745
                      765
                      792

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      1,348
                      1,354
                      1,229

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –50
                      –49

                      1260
                      Appropriations, mandatory (total)
                      1,298
                      1,305
                      1,229

                      1900
                      Budget authority (total)
                      2,043
                      2,070
                      2,021

                      1930
                      Total budgetary resources available
                      2,496
                      2,541
                      2,493

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –8

                      1941
                      Unexpired unobligated balance, end of year
                      471
                      472
                      472

                      Special and non-revolving trust funds:

                      1951
                      Unobligated balance expiring
                      8

                      1952
                      Expired unobligated balance, start of year
                      28
                      32
                      32

                      1953
                      Expired unobligated balance, end of year
                      24
                      32
                      32

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,764
                      1,970
                      1,742

                      3010
                      New obligations, unexpired accounts
                      2,017
                      2,069
                      2,021

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

                      3020
                      Outlays (gross)
                      –1,771
                      –2,297
                      –1,909

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –23

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –19

                      3050
                      Unpaid obligations, end of year
                      1,970
                      1,742
                      1,854

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,764
                      1,970
                      1,742

                      3200
                      Obligated balance, end of year
                      1,970
                      1,742
                      1,854

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      745
                      765
                      792

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      148
                      306
                      317

                      4011
                      Outlays from discretionary balances
                      503
                      124
                      268

                      4020
                      Outlays, gross (total)
                      651
                      430
                      585

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,298
                      1,305
                      1,229

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      355
                      665
                      525

                      4101
                      Outlays from mandatory balances
                      765
                      1,202
                      799

                      4110
                      Outlays, gross (total)
                      1,120
                      1,867
                      1,324

                      4180
                      Budget authority, net (total)
                      2,043
                      2,070
                      2,021

                      4190
                      Outlays, net (total)
                      1,771
                      2,297
                      1,909

             The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse
                Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
                HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
                (HHS), the Department of Justice, and other agencies.

             The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
                integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
                in the Analytical Perspectives volume.

          Object Classification (in millions of dollars)

                      Identification code 075–8393–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent (CMS)
                      38
                      42
                      42

                      11.7
                      Military personnel

                      2
                      2

                      11.9
                      Total personnel compensation

                      44
                      44

                      12.1
                      Civilian personnel benefits (CMS)
                      10
                      10
                      10

                      12.2
                      Military personnel benefits

                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      10
                      11
                      11

                      25.2
                      Other services (CMS/Medicaid)
                      89

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/DOJ)
                      135
                      140
                      147

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OIG)
                      285
                      294
                      319

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OGC)
                      7
                      7
                      8

                      25.3
                      Other goods and services from Federal sources (HHS/CMS)
                      9
                      13
                      15

                      25.3
                      Other goods and services from Government accounts (HHS/FDA)
                      6
                      6
                      7

                      25.6
                      Medical care  (CMS)
                      1,293
                      1,431
                      1,489

                      92.0
                      Undistributed

                      –26
                      –181

                      94.0
                      Financial transfers (FBI)
                      135
                      138
                      151

                      99.9
                      Total new obligations, unexpired accounts
                      2,017
                      2,069
                      2,021

          Employment Summary

                      Identification code 075–8393–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      387
                      409
                      409

                      1101
                      Direct military average strength employment

                      17
                      17

             Federal Supplementary Medical Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year
                      47,105
                      67,416
                      74,724

                      0198
                      Rounding adjustment
                      130

                      0199
                      Balance, start of year
                      47,235
                      67,416
                      74,724

                      Receipts:

                      Current law:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      4,095
                      4,709
                      2,800

                      1130
                      Other Proprietary Interest from the Public, FSMI Fund

                      3
                      3

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      5,254
                      5,341
                      6,051

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      11,670
                      12,142
                      13,035

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      476
                      517
                      568

                      1130
                      Medicare Refunds, SMI
                      4,827
                      4,877
                      4,927

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      18
                      68
                      3

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      77,305
                      84,634
                      91,149

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      13,107
                      12,696
                      13,082

                      1140
                      Federal Contributions, FSMI Fund
                      245,714
                      265,753
                      285,481

                      1140
                      Interest Received by Trust Fund, FSMI Fund
                      2,322
                      1,014
                      1,375

                      1140
                      Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI

                      3
                      5

                      1140
                      Interest, Medicare Prescription Drug Account, FSMI
                      57
                      26
                      19

                      1140
                      Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                      655
                      642
                      662

                      1140
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      71,750
                      67,107
                      87,246

                      1140
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Total current law receipts
                      437,252
                      459,533
                      506,407

                      Proposed:

                      1230
                      Premiums Collected for Medicare Prescription Drug Account, FSMI

                      –10

                      1230
                      Payments from States, Medicare Prescription Drug Account, FSMI

                      –10

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –2,246

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –322

                      1240
                      Federal Contributions, FSMI Fund

                      –7,696

                      1240
                      Federal Contributions for Benefits, Prescription Drug Account, SMI

                      –80

                      1299
                      Total proposed receipts

                      –10,364

                      1999
                      Total receipts
                      437,252
                      459,533
                      496,043

                      2000
                      Total: Balances and receipts
                      484,487
                      526,949
                      570,767

                      Appropriations:

                      Current law:

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –2,933
                      –3,006
                      –2,525

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –345,486
                      –371,229
                      –397,476

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –421
                      –633
                      –858

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –88,420
                      –84,665
                      –105,548

                      2134
                      Federal Supplementary Medical Insurance Trust Fund
                      19,912
                      7,308
                      3,463

                      2199
                      Total current law appropriations
                      –417,348
                      –452,225
                      –502,944

                      Proposed:

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      7,776

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      2,478

                      2201
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

                      100

                      2203
                      Federal Supplementary Medical Insurance Trust Fund

                      –7,776

                      2234
                      Federal Supplementary Medical Insurance Trust Fund

                      7,767

                      2299
                      Total proposed appropriations

                      10,345

                      2999
                      Total appropriations
                      –417,348
                      –452,225
                      –492,599

                      3098
                      Federal Supplementary Medical Insurance Trust Fund
                      –312

                      5098
                      Reconciliation adjustment
                      589

                      5099
                      Balance, end of year
                      67,416
                      74,724
                      78,168

          Program and Financing (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI
                      323,097
                      360,873
                      391,252

                      0002
                      Transfer to Medicaid for payment of SMI premiums
                      1,087
                      1,030
                      1,123

                      0003
                      HIT Incentive Payments
                      16

                      0004
                      Administration, SMI
                      3,027
                      3,223
                      2,573

                      0005
                      Quality Improvement Organizations, SMI
                      252
                      429
                      218

                      0799
                      Total direct obligations
                      327,479
                      365,555
                      395,166

                      0900
                      Total new obligations, unexpired accounts
                      327,479
                      365,555
                      395,166

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1
                      1

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1

                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      30

                      1026
                      Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                      312

                      1033
                      Recoveries of prior year paid obligations
                      3

                      1050
                      Unobligated balance (total)
                      345
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      2,933
                      3,006
                      2,525

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      345,486
                      371,229
                      397,476

                      1234
                      Appropriations precluded from obligation
                      –19,912
                      –7,308
                      –3,463

                      1236
                      Appropriations applied to repay debt
                      –1,372
                      –1,372
                      –1,372

                      1260
                      Appropriations, mandatory (total)
                      324,202
                      362,549
                      392,641

                      1900
                      Budget authority (total)
                      327,135
                      365,555
                      395,166

                      1930
                      Total budgetary resources available
                      327,480
                      365,556
                      395,167

                      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
                      26,304
                      27,918
                      28,124

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      5

                      3010
                      New obligations, unexpired accounts
                      327,479
                      365,555
                      395,166

                      3020
                      Outlays (gross)
                      –325,835
                      –365,354
                      –395,323

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –30

                      3050
                      Unpaid obligations, end of year
                      27,918
                      28,124
                      27,967

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      26,304
                      27,923
                      28,124

                      3200
                      Obligated balance, end of year
                      27,918
                      28,124
                      27,967

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,933
                      3,006
                      2,525

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,700
                      1,988
                      1,739

                      4011
                      Outlays from discretionary balances
                      1,078
                      797
                      836

                      4020
                      Outlays, gross (total)
                      2,778
                      2,785
                      2,575

                      Mandatory:

                      4090
                      Budget authority, gross
                      324,202
                      362,549
                      392,641

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      298,989
                      336,985
                      362,544

                      4101
                      Outlays from mandatory balances
                      24,068
                      25,584
                      30,204

                      4110
                      Outlays, gross (total)
                      323,057
                      362,569
                      392,748

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –3

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      3

                      4160
                      Budget authority, net (mandatory)
                      324,202
                      362,549
                      392,641

                      4170
                      Outlays, net (mandatory)
                      323,054
                      362,569
                      392,748

                      4180
                      Budget authority, net (total)
                      327,135
                      365,555
                      395,166

                      4190
                      Outlays, net (total)
                      325,832
                      365,354
                      395,323

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      70,589
                      98,197
                      104,990

                      5001
                      Total investments, EOY: Federal securities: Par value
                      98,197
                      104,990
                      109,728

                      5080
                      Outstanding debt, SOY
                      –6,396
                      –5,024
                      –3,652

                      5081
                      Outstanding debt, EOY
                      –5,024
                      –3,652
                      –2,280

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      327,135
                      365,555
                      395,166

                      Outlays
                      325,832
                      365,354
                      395,323

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –10,245

                      Outlays

                      –10,245

                      Total:

                      Budget Authority
                      327,135
                      365,555
                      384,921

                      Outlays
                      325,832
                      365,354
                      385,078

             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.

          Status of Funds (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      68,008
                      96,946
                      106,000

                      0999
                      Total balance, start of year
                      68,008
                      96,946
                      106,000

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      4,095
                      4,709
                      2,800

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      5,254
                      5,341
                      6,051

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      11,670
                      12,142
                      13,035

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      476
                      517
                      568

                      1130
                      Medicare Refunds, SMI
                      4,827
                      4,877
                      4,927

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      18
                      68
                      3

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      77,305
                      84,634
                      91,149

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      13,107
                      12,696
                      13,082

                      1130
                      Federal Supplementary Medical Insurance Trust Fund
                      3

                      1130
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      1

                      1150
                      Interest Received by Trust Fund, FSMI Fund
                      2,322
                      1,014
                      1,375

                      1150
                      Other Proprietary Interest from the Public, FSMI Fund

                      3
                      3

                      1150
                      Interest, Medicare Prescription Drug Account, FSMI
                      57
                      26
                      19

                      1160
                      Federal Contributions, FSMI Fund
                      245,714
                      265,753
                      285,481

                      1160
                      Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI

                      3
                      5

                      1160
                      Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                      655
                      642
                      662

                      1160
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      71,750
                      67,107
                      87,246

                      1160
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Income under present law
                      437,256
                      459,533
                      506,407

                      Proposed:

                      Offsetting receipts (proprietary):

                      1230
                      Premiums Collected for Medicare Prescription Drug Account, FSMI

                      –10

                      1230
                      Payments from States, Medicare Prescription Drug Account, FSMI

                      –10

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –2,246

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –322

                      Offsetting governmental receipts:

                      1260
                      Federal Contributions, FSMI Fund

                      –7,696

                      1260
                      Federal Contributions for Benefits, Prescription Drug Account, SMI

                      –80

                      1299
                      Income proposed

                      –10,364

                      1999
                      Total cash income
                      437,256
                      459,533
                      496,043

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]
                      –325,835
                      –365,354
                      –395,323

                      2100
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]
                      –82,488
                      –85,125
                      –106,035

                      2199
                      Outgo under current law
                      –408,323
                      –450,479
                      –501,358

                      Proposed:

                      2200
                      Federal Supplementary Medical Insurance Trust Fund

                      10,245

                      2200
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

                      100

                      2299
                      Outgo under proposed legislation

                      10,345

                      2999
                      Total cash outgo (-)
                      –408,323
                      –450,479
                      –491,013

                      Surplus or deficit:

                      3110
                      Excluding interest
                      26,554
                      8,011
                      3,633

                      3120
                      Interest
                      2,379
                      1,043
                      1,397

                      3199
                      Subtotal, surplus or deficit
                      28,933
                      9,054
                      5,030

                      3298
                      Reconciliation adjustment
                      5

                      3299
                      Total adjustments
                      5

                      3999
                      Total change in fund balance
                      28,938
                      9,054
                      5,030

                      Unexpended balance, end of year:

                      4100
                      Uninvested balance (net), end of year
                      –1,251
                      1,010
                      1,302

                      4200
                      Federal Supplementary Medical Insurance Trust Fund
                      98,197
                      104,990
                      109,728

                      4999
                      Total balance, end of year
                      96,946
                      106,000
                      111,030

          Object Classification (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1
                      1

                      41.0
                      Payment for Quality Improvement Organization (QIO) activity
                      252
                      429
                      218

                      42.0
                      Insurance claims and indemnities
                      323,097
                      360,873
                      391,252

                      94.0
                      Financial transfers
                      4,129
                      4,252
                      3,695

                      99.0
                      Direct obligations
                      327,479
                      365,555
                      395,166

                      99.9
                      Total new obligations, unexpired accounts
                      327,479
                      365,555
                      395,166

          Employment Summary

                      Identification code 075–8004–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      7
                      8
                      8

             Federal Supplementary Medical Insurance Trust Fund
             (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8004–2–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –7,776

                      1203
                      Appropriation (previously unavailable)

                      7,776

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Federal Supplementary Medical Insurance Trust Fund
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8004–4–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI

                      –10,265

                      0004
                      Administration, SMI

                      20

                      0799
                      Total direct obligations

                      –10,245

                      0900
                      Total new obligations, unexpired accounts

                      –10,245

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –2,478

                      1234
                      Appropriations precluded from obligation

                      –7,767

                      1260
                      Appropriations, mandatory (total)

                      –10,245

                      1900
                      Budget authority (total)

                      –10,245

                      1930
                      Total budgetary resources available

                      –10,245

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –10,245

                      3020
                      Outlays (gross)

                      10,245

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –10,245

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –10,245

                      4180
                      Budget authority, net (total)

                      –10,245

                      4190
                      Outlays, net (total)

                      –10,245

             In addition, the Budget includes a package of targeted Medicare proposals designed to improve drug pricing and payment, eliminate
                wasteful Federal spending and spending on government-imposed provider burdens, address fraud and abuse, and reform the Medicare
                appeals process.

          Object Classification (in millions of dollars)

                      Identification code 075–8004–4–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities

                      –10,265

                      94.0
                      Financial transfers

                      20

                      99.0
                      Direct obligations

                      –10,245

                      99.9
                      Total new obligations, unexpired accounts

                      –10,245

             Medicare Prescription Drug Account, Federal Supplementary Insurance Trust FundProgram and Financing (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Prescription Drug Benefits
                      81,103
                      84,656
                      105,544

                      0002
                      Administrative Costs
                      422
                      642
                      861

                      0799
                      Total direct obligations
                      81,525
                      85,298
                      106,405

                      0900
                      Total new obligations, unexpired accounts
                      81,525
                      85,298
                      106,405

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      421
                      633
                      858

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      88,420
                      84,665
                      105,548

                      Spending authority from offsetting collections, mandatory:

                      1801
                      Change in uncollected payments, Federal sources
                      –7,316

                      1900
                      Budget authority (total)
                      81,525
                      85,298
                      106,406

                      1930
                      Total budgetary resources available
                      81,525
                      85,298
                      106,406

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      1

                      Special and non-revolving trust funds:

                      1952
                      Expired unobligated balance, start of year
                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      8,404
                      7,466
                      7,639

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1
                      27

                      3010
                      New obligations, unexpired accounts
                      81,525
                      85,298
                      106,405

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

                      3020
                      Outlays (gross)
                      –82,488
                      –85,125
                      –106,035

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –3

                      3050
                      Unpaid obligations, end of year
                      7,466
                      7,639
                      8,009

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –7,541
                      –225
                      –225

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      7,316

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –225
                      –225
                      –225

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      890
                      7,241
                      7,414

                      3200
                      Obligated balance, end of year
                      7,241
                      7,414
                      7,784

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      421
                      633
                      858

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      218
                      330
                      331

                      4011
                      Outlays from discretionary balances
                      217
                      131
                      147

                      4020
                      Outlays, gross (total)
                      435
                      461
                      478

                      Mandatory:

                      4090
                      Budget authority, gross
                      81,104
                      84,665
                      105,548

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      74,420
                      77,619
                      95,548

                      4101
                      Outlays from mandatory balances
                      7,633
                      7,045
                      10,009

                      4110
                      Outlays, gross (total)
                      82,053
                      84,664
                      105,557

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      7,316

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)
                      7,317

                      4160
                      Budget authority, net (mandatory)
                      88,420
                      84,665
                      105,548

                      4170
                      Outlays, net (mandatory)
                      82,052
                      84,664
                      105,557

                      4180
                      Budget authority, net (total)
                      88,841
                      85,298
                      106,406

                      4190
                      Outlays, net (total)
                      82,487
                      85,125
                      106,035

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      88,841
                      85,298
                      106,406

                      Outlays
                      82,487
                      85,125
                      106,035

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –100

                      Outlays

                      –100

                      Total:

                      Budget Authority
                      88,841
                      85,298
                      106,306

                      Outlays
                      82,487
                      85,125
                      105,935

             Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
                benefit.

          Object Classification (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      25.2
                      Other services from non-Federal sources
                      422
                      642
                      861

                      42.0
                      Insurance claims and indemnities
                      81,103
                      84,656
                      105,544

                      99.0
                      Direct obligations
                      81,525
                      85,298
                      106,405

                      99.9
                      Total new obligations, unexpired accounts
                      81,525
                      85,298
                      106,405

          Employment Summary

                      Identification code 075–8308–0–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4
                      4

             Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8308–4–7–571
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Prescription Drug Benefits

                      –100

                      0799
                      Total direct obligations

                      –100

                      0900
                      Total new obligations, unexpired accounts (object class 42.0)

                      –100

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –100

                      1900
                      Budget authority (total)

                      –100

                      1930
                      Total budgetary resources available

                      –100

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –100

                      3020
                      Outlays (gross)

                      100

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –100

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –100

                      4180
                      Budget authority, net (total)

                      –100

                      4190
                      Outlays, net (total)

                      –100

             The Budget includes a package of proposals designed to modernize the Part D benefit by realigning incentives and enhancing
                benefit management.

             Administration for Children and FamiliesFederal Funds
             Temporary Assistance for Needy FamiliesProgram and Financing (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant
                      16,433
                      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
                      141
                      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
                      16,714
                      16,722
                      16,724

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      16,739
                      16,739
                      16,739

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

                      1260
                      Appropriations, mandatory (total)
                      16,737
                      16,737
                      16,739

                      1900
                      Budget authority (total)

                      16,737
                      16,739

                      1930
                      Total budgetary resources available
                      16,737
                      16,737
                      16,739

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –23
                      –15
                      –15

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,772
                      8,070
                      8,256

                      3010
                      New obligations, unexpired accounts
                      16,714
                      16,722
                      16,724

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

                      3020
                      Outlays (gross)
                      –16,415
                      –16,536
                      –16,219

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –3

                      3050
                      Unpaid obligations, end of year
                      8,070
                      8,256
                      8,761

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,772
                      8,070
                      8,256

                      3200
                      Obligated balance, end of year
                      8,070
                      8,256
                      8,761

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      16,737
                      16,737
                      16,739

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11,018
                      11,495
                      11,497

                      4101
                      Outlays from mandatory balances
                      5,397
                      5,041
                      4,722

                      4110
                      Outlays, gross (total)
                      16,415
                      16,536
                      16,219

                      4180
                      Budget authority, net (total)
                      16,737
                      16,737
                      16,739

                      4190
                      Outlays, net (total)
                      16,415
                      16,536
                      16,219

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      16,737
                      16,737
                      16,739

                      Outlays
                      16,415
                      16,536
                      16,219

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,502

                      Outlays

                      –1,077

                      Total:

                      Budget Authority
                      16,737
                      16,737
                      15,237

                      Outlays
                      16,415
                      16,536
                      15,142

             This account provides funding for the Temporary Assistance for Needy Families (TANF) block grant and related activities authorized
                by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction
                Act of 2005 (P.L. 109–171). The TANF Extension Act of 2019 (P.L. 116–4) authorized TANF through June 30, 2019. The Budget
                proposes to create a comprehensive demonstration opportunity for states to grow capacity across public safety net benefit
                programs to reduce dependency; continue and modify TANF to refocus the program on the core principle of promoting employment;
                continue the 0.33 percent set-aside for TANF evaluation, research, and technical assistance; and to reduce the authorized
                funding for TANF Family Assistance Grants to States, territories, and tribes by 10 percent.

          Object Classification (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      8
                      10
                      9

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.5
                      Other personnel compensation
                      1

                      11.9
                      Total personnel compensation
                      10
                      11
                      10

                      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
                      68
                      67
                      68

                      25.3
                      Other goods and services from Federal sources
                      4
                      20
                      20

                      25.7
                      Operation and maintenance of equipment

                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      16,628
                      16,619
                      16,621

                      99.9
                      Total new obligations, unexpired accounts
                      16,714
                      16,722
                      16,724

          Employment Summary

                      Identification code 075–1552–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      105
                      104
                      97

             Temporary Assistance for Needy Families
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1552–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant

                      –1,594

                      0002
                      Territories - family assistance grants

                      –8

                      0012
                      Promoting Opportunity and Economic Mobility Demonstrations

                      100

                      0900
                      Total new obligations, unexpired accounts

                      –1,502

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,502

                      1930
                      Total budgetary resources available

                      –1,502

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,502

                      3020
                      Outlays (gross)

                      1,077

                      3050
                      Unpaid obligations, end of year

                      –425

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –425

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,502

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,077

                      4180
                      Budget authority, net (total)

                      –1,502

                      4190
                      Outlays, net (total)

                      –1,077

          Object Classification (in millions of dollars)

                      Identification code 075–1552–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      11.1
                      Direct obligations: Personnel compensation: Full-time permanent

                      1

                      11.9
                      Total personnel compensation

                      1

                      25.1
                      Advisory and assistance services

                      29

                      41.0
                      Grants, subsidies, and contributions

                      –1,532

                      99.9
                      Total new obligations, unexpired accounts

                      –1,502

          Employment Summary

                      Identification code 075–1552–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment

                      7

             Contingency FundProgram and Financing (in millions of dollars)

                      Identification code 075–1522–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Contingency Fund for State Welfare Programs
                      608
                      608
                      608

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      608
                      608
                      608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      608
                      608
                      608

                      1930
                      Total budgetary resources available
                      608
                      608
                      608

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      113
                      55
                      66

                      3010
                      New obligations, unexpired accounts
                      608
                      608
                      608

                      3020
                      Outlays (gross)
                      –666
                      –597
                      –608

                      3050
                      Unpaid obligations, end of year
                      55
                      66
                      66

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      113
                      55
                      66

                      3200
                      Obligated balance, end of year
                      55
                      66
                      66

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      608
                      608
                      608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      574
                      545
                      545

                      4101
                      Outlays from mandatory balances
                      92
                      52
                      63

                      4110
                      Outlays, gross (total)
                      666
                      597
                      608

                      4180
                      Budget authority, net (total)
                      608
                      608
                      608

                      4190
                      Outlays, net (total)
                      666
                      597
                      608

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      608
                      608
                      608

                      Outlays
                      666
                      597
                      608

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –608

                      Outlays

                      –545

                      Total:

                      Budget Authority
                      608
                      608

                      Outlays
                      666
                      597
                      63

             The Budget proposes to eliminate funding for the Contingency Fund.

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

                      Identification code 075–1522–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Contingency Fund for State Welfare Programs

                      –608

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

                      –608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –608

                      1930
                      Total budgetary resources available

                      –608

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –608

                      3020
                      Outlays (gross)

                      545

                      3050
                      Unpaid obligations, end of year

                      –63

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –63

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –545

                      4180
                      Budget authority, net (total)

                      –608

                      4190
                      Outlays, net (total)

                      –545

             Payments to states for child support enforcement and family support programsFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
                of July 5, 1960,  $2,890,000,000, to remain available until expended; and for such purposes for the first quarter of fiscal year  2021, $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, 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1501–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs
                      3,793
                      3,924
                      3,969

                      0002
                      Child support incentive payments
                      577
                      574
                      598

                      0003
                      Access and visitation grants
                      10
                      10
                      10

                      0091
                      Subtotal, child support enforcement
                      4,380
                      4,508
                      4,577

                      0102
                      Payments to territories
                      33
                      33
                      33

                      0103
                      Repatriation
                      3
                      1
                      1

                      0191
                      Subtotal, other payments
                      36
                      34
                      34

                      0799
                      Total direct obligations
                      4,416
                      4,542
                      4,611

                      0801
                      Offset obligations (CSE grants to States)
                      13
                      13
                      1

                      0900
                      Total new obligations, unexpired accounts
                      4,429
                      4,555
                      4,612

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      35
                      141
                      121

                      1021
                      Recoveries of prior year unpaid obligations
                      159
                      200
                      200

                      1029
                      Other balances withdrawn to Treasury
                      –32

                      1050
                      Unobligated balance (total)
                      162
                      341
                      321

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      2,995
                      2,922
                      2,890

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      1,400
                      1,400
                      1,400

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      13
                      13
                      1

                      1900
                      Budget authority (total)
                      4,408
                      4,335
                      4,291

                      1930
                      Total budgetary resources available
                      4,570
                      4,676
                      4,612

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      141
                      121

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,263
                      1,383
                      1,490

                      3010
                      New obligations, unexpired accounts
                      4,429
                      4,555
                      4,612

                      3020
                      Outlays (gross)
                      –4,150
                      –4,248
                      –4,308

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –159
                      –200
                      –200

                      3050
                      Unpaid obligations, end of year
                      1,383
                      1,490
                      1,594

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,263
                      1,383
                      1,490

                      3200
                      Obligated balance, end of year
                      1,383
                      1,490
                      1,594

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,408
                      4,335
                      4,291

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3,754
                      3,774
                      3,807

                      4101
                      Outlays from mandatory balances
                      396
                      474
                      501

                      4110
                      Outlays, gross (total)
                      4,150
                      4,248
                      4,308

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –13
                      –13
                      –1

                      4180
                      Budget authority, net (total)
                      4,395
                      4,322
                      4,290

                      4190
                      Outlays, net (total)
                      4,137
                      4,235
                      4,307

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      4,395
                      4,322
                      4,290

                      Outlays
                      4,137
                      4,235
                      4,307

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      50

                      Outlays

                      49

                      Total:

                      Budget Authority
                      4,395
                      4,322
                      4,340

                      Outlays
                      4,137
                      4,235
                      4,356

             This account provides for payments to States for child support enforcement and other family support programs, including access
                and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
                account. The Budget improves establishment and enforcement procedures by closing loopholes and improving Federal processes.
                Proposals target systems modernization, increased collections, expanded distribution, and improved program efficiency.

          Object Classification (in millions of dollars)

                      Identification code 075–1501–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      41.0
                      Direct obligations: Grants, subsidies, and contributions
                      4,416
                      4,542
                      4,611

                      99.0
                      Reimbursable obligations
                      13
                      13
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      4,429
                      4,555
                      4,612

             Payments to States for Child Support Enforcement and Family Support Programs
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1501–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs

                      49

                      0091
                      Subtotal, child support enforcement

                      49

                      0103
                      Repatriation

                      1

                      0191
                      Subtotal, other payments

                      1

                      0799
                      Total direct obligations

                      50

                      0900
                      Total new obligations, unexpired accounts

                      50

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      50

                      1900
                      Budget authority (total)

                      50

                      1930
                      Total budgetary resources available

                      50

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      50

                      3020
                      Outlays (gross)

                      –49

                      3050
                      Unpaid obligations, end of year

                      1

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      50

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      49

                      4180
                      Budget authority, net (total)

                      50

                      4190
                      Outlays, net (total)

                      49

          Object Classification (in millions of dollars)

                      Identification code 075–1501–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services

                      120

                      41.0
                      Grants, subsidies, and contributions

                      –70

                      99.0
                      Direct obligations

                      50

                      99.9
                      Total new obligations, unexpired accounts

                      50

             Low income home energy assistance
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      LIHEAP Block Grant
                      3,641
                      3,690

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      1
                      1

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1050
                      Unobligated balance (total)
                      2
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,640
                      3,690

                      1930
                      Total budgetary resources available
                      3,642
                      3,691
                      1

                      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
                      1,421
                      1,631
                      1,629

                      3010
                      New obligations, unexpired accounts
                      3,641
                      3,690

                      3020
                      Outlays (gross)
                      –3,425
                      –3,692
                      –1,396

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –6

                      3050
                      Unpaid obligations, end of year
                      1,631
                      1,629
                      233

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,421
                      1,631
                      1,629

                      3200
                      Obligated balance, end of year
                      1,631
                      1,629
                      233

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,640
                      3,690

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,248
                      2,362

                      4011
                      Outlays from discretionary balances
                      1,177
                      1,330
                      1,396

                      4020
                      Outlays, gross (total)
                      3,425
                      3,692
                      1,396

                      4180
                      Budget authority, net (total)
                      3,640
                      3,690

                      4190
                      Outlays, net (total)
                      3,425
                      3,692
                      1,396

             The Budget proposes to eliminate funding for the Low Income Home Energy Assistance Program.

          Object Classification (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      3
                      3

                      41.0
                      Grants, subsidies, and contributions
                      3,638
                      3,687

                      99.9
                      Total new obligations, unexpired accounts
                      3,641
                      3,690

             Refugee and entrant assistance
             (including transfer of funds)For 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,  $1,804,066,000, of which  $1,773,066,000  shall remain available through September 30,  2022 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 such Act: 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 "20 percent" for "3 percent": Provided further, That funds made available under this heading shall be available to pay or reimburse other Federal agencies
                   for the costs of construction, improvements to property, and other activities, including structure removal, if such activities
                   are necessary for the purposes of carrying out such sections 462 and 235: Provided further, That such Federal agencies may
                   retain and use such payments and reimbursements to cover costs described in the preceding proviso.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Refugee and entrant assistance
                      503
                      561
                      470

                      0002
                      Assistance for treatment of torture victims
                      11
                      14
                      14

                      0003
                      Unaccompanied Children
                      1,721
                      1,303
                      1,303

                      0005
                      Trafficking Victims program
                      24
                      27
                      17

                      0799
                      Total direct obligations
                      2,259
                      1,905
                      1,804

                      0801
                      Reimbursable program activity
                      190

                      0900
                      Total new obligations, unexpired accounts
                      2,449
                      1,905
                      1,804

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      190
                      40
                      40

                      1011
                      Unobligated balance transfer from other acct [075–0350]
                      17

                      1021
                      Recoveries of prior year unpaid obligations
                      52

                      1050
                      Unobligated balance (total)
                      259
                      40
                      40

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Base Appropriation
                      1,865
                      1,905
                      1,804

                      1121
                      Appropriations transferred from other acct [075–0350]
                      16

                      1121
                      Appropriations transferred from other acct [075–1536]
                      30

                      1121
                      Appropriations transferred from other acct [075–1700]
                      1

                      1121
                      Appropriations transferred from other acct [075–0142]
                      5

                      1121
                      Appropriations transferred from other acct [075–1362]
                      6

                      1121
                      Appropriations transferred from other acct [075–0943]
                      17

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

                      1121
                      Appropriations transferred from other acct [075–9915]
                      87

                      1121
                      Appropriations transferred from other acct [075–1515]
                      13

                      1160
                      Appropriation, discretionary (total)
                      2,041
                      1,905
                      1,804

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      10
                      180

                      1701
                      Change in uncollected payments, Federal sources
                      180
                      –180

                      1750
                      Spending auth from offsetting collections, disc (total)
                      190

                      1900
                      Budget authority (total)
                      2,231
                      1,905
                      1,804

                      1930
                      Total budgetary resources available
                      2,490
                      1,945
                      1,844

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      40
                      40
                      40

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,002
                      1,721
                      1,185

                      3010
                      New obligations, unexpired accounts
                      2,449
                      1,905
                      1,804

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

                      3020
                      Outlays (gross)
                      –1,661
                      –2,441
                      –2,115

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –52

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –19

                      3050
                      Unpaid obligations, end of year
                      1,721
                      1,185
                      874

                      Uncollected payments:

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

                      –180

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –180
                      180

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –180

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,002
                      1,541
                      1,185

                      3200
                      Obligated balance, end of year
                      1,541
                      1,185
                      874

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,231
                      1,905
                      1,804

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      983
                      1,238
                      1,173

                      4011
                      Outlays from discretionary balances
                      678
                      1,203
                      942

                      4020
                      Outlays, gross (total)
                      1,661
                      2,441
                      2,115

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –10
                      –180

                      4033
                      Non-Federal sources
                      –2

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –12
                      –180

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –180
                      180

                      4052
                      Offsetting collections credited to expired accounts
                      2

                      4060
                      Additional offsets against budget authority only (total)
                      –178
                      180

                      4070
                      Budget authority, net (discretionary)
                      2,041
                      1,905
                      1,804

                      4080
                      Outlays, net (discretionary)
                      1,649
                      2,261
                      2,115

                      4180
                      Budget authority, net (total)
                      2,041
                      1,905
                      1,804

                      4190
                      Outlays, net (total)
                      1,649
                      2,261
                      2,115

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      2,041
                      1,905
                      1,804

                      Outlays
                      1,649
                      2,261
                      2,115

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      738

                      Outlays

                      480

                      Total:

                      Budget Authority
                      2,041
                      1,905
                      2,542

                      Outlays
                      1,649
                      2,261
                      2,595

             This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
                programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
                for refugee benefits. The account also includes funding for the rehabilitation of victims of torture and human trafficking
                and for the care and placement of unaccompanied alien children.

          Object Classification (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      10
                      17
                      17

                      11.7
                      Military personnel
                      1
                      2
                      2

                      11.9
                      Total personnel compensation
                      11
                      19
                      19

                      12.1
                      Civilian personnel benefits
                      3
                      5
                      5

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      5
                      8
                      8

                      25.1
                      Advisory and assistance services
                      275
                      275
                      265

                      25.3
                      Other goods and services from Federal sources
                      63
                      60
                      50

                      25.4
                      Operation and maintenance of facilities
                      2
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      1,899
                      1,536
                      1,455

                      99.0
                      Direct obligations
                      2,259
                      1,905
                      1,804

                      99.0
                      Reimbursable obligations
                      190

                      99.9
                      Total new obligations, unexpired accounts
                      2,449
                      1,905
                      1,804

          Employment Summary

                      Identification code 075–1503–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      85
                      154
                      154

                      1101
                      Direct military average strength employment
                      11
                      11
                      11

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

                      Identification code 075–1503–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0009
                      UAC Contingency Fund, mandatory

                      738

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

                      738

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      738

                      1930
                      Total budgetary resources available

                      738

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      738

                      3020
                      Outlays (gross)

                      –480

                      3050
                      Unpaid obligations, end of year

                      258

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      258

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      738

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      480

                      4180
                      Budget authority, net (total)

                      738

                      4190
                      Outlays, net (total)

                      480

             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 .
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Grants to States and Tribes
                      382
                      389
                      363

                      0002
                      Research, training and technical assistance
                      8
                      10
                      10

                      0003
                      State court improvement activities
                      32
                      32
                      32

                      0004
                      Family Connection Grants

                      2

                      0005
                      Personal Responsibility Education (PREP)
                      73
                      74
                      31

                      0006
                      Sexual Risk Abstinence Education (SRAE)
                      64
                      75

                      0007
                      Family Rec. & Reunification

                      2
                      3

                      0900
                      Total new obligations, unexpired accounts
                      559
                      582
                      441

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      28
                      39
                      46

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      30
                      39
                      46

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      100
                      100
                      60

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      503
                      510
                      345

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –23
                      –21

                      1260
                      Appropriations, mandatory (total)
                      480
                      489
                      345

                      1900
                      Budget authority (total)
                      580
                      589
                      405

                      1930
                      Total budgetary resources available
                      610
                      628
                      451

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –12

                      1941
                      Unexpired unobligated balance, end of year
                      39
                      46
                      10

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      593
                      657
                      680

                      3010
                      New obligations, unexpired accounts
                      559
                      582
                      441

                      3020
                      Outlays (gross)
                      –481
                      –559
                      –569

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –13

                      3050
                      Unpaid obligations, end of year
                      657
                      680
                      552

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      593
                      657
                      680

                      3200
                      Obligated balance, end of year
                      657
                      680
                      552

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      100
                      100
                      60

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      16
                      28
                      17

                      4011
                      Outlays from discretionary balances
                      40
                      63
                      67

                      4020
                      Outlays, gross (total)
                      56
                      91
                      84

                      Mandatory:

                      4090
                      Budget authority, gross
                      480
                      489
                      345

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      81
                      98
                      100

                      4101
                      Outlays from mandatory balances
                      344
                      370
                      385

                      4110
                      Outlays, gross (total)
                      425
                      468
                      485

                      4180
                      Budget authority, net (total)
                      580
                      589
                      405

                      4190
                      Outlays, net (total)
                      481
                      559
                      569

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      580
                      589
                      405

                      Outlays
                      481
                      559
                      569

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      220

                      Outlays

                      25

                      Total:

                      Budget Authority
                      580
                      589
                      625

                      Outlays
                      481
                      559
                      594

             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, to increase
                funding for the Court Improvement Program, and a one-year reauthorization of Sexual Risk Avoidance Education and the Personal
                Responsibility Education Program (PREP).

          Object Classification (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      2
                      2

                      25.1
                      Advisory and assistance services
                      26
                      28
                      16

                      25.2
                      Other services from non-Federal sources
                      1

                      25.3
                      Other goods and services from Federal sources
                      3
                      3
                      3

                      41.0
                      Grants, subsidies, and contributions
                      528
                      549
                      420

                      99.9
                      Total new obligations, unexpired accounts
                      559
                      582
                      441

          Employment Summary

                      Identification code 075–1512–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      10
                      21
                      21

             Promoting Safe and Stable Families
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1512–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Grants to States and Tribes

                      40

                      0003
                      State court improvement activities

                      30

                      0005
                      Personal Responsibility Education (PREP)

                      75

                      0006
                      Sexual Risk Abstinence Education (SRAE)

                      75

                      0900
                      Total new obligations, unexpired accounts

                      220

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      220

                      1930
                      Total budgetary resources available

                      220

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      220

                      3020
                      Outlays (gross)

                      –25

                      3050
                      Unpaid obligations, end of year

                      195

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      195

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      220

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      25

                      4180
                      Budget authority, net (total)

                      220

                      4190
                      Outlays, net (total)

                      25

          Object Classification (in millions of dollars)

                      Identification code 075–1512–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      2

                      25.1
                      Advisory and assistance services

                      23

                      25.3
                      Other goods and services from Federal sources

                      3

                      41.0
                      Grants, subsidies, and contributions

                      192

                      99.9
                      Total new obligations, unexpired accounts

                      220

          Employment Summary

                      Identification code 075–1512–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment

                      14

             Child Care Entitlement to StatesProgram and Financing (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Mandatory child care
                      1,178
                      1,178
                      1,178

                      0002
                      Matching child care
                      1,710
                      1,651
                      1,651

                      0003
                      Child Care Training and technical assistance
                      15
                      15
                      15

                      0004
                      Child care tribal grants
                      58
                      58
                      58

                      0005
                      Child Care Research
                      4
                      15
                      15

                      0900
                      Total new obligations, unexpired accounts
                      2,965
                      2,917
                      2,917

                      Budgetary resources:

                      Unobligated balance:

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      48

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      2,917
                      2,917
                      2,917

                      1930
                      Total budgetary resources available
                      2,965
                      2,917
                      2,917

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,061
                      1,614
                      1,712

                      3010
                      New obligations, unexpired accounts
                      2,965
                      2,917
                      2,917

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      9

                      3020
                      Outlays (gross)
                      –2,359
                      –2,819
                      –3,296

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –62

                      3050
                      Unpaid obligations, end of year
                      1,614
                      1,712
                      1,333

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,061
                      1,614
                      1,712

                      3200
                      Obligated balance, end of year
                      1,614
                      1,712
                      1,333

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,917
                      2,917
                      2,917

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,596
                      2,167
                      2,167

                      4101
                      Outlays from mandatory balances
                      763
                      652
                      1,129

                      4110
                      Outlays, gross (total)
                      2,359
                      2,819
                      3,296

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4160
                      Budget authority, net (mandatory)
                      2,917
                      2,917
                      2,917

                      4170
                      Outlays, net (mandatory)
                      2,358
                      2,819
                      3,296

                      4180
                      Budget authority, net (total)
                      2,917
                      2,917
                      2,917

                      4190
                      Outlays, net (total)
                      2,358
                      2,819
                      3,296

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      2,917
                      2,917
                      2,917

                      Outlays
                      2,358
                      2,819
                      3,296

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      1,295

                      Outlays

                      266

                      Total:

                      Budget Authority
                      2,917
                      2,917
                      4,212

                      Outlays
                      2,358
                      2,819
                      3,562

             This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the TANF Extension Act of
                2019 (P.L. 116–4). 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. The Budget also proposes a $1 billion one-time
                fund to build the supply of child care for underserved populations and to stimulate employer investment.

          Object Classification (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      21.0
                      Travel and transportation of persons
                      1

                      23.1
                      Rental payments to GSA
                      1

                      25.1
                      Advisory and assistance services
                      5
                      16
                      16

                      25.2
                      Other services from non-Federal sources
                      11

                      25.3
                      Other goods and services from Federal sources
                      1
                      2
                      2

                      41.0
                      Grants, subsidies, and contributions
                      2,946
                      2,899
                      2,899

                      99.9
                      Total new obligations, unexpired accounts
                      2,965
                      2,917
                      2,917

             Child Care Entitlement to States
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1550–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Mandatory child care

                      1,000

                      0002
                      Matching child care

                      295

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

                      1,295

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      1,295

                      1930
                      Total budgetary resources available

                      1,295

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      1,295

                      3020
                      Outlays (gross)

                      –266

                      3050
                      Unpaid obligations, end of year

                      1,029

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      1,029

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      1,295

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      266

                      4180
                      Budget authority, net (total)

                      1,295

                      4190
                      Outlays, net (total)

                      266

             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"), $5,276,000,000 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 in addition to the amounts required to be reserved by the Secretary under section 658O(a)(2)(A) of such Act, $156,780,000
                shall be for Indian tribes and tribal organizations: Provided further, That none of the funds provided under this heading may be used to implement the national toll-free hotline
                   authorized by section 658L(b) of the CCDBG Act.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Child Care Block grant payments to States
                      5,194
                      5,250
                      5,250

                      0004
                      Child Care Research and evaluation fund
                      19
                      26
                      26

                      0900
                      Total new obligations, unexpired accounts
                      5,213
                      5,276
                      5,276

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      5,226
                      5,276
                      5,276

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –13

                      1160
                      Appropriation, discretionary (total)
                      5,213
                      5,276
                      5,276

                      1930
                      Total budgetary resources available
                      5,213
                      5,276
                      5,276

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,122
                      2,792
                      3,264

                      3010
                      New obligations, unexpired accounts
                      5,213
                      5,276
                      5,276

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

                      3020
                      Outlays (gross)
                      –3,540
                      –4,804
                      –5,013

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –23

                      3050
                      Unpaid obligations, end of year
                      2,792
                      3,264
                      3,527

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,122
                      2,792
                      3,264

                      3200
                      Obligated balance, end of year
                      2,792
                      3,264
                      3,527

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,213
                      5,276
                      5,276

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,732
                      3,007
                      3,007

                      4011
                      Outlays from discretionary balances
                      808
                      1,797
                      2,006

                      4020
                      Outlays, gross (total)
                      3,540
                      4,804
                      5,013

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources
                      –1

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1

                      Additional offsets against gross budget authority only:

                      4052
                      Offsetting collections credited to expired accounts
                      1

                      4070
                      Budget authority, net (discretionary)
                      5,213
                      5,276
                      5,276

                      4080
                      Outlays, net (discretionary)
                      3,539
                      4,804
                      5,013

                      4180
                      Budget authority, net (total)
                      5,213
                      5,276
                      5,276

                      4190
                      Outlays, net (total)
                      3,539
                      4,804
                      5,013

             This program provides grants to States for child care subsidies for low-income working families and activities to improve
                child care quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      2
                      2
                      2

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      101
                      48
                      47

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      5,108
                      5,224
                      5,225

                      99.9
                      Total new obligations, unexpired accounts
                      5,213
                      5,276
                      5,276

          Employment Summary

                      Identification code 075–1515–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      16
                      16
                      16

             Social services block grant
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Social Services Block Grant
                      1,588
                      1,595
                      1,700

                      0002
                      Health Profession Opportunity Grants
                      84
                      85

                      0900
                      Total new obligations, unexpired accounts
                      1,672
                      1,680
                      1,700

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      30
                      29
                      29

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,785
                      1,785
                      1,700

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –113
                      –105

                      1260
                      Appropriations, mandatory (total)
                      1,672
                      1,680
                      1,700

                      1930
                      Total budgetary resources available
                      1,702
                      1,709
                      1,729

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      29
                      29
                      29

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      467
                      544
                      605

                      3010
                      New obligations, unexpired accounts
                      1,672
                      1,680
                      1,700

                      3020
                      Outlays (gross)
                      –1,587
                      –1,619
                      –1,844

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –8

                      3050
                      Unpaid obligations, end of year
                      544
                      605
                      461

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      467
                      544
                      605

                      3200
                      Obligated balance, end of year
                      544
                      605
                      461

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,672
                      1,680
                      1,700

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,227
                      1,279
                      1,360

                      4101
                      Outlays from mandatory balances
                      360
                      340
                      484

                      4110
                      Outlays, gross (total)
                      1,587
                      1,619
                      1,844

                      4180
                      Budget authority, net (total)
                      1,672
                      1,680
                      1,700

                      4190
                      Outlays, net (total)
                      1,587
                      1,619
                      1,844

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      1,672
                      1,680
                      1,700

                      Outlays
                      1,587
                      1,619
                      1,844

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,615

                      Outlays

                      –1,357

                      Total:

                      Budget Authority
                      1,672
                      1,680
                      85

                      Outlays
                      1,587
                      1,619
                      487

             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 2020, for current grantees only.

          Object Classification (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1

                      25.1
                      Advisory and assistance services
                      11
                      11

                      41.0
                      Grants, subsidies, and contributions
                      1,660
                      1,668
                      1,700

                      99.9
                      Total new obligations, unexpired accounts
                      1,672
                      1,680
                      1,700

          Employment Summary

                      Identification code 075–1534–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      7
                      8

             Social Services Block Grant
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1534–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Social Services Block Grant

                      –1,700

                      0002
                      Health Profession Opportunity Grants

                      85

                      0900
                      Total new obligations, unexpired accounts

                      –1,615

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,615

                      1930
                      Total budgetary resources available

                      –1,615

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,615

                      3020
                      Outlays (gross)

                      1,357

                      3050
                      Unpaid obligations, end of year

                      –258

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –258

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,615

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,357

                      4180
                      Budget authority, net (total)

                      –1,615

                      4190
                      Outlays, net (total)

                      –1,357

          Object Classification (in millions of dollars)

                      Identification code 075–1534–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.1
                      Advisory and assistance services

                      11

                      41.0
                      Grants, subsidies, and contributions

                      –1,627

                      99.9
                      Total new obligations, unexpired accounts

                      –1,615

          Employment Summary

                      Identification code 075–1534–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment

                      7

             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), and 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,  $11,187,485,000, of which  $37,943,000, to remain available through September 30,  2021, 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,  2020: Provided, That $10,063,095,000 shall be for making payments under the Head Start Act, including for Early Head Start-Child Care Partnerships, and of which, notwithstanding section 640 of such Act,

           $25,000,000 shall be available for allocation by the Secretary to supplement activities described in paragraphs (7)(B) and
                (9) of section 641(c) of 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, and such funds 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 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 $164,500,000 shall be for carrying out section 303(a) of the Family Violence Prevention and Services Act, of which
                $5,000,000 shall be allocated notwithstanding section 303(a)(2) of such Act for carrying out section 309 of such Act: Provided further, That the percentages specified in section 112(a)(2) of the Child Abuse Prevention and Treatment Act shall not apply to funds
                appropriated under this heading: 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0101
                      Head Start
                      9,556
                      10,422
                      10,063

                      0102
                      Preschool Development Grants
                      256
                      491

                      0103
                      Runaway and homeless youth (basic centers)
                      54
                      54
                      48

                      0104
                      Transitional living
                      55
                      56
                      54

                      0106
                      Education grants to reduce sexual abuse of runaway youth
                      17
                      17
                      17

                      0109
                      Child abuse State grants
                      85
                      85
                      85

                      0110
                      Child abuse discretionary activities
                      33
                      33
                      33

                      0111
                      Community-based child abuse prevention
                      40
                      40
                      40

                      0112
                      Child welfare services
                      269
                      269
                      269

                      0113
                      Child welfare training, research, or demonstration projects
                      18
                      18
                      18

                      0114
                      Adoption opportunities
                      39
                      39
                      39

                      0116
                      Adoption and Legal Guardianship Incentives
                      75
                      75
                      38

                      0117
                      Independent living education and training vouchers
                      43
                      43
                      43

                      0124
                      Native American programs
                      52
                      55
                      52

                      0125
                      Social services and income maintenance research
                      7
                      7
                      7

                      0128
                      ACF Federal administration
                      205
                      205
                      205

                      0131
                      Disaster human services case management
                      2
                      2
                      2

                      0191
                      Direct program activities, subtotal
                      10,806
                      11,911
                      11,013

                      0301
                      Community services block grant
                      715
                      725

                      0303
                      Rural community facilities
                      20
                      20

                      0304
                      Community economic development
                      8
                      9

                      0308
                      Domestic violence hotline
                      9
                      10
                      10

                      0309
                      Family violence prevention and services
                      159
                      164
                      165

                      0391
                      Direct program activities, subtotal
                      911
                      928
                      175

                      0400
                      Total, direct program
                      11,717
                      12,839
                      11,188

                      0799
                      Total direct obligations
                      11,717
                      12,839
                      11,188

                      0801
                      Children and Families Services Programs (Reimbursable)
                      60
                      20
                      20

                      0809
                      Reimbursable program activities, subtotal
                      60
                      20
                      20

                      0900
                      Total new obligations, unexpired accounts
                      11,777
                      12,859
                      11,208

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      330
                      1,251
                      655

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      330
                      1,251

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      12,672
                      12,239
                      11,187

                      1120
                      Appropriations transferred to other accts [075–1503]
                      –30

                      1160
                      Appropriation, discretionary (total)
                      12,642
                      12,239
                      11,187

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      40
                      22
                      22

                      1701
                      Change in uncollected payments, Federal sources
                      17

                      1750
                      Spending auth from offsetting collections, disc (total)
                      57
                      22
                      22

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1
                      1
                      1

                      1801
                      Change in uncollected payments, Federal sources
                      1
                      1
                      1

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

                      1900
                      Budget authority (total)
                      12,701
                      12,263
                      11,211

                      1930
                      Total budgetary resources available
                      13,031
                      13,514
                      11,866

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –3

                      1941
                      Unexpired unobligated balance, end of year
                      1,251
                      655
                      658

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      8,269
                      8,886
                      10,495

                      3010
                      New obligations, unexpired accounts
                      11,777
                      12,859
                      11,208

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      13

                      3020
                      Outlays (gross)
                      –11,060
                      –11,250
                      –11,552

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –113

                      3050
                      Unpaid obligations, end of year
                      8,886
                      10,495
                      10,151

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –4
                      –20
                      –21

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –18
                      –1
                      –1

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –20
                      –21
                      –22

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      8,265
                      8,866
                      10,474

                      3200
                      Obligated balance, end of year
                      8,866
                      10,474
                      10,129

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      12,699
                      12,261
                      11,209

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,230
                      3,988
                      3,567

                      4011
                      Outlays from discretionary balances
                      6,829
                      7,262
                      7,985

                      4020
                      Outlays, gross (total)
                      11,059
                      11,250
                      11,552

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –40
                      –22
                      –22

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –40
                      –22
                      –22

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –17

                      4060
                      Additional offsets against budget authority only (total)
                      –17

                      4070
                      Budget authority, net (discretionary)
                      12,642
                      12,239
                      11,187

                      4080
                      Outlays, net (discretionary)
                      11,019
                      11,228
                      11,530

                      Mandatory:

                      4090
                      Budget authority, gross
                      2
                      2
                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –2
                      –2
                      –2

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –1
                      –1
                      –1

                      4142
                      Offsetting collections credited to expired accounts
                      1
                      1
                      1

                      4170
                      Outlays, net (mandatory)
                      –1
                      –2
                      –2

                      4180
                      Budget authority, net (total)
                      12,642
                      12,239
                      11,187

                      4190
                      Outlays, net (total)
                      11,018
                      11,226
                      11,528

             The request totals $11.2 billion, including almost $10.1 billion for Head Start. This request discontinues funding for the
                Community Services Block Grant, Rural Community Facilities, Community Economic Development, and Preschool Development Grants.

          Object Classification (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      109
                      120
                      120

                      11.3
                      Other than full-time permanent
                      3
                      3
                      3

                      11.5
                      Other personnel compensation
                      2
                      2
                      2

                      11.7
                      Military personnel
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      115
                      126
                      126

                      12.1
                      Civilian personnel benefits
                      36
                      38
                      38

                      21.0
                      Travel and transportation of persons
                      3
                      4
                      4

                      23.1
                      Rental payments to GSA
                      17
                      17
                      16

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      2
                      2

                      25.1
                      Advisory and assistance services
                      238
                      261
                      264

                      25.2
                      Other services from non-Federal sources
                      9
                      15
                      17

                      25.3
                      Other goods and services from Federal sources
                      46
                      48
                      50

                      25.4
                      Operation and maintenance of facilities
                      2
                      3
                      3

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      11,248
                      12,324
                      10,667

                      99.0
                      Direct obligations
                      11,717
                      12,839
                      11,188

                      99.0
                      Reimbursable obligations
                      60
                      20
                      20

                      99.9
                      Total new obligations, unexpired accounts
                      11,777
                      12,859
                      11,208

          Employment Summary

                      Identification code 075–1536–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,028
                      1,140
                      1,114

                      1101
                      Direct military average strength employment
                      6
                      6
                      6

                      2001
                      Reimbursable civilian full-time equivalent employment
                      9
                      10
                      10

             Children's Research and Technical AssistanceProgram and Financing (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Training and technical assistance
                      14
                      18
                      12

                      0002
                      Federal parent locator service
                      25
                      28
                      25

                      0799
                      Total direct obligations
                      39
                      46
                      37

                      0801
                      Federal Parent Locator Service reimbursable
                      22
                      28
                      29

                      0899
                      Total reimbursable obligations
                      22
                      28
                      29

                      0900
                      Total new obligations, unexpired accounts
                      61
                      74
                      66

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      12
                      11

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      15
                      11

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      37
                      37
                      37

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

                      1260
                      Appropriations, mandatory (total)
                      35
                      35
                      37

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      22
                      28
                      28

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      22
                      28
                      29

                      1900
                      Budget authority (total)
                      57
                      63
                      66

                      1930
                      Total budgetary resources available
                      72
                      74
                      66

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      11

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      30
                      25
                      28

                      3010
                      New obligations, unexpired accounts
                      61
                      74
                      66

                      3020
                      Outlays (gross)
                      –63
                      –71
                      –65

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3050
                      Unpaid obligations, end of year
                      25
                      28
                      29

                      Uncollected payments:

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

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      24
                      19
                      22

                      3200
                      Obligated balance, end of year
                      19
                      22
                      23

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      57
                      63
                      66

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      35
                      42
                      42

                      4101
                      Outlays from mandatory balances
                      28
                      29
                      23

                      4110
                      Outlays, gross (total)
                      63
                      71
                      65

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –8
                      –9
                      –9

                      4123
                      Non-Federal sources
                      –14
                      –19
                      –19

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –22
                      –28
                      –28

                      4160
                      Budget authority, net (mandatory)
                      35
                      35
                      38

                      4170
                      Outlays, net (mandatory)
                      41
                      43
                      37

                      4180
                      Budget authority, net (total)
                      35
                      35
                      38

                      4190
                      Outlays, net (total)
                      41
                      43
                      37

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1

             This account provides funding for research and technical assistance activities established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                The Budget includes a set of proposals that would require changes to statute to provide additional access to the National
                Directory of New Hires for evidence building and program integrity purposes, while ensuring privacy and security safeguards.

          Object Classification (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      8
                      9
                      9

                      12.1
                      Civilian personnel benefits
                      2
                      3
                      3

                      21.0
                      Travel and transportation of persons
                      1
                      1

                      23.1
                      Rental payments to GSA
                      4
                      3
                      3

                      25.1
                      Advisory and assistance services

                      2
                      3

                      25.2
                      Other services from non-Federal sources
                      11
                      11
                      8

                      25.3
                      Other goods and services from Federal sources
                      8
                      12
                      7

                      25.4
                      Operation and maintenance of facilities
                      1

                      25.7
                      Operation and maintenance of equipment
                      4
                      5
                      4

                      99.0
                      Direct obligations
                      39
                      46
                      37

                      99.0
                      Reimbursable obligations
                      22
                      28
                      29

                      99.9
                      Total new obligations, unexpired accounts
                      61
                      74
                      66

          Employment Summary

                      Identification code 075–1553–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      62
                      68
                      68

             Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act,  $5,745,000,000.
          For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
                 2021,  $3,000,000,000.
          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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Foster care
                      5,054
                      5,113
                      5,253

                      0002
                      Independent living
                      140
                      140
                      143

                      0004
                      Adoption assistance
                      2,785
                      2,842
                      2,931

                      0005
                      Guardianship
                      155
                      202
                      217

                      0006
                      Technical Assistance and Implementation Services for Tribal Programs
                      3
                      3
                      3

                      0007
                      Prevention Services Technical Assistance
                      1
                      1
                      1

                      0900
                      Total new obligations, unexpired accounts
                      8,138
                      8,301
                      8,548

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      5,639
                      5,602
                      5,748

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –1
                      –1

                      1260
                      Appropriations, mandatory (total)
                      5,638
                      5,601
                      5,748

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      2,500
                      2,700
                      2,800

                      1900
                      Budget authority (total)
                      8,138
                      8,301
                      8,548

                      1930
                      Total budgetary resources available
                      8,138
                      8,301
                      8,548

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,611
                      1,213
                      1,638

                      3010
                      New obligations, unexpired accounts
                      8,138
                      8,301
                      8,548

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      82

                      3020
                      Outlays (gross)
                      –8,581
                      –7,876
                      –8,404

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –37

                      3050
                      Unpaid obligations, end of year
                      1,213
                      1,638
                      1,782

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,611
                      1,213
                      1,638

                      3200
                      Obligated balance, end of year
                      1,213
                      1,638
                      1,782

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      8,138
                      8,301
                      8,548

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      7,425
                      7,002
                      7,504

                      4101
                      Outlays from mandatory balances
                      1,156
                      874
                      900

                      4110
                      Outlays, gross (total)
                      8,581
                      7,876
                      8,404

                      4180
                      Budget authority, net (total)
                      8,138
                      8,301
                      8,548

                      4190
                      Outlays, net (total)
                      8,581
                      7,876
                      8,404

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      8,138
                      8,301
                      8,548

                      Outlays
                      8,581
                      7,876
                      8,404

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      31

                      Outlays

                      31

                      Total:

                      Budget Authority
                      8,138
                      8,301
                      8,579

                      Outlays
                      8,581
                      7,876
                      8,435

             This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, and the Chafee
                Foster Care Independence Program, as well as technical assistance and implementation services for tribal programs.

             Foster Care—The proposed level will support eligible low-income children who must be placed outside the home. An average of 202,900 children
                per month are estimated to be served in FY 2020.

             Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
                An average of 523,000 children per month are estimated to be served in FY 2020.

             Guardianship Assistance Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
                in foster care. An average of 38,400 children per month are estimated to be served in FY 2020.

             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, and to allow states to pay salaries to foster
                parents who can care for children with complex needs. Additionally, the Budget includes the interaction effects from the proposal
                to eliminate SSBG funding, which increases costs in the Foster Care and Permanency account due to State agencies shifting
                eligible expenses previously funded by SSBG to Foster Care and Permanency.

          Object Classification (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      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
                      32
                      30
                      32

                      25.2
                      Other services from non-Federal sources

                      1

                      41.0
                      Grants, subsidies, and contributions
                      8,104
                      8,268
                      8,514

                      99.9
                      Total new obligations, unexpired accounts
                      8,138
                      8,301
                      8,548

          Employment Summary

                      Identification code 075–1545–0–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      3
                      3
                      3

             Payments for Foster Care and Permanency
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1545–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Foster care

                      12

                      0004
                      Adoption assistance

                      11

                      0005
                      Guardianship

                      1

                      0007
                      Prevention Services Technical Assistance

                      7

                      0900
                      Total new obligations, unexpired accounts

                      31

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      31

                      1900
                      Budget authority (total)

                      31

                      1930
                      Total budgetary resources available

                      31

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      31

                      3020
                      Outlays (gross)

                      –31

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      31

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      31

                      4180
                      Budget authority, net (total)

                      31

                      4190
                      Outlays, net (total)

                      31

          Object Classification (in millions of dollars)

                      Identification code 075–1545–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.1
                      Advisory and assistance services

                      6

                      41.0
                      Grants, subsidies, and contributions

                      24

                      99.9
                      Total new obligations, unexpired accounts

                      31

          Employment Summary

                      Identification code 075–1545–4–1–609
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment

                      10

             Administration for Community LivingFederal 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"), the RAISE Family Caregivers
                Act, the Supporting Grandparents Raising Grandchildren Act, titles III and XXIX of the PHS Act, sections 1252 and 1253 of
                the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, title XX-B of the Social Security
                Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and 5 of subtitle D of title II of the Help
                America Vote Act of 2002, the Assistive Technology Act of 1998, titles II and VII (and section 14 with respect to such titles)
                of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals
                with disabilities,  $1,996,556,000, together with  $36,115,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund
                to carry out section 4360 of the Omnibus Budget Reconciliation Act of 1990: 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0101
                      Aging Services Programs
                      1,606
                      1,606
                      1,575

                      0102
                      ACL Program Administration
                      40
                      41
                      39

                      0103
                      Integrated Aging and Disability Services Programs
                      43
                      43
                      41

                      0104
                      Disability Services Programs
                      316
                      321
                      251

                      0105
                      National Institute on Disability, Independent Living & Rehab Research
                      105
                      109
                      90

                      0300
                      Total, direct program
                      2,110
                      2,120
                      1,996

                      0799
                      Total direct obligations
                      2,110
                      2,120
                      1,996

                      0801
                      ACL Reimbursable Programs
                      95
                      94
                      56

                      0900
                      Total new obligations, unexpired accounts
                      2,205
                      2,214
                      2,052

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      5
                      9
                      36

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      4
                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      8
                      9
                      36

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,095
                      2,120
                      1,997

                      1120
                      Appropriations transferred to other accts [012–3507]
                      –3

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –5

                      1160
                      Appropriation, discretionary (total)
                      2,087
                      2,120
                      1,997

                      Appropriations, mandatory:

                      1221
                      PPHF Appropriations transferred from other accounts [075–0116]
                      28
                      28

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected

                      68
                      55

                      1701
                      Change in uncollected payments, Federal sources
                      68

                      1750
                      Spending auth from offsetting collections, disc (total)
                      68
                      68
                      55

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      54
                      52

                      1801
                      Change in uncollected payments, Federal sources
                      –30
                      –27

                      1850
                      Spending auth from offsetting collections, mand (total)
                      24
                      25

                      1900
                      Budget authority (total)
                      2,207
                      2,241
                      2,052

                      1930
                      Total budgetary resources available
                      2,215
                      2,250
                      2,088

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      9
                      36
                      36

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,270
                      1,468
                      1,339

                      3010
                      New obligations, unexpired accounts
                      2,205
                      2,214
                      2,052

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      3

                      3020
                      Outlays (gross)
                      –1,999
                      –2,343
                      –2,313

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –8

                      3050
                      Unpaid obligations, end of year
                      1,468
                      1,339
                      1,078

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –154
                      –189
                      –162

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –38
                      27

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      3

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –189
                      –162
                      –162

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,116
                      1,279
                      1,177

                      3200
                      Obligated balance, end of year
                      1,279
                      1,177
                      916

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,155
                      2,188
                      2,052

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,000
                      1,307
                      1,229

                      4011
                      Outlays from discretionary balances
                      950
                      1,001
                      1,037

                      4020
                      Outlays, gross (total)
                      1,950
                      2,308
                      2,266

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –2
                      –68
                      –55

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –68

                      4052
                      Offsetting collections credited to expired accounts
                      2

                      4060
                      Additional offsets against budget authority only (total)
                      –66

                      4070
                      Budget authority, net (discretionary)
                      2,087
                      2,120
                      1,997

                      4080
                      Outlays, net (discretionary)
                      1,948
                      2,240
                      2,211

                      Mandatory:

                      4090
                      Budget authority, gross
                      52
                      53

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1
                      6

                      4101
                      Outlays from mandatory balances
                      48
                      29
                      47

                      4110
                      Outlays, gross (total)
                      49
                      35
                      47

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –55
                      –52

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      30
                      27

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)
                      31
                      27

                      4160
                      Budget authority, net (mandatory)
                      28
                      28

                      4170
                      Outlays, net (mandatory)
                      –6
                      –17
                      47

                      4180
                      Budget authority, net (total)
                      2,115
                      2,148
                      1,997

                      4190
                      Outlays, net (total)
                      1,942
                      2,223
                      2,258

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

                      2018 actual
                      2019 est.
                      2020 est.

                      Enacted/requested:

                      Budget Authority
                      2,115
                      2,148
                      1,997

                      Outlays
                      1,942
                      2,223
                      2,258

                      Legislative proposal, subject to PAYGO:

                      Outlays

                      –20

                      Total:

                      Budget Authority
                      2,115
                      2,148
                      1,997

                      Outlays
                      1,942
                      2,223
                      2,238

             This account funds formula and discretionary grants that provide home and community-based services and supports to assist
                older adults and people of all ages with disabilities to live independently and to fully participate in their communities.
                ACL works with states, localities, tribal organizations, nonprofit organizations, businesses and families, and through networks
                of aging and disability organizations, to provide these services and supports which include nutrition, supportive, caregiver,
                independent living, and protection and advocacy services.

          Object Classification (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      21
                      22
                      21

                      12.1
                      Civilian personnel benefits
                      7
                      7
                      6

                      23.1
                      Rental payments to GSA
                      5
                      5
                      4

                      25.1
                      Advisory and assistance services
                      41
                      41
                      38

                      41.0
                      Grants, subsidies, and contributions
                      2,036
                      2,045
                      1,927

                      99.0
                      Direct obligations
                      2,110
                      2,120
                      1,996

                      99.0
                      Reimbursable obligations
                      95
                      94
                      56

                      99.9
                      Total new obligations, unexpired accounts
                      2,205
                      2,214
                      2,052

          Employment Summary

                      Identification code 075–0142–0–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      173
                      182
                      173

                      2001
                      Reimbursable civilian full-time equivalent employment
                      15
                      16
                      12

             Aging and Disability Services Programs
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0142–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      ACL Reimbursable Programs

                      25

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      25

                      1900
                      Budget authority (total)

                      25

                      1930
                      Total budgetary resources available

                      25

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      25

                      3020
                      Outlays (gross)

                      –5

                      3050
                      Unpaid obligations, end of year

                      20

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      20

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      5

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –25

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      –20

             This legislative proposal extends funding for Medicare enrollment assistance programs through 2021.

          Object Classification (in millions of dollars)

                      Identification code 075–0142–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      Reimbursable obligations:

                      25.1
                      Advisory and assistance services

                      3

                      41.0
                      Grants, subsidies, and contributions

                      22

                      99.0
                      Reimbursable obligations

                      25

                      99.9
                      Total new obligations, unexpired accounts

                      25

          Employment Summary

                      Identification code 075–0142–4–1–506
                      2018 actual
                      2019 est.
                      2020 est.

                      2001
                      Reimbursable civilian full-time equivalent employment

                      4

             Departmental ManagementFederal Funds
             General departmental managementFor necessary expenses, not otherwise provided, for general departmental management, including 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,  $339,909,000, together with  $68,840,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation
                activities, outreach and media campaign initiatives to prevent opioid misuse, and other activities authorized for such funds in this
                   title, as determined by the Secretary: Provided, That of this amount,  $53,900,000 shall be for minority AIDS prevention and treatment activities .
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      General Departmental Management
                      470
                      481
                      340

                      0801
                      GDM Collected (Reimbursable)
                      157
                      191
                      191

                      0802
                      HCFAC (Mandatory)
                      7
                      10
                      10

                      0803
                      PHS Evaluation (Collected)
                      62
                      65
                      69

                      0804
                      MACRA (Mandatory)
                      5
                      5
                      5

                      0899
                      Total reimbursable obligations
                      231
                      271
                      275

                      0900
                      Total new obligations, unexpired accounts
                      701
                      752
                      615

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      11
                      12
                      12

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      11
                      11

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      471
                      481
                      340

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

                      1160
                      Appropriation, discretionary (total)
                      470
                      481
                      340

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      62
                      256
                      260

                      1701
                      Change in uncollected payments, Federal sources
                      158

                      1750
                      Spending auth from offsetting collections, disc (total)
                      220
                      256
                      260

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      14
                      15
                      15

                      1801
                      Change in uncollected payments, Federal sources
                      –2

                      1850
                      Spending auth from offsetting collections, mand (total)
                      12
                      15
                      15

                      1900
                      Budget authority (total)
                      702
                      752
                      615

                      1930
                      Total budgetary resources available
                      713
                      764
                      627

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      12
                      12
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      466
                      492
                      534

                      3010
                      New obligations, unexpired accounts
                      701
                      752
                      615

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      11

                      3020
                      Outlays (gross)
                      –662
                      –710
                      –690

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –24

                      3050
                      Unpaid obligations, end of year
                      492
                      534
                      459

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –295
                      –318
                      –318

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –156

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      133

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –318
                      –318
                      –318

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      171
                      174
                      216

                      3200
                      Obligated balance, end of year
                      174
                      216
                      141

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      690
                      737
                      600

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      336
                      353
                      293

                      4011
                      Outlays from discretionary balances
                      315
                      337
                      382

                      4020
                      Outlays, gross (total)
                      651
                      690
                      675

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –179
                      –256
                      –260

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –179
                      –256
                      –260

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –158

                      4052
                      Offsetting collections credited to expired accounts
                      117

                      4060
                      Additional offsets against budget authority only (total)
                      –41

                      4070
                      Budget authority, net (discretionary)
                      470
                      481
                      340

                      4080
                      Outlays, net (discretionary)
                      472
                      434
                      415

                      Mandatory:

                      4090
                      Budget authority, gross
                      12
                      15
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      7
                      15
                      15

                      4101
                      Outlays from mandatory balances
                      4
                      5

                      4110
                      Outlays, gross (total)
                      11
                      20
                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources:
                      –21
                      –15
                      –15

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      2

                      4142
                      Offsetting collections credited to expired accounts
                      7

                      4150
                      Additional offsets against budget authority only (total)
                      9

                      4170
                      Outlays, net (mandatory)
                      –10
                      5

                      4180
                      Budget authority, net (total)
                      470
                      481
                      340

                      4190
                      Outlays, net (total)
                      462
                      439
                      415

             Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
                for 2020. The actual allocation is determined annually.

             General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
                to HHS components and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
                activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
                promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
                Prevention and Public Health Fund.

          Object Classification (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      90
                      84
                      96

                      11.3
                      Other than full-time permanent
                      5
                      4
                      5

                      11.5
                      Other personnel compensation
                      2
                      2
                      2

                      11.7
                      Military personnel
                      2
                      1
                      2

                      11.9
                      Total personnel compensation
                      99
                      91
                      105

                      12.1
                      Civilian personnel benefits
                      28
                      25
                      30

                      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
                      17
                      17

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      2
                      2

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      23
                      23
                      14

                      25.2
                      Other services from non-Federal sources
                      59
                      72
                      28

                      25.3
                      Other goods and services from Federal sources
                      76
                      85
                      89

                      25.4
                      Operation and maintenance of facilities
                      6
                      6
                      5

                      25.7
                      Operation and maintenance of equipment
                      4
                      4
                      4

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      148
                      148
                      38

                      99.0
                      Direct obligations
                      470
                      481
                      340

                      99.0
                      Reimbursable obligations
                      231
                      271
                      275

                      99.9
                      Total new obligations, unexpired accounts
                      701
                      752
                      615

          Employment Summary

                      Identification code 075–9912–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      867
                      868
                      978

                      1101
                      Direct military average strength employment
                      11
                      12
                      12

                      2001
                      Reimbursable civilian full-time equivalent employment
                      473
                      470
                      606

                      2101
                      Reimbursable military average strength employment
                      24
                      24
                      22

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

                      Identification code 075–9912–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0805
                      DAB (Mandatory Proposal & User Fee Collection)

                      2

                      0899
                      Total reimbursable obligations

                      2

                      0900
                      Total new obligations, unexpired accounts (object class 25.3)

                      2

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      2

                      1930
                      Total budgetary resources available

                      2

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      2

                      3020
                      Outlays (gross)

                      –2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources:

                      –2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This legislative proposal provides the Departmental Appeals Board (DAB) mandatory resources in user fees to address the Medicare
                appeals backlog.

             Payment to the State Response to the Opioid Abuse Crisis Account, CURES ActProgram and Financing (in millions of dollars)

                      Identification code 075–0146–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Opioid Funding
                      500

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      500

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      500

                      1930
                      Total budgetary resources available
                      500

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      500

                      3020
                      Outlays (gross)
                      –500

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      500

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      500

                      4180
                      Budget authority, net (total)
                      500

                      4190
                      Outlays, net (total)
                      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 ActSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, State Response to the Opioid Abuse Crisis, CURES Act
                      500

                      2000
                      Total: Balances and receipts
                      500

                      Appropriations:

                      Current law:

                      2101
                      State Response to the Opioid Abuse Crisis, Cures Act
                      –500

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      500

                      1120
                      Appropriations transferred to other acct [075–1362]
                      –500

                      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,  $30,286,000.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Office for Civil Rights (Direct)
                      39
                      39
                      30

                      0801
                      Office for Civil Rights (Reimbursable)
                      10
                      14
                      24

                      0900
                      Total new obligations, unexpired accounts
                      49
                      53
                      54

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      35
                      33
                      44

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      39
                      39
                      30

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      7
                      26
                      15

                      1802
                      Offsetting collections (previously unavailable)
                      2

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      8
                      25
                      15

                      1900
                      Budget authority (total)
                      47
                      64
                      45

                      1930
                      Total budgetary resources available
                      82
                      97
                      89

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      33
                      44
                      35

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      17
                      24
                      25

                      3010
                      New obligations, unexpired accounts
                      49
                      53
                      54

                      3020
                      Outlays (gross)
                      –42
                      –52
                      –58

                      3050
                      Unpaid obligations, end of year
                      24
                      25
                      21

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      17
                      24
                      25

                      3200
                      Obligated balance, end of year
                      24
                      25
                      21

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      39
                      39
                      30

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      32
                      31
                      24

                      4011
                      Outlays from discretionary balances
                      7
                      8
                      8

                      4020
                      Outlays, gross (total)
                      39
                      39
                      32

                      Mandatory:

                      4090
                      Budget authority, gross
                      8
                      25
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      2
                      1

                      4101
                      Outlays from mandatory balances
                      3
                      11
                      25

                      4110
                      Outlays, gross (total)
                      3
                      13
                      26

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –7
                      –26
                      –15

                      4180
                      Budget authority, net (total)
                      40
                      38
                      30

                      4190
                      Outlays, net (total)
                      35
                      26
                      43

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      1

                      1

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections

                      1
                      1

             The Office for Civil Rights funds activities that carry out the Department's civil rights, nondiscrimination, health information
                privacy, and security compliance programs.

          Object Classification (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      14
                      16
                      15

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      15
                      17
                      16

                      12.1
                      Civilian personnel benefits
                      5
                      6
                      5

                      21.0
                      Travel and transportation of persons
                      1
                      1

                      23.1
                      Rental payments to GSA
                      4
                      4
                      1

                      25.2
                      Other services from non-Federal sources
                      3
                      1
                      2

                      25.3
                      Other goods and services from Federal sources
                      9
                      9
                      6

                      25.4
                      Operation and maintenance of facilities
                      1

                      31.0
                      Equipment
                      1
                      1

                      99.0
                      Direct obligations
                      39
                      39
                      30

                      99.0
                      Reimbursable obligations
                      10
                      14
                      24

                      99.9
                      Total new obligations, unexpired accounts
                      49
                      53
                      54

          Employment Summary

                      Identification code 075–0135–0–1–751
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      135
                      147
                      139

                      1101
                      Direct military average strength employment
                      1
                      1
                      1

                      2001
                      Reimbursable civilian full-time equivalent employment
                      2
                      2
                      2

             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,  $43,000,000.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Health information technology (IT)
                      60
                      60
                      43

                      0799
                      Total direct obligations
                      60
                      60
                      43

                      0801
                      Office of the National Coordinator for Health IT (ONC): Reimbursable
                      17
                      15
                      16

                      0899
                      Total reimbursable obligations
                      17
                      15
                      16

                      0900
                      Total new obligations, unexpired accounts
                      77
                      75
                      59

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      60
                      60
                      43

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      4
                      15
                      15

                      1701
                      Change in uncollected payments, Federal sources
                      12

                      1750
                      Spending auth from offsetting collections, disc (total)
                      16
                      15
                      15

                      1900
                      Budget authority (total)
                      76
                      75
                      58

                      1930
                      Total budgetary resources available
                      78
                      76
                      59

                      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
                      66
                      68
                      17

                      3010
                      New obligations, unexpired accounts
                      77
                      75
                      59

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

                      3020
                      Outlays (gross)
                      –71
                      –126
                      –63

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –5

                      3050
                      Unpaid obligations, end of year
                      68
                      17
                      13

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –22
                      –19
                      –19

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

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      15

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –19
                      –19
                      –19

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      44
                      49
                      –2

                      3200
                      Obligated balance, end of year
                      49
                      –2
                      –6

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      76
                      75
                      58

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      43
                      64
                      50

                      4011
                      Outlays from discretionary balances
                      28
                      62
                      13

                      4020
                      Outlays, gross (total)
                      71
                      126
                      63

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –17
                      –15
                      –15

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –17
                      –15
                      –15

                      Additional offsets against gross budget authority only:

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

                      4052
                      Offsetting collections credited to expired accounts
                      13

                      4060
                      Additional offsets against budget authority only (total)
                      1

                      4070
                      Budget authority, net (discretionary)
                      60
                      60
                      43

                      4080
                      Outlays, net (discretionary)
                      54
                      111
                      48

                      4180
                      Budget authority, net (total)
                      60
                      60
                      43

                      4190
                      Outlays, net (total)
                      54
                      111
                      48

             This program supports coordination, leadership, and development of Federal health information technology activities and Federal
                initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation
                with participants in the health sector. The Office of the National Coordinator for Health Information Technology was authorized
                in title XXX of the PHS Act as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L.
                111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255), for the purpose of addressing strategic planning, coordination,
                and the analysis of key technical, economic and other issues related to the public and private adoption of health information
                technology.

          Object Classification (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2018 actual
                      2019 est.
                      2020 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
                      6
                      6

                      23.1
                      Rental payments to GSA
                      2
                      2
                      2

                      25.2
                      Other services from non-Federal sources
                      16
                      17
                      7

                      25.3
                      Other goods and services from Federal sources
                      10
                      10
                      8

                      41.0
                      Grants, subsidies, and contributions
                      4
                      4

                      99.0
                      Direct obligations
                      59
                      59
                      43

                      99.0
                      Reimbursable obligations
                      16
                      16
                      16

                      99.5
                      Adjustment for rounding
                      2

                      99.9
                      Total new obligations, unexpired accounts
                      77
                      75
                      59

          Employment Summary

                      Identification code 075–0130–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      174
                      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, $182,381,000 shall remain available until September 30,  2021, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
                Insurance Trust Fund.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0139–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Office of Medicare Hearings and Appeals (Direct)
                      146
                      175
                      182

                      0799
                      Total direct obligations
                      146
                      175
                      182

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      36
                      36

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      93
                      175
                      182

                      1701
                      Change in uncollected payments, Federal sources
                      89

                      1750
                      Spending auth from offsetting collections, disc (total)
                      182
                      175
                      182

                      1900
                      Budget authority (total)
                      182
                      175
                      182

                      1930
                      Total budgetary resources available
                      182
                      211
                      218

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      36
                      36
                      36

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      27
                      56
                      3

                      3010
                      New obligations, unexpired accounts
                      146
                      175
                      182

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

                      3020
                      Outlays (gross)
                      –117
                      –228
                      –182

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      56
                      3
                      3

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –38
                      –106
                      –106

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –89

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      21

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –106
                      –106
                      –106

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –11
                      –50
                      –103

                      3200
                      Obligated balance, end of year
                      –50
                      –103
                      –103

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      182
                      175
                      182

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      100
                      175
                      182

                      4011
                      Outlays from discretionary balances
                      17

                      4020
                      Outlays, gross (total)
                      117
                      175
                      182

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –114
                      –175
                      –182

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –89

                      4052
                      Offsetting collections credited to expired accounts
                      21

                      4060
                      Additional offsets against budget authority only (total)
                      –68

                      4080
                      Outlays, net (discretionary)
                      3

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      53

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      3
                      53

             This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare
                Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides an independent and impartial forum for the adjudication
                of claims brought by or on behalf of Medicare beneficiaries related to their benefits and care.

          Object Classification (in millions of dollars)

                      Identification code 075–0139–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      61
                      87
                      105

                      11.5
                      Other personnel compensation

                      1

                      11.9
                      Total personnel compensation
                      61
                      87
                      106

                      12.1
                      Civilian personnel benefits
                      20
                      29
                      33

                      22.0
                      Transportation of things

                      2
                      1

                      23.1
                      Rental payments to GSA
                      7
                      8
                      10

                      23.3
                      Communications, utilities, and miscellaneous charges
                      4
                      8
                      8

                      25.2
                      Other services from non-Federal sources
                      12
                      13
                      9

                      25.3
                      Other goods and services from Federal sources
                      13
                      16
                      10

                      25.4
                      Operation and maintenance of facilities
                      24
                      5
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      2

                      26.0
                      Supplies and materials
                      2
                      2
                      1

                      31.0
                      Equipment
                      2
                      4
                      1

                      99.0
                      Direct obligations
                      146
                      175
                      182

                      99.9
                      Total new obligations, unexpired accounts
                      146
                      175
                      182

          Employment Summary

                      Identification code 075–0139–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      664
                      950
                      1,375

             Office of Medicare Hearings and Appeals
             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0139–4–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      Reimbursable program activity

                      4

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

                      4

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      4

                      1930
                      Total budgetary resources available

                      4

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      4

                      3020
                      Outlays (gross)

                      –4

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      4

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –4

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This legislative proposal provides the Office of Medicare Hearings and Appeals (OMHA) mandatory resources to address the Medicare
                appeals backlog.  The 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.

             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,  $1,051,591,000, of which  $561,700,000 shall remain available through September 30,  2021, 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,
                 2022: Provided further, That $20,000,000 of the amounts made available to the National Disaster Medical System shall remain
                   available through September 30, 2021, for activities related to the Pediatric Disaster Care Program: Provided further, That
                   $5,000,000 of the amounts made available for policy and planning shall remain available until expended, for implementation
                   activities related to the National Biodefense Strategy.
          For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act),  $735,000,000, to remain available until expended.
          For expenses necessary to carry out section 319F-2(a) of the PHS Act, $620,000,000, to remain available until expended.
          For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic,  $260,000,000; of which  $225,000,000 shall be available until expended, for activities including the development and purchase of vaccine, antivirals, necessary
                medical supplies, diagnostics, and other surveillance tools: Provided, That notwithstanding section 496(b) of the PHS Act, 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0140–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Public Health and Social Services Emergency Fund
                      1,991
                      2,631
                      2,667

                      0100
                      Direct program activities, subtotal
                      1,991
                      2,631
                      2,667

                      0801
                      Reimbursable program (FEMA)
                      188
                      162
                      162

                      0802
                      Reimbursable program activity (OPP)
                      2
                      2
                      2

                      0899
                      Total reimbursable obligations
                      190
                      164
                      164

                      0900
                      Total new obligations, unexpired accounts
                      2,181
                      2,795
                      2,831

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      124
                      437
                      858

                      1010
                      Unobligated balance transfer to other accts [075–0343]
                      –2
                      –2
                      –3

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

                      429

                      1021
                      Recoveries of prior year unpaid obligations
                      274

                      1050
                      Unobligated balance (total)
                      396
                      864
                      855

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,115
                      2,021
                      2,667

                      1120
                      Appropriations transferred to other acct [075–0360]
                      –60

                      1120
                      Appropriations transferred to other acct [075–0128]
                      –2

                      1120
                      Appropriations transferred to other acct [075–1362]
                      –20

                      1121
                      Appropriations transferred from other acct [075–0943]

                      604

                      1160
                      Appropriation, discretionary (total)
                      2,033
                      2,625
                      2,667

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      52
                      82
                      82

                      1701
                      Change in uncollected payments, Federal sources
                      139
                      82
                      82

                      1750
                      Spending auth from offsetting collections, disc (total)
                      191
                      164
                      164

                      1900
                      Budget authority (total)
                      2,224
                      2,789
                      2,831

                      1930
                      Total budgetary resources available
                      2,620
                      3,653
                      3,686

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –2

                      1941
                      Unexpired unobligated balance, end of year
                      437
                      858
                      855

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      4,745
                      4,478
                      4,365

                      3010
                      New obligations, unexpired accounts
                      2,181
                      2,795
                      2,831

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      58

                      3020
                      Outlays (gross)
                      –2,054
                      –2,908
                      –2,943

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –274

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –178

                      3050
                      Unpaid obligations, end of year
                      4,478
                      4,365
                      4,253

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –107
                      –198
                      –280

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –139
                      –82
                      –82

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      48

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –198
                      –280
                      –362

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      4,638
                      4,280
                      4,085

                      3200
                      Obligated balance, end of year
                      4,280
                      4,085
                      3,891

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,224
                      2,789
                      2,831

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      512
                      594
                      623

                      4011
                      Outlays from discretionary balances
                      1,542
                      2,314
                      2,320

                      4020
                      Outlays, gross (total)
                      2,054
                      2,908
                      2,943

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –84
                      –82
                      –82

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –84
                      –82
                      –82

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –139
                      –82
                      –82

                      4052
                      Offsetting collections credited to expired accounts
                      32

                      4060
                      Additional offsets against budget authority only (total)
                      –107
                      –82
                      –82

                      4070
                      Budget authority, net (discretionary)
                      2,033
                      2,625
                      2,667

                      4080
                      Outlays, net (discretionary)
                      1,970
                      2,826
                      2,861

                      4180
                      Budget authority, net (total)
                      2,033
                      2,625
                      2,667

                      4190
                      Outlays, net (total)
                      1,970
                      2,826
                      2,861

             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 and National Biodefense Strategy implementation. The PHSSEF continues to support
                the advanced development, procurement, and stockpiling of biodefense and pandemic influenza countermeasures.

             The PHSSEF also supports the HHS Cybersecurity program, National Security and Strategic Information programs, and the Medical
                Reserve Corps.

          Object Classification (in millions of dollars)

                      Identification code 075–0140–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      98
                      139
                      140

                      11.7
                      Military personnel
                      7
                      9
                      9

                      11.9
                      Total personnel compensation
                      105
                      148
                      149

                      12.1
                      Civilian personnel benefits
                      44
                      53
                      53

                      12.2
                      Military personnel benefits
                      3
                      4
                      4

                      21.0
                      Travel and transportation of persons
                      7
                      9
                      9

                      22.0
                      Transportation of things

                      1
                      1

                      23.1
                      Rental payments to GSA
                      9
                      11
                      11

                      23.2
                      Rental payments to others
                      14
                      17
                      17

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      2
                      2

                      25.1
                      Advisory and assistance services
                      733
                      776
                      805

                      25.2
                      Other services from non-Federal sources
                      34
                      32
                      32

                      25.3
                      Other goods and services from Federal sources
                      115
                      122
                      122

                      25.4
                      Operation and maintenance of facilities
                      4
                      8
                      8

                      25.5
                      Research and development contracts
                      557
                      637
                      637

                      25.7
                      Operation and maintenance of equipment
                      81
                      75
                      77

                      26.0
                      Supplies and materials
                      2
                      409
                      403

                      31.0
                      Equipment
                      1
                      16
                      16

                      41.0
                      Grants, subsidies, and contributions
                      280
                      311
                      321

                      99.0
                      Direct obligations
                      1,991
                      2,631
                      2,667

                      99.0
                      Reimbursable obligations
                      190
                      164
                      164

                      99.9
                      Total new obligations, unexpired accounts
                      2,181
                      2,795
                      2,831

          Employment Summary

                      Identification code 075–0140–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      658
                      933
                      943

                      1101
                      Direct military average strength employment
                      74
                      74
                      74

             Transfers from the Patient-Centered Outcomes Research Trust FundProgram and Financing (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      AHRQ
                      68
                      58

                      0002
                      Office of the Secretary
                      17
                      48
                      15

                      0003
                      NIRSQ

                      41

                      0900
                      Total new obligations, unexpired accounts
                      85
                      106
                      56

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      88
                      127
                      171

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      89
                      127
                      171

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      123
                      150

                      1930
                      Total budgetary resources available
                      212
                      277
                      171

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      127
                      171
                      115

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      123
                      119
                      183

                      3010
                      New obligations, unexpired accounts
                      85
                      106
                      56

                      3020
                      Outlays (gross)
                      –88
                      –42
                      –77

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      119
                      183
                      162

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      123
                      119
                      183

                      3200
                      Obligated balance, end of year
                      119
                      183
                      162

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      123
                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4

                      4101
                      Outlays from mandatory balances
                      88
                      38
                      77

                      4110
                      Outlays, gross (total)
                      88
                      42
                      77

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –123
                      –150

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –35
                      –108
                      77

             Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
                20 percent of the funds appropriated or credited to the PCORTF was 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 2020 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. In FY 2020, this institute will continue to obligate remaining
                resources available until expended. The PCORTF terminates at the end of FY 2019, and the Budget does not propose to extend
                it.

          Object Classification (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      7

                      25.3
                      Other goods and services from Federal sources
                      22
                      71
                      37

                      41.0
                      Grants, subsidies, and contributions
                      53
                      32
                      16

                      99.9
                      Total new obligations, unexpired accounts
                      85
                      106
                      56

          Employment Summary

                      Identification code 075–0145–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      5
                      5
                      5

             Nonrecurring Expenses FundProgram and Financing (in millions of dollars)

                      Identification code 075–0125–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Nonrecurring Expenses Fund Projects
                      131
                      806
                      130

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      565
                      1,116
                      520

                      1010
                      Unobligated balance transfer to other accts [075–0960]
                      –240

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      909
                      610
                      600

                      1021
                      Recoveries of prior year unpaid obligations
                      13

                      1050
                      Unobligated balance (total)
                      1,247
                      1,726
                      1,120

                      Budget authority:

                      Appropriations, discretionary:

                      1131
                      Unobligated balance of appropriations permanently reduced

                      –400
                      –400

                      1930
                      Total budgetary resources available
                      1,247
                      1,326
                      720

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1,116
                      520
                      590

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      668
                      544
                      1,443

                      3010
                      New obligations, unexpired accounts
                      131
                      806
                      130

                      3020
                      Outlays (gross)
                      –242
                      93
                      201

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –13

                      3050
                      Unpaid obligations, end of year
                      544
                      1,443
                      1,774

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      668
                      544
                      1,443

                      3200
                      Obligated balance, end of year
                      544
                      1,443
                      1,774

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –400
                      –400

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      –400
                      –400

                      4011
                      Outlays from discretionary balances
                      242
                      307
                      199

                      4020
                      Outlays, gross (total)
                      242
                      –93
                      –201

                      4180
                      Budget authority, net (total)

                      –400
                      –400

                      4190
                      Outlays, net (total)
                      242
                      –93
                      –201

             The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
                accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
                technology infrastructure.

          Object Classification (in millions of dollars)

                      Identification code 075–0125–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      23.1
                      Rental payments to GSA
                      15
                      93
                      15

                      25.1
                      Advisory and assistance services
                      3
                      18
                      3

                      25.2
                      Other services from non-Federal sources
                      47
                      292
                      46

                      25.3
                      Other goods and services from Federal sources
                      13
                      81
                      13

                      25.4
                      Operation and maintenance of facilities
                      3
                      19
                      3

                      25.5
                      Research and development contracts
                      4
                      24
                      4

                      25.7
                      Operation and maintenance of equipment
                      17
                      105
                      17

                      31.0
                      Equipment
                      26
                      161
                      26

                      32.0
                      Land and structures
                      2
                      12
                      2

                      99.0
                      Direct obligations
                      130
                      805
                      129

                      99.5
                      Adjustment for rounding
                      1
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      131
                      806
                      130

          Employment Summary

                      Identification code 075–0125–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4
                      4

             Health Insurance Reform Implementation FundProgram and Financing (in millions of dollars)

                      Identification code 075–0119–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Health Insurance Reform Implementation Fund (Direct)
                      5

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)
                      5

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      6
                      1
                      1

                      1930
                      Total budgetary resources available
                      6
                      1
                      1

                      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
                      18
                      23
                      21

                      3010
                      New obligations, unexpired accounts
                      5

                      3020
                      Outlays (gross)

                      –2
                      –2

                      3050
                      Unpaid obligations, end of year
                      23
                      21
                      19

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      18
                      23
                      21

                      3200
                      Obligated balance, end of year
                      23
                      21
                      19

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      2
                      2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      2
                      2

             Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the
                Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
                Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
                of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.

             Prevention and Public Health FundProgram and Financing (in millions of dollars)

                      Identification code 075–0116–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      6
                      6

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      6

                      1050
                      Unobligated balance (total)
                      6
                      6
                      6

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      900
                      900
                      950

                      1220
                      Appropriations transferred to other accts [075–0142]
                      –28
                      –28

                      1220
                      Appropriations transferred to other accts [075–0943]
                      –801
                      –805
                      –894

                      1220
                      Appropriations transferred to other accts [075–1362]
                      –12
                      –12

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                      –59
                      –55
                      –56

                      1930
                      Total budgetary resources available
                      6
                      6
                      6

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      6
                      6
                      6

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The Prevention and Public Health Fund supports prevention and public health activities. In FY 2020, $894 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 FundProgram and Financing (in millions of dollars)

                      Identification code 075–0117–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Pregnancy Assistance Fund (Direct)
                      23
                      23

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      2

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      25
                      25

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

                      1260
                      Appropriations, mandatory (total)
                      23
                      25

                      1930
                      Total budgetary resources available
                      23
                      25
                      2

                      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
                      29
                      23

                      3010
                      New obligations, unexpired accounts
                      23
                      23

                      3020
                      Outlays (gross)
                      –21
                      –29
                      –9

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      29
                      23
                      14

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      28
                      29
                      23

                      3200
                      Obligated balance, end of year
                      29
                      23
                      14

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      23
                      25

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      21
                      29
                      9

                      4180
                      Budget authority, net (total)
                      23
                      25

                      4190
                      Outlays, net (total)
                      21
                      29
                      9

             This appropriation funds competitive grants to States to assist pregnant and parenting teens and women. Annual funding for
                this program expires at the end of FY 2019. The Budget does request an extension of this program.

          Object Classification (in millions of dollars)

                      Identification code 075–0117–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      25.3
                      Other goods and services from Federal sources
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      22
                      22

                      99.9
                      Total new obligations, unexpired accounts
                      23
                      23

          Employment Summary

                      Identification code 075–0117–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      2

             Section 241 Evaluation Transactions AccountProgram and Financing (in millions of dollars)

                      Identification code 075–3902–0–1–552
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      Section 241 Evaluation Transactions Account (Reimbursable)
                      512
                      516
                      528

                      0809
                      Reimbursable program activities, subtotal
                      512
                      516
                      528

                      0900
                      Total new obligations, unexpired accounts (object class 25.3)
                      512
                      516
                      528

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      74
                      516
                      528

                      1701
                      Change in uncollected payments, Federal sources
                      438

                      1750
                      Spending auth from offsetting collections, disc (total)
                      512
                      516
                      528

                      1930
                      Total budgetary resources available
                      512
                      516
                      528

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      559
                      634

                      3010
                      New obligations, unexpired accounts
                      512
                      516
                      528

                      3020
                      Outlays (gross)
                      –437
                      –1,150
                      –528

                      3050
                      Unpaid obligations, end of year
                      634

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –556
                      –630
                      –630

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –438

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      364

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –630
                      –630
                      –630

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3
                      4
                      –630

                      3200
                      Obligated balance, end of year
                      4
                      –630
                      –630

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      512
                      516
                      528

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      74
                      516
                      528

                      4011
                      Outlays from discretionary balances
                      363
                      634

                      4020
                      Outlays, gross (total)
                      437
                      1,150
                      528

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –438
                      –516
                      –528

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –438
                      –516
                      –528

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –438

                      4052
                      Offsetting collections credited to expired accounts
                      364

                      4060
                      Additional offsets against budget authority only (total)
                      –74

                      4080
                      Outlays, net (discretionary)
                      –1
                      634

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –1
                      634

             The Public Health Service (PHS) Act Evaluation Transactions account supports the execution of section 241 of the PHS Act.

             Program Support CenterFederal 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 the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0379–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Retirement payments
                      462
                      476
                      491

                      0002
                      Survivors' benefits
                      30
                      31
                      32

                      0003
                      Medical care
                      115
                      100
                      101

                      0900
                      Total new obligations, unexpired accounts
                      607
                      607
                      624

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      607
                      607
                      624

                      1930
                      Total budgetary resources available
                      607
                      607
                      624

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      62
                      102
                      35

                      3010
                      New obligations, unexpired accounts
                      607
                      607
                      624

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

                      3020
                      Outlays (gross)
                      –556
                      –674
                      –623

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –23

                      3050
                      Unpaid obligations, end of year
                      102
                      35
                      36

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      62
                      102
                      35

                      3200
                      Obligated balance, end of year
                      102
                      35
                      36

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      607
                      607
                      624

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      535
                      577
                      593

                      4101
                      Outlays from mandatory balances
                      21
                      97
                      30

                      4110
                      Outlays, gross (total)
                      556
                      674
                      623

                      4180
                      Budget authority, net (total)
                      607
                      607
                      624

                      4190
                      Outlays, net (total)
                      556
                      674
                      623

             The number of beneficiaries using the Commissioned Corps system is estimated as follows:
             Retirement Pay, Survivor Benefits, and Medical Benefits

                         2018
                         2019
                         2020

                         Active Duty:

                         HHS
                         4,781
                         4,876
                         4,859

                         DOJ, BOP
                         787
                         787
                         787

                         Homeland Security
                         471
                         400
                         400

                         EPA
                         55
                         55
                         53

                         All Other
                         280
                         294
                         312

                         Total Active Duty
                         6,374
                         6,412
                         6,411

                         Retirees & Survivors:

                         Retirees
                         6,200
                         6,150
                         6,300

                         Retiree family members and survivors
                         1,135
                         1,125
                         1,100

                         Total Retirement Pay
                         7,335
                         7,275
                         7,400

                         Total Beneficiaries (active duty, retirees, survivors)
                         13,709
                         13,687
                         13,811

             This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
                medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned
                Corps.

          Object Classification (in millions of dollars)

                      Identification code 075–0379–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      13.0
                      Benefits for former personnel
                      492
                      507
                      523

                      25.6
                      Medical care
                      115
                      100
                      101

                      99.9
                      Total new obligations, unexpired accounts
                      607
                      607
                      624

             Retirement Pay and Medical Benefits for Commissioned Officers
             (Legislative proposal, subject to PAYGO)
             The Budget includes a mandatory proposal, effective FY 2021, which shifts the U.S. Public Health Service Commissioned Corps
                retirement pay and survivor benefit costs from mandatory to discretionary.

             HHS Accrual Contribution to the Uniformed Services Retiree Health Care FundProgram and Financing (in millions of dollars)

                      Identification code 075–0170–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Medicare eligible accruals
                      32
                      29
                      30

                      0900
                      Total new obligations, unexpired accounts (object class 12.2)
                      32
                      29
                      30

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      32
                      29
                      30

                      1900
                      Budget authority (total)
                      32
                      29
                      30

                      1930
                      Total budgetary resources available
                      32
                      29
                      30

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      32
                      29
                      30

                      3020
                      Outlays (gross)
                      –32
                      –29
                      –30

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      32
                      29
                      30

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      32
                      29
                      30

                      4180
                      Budget authority, net (total)
                      32
                      29
                      30

                      4190
                      Outlays, net (total)
                      32
                      29
                      30

             The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
                Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
                appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).

             General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
             General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
             (Legislative proposal, not subject to PAYGO)
             Beginning FY 2021, this account would support the unfunded liability of U.S. Public Health Service Commissioned Corps retirement
                pay and survivor benefits costs.

             Health Activities FundsProgram and Financing (in millions of dollars)

                      Identification code 075–9913–0–1–551
                      2018 actual
                      2019 est.
                      2020 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 FundProgram and Financing (in millions of dollars)

                      Identification code 075–9941–0–4–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0801
                      Program Support Center
                      1,447
                      1,641
                      1,659

                      0802
                      OS activities
                      449
                      532
                      539

                      0900
                      Total new obligations, unexpired accounts
                      1,896
                      2,173
                      2,198

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      200
                      206

                      1021
                      Recoveries of prior year unpaid obligations
                      53

                      250

                      1050
                      Unobligated balance (total)
                      253
                      206
                      250

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,711
                      1,967
                      1,948

                      1701
                      Change in uncollected payments, Federal sources
                      138

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,849
                      1,967
                      1,948

                      1930
                      Total budgetary resources available
                      2,102
                      2,173
                      2,198

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      206

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,011
                      1,264
                      442

                      3010
                      New obligations, unexpired accounts
                      1,896
                      2,173
                      2,198

                      3020
                      Outlays (gross)
                      –1,590
                      –2,995
                      –1,948

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –53

                      –250

                      3050
                      Unpaid obligations, end of year
                      1,264
                      442
                      442

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –536
                      –674
                      –674

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –138

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –674
                      –674
                      –674

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      475
                      590
                      –232

                      3200
                      Obligated balance, end of year
                      590
                      –232
                      –232

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,849
                      1,967
                      1,948

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      901
                      1,967
                      1,948

                      4011
                      Outlays from discretionary balances
                      689
                      1,028

                      4020
                      Outlays, gross (total)
                      1,590
                      2,995
                      1,948

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –1,142
                      –1,967
                      –1,948

                      4033
                      Non-Federal sources
                      –569

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,711
                      –1,967
                      –1,948

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –138

                      4080
                      Outlays, net (discretionary)
                      –121
                      1,028

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –121
                      1,028

             The HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department
                and other Federal agencies. The Program Support Center includes activities, such as personnel and payroll support, information
                technology, financial management operations, and administrative services, including acquisitions management, building and
                property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational
                Health Service. The Office of the Secretary activities include the Service and Supply Fund Manager's Office, departmental
                contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
                small business consolidation, grants tracking, the physical security component of the Department's implementation of Homeland
                Security Presidential Directive 12, and commercial services management.

             Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the
                agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section
                in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either
                through an allocation account or by directly citing that agency's appropriation.

          Object Classification (in millions of dollars)

                      Identification code 075–9941–0–4–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      99
                      114
                      117

                      11.3
                      Other than full-time permanent
                      3
                      3
                      3

                      11.5
                      Other personnel compensation
                      3
                      3
                      3

                      11.7
                      Military personnel
                      6
                      7
                      8

                      11.8
                      Special personal services payments
                      10
                      11
                      11

                      11.9
                      Total personnel compensation
                      121
                      138
                      142

                      12.1
                      Civilian personnel benefits
                      32
                      37
                      38

                      12.2
                      Military personnel benefits
                      3
                      2
                      3

                      21.0
                      Travel and transportation of persons
                      3
                      2
                      2

                      22.0
                      Transportation of things
                      2
                      3
                      3

                      23.1
                      Rental payments to GSA
                      19
                      17
                      18

                      23.3
                      Communications, utilities, and miscellaneous charges
                      7
                      9
                      9

                      24.0
                      Printing and reproduction
                      10
                      6
                      6

                      25.1
                      Advisory and assistance services
                      218
                      182
                      196

                      25.2
                      Other services from non-Federal sources
                      1,278
                      1,555
                      1,557

                      25.3
                      Other goods and services from Federal sources
                      67
                      70
                      72

                      25.4
                      Operation and maintenance of facilities
                      12
                      14
                      14

                      25.6
                      Medical care
                      23
                      33
                      32

                      25.7
                      Operation and maintenance of equipment
                      57
                      49
                      51

                      25.8
                      Subsistence and support of persons
                      1

                      26.0
                      Supplies and materials
                      41
                      51
                      50

                      31.0
                      Equipment
                      2
                      5
                      5

                      99.9
                      Total new obligations, unexpired accounts
                      1,896
                      2,173
                      2,198

          Employment Summary

                      Identification code 075–9941–0–4–551
                      2018 actual
                      2019 est.
                      2020 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      923
                      923
                      923

                      2101
                      Reimbursable military average strength employment
                      75
                      75
                      75

                      3101
                      Allocation account military average strength employment
                      1,517
                      1,481
                      1,499

          Trust Funds
             Retirement Pay and Survivor Benefits Payments to Commissioned Corps Officers
             Retirement Pay and Survivor Benefits Payments to Commissioned Corps Officers
             (Legislative proposal, not subject to PAYGO)
             Beginning FY 2021, this account would fund the U.S. Public Health Service Commissioned Corps retirement pay and survivor benefit
                payments.

             Retirement Pay and Survivor Benefits Payments to Commissioned Corps Officers
             (Legislative proposal, subject to PAYGO)
             Beginning FY 2021, this account would fund the U.S. Public Health Service Commissioned Corps retirement pay and survivor benefit
                payments.

             Miscellaneous Trust FundsSpecial and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Contributions, Indian Health Facilities
                      36
                      48
                      48

                      1130
                      Contributions, N.I.H., Unconditional Gift Fund
                      5
                      3
                      3

                      1130
                      Centers for Disease Control, Gifts and Donations
                      27
                      15
                      15

                      1130
                      Contributions, N.I.H., Conditional Gift Fund
                      43
                      27
                      27

                      1130
                      Contributions to the Indian Health Service Gift Fund

                      1
                      1

                      1140
                      Interest, Miscellaneous Trust Funds
                      1
                      1
                      1

                      1198
                      Rounding adjustment
                      –1

                      1199
                      Total current law receipts
                      111
                      95
                      95

                      1999
                      Total receipts
                      111
                      95
                      95

                      2000
                      Total: Balances and receipts
                      111
                      95
                      95

                      Appropriations:

                      Current law:

                      2101
                      Miscellaneous Trust Funds
                      –111
                      –95
                      –95

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0002
                      Gifts
                      72
                      72
                      72

                      0003
                      Contributions, Indian Health Facilities
                      36
                      36
                      36

                      0900
                      Total new obligations, unexpired accounts
                      108
                      108
                      108

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      198
                      188
                      244

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –17

                      1021
                      Recoveries of prior year unpaid obligations
                      4
                      8
                      8

                      1033
                      Recoveries of prior year paid obligations

                      61
                      61

                      1050
                      Unobligated balance (total)
                      185
                      257
                      313

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      111
                      95
                      95

                      1930
                      Total budgetary resources available
                      296
                      352
                      408

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      188
                      244
                      300

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      72
                      99
                      50

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1
                      17

                      3010
                      New obligations, unexpired accounts
                      108
                      108
                      108

                      3020
                      Outlays (gross)
                      –94
                      –149
                      –149

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –4
                      –8
                      –8

                      3050
                      Unpaid obligations, end of year
                      99
                      50
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      89
                      99
                      50

                      3200
                      Obligated balance, end of year
                      99
                      50
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      111
                      95
                      95

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      24
                      15
                      15

                      4101
                      Outlays from mandatory balances
                      70
                      134
                      134

                      4110
                      Outlays, gross (total)
                      94
                      149
                      149

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –61
                      –61

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts

                      61
                      61

                      4160
                      Budget authority, net (mandatory)
                      111
                      95
                      95

                      4170
                      Outlays, net (mandatory)
                      94
                      88
                      88

                      4180
                      Budget authority, net (total)
                      111
                      95
                      95

                      4190
                      Outlays, net (total)
                      94
                      88
                      88

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      34
                      37
                      37

                      5001
                      Total investments, EOY: Federal securities: Par value
                      37
                      37
                      37

             Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction,
                improvement, extension, and provision of sanitation facilities.

          Object Classification (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      4
                      4
                      4

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.8
                      Special personal services payments
                      4
                      4
                      4

                      11.9
                      Total personnel compensation
                      9
                      9
                      9

                      12.1
                      Civilian personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      5
                      5
                      5

                      25.2
                      Other services from non-Federal sources
                      27
                      27
                      27

                      25.3
                      Other goods and services from Federal sources
                      2
                      2
                      2

                      25.5
                      Research and development contracts
                      3
                      3
                      3

                      25.6
                      Medical care
                      1
                      1
                      1

                      25.8
                      Subsistence and support of persons
                      21
                      21
                      21

                      26.0
                      Supplies and materials
                      7
                      7
                      7

                      31.0
                      Equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      27
                      27
                      27

                      99.9
                      Total new obligations, unexpired accounts
                      108
                      108
                      108

          Employment Summary

                      Identification code 075–9971–0–7–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      60
                      60
                      60

             Office of the Inspector GeneralFederal 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.
          (Department of Health and Human Services Appropriations Act, 2019.)
          Program and Financing (in millions of dollars)

                      Identification code 075–0128–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Obligations by program activity:

                      0001
                      Office of Inspector General (Direct)
                      82
                      86
                      80

                      0801
                      Office of Inspector General HCFAC Trust Fund
                      213
                      233
                      222

                      0802
                      Office of Inspector General (Direct Reimbursable)
                      15
                      21
                      21

                      0803
                      Office of Inspector General HCFAC Discretionary
                      88
                      91
                      98

                      0899
                      Total reimbursable obligations
                      316
                      345
                      341

                      0900
                      Total new obligations, unexpired accounts
                      398
                      431
                      421

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      41
                      42
                      14

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      44
                      42
                      14

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      80
                      80
                      80

                      1121
                      Appropriations transferred from other acct [075–9911]
                      2
                      2

                      1121
                      Appropriations transferred from other acct [075–0140]
                      2

                      1121
                      Appropriations transferred from other acct [075–9915]

                      5

                      1160
                      Appropriation, discretionary (total)
                      84
                      87
                      80

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      92
                      108
                      111

                      1701
                      Change in uncollected payments, Federal sources
                      7

                      1750
                      Spending auth from offsetting collections, disc (total)
                      99
                      108
                      111

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      192
                      208
                      225

                      1801
                      Change in uncollected payments, Federal sources
                      21

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      213
                      208
                      226

                      1900
                      Budget authority (total)
                      396
                      403
                      417

                      1930
                      Total budgetary resources available
                      440
                      445
                      431

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      42
                      14
                      10

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      78
                      97
                      89

                      3010
                      New obligations, unexpired accounts
                      398
                      431
                      421

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

                      3020
                      Outlays (gross)
                      –376
                      –439
                      –419

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      97
                      89
                      91

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –114
                      –134
                      –134

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –28

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      8

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –134
                      –134
                      –134

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –36
                      –37
                      –45

                      3200
                      Obligated balance, end of year
                      –37
                      –45
                      –43

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      183
                      195
                      191

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      153
                      177
                      174

                      4011
                      Outlays from discretionary balances
                      27
                      23
                      19

                      4020
                      Outlays, gross (total)
                      180
                      200
                      193

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –100
                      –108
                      –111

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –7

                      4052
                      Offsetting collections credited to expired accounts
                      8

                      4060
                      Additional offsets against budget authority only (total)
                      1

                      4070
                      Budget authority, net (discretionary)
                      84
                      87
                      80

                      4080
                      Outlays, net (discretionary)
                      80
                      92
                      82

                      Mandatory:

                      4090
                      Budget authority, gross
                      213
                      208
                      226

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      135
                      189
                      206

                      4101
                      Outlays from mandatory balances
                      61
                      50
                      20

                      4110
                      Outlays, gross (total)
                      196
                      239
                      226

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –179
                      –196
                      –213

                      4123
                      Non-Federal sources
                      –13
                      –12
                      –12

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –192
                      –208
                      –225

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –21

                      4160
                      Budget authority, net (mandatory)

                      1

                      4170
                      Outlays, net (mandatory)
                      4
                      31
                      1

                      4180
                      Budget authority, net (total)
                      84
                      87
                      81

                      4190
                      Outlays, net (total)
                      84
                      123
                      83

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1

             The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
                Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
                1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
                and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
                HHS programs well serve the people that use them. OIG fulfills its mission through a broad range of audits, evaluations, investigations,
                and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health
                Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996.

          Object Classification (in millions of dollars)

                      Identification code 075–0128–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      40
                      40
                      42

                      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
                      44

                      12.1
                      Civilian personnel benefits
                      16
                      16
                      16

                      21.0
                      Travel and transportation of persons
                      2
                      2
                      2

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      5
                      5
                      6

                      23.3
                      Communications, utilities, and miscellaneous charges
                      3
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      6
                      11
                      1

                      25.3
                      Other goods and services from Federal sources
                      2
                      2
                      2

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.7
                      Operation and maintenance of equipment
                      1

                      1

                      31.0
                      Equipment
                      3
                      3
                      3

                      99.0
                      Direct obligations
                      82
                      86
                      80

                      99.0
                      Reimbursable obligations
                      316
                      345
                      341

                      99.9
                      Total new obligations, unexpired accounts
                      398
                      431
                      421

          Employment Summary

                      Identification code 075–0128–0–1–551
                      2018 actual
                      2019 est.
                      2020 est.

                      1001
                      Direct civilian full-time equivalent employment
                      335
                      344
                      349

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,266
                      1,306
                      1,321

             General and Administrative Provisions
             GENERAL FUND RECEIPT ACCOUNTS(in millions of dollars)

                      2018 actual
                      2019 est.
                      2020 est.

                      Offsetting receipts from the public:

                      075–143500
                      General Fund Proprietary Interest Receipts, not Otherwise Classified
                      114
                      90
                      90

                      075–267403
                      Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                      15

                      075–275830
                      Downward Reestimates of Subsidies, Health Centers

                      1

                      075–310700
                      Federal Share of Child Support Collections
                      609
                      596
                      585

                      075–310700
                      Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO

                      10

                      075–322000
                      All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                      1,083
                      34
                      34

                      General Fund Offsetting receipts from the public
                      1,821
                      721
                      719

                      Intragovernmental payments:

                      075–388500
                      Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                      –729

                      General Fund Intragovernmental payments
                      –729

             GENERAL PROVISIONS
             General provisionsSEC. 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 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  effective date of a contract awarded in fiscal year  2020 under section 338B of such Act, or at any time if the individual who has been awarded such contract has not received funds due under the contract.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  2020:
          (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
             Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
             that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
             of 1980 and other applicable statutes administered by the Department of State.

          (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
             to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
             for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
             functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
             and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
             through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
             foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
             of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
             chronic and environmental diseases, and other health activities abroad.

          (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
             benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
             4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
             comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
             percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
             official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
             the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
             Service Act of 1980, to individuals serving in the Foreign Service.
          '

          (transfer of funds)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
          and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
          virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
          of any transfer.'

          (transfer of funds)SEC. 212. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
          jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
          "Office of AIDS Research" account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
          to carry out section 2353(d)(3) of the PHS Act.SEC. 213. (a) Authority.—Notwithstanding any other provision of law, the Director of NIH ("Director") may use funds authorized under section 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 or research and activities described in such section 402(b)(12).
          (b) Peer review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
             with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
             technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
             that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
             Act.
          SEC. 214. Not to exceed  $100,000,000 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: Provided, That funds for projects in excess of $3,500,000 shall not be obligated unless such projects are approved by the
             Office of Management and Budget .'

          (transfer of funds)SEC. 215. Of the amounts made available for NIH, 1 percent of the amount made available for National Research Service Awards ("NRSA")
          shall be made available to the Administrator of the Health Resources and Services Administration to make NRSA awards for research
          in primary medical care to individuals affiliated with entities who have received grants or contracts under sections 736,
          739, or 747 of the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of
          the  National Institute for Research on Safety and Quality to make NRSA awards for health service research.SEC. 216. (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
          than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
          319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), if—
          (1) funds are available and obligated—
             (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
             (B) for the estimated costs associated with a necessary termination of the contract; and

          (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
             full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.

          (b) A contract entered into under this section—
             (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
             (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
          '

          (transfer of funds)SEC. 217. Effective during the period beginning on November 1, 2015 and ending January 1, 2021, any provision of law that refers (including
          through cross-reference to another provision of law) to the current recommendations of the United States Preventive Services
          Task Force with respect to breast cancer screening, mammography, and prevention shall be administered by the Secretary involved
          as if—
          (1) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to
             breast cancer screening, mammography, and prevention last issued before 2009; and

          (2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social
             Security Act (42 U.S.C. 1395x(jj)).
          '

          (transfer of funds)SEC. 218. The NIH Director may transfer  discretionary amounts identified by the Director as funding for opioid addiction, opioid alternatives, pain management, and addiction treatment  among Institutes and Centers of the NIH to be used for the same purpose 15 days after notifying the Committees on Appropriations:
          Provided, That the transfer authority provided in the previous proviso is in addition to any other transfer authority provided by
          law.'

           (cancellation)SEC. 219. Of the unobligated balances available in the "Nonrecurring Expenses Fund" established in section 223 of division G of Public
          Law 110–161, $400,000,000 are hereby  permanently cancelled.SEC. 220. Funds appropriated in this 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. 221. (a)   IN GENERAL.—Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
                the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
                within the Department or of another agency under which— (1)  the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
                   or cooperative agreement on behalf of the ordering agency or unit;
          (2)  the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
                   and
          (3)  the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
                   and for the service of executing or managing the grant or cooperative agreement.
          (b)  CONDITIONS.—The conditions for making an agreement described in subsection (a) are that— (1)  amounts are available;
             (2)  the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
             (3)  the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.

          (c)  PAYMENT.—Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
                   agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
                   any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
                   request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
                   shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
                   and the actual cost of service provided.
          (d)  LIMITATIONS ON FUNDS.—A condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
                   agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement.
          (e)  OBLIGATION OF APPROPRIATIONS.—An agreement made under this section obligates an appropriation of the ordering agency or unit.
                   The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
                   before the end of the period of availability of the appropriation, in— (1)  awarding the grant or cooperative agreement; or
             (2)  providing the agreed-on services.

          (f)  NO EFFECT ON OTHER LAWS—This section does not affect other laws about reimbursable agreements. SEC. 222. The Department of Health and Human Services may accept donations from the private sector, nongovernmental organizations, and
          other groups independent of the Federal Government for the care of unaccompanied alien children (as defined in section 462(g)(2)
          of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in the care of the Office of Refugee Resettlement of the Administration
          for Children and Families, including monetary donations, medical goods and services, school supplies, toys, clothing, and any other items and services intended to promote the wellbeing of such children.SEC. 223.   Funds appropriated in this Act to accounts that received appropriations in title II of division B of Public Law 115–254 for
                the administrative expenses of programs or activities for which appropriations are not provided in this Act shall be available
                for necessary expenses to carry out the closure of such programs or activities. SEC. 224.   For fiscal year 2020 and each subsequent fiscal year, the notification requirements described in sections 1804(a) and 1851(d)
                of the Social Security Act may be fulfilled by the Secretary in a manner similar to that described in paragraphs (1) and (2)
                of section 1806(c) of such Act. SEC. 225.   Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)), the Secretary of Health and Human Services
                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 or entities. Such fees shall
                be in addition to any other funds available for conducting such surveys and shall be credited to the "Department of Health
                and Human Services— Centers for Medicare and Medicaid Services—Program Management" account, to remain available until expended,
                for such purpose. No such fees shall be charged to an Indian Health Program (as that term is defined in section 4 of the Indian
                Health Care Improvement Act). SEC. 226.  Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended— (a)  in subsection (a)(5)(C)— (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE.—A covered entity shall
                      permit" and;
             (2)  by inserting at the end the following:

             "(ii) USE OF SAVINGS.—A covered entity shall permit the Secretary to audit, at the Secretary's expense, the records of the
                      entity to determine how net income from purchases under this section are used by the covered entity.

             "(iii) RECORDS RETENTION.—Covered entities shall retain such records and provide such records and reports as deemed necessary
                      by the Secretary for carrying out this subparagraph.".

          (b)  by adding at the end the following new subsection: "(f) REGULATIONS.—The Secretary may promulgate such regulations as the
                   Secretary determines necessary or appropriate to carry out the provisions of this section.". SEC. 227. (a)   IN GENERAL.—A State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
                of Health and Human Services—Administration for Community Living—Aging and Disability Services Programs" to carry out programs
                under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
                the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
                or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
                limitations on such transfers under the OAA or such heading.  (b)  NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.—A State or tribal organization which elects to make a transfer under
                   subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
                   of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
                   the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
                   the Secretary determines that such transfer is not consistent with the objectives of the OAA.
          (c)  RULES OF CONSTRUCTION.—No transfer of grant funds by a State or tribal organization under this section shall be construed— (1)  as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
                      by the Secretary; or
             (2)  to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
                      funds.
          SEC. 228.  Funds made available to the Secretary of Health and Human Services (HHS) in this or any other or prior Acts that are available
                for acquisition of real property or for construction or improvement of facilities shall also be available to make improvements
                on non-federally owned property located directly adjacent to property owned by HHS or a component thereof, provided that the
                primary benefit of such improvements accrues to HHS or the component thereof funding the improvements. SEC. 229.  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. 230.   Notwithstanding section 12(b) of the Federal Advisory Committee Act, funds made available by this Act for the "NIH—Office
                of the Director" account shall also be available to establish and operate the Research Policy Board authorized by section
                2034(f) of Public Law 114–255. '

          (Including transfer of funds)SEC. 231. (a)   The Secretary may reserve not more than 0.25 percent from each appropriation made available in this Act to the accounts of
                the Administration of Children and Families identified in subsection (b) in order to carry out evaluations of any of the programs
                or activities that are funded under such accounts. Any such funds reserved under this section may be transferred to ''Children
                and Families Services Programs'' for use by the Assistant Secretary for the Administration for Children and Families and shall
                remain available until expended: Provided, That such funds shall only be available if such Assistant Secretary submits a plan
                to the Committees on Appropriations of the House of Representatives and the Senate describing the evaluations to be carried
                out 15 days in advance of any such transfer.  (b)  The accounts referred to in subsection (a) are: ''Low Income Home Energy Assistance'', ''Refugee and Entrant Assistance'',
                   ''Payments to States for the Child Care and Development Block Grant'', and ''Children and Families Services Programs''. SEC. 232.  REAUTHORIZATION AND MODIFICATION OF CDC LOAN REPAYMENT PROGRAM. Section 317F of the Public Health Service Act (42 U.S.C. 247b-7)
                is amended— (a)  in subsection (a),— (1)  in paragraph (1), by striking "$35,000" and inserting "$15,000";
             (2)  in paragraph (2), by striking "3 years" and inserting "2 years"; and
             (3)  by adding the following new paragraph: "(3) HEALTH PROFESSIONAL.—For purposes of this section, the term 'health professional'
                      includes information technology specialists and data surveillance specialists."; and

          (b)  in subsection (c), by striking "1995 through 2002" and inserting "thereafter". '

          (Including transfer of funds)SEC. 233.   There is hereby established in the Treasury 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, and domestic preparedness activities and global health; to prevent, prepare for, or respond to a
                chemical, biological, radiological, or nuclear defense threat; or to prevent, prepare for, or respond to an emerging infectious
                disease; and may be used 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 such threats or emergencies that the Secretary determines have
                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 subsection. 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. 234.  Funds appropriated in this Act, or any other Act making appropriations for fiscal year 2020, to any component of the Department
                of Health and Human Services that are available for activities to address opioid use shall also be available to such component
                to carry out activities authorized under the SUPPORT for Patients and Communities Act or under an amendment made by such Act. SEC. 235.   Any assessment or user fee charged pursuant to section 1311(d)(5)(A) of the Patient Protection and Affordable Care Act shall
                be available for any other Federal administrative expenses the Secretary incurs for activities related to the Exchange program,
                in addition to any other purposes authorized by law: Provided, That such collections shall be credited to the "Centers for
                Medicare and Medicaid Services—Program Management" account and shall remain available until expended for the purposes described
                in this section. (Department of Health and Human Services Appropriations Act, 2019.)