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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES
         Food and Drug 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 92â313 for programs and activities of the Food and Drug Administration
            which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
            and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
            on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107â188; $5,833,942,000: 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.â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. 115â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 075â9911â0â1â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
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  1
                  2
                  3
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  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 [075â0128]
                  â2
                  â2
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â4613]
                  
                  â5
                  â5
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â31
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  197
                  
                  
               
               
                  1710
                  Spending authority from offsetting collections transferred to other accounts [075â4613]
                  â5
                  
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â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
                  â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)
                  â5,001
                  â5,303
                  â5,483
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â54
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â79
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,978
                  3,178
                  3,680
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â65
                  â70
                  â39
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  31
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â70
                  â39
                  â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:
                  â33
                  â31
                  
               
               
                  4033
                  Non-Federal sources:
                  â2,933
                  â2,526
                  â2,650
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â2,966
                  â2,557
                  â2,650
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  31
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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:
                  â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 075â9911â0â1â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 075â9911â0â1â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.â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. 115â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 075â9911â2â1â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)
                  
                  
                  â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:
                  
                  
                  â156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â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 075â9911â2â1â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 075â9911â2â1â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 075â4613â0â4â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 [075â9911]
                  
                  5
                  5
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1711
                  Spending authority from offsetting collections transferred from other accounts [075â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)
                  
                  
                  â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 075â0148â0â1â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)
                  â60
                  â60
                  â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.â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. 115â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 075â5629â0â2â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
                  â60
                  â60
                  â75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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 [075â9911]
                  
                  â60
                  â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)
                  â23
                  â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 075â5629â0â2â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 075â5629â0â2â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 075â4309â0â3â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
                  â1
                  â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)
                  â9
                  â14
                  â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
                  â9
                  â10
                  â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 075â4309â0â3â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 075â4309â0â3â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 075â0350â0â1â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 [075â1503]
                  â17
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [015â5606]
                  â5
                  â5
                  â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 [075â1503]
                  â16
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â2
                  â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
                  â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)
                  â10,519
                  â10,827
                  â9,281
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â61
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â107
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,968
                  8,613
                  5,257
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â16
                  â16
                  â16
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â16
                  â16
                  â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
                  â11
                  â12
                  â12
               
               
                  4033
                  Non-Federal sources
                  â26
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â37
                  â30
                  â49
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â32
                  â20
                  â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 075â0350â0â1â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
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  235999
                  Total guaranteed loan reestimates
                  
                  â1
                  
               
               
                  
                     
                  
               
            
         
      
      
         Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
            activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training,
            maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical
            malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free
            clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.
         
         HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL),
            Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts
            (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are
            awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the 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 2017â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 075â0350â0â1â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 075â0350â0â1â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 075â0350â4â1â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)
                  
                  
                  â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 075â0350â4â1â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 075â0350â4â1â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 075â0320â0â1â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
                  â2
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â2
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203, and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â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 [075â0140]
                  2
                  2
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  3
                  3
               
               
                  1930
                  Total budgetary resources available
                  3
                  3
                  3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  1
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  3
                  3
               
               
                  3020
                  Outlays (gross)
                  â2
                  â3
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  1
                  1
               
               
                  3200
                  Obligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  2
                  3
                  3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
      
         The Covered Countermeasure Process Fund is established pursuant to the Public Health Service (PHS) Act, as amended by Division
            C of Public Law 109â148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
            resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
            has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
            claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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 075â0343â0â1â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 075â0321â0â1â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)
                  â366
                  â383
                  â393
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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 075â0321â0â1â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 075â0321â0â1â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 075â4442â0â3â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 075â4442â0â3â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
                  â888
                  â885
                  â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
                  â16
                  â10
                  â10
               
               
                  
                  Adjustments:
               
               
                  2263
                  Terminations for default that result in claim payments
                  
                  â1
                  â1
               
               
                  2264
                  Other adjustments, net
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  60
                  52
                  101
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  45
                  39
                  78
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 104â299, Public Law 104â208, and Public Law 115â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 (75â0350) as a line in the program and financing schedule.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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 075â9931â0â3â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 075â9931â0â3â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 075â8175â0â7â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
                  â27
                  â27
                  â33
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â227
                  â280
                  â286
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â254
                  â307
                  â319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â254
                  â307
                  â319
               
               
                  4030
                  Vaccine Injury Compensation Program Trust Fund
                  5
                  
                  
               
               
                  5098
                  Reconciliation adjustment
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  3,684
                  3,812
                  3,949
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â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)
                  â246
                  â325
                  â319
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
            for vaccine-related injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  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 075â8175â0â7â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 93â638, such individually identifiable health information relating to disabled children
            as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
            U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
            Indian Health Facilities account.
      Note.âA full-year 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. 115â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 075â0390â0â1â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
                  â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)
                  â5,431
                  â6,334
                  â5,796
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â185
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â24
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,139
                  553
                  678
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â100
                  â106
                  â106
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â106
                  â106
                  â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
                  â441
                  â441
                  â441
               
               
                  4033
                  Non-Federal sources
                  â1,210
                  â1,193
                  â1,193
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,651
                  â1,634
                  â1,634
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â0390â0â1â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 075â0390â0â1â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 075â0390â4â1â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)
                  
                  
                  â144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  6
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  144
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  144
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to extend the Special Diabetes Program for Indians through fiscal year 2021. 
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â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.â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. 115â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.â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. 115â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 075â0344â0â1â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)
                  â754
                  â882
                  â855
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.â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. 115â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 075â0391â0â1â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
                  â8
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  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)
                  â528
                  â835
                  â868
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  679
                  488
                  266
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â9
                  â18
                  â18
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â18
                  â18
                  â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
                  â59
                  â59
                  â59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â59
                  â59
                  â59
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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 075â0391â0â1â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 075â0391â0â1â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 PROVISIONSâINDIAN HEALTH SERVICE
         Administrative provisionsâindian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
            3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
            5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
            and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
            in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
            5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
            Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
            care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
            recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
            providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
            to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
            Law 93â638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
            purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
            by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
            the House and Senate Committees on Appropriations are notified through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization
            through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance
            Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance
            agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal
            year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule
            published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility
            for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting
            the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and
            enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health
            Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance
            with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant
            to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds
            were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total
            costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance:
            Provided further, That, notwithstanding any other provision of law, for any lease under section 105(l) of the Indian Self-Determination and
            Education Assistance Act, as amended, no additional compensation is required by the Act above the amount provided to the tribe
            or tribal organization under section 106(a)(1), except the Secretary, in the discretion of the Secretary, may award compensation
            for such leases, above the section 106(a)(1) amount, and if the Secretary awards such additional compensation the amount of
            such compensation may be based on such reasonable expenses, if any, as the Secretary determines to be appropriate, which may
            include the expenses described in section 105(l)(2), and the exercise of this discretion to award additional compensation
            and determine its amount is not subject to sections 102(a)-(b), (e) or 507(b)-(d) of the Act.
      
         Centers for Disease Control and 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 106â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 112â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 115â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 075â0943â0â1â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
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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 [075â0960]
                  â1
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â3
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  
                  â406
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  
                  â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 [075â1503]
                  â17
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0960]
                  â6
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0140]
                  
                  â604
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0945]
                  
                  â50
                  â50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  7,112
                  6,404
                  5,135
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1200
                  Appropriation (Childhood Obesity 075â0943)
                  30
                  
                  
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  1
                  1
                  1
               
               
                  1221
                  Appropriations transferred from other acct PPHF [075â0116]
                  801
                  805
                  894
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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
                  â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
                  â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)
                  â7,884
                  â7,407
                  â7,637
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â148
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â155
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,935
                  7,135
                  6,333
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â190
                  â127
                  â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
                  â127
                  â127
                  â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
                  â310
                  â301
                  â331
               
               
                  4033
                  Non-Federal sources
                  â20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â330
                  â301
                  â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
                  â5
                  â4
                  â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 075â0943â0â1â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 075â0943â0â1â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 075â0960â0â1â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 [075â0125]
                  240
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  248
                  499
                  504
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  270
                  30
                  30
               
               
                  1121
                  Appropriations transferred from other acct [075â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)
                  â8
                  â27
                  â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 075â0960â0â1â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 075â4553â0â4â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)
                  â566
                  â561
                  â545
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  199
                  207
                  231
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â2
                  â2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â564
                  â576
                  â532
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  2
                  â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 075â4553â0â4â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 075â4553â0â4â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 075â0945â0â1â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 [075â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)
                  
                  
                  â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.â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. 115â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 075â0944â0â1â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 [097â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)
                  â79
                  â97
                  â71
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  64
                  42
                  33
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â4
                  â15
                  â15
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â15
                  â15
                  â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
                  â5
                  â3
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â5
                  â3
                  â3
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â0944â0â1â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 075â0944â0â1â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 075â0946â0â1â551
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  World Trade Center Health ProgramâFederal Share (CDC/NIOSH)
                  432
                  517
                  541
               
               
                  0002
                  World Trade Center Health Programâ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 (WTCâNYC DHSSâ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)
                  â393
                  â387
                  â401
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â25
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 111â347)
            on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
            Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
            health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
            2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
            Compensation Reauthorization Act of 2015 (P.L. 114â113, Division O, Title III). The amounts included for 2019 and 2020 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  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 075â0946â0â1â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 InstituteâFrederick Federally Funded Research
            and Development Center in Frederick, Maryland.
      
         national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
            and blood products,  $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.â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. 115â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 075â9915â0â1â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
                  â45
                  â42
                  â42
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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 [075â0943]
                  3
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â1503]
                  â87
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  
                  â5
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5628]
                  386
                  515
                  335
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â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
                  â10
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  39,830
                  43,138
                  37,387
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  493
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â36,720
                  â39,788
                  â40,881
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â88
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â779
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  37,408
                  40,758
                  37,264
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â671
                  â565
                  â565
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  51
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â137
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  192
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â565
                  â565
                  â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
                  â3,654
                  â4,439
                  â4,439
               
               
                  4033
                  Non-Federal sources
                  â366
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,020
                  â4,439
                  â4,439
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â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 075â9915â0â1â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 075â9915â0â1â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 075â9915â4â1â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)
                  
                  
                  â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 075â0147â0â1â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)
                  â496
                  â711
                  â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 075â5628â0â2â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
                  â496
                  â711
                  â492
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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 [075â9915]
                  â386
                  â515
                  â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)
                  â20
                  â105
                  â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 075â5628â0â2â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 075â5628â0â2â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 075â5736â0â2â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
                  
                  â13
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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 [075â9915]
                  
                  â13
                  â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 113â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 113â93; 42 U.S.C. 290aa 22 note).
      
         SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
            respect to substance abuse treatment and prevention 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 107â82, as amended by Public
               Law 115â271, and $3,000,000, to remain available until expended, shall be for activities authorized by section 103 of Public
               Law 114â198.
      
         HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
            Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act 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 075â1362â0â1â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 [075â1503]
                  â6
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5627]
                  500
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,527
                  5,597
                  5,535
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [075â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
                  â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)
                  â4,085
                  â5,194
                  â5,857
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â124
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,127
                  6,824
                  6,675
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â143
                  â165
                  â165
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â115
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  93
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â165
                  â165
                  â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
                  â250
                  â280
                  â171
               
               
                  4033
                  Non-Federal sources
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â252
                  â282
                  â173
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â115
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  89
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â1362â0â1â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 075â1362â0â1â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 075â1700â0â1â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 [075â9915]
                  
                  
                  â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 [075â1503]
                  â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)
                  â358
                  â266
                  â299
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  â1
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  335
                  432
                  133
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â52
                  â35
                  â18
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â17
                  â17
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  34
                  34
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â35
                  â18
                  â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
                  â28
                  â28
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â28
                  â28
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â17
                  â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
                  â6
                  â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 075â1700â0â1â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 075â1700â0â1â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 075â0512â0â1â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)
                  â405,358
                  â419,714
                  â427,114
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â29,936
                  â35,570
                  â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
                  â393
                  â723
                  â723
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â330
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â723
                  â723
                  â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
                  â1,087
                  â1,033
                  â1,128
               
               
                  4123
                  Non-Federal sources
                  â15,114
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â16,201
                  â1,033
                  â1,128
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  
                  
                  â7,835
               
               
                  
                  Outlays
                  
                  
                  â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 075â0512â4â1â551
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  â7,835
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â7,835
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â7,835
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â7,835
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â7,835
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â7,835
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â7,835
               
               
                  3020
                  Outlays (gross)
                  
                  
                  7,835
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â7,835
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â7,835
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â7,835
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â7,835
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals. 
      
         State Grants and DemonstrationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â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
                  â6
                  â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)
                  â482
                  â476
                  â610
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10). The account also includes funding for grant programs
            enacted in the HEALTHY KIDS Act (P.L. 115â120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115â123),
            the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115â271),
            and the Medicaid Extenders Act of 2019 (P.L. 116â3).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â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 075â0516â0â1â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 97â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 075â0580â0â1â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 (HCFACâ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
                  â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)
                  â348,189
                  â358,997
                  â401,440
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â3,980
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â228
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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
                  
                  
                  â7,786
               
               
                  
                  Outlays
                  
                  
                  â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 075â0580â0â1â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 075â0580â2â1â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â7,696
               
               
                  0002
                  Part D benefits (Rx Drug)
                  
                  
                  â90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â7,786
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â7,786
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â7,786
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â7,786
               
               
                  3020
                  Outlays (gross)
                  
                  
                  7,786
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â7,786
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â7,786
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â7,786
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â7,786
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement OrganizationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â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
                  â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)
                  â934
                  â1,320
                  â670
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  867
                  867
                  867
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,982
                  â1,616
                  â1,616
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â607
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  973
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,616
                  â1,616
                  â1,616
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â794
                  â749
                  â749
               
               
                  3200
                  Obligated balance, end of year
                  â749
                  â749
                  â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
                  â1,040
                  â1,320
                  â670
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â607
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  868
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  261
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â106
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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. 97â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 075â0519â0â1â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 075â0519â0â1â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 075â0511â0â1â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
                  â9,240
                  3,123
                  3,838
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â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
                  â88
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  101
                  116
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â145
                  â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
                  â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)
                  â5,553
                  â5,870
                  â6,691
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12,330
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â221
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,599
                  4,568
                  3,116
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6,082
                  â5,839
                  â5,839
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  â10
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,116
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,369
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5,839
                  â5,839
                  â5,839
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  10,539
                  â1,240
                  â1,271
               
               
                  3200
                  Obligated balance, end of year
                  â1,240
                  â1,271
                  â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
                  â4,056
                  â3,985
                  â3,579
               
               
                  4033
                  Non-Federal sources
                  â54
                  â50
                  â50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,110
                  â4,035
                  â3,629
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,204
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,278
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  74
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â87
                  â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
                  â314
                  â159
                  â36
               
               
                  4123
                  Non-Federal sources
                  â1,935
                  â2,401
                  â2,455
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2,249
                  â2,560
                  â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)
                  â41
                  â41
                  3
               
               
                  4170
                  Outlays, net (mandatory)
                  â719
                  76
                  369
               
               
                  4180
                  Budget authority, net (total)
                  â41
                  â41
                  3
               
               
                  4190
                  Outlays, net (total)
                  â806
                  â725
                  571
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  476
                  515
                  559
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â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
                  â41
                  â41
                  3
               
               
                  
                  Outlays
                  â806
                  â725
                  571
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  12
               
               
                  
                  Outlays
                  
                  
                  2
               
               
                  Total:
               
               
                  
                  Budget Authority
                  â41
                  â41
                  15
               
               
                  
                  Outlays
                  â806
                  â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 075â0511â0â1â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 075â0511â0â1â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 075â0511â4â1â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)
                  
                  
                  â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
                  
                  
                  â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 075â0511â4â1â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 075â0514â4â1â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)
                  
                  
                  â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 075â0515â0â1â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 [075â5551]
                  
                  
                  4,632
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  101
                  
                  
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â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
                  
                  
                  â15,352
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  21,590
                  22,600
                  23,700
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  
                  5,604
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3,645
                  â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
                  â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)
                  â17,282
                  â18,434
                  â16,882
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2,041
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â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. 105â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. 111â3, CHIPRA) reauthorized the CHIP program and appropriated funding
            for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and
            territories, and support for child health quality and outreach activities. A contingency fund to assist States who project
            spending above their available allocated CHIP funds was also created by CHIPRA, and funding is included in a separate account.
            The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) and the Medicare Access and CHIP Reauthorization Act
            of 2015 (P.L. 114â10) extended CHIP funding through fiscal year 2015 and 2017, respectively.  The HEALTHY KIDS Act (P.L. 115â120)
            and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115â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 075â0522â0â1â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)
                  â1,013
                  â1,089
                  â1,226
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 075â0522â0â1â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 075â0522â0â1â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 075â5551â0â2â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
                  
                  â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
                  â27
                  â246
                  â156
               
               
                  2103
                  Child Enrollment Contingency Fund
                  â572
                  â3,128
                  â5,604
               
               
                  2134
                  Child Enrollment Contingency Fund
                  2,562
                  3,262
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  1,963
                  â112
                  â5,760
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  1,963
                  â112
                  â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 075â5551â0â2â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 [075â0515]
                  
                  
                  â4,632
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â2
                  4
                  
               
               
                  1035
                  Unobligated balance precluded from obligation (limitation on obligations)
                  â570
                  â2,342
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  
                  
                  â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 [075â0515]
                  
                  
                  â5,604
               
               
                  1234
                  Appropriations precluded from obligation
                  â2,562
                  â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)
                  
                  â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
                  
                  
                  â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. 111â3) established the Child Enrollment Contingency
            Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
            it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
            number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) and the Medicare
            Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended the Contingency Fund through fiscal years 2015 and 2017,
            respectively. The HEALTHY KIDS Act (P.L. 115â120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L.
            115â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 075â0508â0â1â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
                  â10
                  
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â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)
                  â53
                  â45
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  25
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â171
                  â161
                  â161
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â161
                  â161
                  â161
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â153
                  â136
                  â161
               
               
                  3200
                  Obligated balance, end of year
                  â136
                  â161
                  â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
                  â71
                  â20
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â8
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â18
                  25
                  
               
               
                  4180
                  Budget authority, net (total)
                  â8
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â0112â0â1â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)
                  â19
                  â33
                  â4
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â15
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â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 075â0113â0â1â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)
                  â55
                  â56
                  â43
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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.
            111â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 075â0114â0â1â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)
                  
                  â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. 111â148) authorized and appropriated $5 billion for the Early Retiree
            Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
            sponsors.
         
      
         Affordable Insurance Exchange GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â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
                  â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)
                  â48
                  â7
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â148) provided amounts necessary to enable the Secretary to award
            grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
            round of grants was awarded to States in December 2014.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  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 075â0115â0â1â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 075â0126â0â1â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
                  
                  â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)
                  
                  â7,575
                  â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
                  
                  â6,301
                  479
               
               
                  
                  Outlays
                  
                  â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 075â0126â4â1â551
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Cost Sharing Reductions
                  
                  â5,070
                  397
               
               
                  0002
                  Basic Health Program
                  
                  â1,231
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  â6,301
                  479
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  â6,802
                  
               
               
                  1200
                  Appropriation
                  
                  501
                  479
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  â6,301
                  479
               
               
                  1930
                  Total budgetary resources available
                  
                  â6,301
                  479
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  â6,301
                  479
               
               
                  3020
                  Outlays (gross)
                  
                  6,301
                  â479
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â6,301
                  479
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â6,301
                  479
               
               
                  4180
                  Budget authority, net (total)
                  
                  â6,301
                  479
               
               
                  4190
                  Outlays, net (total)
                  
                  â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 075â5733â0â2â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
                  â4,705
                  â4,786
                  â4,022
               
               
                  2103
                  Risk Adjustment Program Payments
                  â371
                  â311
                  â297
               
               
                  2132
                  Risk Adjustment Program Payments
                  311
                  297
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â4,765
                  â4,800
                  â4,319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â4,765
                  â4,800
                  â4,319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  311
                  297
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â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
                  â311
                  â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)
                  â2,599
                  â6,991
                  â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. 111â148) established a permanent risk adjustment program
            for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
            and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
            with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
            a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
            they are calculated.
         
      
         Transitional Reinsurance ProgramSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â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
                  â383
                  
                  
               
               
                  2103
                  Transitional Reinsurance Program
                  â286
                  â25
                  
               
               
                  2132
                  Transitional Reinsurance Program
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â644
                  â25
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â644
                  â25
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  25
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â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
                  â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)
                  â666
                  â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. 111â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 075â0524â0â1â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)
                  â136
                  â6
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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 075â0524â0â1â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.
            112â240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
            loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
         Consumer Operated and Oriented Plan Program AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â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)
                  â260
                  â262
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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 075â0118â0â1â551
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  â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. 111â148) authorized and appropriated funding for the
            Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
            insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
            markets in the States. The Secretary 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 075â4418â0â3â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
                  â127
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â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
                  â1
                  
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  â251
                  â294
                  â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)
                  â28
                  â7
                  â7
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â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
                  â259
                  â259
                  
               
               
                  4122
                  Interest on uninvested funds
                  â6
                  â5
                  â5
               
               
                  4123
                  Non-Federal sources
                  
                  â37
                  â560
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â265
                  â301
                  â565
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â229
                  â292
                  â563
               
               
                  4170
                  Outlays, net (mandatory)
                  â237
                  â294
                  â558
               
               
                  4180
                  Budget authority, net (total)
                  â229
                  â292
                  â563
               
               
                  4190
                  Outlays, net (total)
                  â237
                  â294
                  â558
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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
                  
                  â35
                  â11
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â582
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,893
                  1,858
                  1,265
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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 (-)
                  â1,278
                  â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 075â4482â0â3â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
                  â24
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â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
                  â1
                  
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  â133
                  â3
                  â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)
                  â4
                  â1
                  â1
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â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
                  â134
                  â5
                  
               
               
                  4122
                  Interest on uninvested funds
                  â3
                  
                  â164
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â137
                  â5
                  â164
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â132
                  â1
                  â163
               
               
                  4170
                  Outlays, net (mandatory)
                  â133
                  â4
                  â163
               
               
                  4180
                  Budget authority, net (total)
                  â132
                  â1
                  â163
               
               
                  4190
                  Outlays, net (total)
                  â133
                  â4
                  â163
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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
                  
                  
                  â139
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  480
                  480
                  341
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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 (-)
                  â291
                  â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 075â8005â0â7â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)
                  
                  
                  â8
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â5
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â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
                  â3,247
                  â3,039
                  â2,878
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â303,458
                  â319,485
                  â334,568
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â745
                  â765
                  â792
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,348
                  â1,354
                  â1,229
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  
                  â7,210
                  â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
                  â304,744
                  â331,804
                  â352,353
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  â14
                  â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
                  â304,744
                  â331,804
                  â336,668
               
               
                  3098
                  Federal Hospital Insurance Trust Fund
                  â203
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  164,161
                  156,887
                  159,860
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â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)
                  â8
                  
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  â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)
                  â301,430
                  â329,307
                  â350,596
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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
                  
                  
                  â15,685
               
               
                  
                  Outlays
                  
                  
                  â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 075â8005â0â7â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)
                  
                  
                  â8
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â5
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â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 [009â38â8005â0]
                  â301,430
                  â329,307
                  â350,596
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [009â38â8393â0]
                  â1,771
                  â2,297
                  â1,909
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â303,201
                  â331,604
                  â352,505
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Hospital Insurance Trust Fund
                  
                  
                  15,685
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  15,685
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â303,201
                  â331,604
                  â336,820
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  â1,647
                  â14,155
                  â4,150
               
               
                  3120
                  Interest
                  7,354
                  7,081
                  6,971
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  5,707
                  â7,074
                  2,821
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  5,707
                  â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 075â8005â0â7â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 075â8005â0â7â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 075â8005â2â7â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
                  
                  â14
                  â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 075â8005â4â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â15,703
               
               
                  0003
                  Administration, HI
                  
                  
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â15,685
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â15,685
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â230
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â15,455
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â15,685
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â15,685
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â15,685
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â15,685
               
               
                  3020
                  Outlays (gross)
                  
                  
                  15,685
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â15,685
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â15,685
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â15,685
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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 075â8005â4â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â15,703
               
               
                  94.0
                  Financial transfers
                  
                  
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â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 075â8393â0â7â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
                  
                  â26
                  â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
                  â50
                  â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
                  â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)
                  â1,771
                  â2,297
                  â1,909
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â23
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
            in the Analytical Perspectives volume.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  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
                  
                  â26
                  â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 075â8393â0â7â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 075â8004â0â7â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
                  
                  
                  â10
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â10
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â2,246
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â322
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  
                  
                  â7,696
               
               
                  1240
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â80
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â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
                  â2,933
                  â3,006
                  â2,525
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â345,486
                  â371,229
                  â397,476
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â421
                  â633
                  â858
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â88,420
                  â84,665
                  â105,548
               
               
                  2134
                  Federal Supplementary Medical Insurance Trust Fund
                  19,912
                  7,308
                  3,463
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â417,348
                  â452,225
                  â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
                  
                  
                  â7,776
               
               
                  2234
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  7,767
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  
                  10,345
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â417,348
                  â452,225
                  â492,599
               
               
                  3098
                  Federal Supplementary Medical Insurance Trust Fund
                  â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 075â8004â0â7â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
                  â19,912
                  â7,308
                  â3,463
               
               
                  1236
                  Appropriations applied to repay debt
                  â1,372
                  â1,372
                  â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)
                  â325,835
                  â365,354
                  â395,323
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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
                  â6,396
                  â5,024
                  â3,652
               
               
                  5081
                  Outstanding debt, EOY
                  â5,024
                  â3,652
                  â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
                  
                  
                  â10,245
               
               
                  
                  Outlays
                  
                  
                  â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 075â8004â0â7â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
                  
                  
                  â10
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â10
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â2,246
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â322
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  Federal Contributions, FSMI Fund
                  
                  
                  â7,696
               
               
                  1260
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â80
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â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 [009â38â8004â0]
                  â325,835
                  â365,354
                  â395,323
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009â38â8308â0]
                  â82,488
                  â85,125
                  â106,035
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â408,323
                  â450,479
                  â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 (-)
                  â408,323
                  â450,479
                  â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
                  â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 075â8004â0â7â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 075â8004â0â7â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 075â8004â2â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â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 075â8004â4â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â10,265
               
               
                  0004
                  Administration, SMI
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â10,245
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â10,245
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â2,478
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â7,767
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â10,245
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â10,245
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â10,245
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â10,245
               
               
                  3020
                  Outlays (gross)
                  
                  
                  10,245
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â10,245
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â10,245
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â10,245
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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 075â8004â4â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  
                  â10,265
               
               
                  94.0
                  Financial transfers
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  â10,245
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â10,245
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â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
                  â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)
                  â82,488
                  â85,125
                  â106,035
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,466
                  7,639
                  8,009
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â7,541
                  â225
                  â225
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  7,316
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â225
                  â225
                  â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
                  â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
                  
                  
                  â100
               
               
                  
                  Outlays
                  
                  
                  â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 075â8308â0â7â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 075â8308â0â7â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 075â8308â4â7â571
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  
                  
                  â100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 42.0)
                  
                  
                  â100
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â100
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â100
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â100
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â100
               
               
                  3020
                  Outlays (gross)
                  
                  
                  100
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â100
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â100
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â100
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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 075â1552â0â1â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
                  â2
                  â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
                  â23
                  â15
                  â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)
                  â16,415
                  â16,536
                  â16,219
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â1,502
               
               
                  
                  Outlays
                  
                  
                  â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. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171). The TANF Extension Act of 2019 (P.L. 116â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 075â1552â0â1â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 075â1552â0â1â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 075â1552â4â1â609
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  
                  
                  â1,594
               
               
                  0002
                  Territories - family assistance grants
                  
                  
                  â8
               
               
                  0012
                  Promoting Opportunity and Economic Mobility Demonstrations
                  
                  
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,502
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,502
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,502
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,502
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,077
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â425
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â425
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,502
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,077
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,502
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,077
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â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
                  
                  
                  â1,532
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,502
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â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 075â1522â0â1â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)
                  â666
                  â597
                  â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
                  
                  
                  â608
               
               
                  
                  Outlays
                  
                  
                  â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 075â1522â4â1â609
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency Fund for State Welfare Programs
                  
                  
                  â608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â608
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â608
               
               
                  3020
                  Outlays (gross)
                  
                  
                  545
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â63
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â63
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â545
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â608
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â545
               
               
                  
                     
                  
               
            
         
      
         Payments to states for child support enforcement and family support programsFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
            of July 5, 1960,  $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 075â1501â0â1â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
                  â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)
                  â4,150
                  â4,248
                  â4,308
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â159
                  â200
                  â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
                  â13
                  â13
                  â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 075â1501â0â1â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 075â1501â4â1â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)
                  
                  
                  â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 075â1501â4â1â609
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  120
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  â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 075â1502â0â1â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)
                  â3,425
                  â3,692
                  â1,396
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â1502â0â1â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 075â1503â0â1â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 [075â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 [075â0350]
                  16
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1536]
                  30
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1700]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0142]
                  5
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1362]
                  6
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  17
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9912]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  87
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â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
                  â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)
                  â1,661
                  â2,441
                  â2,115
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â52
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,721
                  1,185
                  874
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â180
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â180
                  180
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â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
                  â10
                  â180
                  
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â12
                  â180
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â180
                  180
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â1503â0â1â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 075â1503â0â1â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 075â1503â4â1â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)
                  
                  
                  â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 075â1512â0â1â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
                  â23
                  â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
                  â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)
                  â481
                  â559
                  â569
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â1512â0â1â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 075â1512â0â1â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 075â1512â4â1â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)
                  
                  
                  â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 075â1512â4â1â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 075â1512â4â1â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 075â1550â0â1â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)
                  â2,359
                  â2,819
                  â3,296
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the TANF Extension Act of
            2019 (P.L. 116â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 075â1550â0â1â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 075â1550â4â1â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)
                  
                  
                  â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 075â1515â0â1â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 [075â1503]
                  â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)
                  â3,540
                  â4,804
                  â5,013
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â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 075â1515â0â1â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 075â1515â0â1â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 075â1534â0â1â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
                  â113
                  â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
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  29
                  29
                  29
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  467
                  544
                  605
               
               
                  3010
                  New obligations, unexpired accounts
                  1,672
                  1,680
                  1,700
               
               
                  3020
                  Outlays (gross)
                  â1,587
                  â1,619
                  â1,844
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â1,615
               
               
                  
                  Outlays
                  
                  
                  â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 075â1534â0â1â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 075â1534â0â1â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 075â1534â4â1â506
                  2018 actual
                  2019 est.
                  2020 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  
                  
                  â1,700
               
               
                  0002
                  Health Profession Opportunity Grants
                  
                  
                  85
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,615
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,357
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â258
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â258
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,615
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,357
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,615
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,357
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â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
                  
                  
                  â1,627
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â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 075â1536â0â1â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 [075â1503]
                  â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
                  â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)
                  â11,060
                  â11,250
                  â11,552
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â113
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,886
                  10,495
                  10,151
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â4
                  â20
                  â21
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â18
                  â1
                  â1
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â20
                  â21
                  â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
                  â40
                  â22
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â40
                  â22
                  â22
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â2
                  â2
                  â2
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  â1
                  â1
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  1
                  1
               
               
                  4170
                  Outlays, net (mandatory)
                  â1
                  â2
                  â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 075â1536â0â1â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 075â1536â0â1â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 075â1553â0â1â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
                  â2
                  â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
                  â1
                  â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)
                  â63
                  â71
                  â65
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  25
                  28
                  29
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â8
                  â9
                  â9
               
               
                  4123
                  Non-Federal sources
                  â14
                  â19
                  â19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â22
                  â28
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â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 075â1553â0â1â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 075â1553â0â1â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 075â1545â0â1â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
                  â1
                  â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)
                  â8,581
                  â7,876
                  â8,404
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 Careâ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 Assistanceâ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 ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 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 075â1545â0â1â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 075â1545â0â1â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 075â1545â4â1â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)
                  
                  
                  â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 075â1545â4â1â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 075â1545â4â1â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 075â0142â0â1â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 [012â3507]
                  â3
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,087
                  2,120
                  1,997
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â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
                  â30
                  â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
                  â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)
                  â1,999
                  â2,343
                  â2,313
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,468
                  1,339
                  1,078
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â154
                  â189
                  â162
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â38
                  27
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â189
                  â162
                  â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
                  â2
                  â68
                  â55
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â68
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â55
                  â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)
                  â6
                  â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
                  
                  
                  â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 075â0142â0â1â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 075â0142â0â1â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 075â0142â4â1â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)
                  
                  
                  â5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  5
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â25
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â20
               
               
                  
                     
                  
               
            
         
      
      
         This legislative proposal extends funding for Medicare enrollment assistance programs through 2021. 
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â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 075â0142â4â1â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 075â9912â0â1â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 [075â1503]
                  â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
                  â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)
                  â662
                  â710
                  â690
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â24
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  492
                  534
                  459
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â295
                  â318
                  â318
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â156
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  133
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â318
                  â318
                  â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:
                  â179
                  â256
                  â260
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â179
                  â256
                  â260
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â158
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  117
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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:
                  â21
                  â15
                  â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)
                  â10
                  5
                  
               
               
                  4180
                  Budget authority, net (total)
                  470
                  481
                  340
               
               
                  4190
                  Outlays, net (total)
                  462
                  439
                  415
               
               
                  
                     
                  
               
            
         
      
      
         Note.â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 075â9912â0â1â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 075â9912â0â1â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 075â9912â4â1â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)
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  
                  
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         This legislative proposal provides the Departmental Appeals Board (DAB) mandatory resources 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 075â0146â0â1â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)
                  â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 075â5627â0â2â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
                  â500
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5627â0â2â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 [075â1362]
                  â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 075â0135â0â1â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
                  â1
                  â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)
                  â42
                  â52
                  â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
                  â7
                  â26
                  â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 075â0135â0â1â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 075â0135â0â1â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 075â0130â0â1â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)
                  â71
                  â126
                  â63
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  68
                  17
                  13
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â22
                  â19
                  â19
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â19
                  â19
                  â19
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  44
                  49
                  â2
               
               
                  3200
                  Obligated balance, end of year
                  49
                  â2
                  â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:
                  â17
                  â15
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â17
                  â15
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.
            111â5, Title XIII) and the 21st Century Cures Act (P.L. 114â255), for the purpose of addressing strategic planning, coordination,
            and the analysis of key technical, economic and other issues related to the public and private adoption of health information
            technology.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  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 075â0130â0â1â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 075â0139â0â1â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)
                  â117
                  â228
                  â182
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  56
                  3
                  3
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â38
                  â106
                  â106
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â89
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â106
                  â106
                  â106
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â11
                  â50
                  â103
               
               
                  3200
                  Obligated balance, end of year
                  â50
                  â103
                  â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
                  â114
                  â175
                  â182
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â89
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â0139â0â1â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 075â0139â0â1â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 075â0139â4â1â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)
                  
                  
                  â4
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  4
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  4
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â4
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0140â0â1â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 [075â0343]
                  â2
                  â2
                  â3
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â0360]
                  â60
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â2
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1362]
                  â20
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â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)
                  â2,054
                  â2,908
                  â2,943
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â274
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â178
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,478
                  4,365
                  4,253
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â107
                  â198
                  â280
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â139
                  â82
                  â82
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â198
                  â280
                  â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
                  â84
                  â82
                  â82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â84
                  â82
                  â82
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â139
                  â82
                  â82
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â107
                  â82
                  â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 075â0140â0â1â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 075â0140â0â1â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 075â0145â0â1â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)
                  â88
                  â42
                  â77
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â123
                  â150
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â35
                  â108
                  77
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
            20 percent of the funds appropriated or credited to the PCORTF 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 075â0145â0â1â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 075â0145â0â1â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 075â0125â0â1â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 [075â0960]
                  â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
                  
                  â400
                  â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)
                  â242
                  93
                  201
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  
                  â400
                  â400
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â400
                  â400
               
               
                  4011
                  Outlays from discretionary balances
                  242
                  307
                  199
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  242
                  â93
                  â201
               
               
                  4180
                  Budget authority, net (total)
                  
                  â400
                  â400
               
               
                  4190
                  Outlays, net (total)
                  242
                  â93
                  â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 075â0125â0â1â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 075â0125â0â1â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 075â0119â0â1â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)
                  
                  â2
                  â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. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
         Prevention and Public Health FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â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 [075â0142]
                  â28
                  â28
                  
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â801
                  â805
                  â894
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  â12
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â59
                  â55
                  â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 075â0117â0â1â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
                  â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)
                  â21
                  â29
                  â9
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â0117â0â1â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 075â0117â0â1â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 075â3902â0â1â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)
                  â437
                  â1,150
                  â528
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  634
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â556
                  â630
                  â630
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â438
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  364
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â630
                  â630
                  â630
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3
                  4
                  â630
               
               
                  3200
                  Obligated balance, end of year
                  4
                  â630
                  â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
                  â438
                  â516
                  â528
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â438
                  â516
                  â528
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â438
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  364
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â74
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â1
                  634
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â0379â0â1â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)
                  â556
                  â674
                  â623
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â0379â0â1â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 075â0170â0â1â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)
                  â32
                  â29
                  â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. 108â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 075â9913â0â1â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 075â9941â0â4â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)
                  â1,590
                  â2,995
                  â1,948
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â53
                  
                  â250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,264
                  442
                  442
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â536
                  â674
                  â674
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â138
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â674
                  â674
                  â674
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  475
                  590
                  â232
               
               
                  3200
                  Obligated balance, end of year
                  590
                  â232
                  â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
                  â1,142
                  â1,967
                  â1,948
               
               
                  4033
                  Non-Federal sources
                  â569
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,711
                  â1,967
                  â1,948
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â138
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â121
                  1,028
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â9941â0â4â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 075â9941â0â4â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 075â9971â0â7â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
                  â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
                  â111
                  â95
                  â95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â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
                  â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)
                  â94
                  â149
                  â149
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  â8
                  â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
                  
                  â61
                  â61
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  
                  61
                  61
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  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 075â9971â0â7â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 075â9971â0â7â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 075â0128â0â1â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 [075â9911]
                  2
                  2
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  2
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â1
                  â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)
                  â376
                  â439
                  â419
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  97
                  89
                  91
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â114
                  â134
                  â134
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â28
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â134
                  â134
                  â134
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â36
                  â37
                  â45
               
               
                  3200
                  Obligated balance, end of year
                  â37
                  â45
                  â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
                  â100
                  â108
                  â111
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â179
                  â196
                  â213
               
               
                  4123
                  Non-Federal sources
                  â13
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â192
                  â208
                  â225
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  
                  1
               
               
                  4170
                  Outlays, net (mandatory)
                  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 075â0128â0â1â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 075â0128â0â1â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:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  114
                  90
                  90
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                  15
                  
                  
               
               
                  075â275830
                  Downward Reestimates of Subsidies, Health Centers
                  
                  1
                  
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  609
                  596
                  585
               
               
                  075â310700
                  Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO
                  
                  
                  10
               
               
                  075â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:
               
               
                  075â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  â729
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  â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.â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.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      SEC. 214. Not to exceed  $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)), ifâ
      (1) funds are available and obligatedâ
         (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
         (B) for the estimated costs associated with a necessary termination of the contract; and
      
      (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
         full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
      
      (b) A contract entered into under this sectionâ
         (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
         (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
      '
      			
      (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 ifâ
      (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 110â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.âUnder the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
            the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
            within the Department or of another agency under whichâ (1)  the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
               or cooperative agreement on behalf of the ordering agency or unit;  
      (2)  the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
               and  
      (3)  the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
               and for the service of executing or managing the grant or cooperative agreement. 
      (b)  CONDITIONS.âThe conditions for making an agreement described in subsection (a) are thatâ (1)  amounts are available; 
         (2)  the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and 
         (3)  the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service. 
      
      (c)  PAYMENT.âPayment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
               agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
               any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
               request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
               shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
               and the actual cost of service provided. 
      (d)  LIMITATIONS ON FUNDS.âA condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
               agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement. 
      (e)  OBLIGATION OF APPROPRIATIONS.âAn agreement made under this section obligates an appropriation of the ordering agency or unit.
               The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
               before the end of the period of availability of the appropriation, inâ (1)  awarding the grant or cooperative agreement; or 
         (2)  providing the agreed-on services. 
      
      (f)  NO EFFECT ON OTHER LAWSâ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 115â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 Servicesâ Centers for Medicare and Medicaid ServicesâProgram Management" account, to remain available until expended,
            for such purpose. No such fees shall be charged to an Indian Health Program (as that term is defined in section 4 of the Indian
            Health Care Improvement Act). SEC. 226.  Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amendedâ (a)  in subsection (a)(5)(C)â (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE.âA covered entity shall
                  permit" and;  
         (2)  by inserting at the end the following:  
      
      
         "(ii) USE OF SAVINGS.âA covered entity shall permit the Secretary to audit, at the Secretary's expense, the records of the
                  entity to determine how net income from purchases under this section are used by the covered entity. 
      
      
         "(iii) RECORDS RETENTION.âCovered entities shall retain such records and provide such records and reports as deemed necessary
                  by the Secretary for carrying out this subparagraph.". 
      
      (b)  by adding at the end the following new subsection: "(f) REGULATIONS.âThe Secretary may promulgate such regulations as the
               Secretary determines necessary or appropriate to carry out the provisions of this section.". SEC. 227. (a)   IN GENERAL.âA State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
            of Health and Human ServicesâAdministration for Community LivingâAging and Disability Services Programs" to carry out programs
            under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
            the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
            or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
            limitations on such transfers under the OAA or such heading.  (b)  NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.âA State or tribal organization which elects to make a transfer under
               subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
               of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
               the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
               the Secretary determines that such transfer is not consistent with the objectives of the OAA.  
      (c)  RULES OF CONSTRUCTION.âNo transfer of grant funds by a State or tribal organization under this section shall be construedâ (1)  as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
                  by the Secretary; or  
         (2)  to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
                  funds. 
      SEC. 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 "NIHâOffice
            of the Director" account shall also be available to establish and operate the Research Policy Board authorized by section
            2034(f) of Public Law 114â255. '
      			
      (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 amendedâ (a)  in subsection (a),â (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.â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 Servicesâ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.)