[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; in addition
            to amounts appropriated to the FDA Innovation Account, for carrying out the activities described in section 1002(b)(4) of
            the 21st Century Cures Act (Public Law 114â255); 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;  $5,897,299,000: Provided, That of the amount provided under this heading,  $1,119,188,000 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;  $238,595,000 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;  $526,039,000 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;  $42,998,000 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;  $31,306,000 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;  $20,609,000 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 new animal drug user fees that exceed the respective fiscal year  2021 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 new animal drug assessments for fiscal year  2021, including any such fees collected prior to fiscal year  2021 but credited for fiscal year  2021, shall be subject to the fiscal year  2021 limitations: Provided further, That the Secretary may accept payment during fiscal year  2021 of user fees specified under this heading and authorized for fiscal year  2022, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year  2022 for which the Secretary accepts payment in fiscal year  2021 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 any transfer of funds pursuant to section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd(n)) shall
            only be from amounts made available under this heading for other activities:  Provided further, That funds may be transferred from one specified activity to another with the prior  notice to 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, and, contingent
            upon the enactment of the Over-the-Counter Monograph User Fee Act of  2020, fees relating to over-the-counter monograph drugs authorized by part 10 of subchapter C of Chapter VII of the Federal Food,
            Drug and Cosmetic Act shall be credited to this account, to remain available until expended.
      (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2020.)
         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,  $13,788,000, to remain available until expended.
      (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foods
                  1,060
                  1,089
                  1,091
               
               
                  0002
                  Human Drugs
                  663
                  683
                  683
               
               
                  0003
                  Devices and Radiological Health
                  387
                  395
                  416
               
               
                  0004
                  National Center for Toxicological Research
                  67
                  67
                  66
               
               
                  0005
                  FDA Other Activities (FDA Headquaters)
                  186
                  185
                  187
               
               
                  0006
                  FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)
                  115
                  126
                  154
               
               
                  0007
                  FDA GSA Rental Payments
                  170
                  171
                  167
               
               
                  0008
                  FDA Buildings and Facilities
                  12
                  32
                  14
               
               
                  0009
                  Cooperative Research and Development (CRADA)
                  1
                  2
                  2
               
               
                  0010
                  Animal Drugs and Feed
                  179
                  191
                  190
               
               
                  0011
                  Biologics
                  240
                  252
                  252
               
               
                  0015
                  CURES Activities
                  
                  75
                  70
               
               
                  0016
                  Emerging Health Threats
                  5
                  
                  
               
               
                  0017
                  Opioids - IMF
                  65
                  
                  
               
               
                  0018
                  FDA HCFAC Wedge Fund
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,156
                  3,268
                  3,292
               
               
                  0801
                  FDA Reimbursable program (User fees)
                  2,447
                  2,664
                  2,744
               
               
                  0802
                  FDA Reimbursable program (Federal sources)
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  2,479
                  2,664
                  2,744
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  5,635
                  5,932
                  6,036
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  927
                  1,022
                  1,017
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  926
                  1,000
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  984
                  1,022
                  1,017
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,080
                  3,192
                  3,220
               
               
                  1120
                  Appropriations transferred to other accts [075â0128]
                  â2
                  â2
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5629]
                  
                  75
                  70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,078
                  3,265
                  3,290
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1
                  2
                  2
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2,557
                  2,660
                  2,743
               
               
                  1700
                  Collected
                  10
                  22
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  22
                  â22
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  772
                  
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â774
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  2,587
                  2,660
                  2,743
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1
                  
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  7
                  
                  
               
               
                  1900
                  Budget authority (total)
                  5,673
                  5,927
                  6,035
               
               
                  1930
                  Total budgetary resources available
                  6,657
                  6,949
                  7,052
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,022
                  1,017
                  1,016
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,978
                  2,867
                  2,993
               
               
                  3010
                  New obligations, unexpired accounts
                  5,635
                  5,932
                  6,036
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  26
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,615
                  â5,806
                  â6,294
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â57
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â100
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,867
                  2,993
                  2,735
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â70
                  â66
                  â44
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â28
                  22
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â66
                  â44
                  â44
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,908
                  2,801
                  2,949
               
               
                  3200
                  Obligated balance, end of year
                  2,801
                  2,949
                  2,691
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,665
                  5,925
                  6,033
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  3,323
                  4,735
                  4,832
               
               
                  4011
                  Outlays from discretionary balances
                  2,284
                  1,063
                  1,460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  5,607
                  5,798
                  6,292
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â35
                  â22
                  
               
               
                  4033
                  Non-Federal sources:
                  â2,557
                  â2,660
                  â2,743
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â2,592
                  â2,682
                  â2,743
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â22
                  22
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  3
                  22
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,076
                  3,265
                  3,290
               
               
                  4080
                  Outlays, net (discretionary)
                  3,015
                  3,116
                  3,549
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8
                  2
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6
                  2
                  2
               
               
                  4101
                  Outlays from mandatory balances
                  2
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8
                  8
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  
                  â6
                  
               
               
                  4123
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â1
                  â6
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â6
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â6
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  1
                  2
                  2
               
               
                  4170
                  Outlays, net (mandatory)
                  7
                  2
                  2
               
               
                  4180
                  Budget authority, net (total)
                  3,077
                  3,267
                  3,292
               
               
                  4190
                  Outlays, net (total)
                  3,022
                  3,118
                  3,551
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  804
                  806
                  806
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  806
                  806
                  806
               
               
                  
                     
                  
               
            
         
      
      
         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 2021 Budget includes $6.2 billion in total resources for FDA. The Budget
            invests in priority activities such as artificial intelligence, regulation of cannabis and cannabis derivatives, modernizing
            influenza vaccines, food safety track and trace, and infrastructure.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  880
                  971
                  977
               
               
                  11.3
                  Other than full-time permanent
                  88
                  99
                  100
               
               
                  11.5
                  Other personnel compensation
                  39
                  45
                  45
               
               
                  11.7
                  Military personnel
                  59
                  61
                  62
               
               
                  11.8
                  Special personal services payments
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,067
                  1,177
                  1,185
               
               
                  12.1
                  Civilian personnel benefits
                  332
                  367
                  369
               
               
                  12.2
                  Military personnel benefits
                  32
                  33
                  34
               
               
                  21.0
                  Travel and transportation of persons
                  50
                  47
                  48
               
               
                  22.0
                  Transportation of things
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  173
                  171
                  167
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  18
                  17
                  17
               
               
                  24.0
                  Printing and reproduction
                  2
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  44
                  42
                  43
               
               
                  25.2
                  Other services from non-Federal sources
                  412
                  412
                  416
               
               
                  25.3
                  Other goods and services from Federal sources
                  506
                  484
                  489
               
               
                  25.4
                  Operation and maintenance of facilities
                  139
                  133
                  135
               
               
                  25.5
                  Research and development contracts
                  20
                  19
                  20
               
               
                  25.7
                  Operation and maintenance of equipment
                  35
                  33
                  34
               
               
                  26.0
                  Supplies and materials
                  39
                  38
                  38
               
               
                  31.0
                  Equipment
                  63
                  60
                  61
               
               
                  32.0
                  Land and structures
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  215
                  223
                  225
               
               
                  42.0
                  Insurance claims and indemnities
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,156
                  3,267
                  3,292
               
               
                  99.0
                  Reimbursable obligations
                  2,479
                  2,665
                  2,744
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,635
                  5,932
                  6,036
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8,439
                  8,576
                  8,637
               
               
                  1101
                  Direct military average strength employment
                  658
                  658
                  658
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  6,269
                  6,811
                  6,974
               
               
                  2101
                  Reimbursable military average strength employment
                  488
                  488
                  488
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  25
                  25
                  25
               
               
                  3101
                  Allocation account military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses 
         (Legislative proposal, not subject to PAYGO) 
       Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for 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 2021 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 2021 received during fiscal year 2021, including any such fees assessed prior to fiscal year
               2021 but credited for fiscal year 2021, shall be subject to the fiscal year 2021 limitations: Provided further, That the Secretary
               may accept payment during fiscal year 2021 of user fees specified in this paragraph and authorized for fiscal year 2022, prior
               to the due date for such fees, and that amounts of such fees assessed for fiscal year 2022 for which the Secretary accepts
               payment in fiscal year 2021 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.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  FDA Reimbursable program (Tobacco, OTC and Food innovation)
                  
                  
                  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 2021 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
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  324
                  324
                  324
               
               
                  0801
                  Reimbursable program activity
                  257
                  295
                  295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  581
                  619
                  619
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  33
                  33
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  609
                  619
                  619
               
               
                  1900
                  Budget authority (total)
                  609
                  619
                  619
               
               
                  1930
                  Total budgetary resources available
                  614
                  652
                  652
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  33
                  33
                  33
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  205
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  581
                  619
                  619
               
               
                  3020
                  Outlays (gross)
                  â376
                  â824
                  â619
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  205
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  205
                  
               
               
                  3200
                  Obligated balance, end of year
                  205
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  609
                  619
                  619
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  376
                  619
                  619
               
               
                  4011
                  Outlays from discretionary balances
                  
                  205
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  376
                  824
                  619
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â609
                  â619
                  â619
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â233
                  205
                  
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  73
                  73
                  73
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  77
                  77
                  77
               
               
                  12.1
                  Civilian personnel benefits
                  26
                  26
                  26
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  6
                  6
                  6
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  15
                  15
                  15
               
               
                  25.2
                  Other services from non-Federal sources
                  77
                  77
                  77
               
               
                  25.3
                  Other goods and services from Federal sources
                  54
                  54
                  54
               
               
                  25.4
                  Operation and maintenance of facilities
                  3
                  3
                  3
               
               
                  25.7
                  Operation and maintenance of equipment
                  56
                  56
                  56
               
               
                  26.0
                  Supplies and materials
                  4
                  4
                  4
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1
                  1
                  1
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  324
                  324
                  324
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  58
                  58
                  58
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  61
                  61
                  61
               
               
                  12.1
                  Civilian personnel benefits
                  20
                  20
                  20
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  5
                  5
                  5
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  12
                  12
                  12
               
               
                  25.2
                  Other services from non-Federal sources
                  63
                  63
                  63
               
               
                  25.3
                  Other goods and services from Federal sources
                  43
                  81
                  81
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  2
               
               
                  25.7
                  Operation and maintenance of equipment
                  44
                  44
                  44
               
               
                  26.0
                  Supplies and materials
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1
                  1
                  1
               
               
                  43.0
                  Interest and dividends
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  257
                  295
                  295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  581
                  619
                  619
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  697
                  697
                  697
               
               
                  1101
                  Direct military average strength employment
                  8
                  8
                  8
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  480
                  480
                  480
               
               
                  2101
                  Reimbursable military average strength employment
                  6
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
         Payment to the FDA Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0148â0â1â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  70
                  75
                  70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 94.0)
                  70
                  75
                  70
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  70
                  75
                  70
               
               
                  1930
                  Total budgetary resources available
                  70
                  75
                  70
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  70
                  75
                  70
               
               
                  3020
                  Outlays (gross)
                  â70
                  â75
                  â70
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  70
                  75
                  70
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  70
                  75
                  70
               
               
                  4180
                  Budget authority, net (total)
                  70
                  75
                  70
               
               
                  4190
                  Outlays, net (total)
                  70
                  75
                  70
               
               
                  
                     
                  
               
            
         
      
      
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         FDA Innovation Account, Cures Act
         (including transfer of funds)For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes under the heading "Salaries and Expenses",  $70,000,000, to remain available until expended: Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act,
            are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the Commissioner
            of Food and Drugs to the appropriation for "Department of Health and Human Services Food and Drug Administration Salaries
            and Expenses" solely for the purposes provided in such Act: Provided further, That upon a determination by the Commissioner 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 such transfer authority is in addition to any other transfer authority provided by law.
      (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  General Fund Payment, FDA Innovation, CURES Act
                  70
                  75
                  70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  70
                  75
                  70
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  FDA Innovation, Cures Act
                  â70
                  â75
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  New Obligations for CURES Activities
                  58
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  26
                  38
                  38
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  70
                  75
                  70
               
               
                  1120
                  Appropriations transferred to other acct [075â9911]
                  
                  â75
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  70
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  96
                  38
                  38
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  38
                  38
                  38
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  27
                  42
                  2
               
               
                  3010
                  New obligations, unexpired accounts
                  58
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â43
                  â40
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  42
                  2
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  27
                  42
                  2
               
               
                  3200
                  Obligated balance, end of year
                  42
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  70
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  17
                  
                  
               
               
                  4011
                  Outlays from discretionary balances
                  26
                  40
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  43
                  40
                  
               
               
                  4180
                  Budget authority, net (total)
                  70
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  43
                  40
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 product, 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  13
                  
                  
               
               
                  11.3
                  Other than full-time permanent
                  3
                  
                  
               
               
                  11.5
                  Other personnel compensation
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  18
                  
                  
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  15
                  
                  
               
               
                  26.0
                  Supplies and materials
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  58
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  136
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other ServicesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Revolving Fund for Certification and Other Services (Reimbursable)
                  9
                  10
                  11
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  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
                  12
                  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
                  4
                  5
                  2
               
               
                  3010
                  New obligations, unexpired accounts
                  9
                  10
                  11
               
               
                  3020
                  Outlays (gross)
                  â8
                  â13
                  â11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5
                  2
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4
                  5
                  2
               
               
                  3200
                  Obligated balance, end of year
                  5
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  9
                  10
                  11
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  5
                  10
                  11
               
               
                  4101
                  Outlays from mandatory balances
                  3
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8
                  13
                  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)
                  â1
                  3
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  3
                  3
                  3
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  4
                  4
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  2
                  2
               
               
                  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
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  9
                  10
                  11
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  33
                  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,  $1,728,522,000: 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,  $370,425,000: 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 $120,000,000 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,  $919,018,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than  $132,593,000 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,  $2,483,781,000, of which $1,970,881,000 shall remain available to the Secretary through September 30,  2023, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance
            Programs under the authority of section 2616 or 311(c) of such Act; and of which  $165,000,000, 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 HIV/AIDS 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,  $102,033,000: Provided, That in addition to amounts provided herein, $13,385,000 shall be from funds available under section
               241 of the PHS Act to supplement funding for organ transplantation activities: Provided further, That the Secretary may collect
               a fee of 0.1 percent of each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant to section
               340B of the PHS Act to pay for the operating costs of such program: Provided further, That fees pursuant to the 340B Drug
               Pricing Program shall be collected by the Secretary based on sales data that shall be submitted by drug manufacturers and
               shall be credited to this account to remain available until expended. 
      
         Rural healthFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
            and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act,  $246,834,000.
      
         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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0005
                  Primary Health Care (Health Centers, Free Clinics)
                  1,644
                  1,707
                  1,729
               
               
                  0010
                  Primary Health Care (Mandatory)
                  4,047
                  2,576
                  
               
               
                  0015
                  Health Workforce
                  1,091
                  1,324
                  370
               
               
                  0020
                  Health Workforce (Mandatory)
                  439
                  281
                  
               
               
                  0025
                  Maternal and Child Health
                  923
                  944
                  919
               
               
                  0030
                  Maternal and Child Health (Mandatory)
                  6
                  6
                  6
               
               
                  0035
                  Ryan White HIV/AIDS
                  2,332
                  2,390
                  2,484
               
               
                  0040
                  Health Care Systems
                  114
                  124
                  102
               
               
                  0045
                  Rural Health
                  352
                  361
                  247
               
               
                  0050
                  Family Planning
                  285
                  286
                  286
               
               
                  0055
                  HRSA Program Management
                  155
                  155
                  152
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Direct program activities, subtotal
                  11,388
                  10,154
                  6,295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  11,388
                  10,154
                  6,295
               
               
                  
                  Credit program obligations:
               
               
                  0702
                  Loan guarantee subsidy
                  
                  1
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  11,388
                  10,155
                  6,297
               
               
                  0801
                  Health Resources and Services (Reimbursable)
                  68
                  51
                  75
               
               
                  0802
                  HRSA Reimbursable program: PHS evaluation
                  
                  
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  68
                  51
                  88
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  11,456
                  10,206
                  6,385
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  454
                  460
                  201
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  336
                  345
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0116]
                  â8
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [015â5606]
                  â5
                  â5
                  â5
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  72
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  513
                  455
                  196
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  6,844
                  7,037
                  6,289
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â21
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  80
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  6,903
                  7,037
                  6,289
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  4,443
                  2,863
                  6
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  22
                  31
                  68
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  32
                  31
                  68
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Offsetting collections (cash)(HPSL&NSL)
                  27
                  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)
                  27
                  21
                  21
               
               
                  1900
                  Budget authority (total)
                  11,405
                  9,952
                  6,384
               
               
                  1930
                  Total budgetary resources available
                  11,918
                  10,407
                  6,580
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  460
                  201
                  195
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  7,969
                  8,278
                  8,025
               
               
                  3010
                  New obligations, unexpired accounts
                  11,456
                  10,206
                  6,385
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  34
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â11,002
                  â10,459
                  â8,565
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â72
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â107
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,278
                  8,025
                  5,845
               
               
                  
                  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
                  7,953
                  8,262
                  8,009
               
               
                  3200
                  Obligated balance, end of year
                  8,262
                  8,009
                  5,829
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  6,935
                  7,068
                  6,357
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,247
                  2,297
                  2,040
               
               
                  4011
                  Outlays from discretionary balances
                  4,388
                  4,476
                  4,822
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  6,635
                  6,773
                  6,862
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â12
                  â12
                  â25
               
               
                  4033
                  Non-Federal sources
                  â23
                  â19
                  â43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â35
                  â31
                  â68
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  6,903
                  7,037
                  6,289
               
               
                  4080
                  Outlays, net (discretionary)
                  6,600
                  6,742
                  6,794
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,470
                  2,884
                  27
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,904
                  1,269
                  23
               
               
                  4101
                  Outlays from mandatory balances
                  2,463
                  2,417
                  1,680
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,367
                  3,686
                  1,703
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â27
                  â20
                  â20
               
               
                  4180
                  Budget authority, net (total)
                  11,346
                  9,901
                  6,296
               
               
                  4190
                  Outlays, net (total)
                  10,940
                  10,408
                  8,477
               
               
                  
                     
                  
               
               
                  
                  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)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  11,346
                  9,901
                  6,296
               
               
                  
                  Outlays
                  10,940
                  10,408
                  8,477
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  1,580
                  4,437
               
               
                  
                  Outlays
                  
                  689
                  2,771
               
               
                  Total:
               
               
                  
                  Budget Authority
                  11,346
                  11,481
                  10,733
               
               
                  
                  Outlays
                  10,940
                  11,097
                  11,248
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Guaranteed loan levels supportable by subsidy budget authority:
               
               
                  215001
                  Health centers: Facilities renovation loan guarantee levels
                  
                  60
                  66
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  215999
                  Total loan guarantee levels
                  
                  60
                  66
               
               
                  
                  Guaranteed loan subsidy (in percent):
               
               
                  232001
                  Health centers: Facilities renovation loan guarantee levels
                  0.00
                  2.57
                  2.78
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  232999
                  Weighted average subsidy rate
                  0.00
                  2.57
                  2.78
               
               
                  
                  Guaranteed loan subsidy budget authority:
               
               
                  233001
                  Health centers: Facilities renovation loan guarantee levels
                  
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  233999
                  Total subsidy budget authority
                  
                  2
                  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 2018â2019 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     436,419,789
                  
                  
                     NSL
                     201,922,803
                  
                  
                     PCL
                     216,454,324
                  
                  
                     LDS
                     187,255,691
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     1,042,052,607
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  205
                  199
                  161
               
               
                  11.3
                  Other than full-time permanent
                  7
                  7
                  6
               
               
                  11.5
                  Other personnel compensation
                  5
                  5
                  4
               
               
                  11.7
                  Military personnel
                  20
                  18
                  14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  237
                  229
                  185
               
               
                  12.1
                  Civilian personnel benefits
                  67
                  64
                  52
               
               
                  12.2
                  Military personnel benefits
                  11
                  10
                  8
               
               
                  13.0
                  Benefits for former personnel
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  4
                  4
                  3
               
               
                  23.1
                  Rental payments to GSA
                  20
                  20
                  16
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  5
                  4
                  2
               
               
                  25.1
                  Advisory and assistance services
                  12
                  12
                  9
               
               
                  25.2
                  Other services from non-Federal sources
                  266
                  268
                  210
               
               
                  25.3
                  Other goods and services from Federal sources
                  303
                  293
                  146
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.6
                  Medical care
                  2
                  2
                  2
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  5
                  4
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  8
                  6
                  5
               
               
                  32.0
                  Land and structures
                  4
                  4
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions
                  10,304
                  9,122
                  5,538
               
               
                  42.0
                  Insurance claims and indemnities
                  135
                  107
                  108
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  11,388
                  10,155
                  6,297
               
               
                  99.0
                  Reimbursable obligations
                  68
                  51
                  88
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  11,456
                  10,206
                  6,385
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,808
                  1,735
                  1,426
               
               
                  1101
                  Direct military average strength employment
                  191
                  178
                  144
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  52
                  52
                  68
               
               
                  2101
                  Reimbursable military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0010
                  Primary Health Care (Mandatory)
                  
                  1,425
                  4,000
               
               
                  0020
                  Health Workforce (Mandatory)
                  
                  155
                  437
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Direct program activities, subtotal
                  
                  1,580
                  4,437
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  
                  1,580
                  4,437
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  1,580
                  4,437
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  1,580
                  4,437
               
               
                  1900
                  Budget authority (total)
                  
                  1,580
                  4,437
               
               
                  1930
                  Total budgetary resources available
                  
                  1,580
                  4,437
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  891
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  1,580
                  4,437
               
               
                  3020
                  Outlays (gross)
                  
                  â689
                  â2,771
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  891
                  2,557
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  891
               
               
                  3200
                  Obligated balance, end of year
                  
                  891
                  2,557
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  1,580
                  4,437
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  689
                  1,935
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  836
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  689
                  2,771
               
               
                  4180
                  Budget authority, net (total)
                  
                  1,580
                  4,437
               
               
                  4190
                  Outlays, net (total)
                  
                  689
                  2,771
               
               
                  
                     
                  
               
            
         
      
      
         Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
            activities include support for Health Centers and health workforce programs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  17
                  48
               
               
                  11.3
                  Other than full-time permanent
                  
                  
                  1
               
               
                  11.5
                  Other personnel compensation
                  
                  
                  1
               
               
                  11.7
                  Military personnel
                  
                  2
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  19
                  56
               
               
                  12.1
                  Civilian personnel benefits
                  
                  6
                  16
               
               
                  12.2
                  Military personnel benefits
                  
                  1
                  3
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  4
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  2
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  37
                  42
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  112
                  122
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  1
               
               
                  31.0
                  Equipment
                  
                  
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  1,403
                  4,188
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  1,580
                  4,437
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  130
                  365
               
               
                  1101
                  Direct military average strength employment
                  
                  13
                  36
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury CompensationProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0320â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  33
                  35
                  35
               
               
                  1033
                  Recoveries of prior year paid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  35
                  35
                  35
               
               
                  1930
                  Total budgetary resources available
                  35
                  35
                  35
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  35
                  35
                  35
               
               
                  
                     
                  
               
               
                  
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Claims
                  
                  1
                  1
               
               
                  0103
                  Admin Expense
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2
                  3
                  3
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  1
                  1
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  2
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  4
                  4
               
               
                  1930
                  Total budgetary resources available
                  3
                  4
                  4
               
               
                  
                  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
                  1
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  3
                  3
               
               
                  3020
                  Outlays (gross)
                  â2
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  1
                  4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  1
                  1
               
               
                  3200
                  Obligated balance, end of year
                  1
                  1
                  4
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  2
                  3
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  2
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1
                  2
                  2
               
               
                  99.5
                  Adjustment for rounding
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  3
                  3
               
               
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0010
                  Maternal, Infant, and Early Childhood Home Visiting Programs
                  402
                  376
                  400
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  20
                  26
                  26
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  28
                  26
                  26
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  400
                  400
                  400
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â24
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  400
                  376
                  400
               
               
                  1930
                  Total budgetary resources available
                  428
                  402
                  426
               
               
                  
                  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
                  748
                  758
                  748
               
               
                  3010
                  New obligations, unexpired accounts
                  402
                  376
                  400
               
               
                  3020
                  Outlays (gross)
                  â384
                  â386
                  â392
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  758
                  748
                  756
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  748
                  758
                  748
               
               
                  3200
                  Obligated balance, end of year
                  758
                  748
                  756
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  400
                  376
                  400
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  11
                  15
                  16
               
               
                  4101
                  Outlays from mandatory balances
                  373
                  371
                  376
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  384
                  386
                  392
               
               
                  4180
                  Budget authority, net (total)
                  400
                  376
                  400
               
               
                  4190
                  Outlays, net (total)
                  384
                  386
                  392
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 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
                  14
                  13
                  13
               
               
                  41.0
                  Grants, subsidies, and contributions
                  381
                  356
                  380
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  402
                  376
                  400
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  36
                  36
                  36
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  2019 actual
                  2020 est.
                  2021 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
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  1
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on commitments:
               
               
                  2111
                  Guaranteed loan commitments from current-year authority
                  
                  
                  
               
               
                  2121
                  Limitation available from carry-forward
                  888
                  888
                  828
               
               
                  2143
                  Uncommitted limitation carried forward
                  â888
                  â828
                  â762
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2150
                  Total guaranteed loan commitments
                  
                  60
                  66
               
               
                  2199
                  Guaranteed amount of guaranteed loan commitments
                  
                  48
                  53
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of guaranteed loans outstanding:
               
               
                  2210
                  Outstanding, start of year
                  60
                  34
                  83
               
               
                  2231
                  Disbursements of new guaranteed loans
                  
                  60
                  66
               
               
                  2251
                  Repayments and prepayments
                  â26
                  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
                  34
                  83
                  138
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  25
                  64
                  108
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2018 actual
                  2019 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  1
                  1
               
               
                  
                  LIABILITIES:
               
               
                  2204
                  Non-Federal liabilities: Liabilities for loan guarantees
                  1
                  1
               
               
                  
                  NET POSITION:
               
               
                  3300
                  Cumulative results of operations
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan FundStatus of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â551
                  2019 actual
                  2020 est.
                  2021 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
                  2018 actual
                  2019 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  $16,200,000 shall be available from the Trust Fund to the Secretary.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  3,684
                  3,818
                  3,921
               
               
                  0198
                  Adjustment to reconcile to budgetary accounting
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  3,688
                  3,818
                  3,921
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Deposits, Vaccine Injury Compensation Trust Fund
                  280
                  303
                  309
               
               
                  1140
                  Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                  94
                  92
                  101
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  374
                  395
                  410
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  374
                  395
                  410
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  4,062
                  4,213
                  4,331
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â28
                  â32
                  â45
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â346
                  â260
                  â266
               
               
                  2135
                  Vaccine Injury Compensation Program Trust Fund
                  120
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â254
                  â292
                  â311
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â254
                  â292
                  â311
               
               
                  4030
                  Vaccine Injury Compensation Program Trust Fund
                  9
                  
                  
               
               
                  5098
                  Adjustment to reconcile to budgetary accounting
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  3,818
                  3,921
                  4,020
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Compensation: Claims for post - FY 1989 injuries
                  226
                  260
                  266
               
               
                  0103
                  Claims processing (Claims Court)
                  9
                  9
                  10
               
               
                  0104
                  Claims processing (HRSA)
                  9
                  10
                  16
               
               
                  0105
                  Claims processing (Dept. of Justice)
                  10
                  13
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Direct program activities, subtotal
                  28
                  32
                  45
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  254
                  292
                  311
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1033
                  Recoveries of prior year paid obligations
                  9
                  
                  
               
               
                  1035
                  Unobligated balance of appropriations withdrawn
                  â9
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  28
                  32
                  45
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  346
                  260
                  266
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  â120
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  226
                  260
                  266
               
               
                  1900
                  Budget authority (total)
                  254
                  292
                  311
               
               
                  1930
                  Total budgetary resources available
                  254
                  292
                  311
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  19
                  13
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  254
                  292
                  311
               
               
                  3020
                  Outlays (gross)
                  â260
                  â305
                  â311
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  13
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  19
                  13
                  
               
               
                  3200
                  Obligated balance, end of year
                  13
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  28
                  32
                  45
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  21
                  32
                  45
               
               
                  4011
                  Outlays from discretionary balances
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  34
                  32
                  45
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  226
                  260
                  266
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  226
                  260
                  266
               
               
                  4101
                  Outlays from mandatory balances
                  
                  13
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  226
                  273
                  266
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â9
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  226
                  260
                  266
               
               
                  4170
                  Outlays, net (mandatory)
                  217
                  273
                  266
               
               
                  4180
                  Budget authority, net (total)
                  254
                  292
                  311
               
               
                  4190
                  Outlays, net (total)
                  251
                  305
                  311
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  3,750
                  3,849
                  3,984
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  3,849
                  3,984
                  4,128
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 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
                  5
                  5
                  5
               
               
                  42.0
                  Insurance claims and indemnities
                  246
                  284
                  302
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  254
                  292
                  311
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  14
                  16
                  23
               
               
                  1101
                  Direct military average strength employment
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
         Indian Health ServiceFederal Funds
         Indian health serviceFor 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,  $4,507,113,000 to remain available until September 30,  2022, except as otherwise provided herein, together with payments received during the fiscal year pursuant to sections 231(b)
            and 233 of the Public Health Service Act (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  $964,783,000 for Purchased/Referred Care, including $53,000,000 for the Indian Catastrophic Health Emergency Fund, shall remain available
            until expended: Provided further, That of the funds provided, up to  $44,000,000 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,  $58,000,000 shall be for costs related to or resulting from accreditation emergencies, including supplementing activities
            funded under the heading "Indian Health Facilities," of which up to $4,000,000 may be used to supplement amounts otherwise
            available for Purchased/Referred Care: 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 that Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c)
            of that 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 that Act (25 U.S.C. 1613a and 1616a): Provided further, That the amounts made available within this account for the Substance Abuse and Suicide Prevention Program, for Opioid Prevention,
            Treatment and Recovery Services, for the Domestic Violence Prevention Program, for the Zero Suicide Initiative, for  recruitment and retention, including a housing subsidy authority for civilian employees, for Aftercare Pilot Programs at Youth Regional Treatment Centers, for transformation
            and modernization costs of the Indian Health Service Electronic Health Record system, for national quality and oversight activities,to
            improve collections from public and private insurance at Indian Health Service and tribally operated facilities, for an initiative to treat or reduce the transmission of HIV and HCV, for the Telebehaviorial Health Center of Excellence,
               for a maternal health initiative, for Community Health, 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 (25 U.S.C. 1613) 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, and from 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 of the funds provided, $72,280,000 is for the Indian Health Care Improvement Fund and may be used, as needed, to carry
            out activities typically funded under the Indian Health Facilities account.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Clinical services
                  3,753
                  3,935
                  4,178
               
               
                  0002
                  Preventive health
                  165
                  178
                  142
               
               
                  0003
                  Urban health
                  49
                  58
                  49
               
               
                  0004
                  Indian health professions
                  60
                  65
                  52
               
               
                  0005
                  Tribal management
                  2
                  2
                  
               
               
                  0006
                  Direct operations
                  70
                  72
                  81
               
               
                  0007
                  Self-governance
                  4
                  6
                  5
               
               
                  0009
                  Diabetes funds
                  150
                  97
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,253
                  4,413
                  4,507
               
               
                  0801
                  Indian Health Services (Reimbursable)
                  1,641
                  1,704
                  1,771
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  5,894
                  6,117
                  6,278
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,219
                  1,510
                  1,606
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1,192
                  1,504
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  192
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,411
                  1,510
                  1,606
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  4,103
                  4,315
                  4,507
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  97
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,738
                  1,801
                  1,868
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,742
                  1,801
                  1,868
               
               
                  1900
                  Budget authority (total)
                  5,995
                  6,213
                  6,375
               
               
                  1930
                  Total budgetary resources available
                  7,406
                  7,723
                  7,981
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,510
                  1,606
                  1,703
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,139
                  1,199
                  767
               
               
                  3010
                  New obligations, unexpired accounts
                  5,894
                  6,117
                  6,278
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  43
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,670
                  â6,549
                  â6,341
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â192
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,199
                  767
                  704
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â106
                  â109
                  â109
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â4
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â109
                  â109
                  â109
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,033
                  1,090
                  658
               
               
                  3200
                  Obligated balance, end of year
                  1,090
                  658
                  595
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,845
                  6,116
                  6,375
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,504
                  5,339
                  5,564
               
               
                  4011
                  Outlays from discretionary balances
                  1,018
                  1,111
                  773
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  5,522
                  6,450
                  6,337
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â437
                  â436
                  â436
               
               
                  4033
                  Non-Federal sources
                  â1,302
                  â1,365
                  â1,432
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,739
                  â1,801
                  â1,868
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â4
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  4,103
                  4,315
                  4,507
               
               
                  4080
                  Outlays, net (discretionary)
                  3,783
                  4,649
                  4,469
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  150
                  97
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  52
                  93
                  
               
               
                  4101
                  Outlays from mandatory balances
                  96
                  6
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  148
                  99
                  4
               
               
                  4180
                  Budget authority, net (total)
                  4,253
                  4,412
                  4,507
               
               
                  4190
                  Outlays, net (total)
                  3,931
                  4,748
                  4,473
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,253
                  4,412
                  4,507
               
               
                  
                  Outlays
                  3,931
                  4,748
                  4,473
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  53
                  150
               
               
                  
                  Outlays
                  
                  51
                  146
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,253
                  4,465
                  4,657
               
               
                  
                  Outlays
                  3,931
                  4,799
                  4,619
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Services account provides medical care, public health services, and health professions training opportunities
            to American Indians and Alaska Natives. More than $2.7 billion, primarily through self-determination contracts and compacts,
            will be administered by tribal governments in 2021.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  416
                  440
                  445
               
               
                  11.3
                  Other than full-time permanent
                  18
                  19
                  18
               
               
                  11.5
                  Other personnel compensation
                  66
                  68
                  68
               
               
                  11.7
                  Military personnel
                  56
                  58
                  57
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  556
                  585
                  588
               
               
                  12.1
                  Civilian personnel benefits
                  166
                  175
                  174
               
               
                  12.2
                  Military personnel benefits
                  29
                  30
                  30
               
               
                  13.0
                  Benefits for former personnel
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  8
                  8
                  14
               
               
                  21.0
                  Patient travel
                  20
                  21
                  20
               
               
                  22.0
                  Transportation of things
                  6
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  14
                  14
                  14
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  10
                  10
                  10
               
               
                  25.1
                  Advisory and assistance services
                  5
                  5
                  5
               
               
                  25.2
                  Other services from non-Federal sources
                  291
                  301
                  384
               
               
                  25.3
                  Other goods and services from Federal sources
                  111
                  114
                  112
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  2
               
               
                  25.6
                  Medical care
                  390
                  401
                  396
               
               
                  25.7
                  Operation and maintenance of equipment
                  9
                  9
                  9
               
               
                  25.8
                  Subsistence and support of persons
                  7
                  7
                  7
               
               
                  26.0
                  Supplies and materials
                  109
                  112
                  131
               
               
                  31.0
                  Equipment
                  8
                  8
                  45
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,495
                  2,588
                  2,543
               
               
                  42.0
                  Insurance claims and indemnities
                  15
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,253
                  4,413
                  4,507
               
               
                  99.0
                  Reimbursable obligations
                  1,641
                  1,704
                  1,771
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,894
                  6,117
                  6,278
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6,449
                  6,449
                  6,468
               
               
                  1101
                  Direct military average strength employment
                  1,530
                  1,530
                  1,531
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  6,102
                  6,102
                  6,102
               
               
                  
                     
                  
               
            
         
      
         Indian Health Services
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0009
                  Diabetes funds
                  
                  53
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  53
                  150
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  53
                  150
               
               
                  1930
                  Total budgetary resources available
                  
                  53
                  150
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  2
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  53
                  150
               
               
                  3020
                  Outlays (gross)
                  
                  â51
                  â146
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  2
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  2
               
               
                  3200
                  Obligated balance, end of year
                  
                  2
                  6
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  53
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  51
                  144
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  51
                  146
               
               
                  4180
                  Budget authority, net (total)
                  
                  53
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  51
                  146
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  25.6
                  Medical care
                  
                  
                  10
               
               
                  31.0
                  Equipment
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  53
                  136
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  53
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  53
                  150
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  23
               
               
                  
                     
                  
               
            
         
      
         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  2021, such sums as may be necessary: Provided, That notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
            to another budget account: Provided further, 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 due for such agreements for subsequent
               fiscal years.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contract Support Costs
                  799
                  855
                  855
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  799
                  855
                  855
               
               
                  1930
                  Total budgetary resources available
                  799
                  855
                  855
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  62
                  59
                  37
               
               
                  3010
                  New obligations, unexpired accounts
                  799
                  855
                  855
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  38
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â830
                  â877
                  â892
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  59
                  37
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  62
                  59
                  37
               
               
                  3200
                  Obligated balance, end of year
                  59
                  37
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  799
                  855
                  855
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  777
                  855
                  855
               
               
                  4011
                  Outlays from discretionary balances
                  53
                  22
                  37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  830
                  877
                  892
               
               
                  4180
                  Budget authority, net (total)
                  799
                  855
                  855
               
               
                  4190
                  Outlays, net (total)
                  830
                  877
                  892
               
               
                  
                     
                  
               
            
         
      
      
         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 2021.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  799
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  855
                  855
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  799
                  855
                  855
               
               
                  
                     
                  
               
            
         
      
         Payments for Tribal Leases  For payments to tribes and tribal organizations for leases pursuant to section 105(l) of the Indian Self-Determination and
               Education Assistance Act (25 U.S.C. 5324(l)) for fiscal year 2021, such sums as may be necessary: Provided, That notwithstanding
               any other provision of law, no amounts made available under this heading shall be available for transfer to another budget
               account.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0200â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Payments for Tribal Leases
                  
                  
                  101
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  101
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  101
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  101
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  101
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â101
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  101
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  101
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  101
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  101
               
               
                  
                     
                  
               
            
         
      
      
         The Payments for Tribal Leases account provides for the reasonable and allowable costs for leases with a Tribe or tribal organization
            for a building owned or leased by the tribe or tribal organization that is used for administration or delivery of services
            under the Indian Self-Determination and Education Assistance Act. An estimated $101 million in lease funds will be provided
            to tribal governments and tribal organizations in 2021. 
         
      
         Indian health facilitiesFor construction, repair, maintenance, demolition, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans,
            specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers;
            and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August
            5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses
            necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health
            and facilities support activities of the Indian Health Service,  $769,455,000 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.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Maintenance
                  135
                  170
                  168
               
               
                  0002
                  Sanitation Facilities Construction
                  208
                  214
                  193
               
               
                  0003
                  Facilities and environmental health
                  244
                  261
                  259
               
               
                  0004
                  Equipment
                  24
                  28
                  24
               
               
                  0005
                  Health Care Facilities Construction
                  304
                  359
                  125
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  915
                  1,032
                  769
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  915
                  1,032
                  769
               
               
                  0801
                  Indian Health Facilities (Reimbursable)
                  8
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  923
                  1,041
                  778
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  621
                  630
                  569
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  617
                  614
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  635
                  630
                  569
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  879
                  912
                  769
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  8
                  9
                  9
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  31
                  59
                  59
               
               
                  1900
                  Budget authority (total)
                  918
                  980
                  837
               
               
                  1930
                  Total budgetary resources available
                  1,553
                  1,610
                  1,406
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  630
                  569
                  628
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  678
                  862
                  990
               
               
                  3010
                  New obligations, unexpired accounts
                  923
                  1,041
                  778
               
               
                  3020
                  Outlays (gross)
                  â725
                  â913
                  â926
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  862
                  990
                  842
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â18
                  â18
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â18
                  â18
                  â18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  660
                  844
                  972
               
               
                  3200
                  Obligated balance, end of year
                  844
                  972
                  824
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  910
                  971
                  828
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  349
                  333
                  290
               
               
                  4011
                  Outlays from discretionary balances
                  370
                  564
                  627
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  719
                  897
                  917
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â31
                  â59
                  â59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â31
                  â59
                  â59
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8
                  9
                  9
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  9
                  9
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6
                  16
                  9
               
               
                  4180
                  Budget authority, net (total)
                  887
                  921
                  778
               
               
                  4190
                  Outlays, net (total)
                  694
                  854
                  867
               
               
                  
                     
                  
               
            
         
      
      
         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 2021.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  45
                  47
                  48
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  20
                  21
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  68
                  71
                  73
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  17
                  17
               
               
                  12.2
                  Military personnel benefits
                  7
                  7
                  7
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  5
                  5
                  5
               
               
                  25.1
                  Advisory and assistance services
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  301
                  349
                  330
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  3
                  4
               
               
                  25.4
                  Operation and maintenance of facilities
                  3
                  3
                  3
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  3
                  3
                  3
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  32.0
                  Land and structures
                  110
                  128
                  60
               
               
                  41.0
                  Grants, subsidies, and contributions
                  383
                  432
                  253
               
               
                  42.0
                  Insurance claims and indemnities
                  8
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  914
                  1,032
                  769
               
               
                  99.0
                  Reimbursable obligations
                  9
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  923
                  1,041
                  778
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  946
                  946
                  946
               
               
                  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 provisions-indian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
            3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
            5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
            and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
            in the field, when authorized under regulations approved by the Secretary of Health and Human Services; 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: 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 et seq.), 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 costs associated with the provision of goods, services, or technical
            assistance: Provided further, That the Indian Health Service may provide to civilian medical personnel serving in hospitals operated by the Indian Health
            Service housing allowances equivalent to those that would be provided to members of the Commissioned Corps of the United States
            Public Health Service serving in similar positions at such hospitals: Provided further, That  none of the funds made available in this Act may be used to compensate an Indian tribe or tribal organization for any lease
               under section 105(l) of the Indian Self-Determination and Education Assistance Act relating to a facility exceeding 40,000
               square feet unless funds for the lease are specifically appropriated in advance for such purpose.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
         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,  $527,160,000.
      
         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,  $1,552,556,000.
      
         Emerging and zoonotic infectious diseasesFor carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
            Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases,  $413,464,000: Provided, That of the amounts made available under this heading, up to $1,000,000 shall remain available until
               expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated
               under federal or state quarantine law.
      
         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,  $359,145,000: Provided, That such amounts and any amounts transferred to this appropriation shall be available for the Director of the Centers for
               Disease Control and Prevention (CDC) to administer a program, to be known as The 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 the purposes of carrying out such program, the Director may award grants to States, territories, tribes, and tribal
               organizations 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 such purposes, to make grant awards 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,  $112,250,000.
      
         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,  $58,000,000: Provided, That, in addition to amounts provided under this heading, $463,000,000 is available to this appropriation,
               for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act.
      
         Environmental healthFor carrying out titles II, III, and XVII of the PHS Act with respect to environmental health,  $182,000,000.
      
         Injury prevention and controlFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control and for carrying out the Drug-Free Communities Support Program (the Program) authorized by chapter 2 of subtitle A of title
               I of the National Narcotics Leadership Act of 1988 (chapter 2), $730,159,000: Provided, That the Secretary shall have the
               same authorities as those delegated by chapter 2 to the Office of National Drug Control Policy (ONDCP), the Director of ONDCP,
               and the Administrator of the Program: Provided further, That the Secretary may make grants to, or enter into cooperative agreements
               with, states, territories and Indian tribes for such entities to make subgrants under the Program to eligible coalitions,
               as defined in section 1023 of chapter 2: Provided further, That for such purpose, the Secretary may delegate to such entities
               those of the Secretary's authorities under subchapter I of chapter 2 and the previous proviso that the Secretary considers
               necessary or appropriate for efficient and effective management of the Program: Provided further, That the limitation on administrative
               costs in section 1024(b) of chapter 2 shall not apply to amounts made available under this heading.
      
         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,  $111,362,000: Provided, That, in addition to amounts provided herein, $78,638,000 shall be available to this appropriation,
               for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act.
      
         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,  $532,222,000, of which: (1)  $69,547,000 shall remain available through September 30,  2022, for international HIV/AIDS; and (2)  $225,000,000 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,  $802,000,000: 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 support
         (including transfer of funds)For carrying out titles II, III, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program
            support for activities funded in other appropriations included in this Act for the Centers for Disease Control and Prevention,
             $155,000,000, of which up to $5,000,000 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 amounts 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,  2022.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Birth Defects, Developmental Disabilities, Disability and Health (0958)
                  155
                  161
                  112
               
               
                  0002
                  CDC-Wide Activities and Program Support (0943)
                  483
                  359
                  155
               
               
                  0004
                  Chronic Disease Prevention and Health Promotion (0948)
                  1,196
                  1,240
                  813
               
               
                  0005
                  Emerging and Zoonotic Infectious Diseases (0949)
                  619
                  636
                  550
               
               
                  0006
                  Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                  52
                  55
                  55
               
               
                  0007
                  Environmental Health (0947)
                  213
                  214
                  182
               
               
                  0008
                  Global Health (0955)
                  480
                  571
                  532
               
               
                  0012
                  HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                  1,130
                  1,274
                  1,553
               
               
                  0013
                  Immunization and Respiratory Diseases (0951)
                  838
                  790
                  830
               
               
                  0015
                  Injury Prevention and Control (0952)
                  702
                  677
                  730
               
               
                  0016
                  Occupational Safety and Health (0953)
                  335
                  343
                  111
               
               
                  0019
                  Public Health Preparedness and Response (0956)
                  860
                  827
                  802
               
               
                  0020
                  Public Health Scientific Services (0959)
                  494
                  578
                  58
               
               
                  0021
                  Cooperative Research and Development Agreements (CRADA) (5146)
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  7,558
                  7,726
                  6,484
               
               
                  0802
                  CDC-Wide Activities and Program Support (Reimbursable)
                  158
                  366
                  399
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  158
                  366
                  399
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  7,716
                  8,092
                  6,883
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  934
                  307
                  224
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  439
                  174
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0960]
                  â7
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  â425
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  â50
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  10
                  
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  36
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  111
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  610
                  307
                  224
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  7,058
                  6,815
                  5,535
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â14
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0140]
                  â604
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â4553]
                  â9
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0945]
                  â50
                  â85
                  â50
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  6,401
                  6,730
                  5,485
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  1
                  1
                  1
               
               
                  1221
                  Appropriations transferred from other acct PPHF [075â0116]
                  805
                  854
                  894
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  856
                  910
                  950
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  137
                  366
                  399
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  24
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  161
                  366
                  399
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  4
                  3
                  3
               
               
                  1900
                  Budget authority (total)
                  7,422
                  8,009
                  6,837
               
               
                  1930
                  Total budgetary resources available
                  8,032
                  8,316
                  7,061
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â9
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  307
                  224
                  178
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,934
                  6,671
                  7,189
               
               
                  3010
                  New obligations, unexpired accounts
                  7,716
                  8,092
                  6,883
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  38
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â7,395
                  â7,574
                  â7,879
               
               
                  3030
                  Unpaid obligations transferred to other accts [075â0140]
                  â242
                  
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â111
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â269
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,671
                  7,189
                  6,193
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â127
                  â108
                  â108
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â24
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  43
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â108
                  â108
                  â108
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,807
                  6,563
                  7,081
               
               
                  3200
                  Obligated balance, end of year
                  6,563
                  7,081
                  6,085
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  6,562
                  7,096
                  5,884
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,454
                  3,050
                  2,558
               
               
                  4011
                  Outlays from discretionary balances
                  4,121
                  3,658
                  4,401
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  6,575
                  6,708
                  6,959
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â167
                  â366
                  â399
               
               
                  4033
                  Non-Federal sources
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â179
                  â366
                  â399
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â24
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  41
                  
                  
               
               
                  4053
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  6,401
                  6,730
                  5,485
               
               
                  4080
                  Outlays, net (discretionary)
                  6,396
                  6,342
                  6,560
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  860
                  913
                  953
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  146
                  218
                  226
               
               
                  4101
                  Outlays from mandatory balances
                  674
                  648
                  694
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  820
                  866
                  920
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â4
                  â3
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  7,257
                  7,640
                  6,435
               
               
                  4190
                  Outlays, net (total)
                  7,212
                  7,205
                  7,477
               
               
                  
                     
                  
               
            
         
      
      
         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 2021 Budget provides $371 million for CDC to undertake the second year of the Ending
            the HIV Epidemic initative. The FY 2021 Budget maintains the proposal to establish a new block grant, proposed at $350 million,
            to increase flexibility for States to address their population's unique public health needs. The FY 2021 Budget provides $175
            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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  766
                  744
                  761
               
               
                  11.3
                  Other than full-time permanent
                  112
                  99
                  101
               
               
                  11.5
                  Other personnel compensation
                  39
                  38
                  38
               
               
                  11.7
                  Military personnel
                  70
                  65
                  68
               
               
                  11.8
                  Special personal services payments
                  6
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  993
                  951
                  973
               
               
                  12.1
                  Civilian personnel benefits
                  305
                  291
                  291
               
               
                  12.2
                  Military personnel benefits
                  55
                  53
                  54
               
               
                  13.0
                  Benefits for former personnel
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  59
                  42
                  42
               
               
                  22.0
                  Transportation of things
                  9
                  7
                  7
               
               
                  23.1
                  Rental payments to GSA
                  6
                  4
                  4
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  9
                  5
                  5
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  811
                  784
                  607
               
               
                  25.2
                  Other services from non-Federal sources
                  105
                  107
                  78
               
               
                  25.3
                  Other goods and services from Federal sources
                  890
                  899
                  662
               
               
                  25.4
                  Operation and maintenance of facilities
                  14
                  11
                  8
               
               
                  25.5
                  Research and development contracts
                  41
                  38
                  27
               
               
                  25.6
                  Medical care
                  31
                  33
                  24
               
               
                  25.7
                  Operation and maintenance of equipment
                  33
                  30
                  22
               
               
                  26.0
                  Supplies and materials
                  129
                  125
                  127
               
               
                  31.0
                  Equipment
                  70
                  63
                  63
               
               
                  32.0
                  Land and structures
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,984
                  4,269
                  3,476
               
               
                  42.0
                  Insurance claims and indemnities
                  7
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  7,558
                  7,726
                  6,484
               
               
                  99.0
                  Reimbursable obligations
                  158
                  366
                  399
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  7,716
                  8,092
                  6,883
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8,486
                  8,477
                  8,630
               
               
                  1101
                  Direct military average strength employment
                  807
                  812
                  812
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  198
                  197
                  197
               
               
                  2101
                  Reimbursable military average strength employment
                  27
                  27
                  27
               
               
                  
                     
                  
               
            
         
      
         Buildings and facilities
         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,  2025.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  CDC Buildings and Facilities (0960)
                  153
                  25
                  30
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  500
                  384
                  384
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  507
                  384
                  384
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  30
                  25
                  30
               
               
                  1930
                  Total budgetary resources available
                  537
                  409
                  414
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  384
                  384
                  384
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  26
                  144
                  109
               
               
                  3010
                  New obligations, unexpired accounts
                  153
                  25
                  30
               
               
                  3020
                  Outlays (gross)
                  â35
                  â60
                  â49
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  144
                  109
                  90
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  26
                  144
                  109
               
               
                  3200
                  Obligated balance, end of year
                  144
                  109
                  90
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  30
                  25
                  30
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2
                  10
                  12
               
               
                  4011
                  Outlays from discretionary balances
                  33
                  50
                  37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  35
                  60
                  49
               
               
                  4180
                  Budget authority, net (total)
                  30
                  25
                  30
               
               
                  4190
                  Outlays, net (total)
                  35
                  60
                  49
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  1
                  1
                  1
               
               
                  25.4
                  Operation and maintenance of facilities
                  8
                  8
                  8
               
               
                  32.0
                  Land and structures
                  144
                  16
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  153
                  25
                  30
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  CDC Working Capital Fund (Reimbursable)
                  591
                  569
                  569
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  50
                  54
                  73
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  62
                  54
                  73
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  9
                  
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  573
                  588
                  532
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  574
                  588
                  532
               
               
                  1900
                  Budget authority (total)
                  583
                  588
                  532
               
               
                  1930
                  Total budgetary resources available
                  645
                  642
                  605
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  54
                  73
                  36
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  198
                  210
                  197
               
               
                  3010
                  New obligations, unexpired accounts
                  591
                  569
                  569
               
               
                  3020
                  Outlays (gross)
                  â567
                  â582
                  â550
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  210
                  197
                  216
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  â3
                  â3
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â3
                  â3
                  â3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  196
                  207
                  194
               
               
                  3200
                  Obligated balance, end of year
                  207
                  194
                  213
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  583
                  588
                  532
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  396
                  388
                  351
               
               
                  4011
                  Outlays from discretionary balances
                  171
                  194
                  199
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  567
                  582
                  550
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â573
                  â588
                  â532
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  9
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â6
                  â6
                  18
               
               
                  4180
                  Budget authority, net (total)
                  9
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â6
                  â6
                  18
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  148
                  148
                  148
               
               
                  11.3
                  Other than full-time permanent
                  3
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  3
                  4
                  4
               
               
                  11.7
                  Military personnel
                  4
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  158
                  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
                  33
                  32
                  32
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  17
                  22
                  22
               
               
                  25.1
                  Advisory and assistance services
                  34
                  31
                  31
               
               
                  25.2
                  Other services from non-Federal sources
                  86
                  77
                  77
               
               
                  25.3
                  Other goods and services from Federal sources
                  82
                  68
                  68
               
               
                  25.4
                  Operation and maintenance of facilities
                  53
                  10
                  10
               
               
                  25.7
                  Operation and maintenance of equipment
                  53
                  52
                  52
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  10
                  12
                  12
               
               
                  32.0
                  Land and structures
                  9
                  50
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  591
                  569
                  569
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,484
                  1,484
                  1,484
               
               
                  2101
                  Reimbursable military average strength employment
                  34
                  34
                  34
               
               
                  
                     
                  
               
            
         
      
         Infectious Diseases Rapid Response Reserve FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  85
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  85
                  50
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  50
                  50
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  50
                  85
                  50
               
               
                  1930
                  Total budgetary resources available
                  50
                  135
                  100
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  50
                  50
                  50
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  35
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  85
                  50
               
               
                  3020
                  Outlays (gross)
                  
                  â50
                  â85
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  35
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  35
               
               
                  3200
                  Obligated balance, end of year
                  
                  35
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  50
                  85
                  50
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  
                  50
                  85
               
               
                  4180
                  Budget authority, net (total)
                  50
                  85
                  50
               
               
                  4190
                  Outlays, net (total)
                  
                  50
                  85
               
               
                  
                     
                  
               
            
         
      
      
         The FY 2021 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  2021, and existing profiles may be updated as necessary.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Agency for Toxic Substances and Disease Registry, Toxic Substance (Direct)
                  87
                  62
                  62
               
               
                  0801
                  Agency for Toxic Substances and Disease Registry, Toxic Substance (Reimbursable)
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  90
                  62
                  62
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  20
                  18
                  36
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  75
                  77
                  62
               
               
                  1121
                  Appropriations transferred from other acct [097â0100]
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  85
                  77
                  62
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1
                  3
                  3
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  3
                  3
                  3
               
               
                  1900
                  Budget authority (total)
                  88
                  80
                  65
               
               
                  1930
                  Total budgetary resources available
                  108
                  98
                  101
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  18
                  36
                  39
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  64
                  70
                  48
               
               
                  3010
                  New obligations, unexpired accounts
                  90
                  62
                  62
               
               
                  3020
                  Outlays (gross)
                  â81
                  â84
                  â69
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  70
                  48
                  41
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â15
                  â12
                  â12
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â12
                  â12
                  â12
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  49
                  58
                  36
               
               
                  3200
                  Obligated balance, end of year
                  58
                  36
                  29
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  88
                  80
                  65
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  49
                  52
                  42
               
               
                  4011
                  Outlays from discretionary balances
                  30
                  32
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  79
                  84
                  69
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â6
                  â3
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â6
                  â3
                  â3
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  85
                  77
                  62
               
               
                  4080
                  Outlays, net (discretionary)
                  73
                  81
                  66
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  85
                  77
                  62
               
               
                  4190
                  Outlays, net (total)
                  75
                  81
                  66
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  22
                  14
                  14
               
               
                  11.3
                  Other than full-time permanent
                  2
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  
                  
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  28
                  18
                  18
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  5
                  5
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  5
                  9
                  9
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  3
                  3
               
               
                  25.3
                  Other goods and services from Federal sources
                  16
                  15
                  15
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  
                  
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  21
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  87
                  62
                  62
               
               
                  99.0
                  Reimbursable obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  90
                  62
                  62
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  198
                  198
                  198
               
               
                  1101
                  Direct military average strength employment
                  28
                  28
                  28
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  2
                  2
                  2
               
               
                  2101
                  Reimbursable military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  World Trade Center Health ProgramâFederal Share (CDC/NIOSH)
                  530
                  541
                  540
               
               
                  0002
                  World Trade Center Health ProgramâNYC
                  59
                  60
                  60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  589
                  601
                  600
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  873
                  797
                  735
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  7
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  897
                  797
                  735
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (WTC (CDC Direct))
                  402
                  485
                  501
               
               
                  1200
                  Appropriation (WTCâNYC DHSSâCDC)
                  45
                  54
                  56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  447
                  539
                  557
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  42
                  
                  
               
               
                  1900
                  Budget authority (total)
                  489
                  539
                  557
               
               
                  1930
                  Total budgetary resources available
                  1,386
                  1,336
                  1,292
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  797
                  735
                  692
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  224
                  327
                  528
               
               
                  3010
                  New obligations, unexpired accounts
                  589
                  601
                  600
               
               
                  3020
                  Outlays (gross)
                  â483
                  â400
                  â479
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  327
                  528
                  649
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  224
                  327
                  528
               
               
                  3200
                  Obligated balance, end of year
                  327
                  528
                  649
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  489
                  539
                  557
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  248
                  256
               
               
                  4101
                  Outlays from mandatory balances
                  483
                  152
                  223
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  483
                  400
                  479
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â63
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  447
                  539
                  557
               
               
                  4170
                  Outlays, net (mandatory)
                  420
                  400
                  479
               
               
                  4180
                  Budget authority, net (total)
                  447
                  539
                  557
               
               
                  4190
                  Outlays, net (total)
                  420
                  400
                  479
               
               
                  
                     
                  
               
            
         
      
      
         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 2020 and 2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  4
                  4
                  4
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  5
                  5
                  5
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  2
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  39
                  39
                  39
               
               
                  25.2
                  Other services from non-Federal sources
                  105
                  105
                  105
               
               
                  25.3
                  Other goods and services from Federal sources
                  12
                  12
                  12
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  24
                  24
                  24
               
               
                  42.0
                  Insurance claims and indemnities
                  399
                  411
                  410
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  589
                  601
                  600
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  38
                  43
                  43
               
               
                  1101
                  Direct military average strength employment
                  7
                  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,  $5,686,173,000, of which up to $30,000,000 may be used for facilities repairs and improvements at the National Cancer Institute-Frederick
            Federally Funded Research and Development Center in Frederick, Maryland.
      
         national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
            and blood products,  $3,298,004,000.
      
         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,  $434,559,000.
      
         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,  $1,924,211,000.
      
         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,  $2,195,110,000.
      
         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,  $5,445,886,000.
      
         national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences,  $2,672,074,000, of which  $741,000,000 shall be from funds available under section 241 of the PHS Act: Provided, That not less than  $351,781,000 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,  $1,416,366,000.
      
         national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders,  $749,003,000.
      
         national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences,  $730,147,000.
      (Department of Health and Human Services Appropriations Act, 2020.)
         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,  $73,688,000.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
         national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging,  $3,225,782,000.
      
         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,
             $568,480,000.
      
         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,  $446,397,000.
      
         national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research,  $156,804,000.
      
         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,  $497,346,000.
      
         National institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse,  $1,431,770,000.
      
         national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health,  $1,794,865,000.
      
         national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research,  $550,116,000.
      
         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,  $368,111,000.
      
         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,  $138,167,000.
      
         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,
             $305,498,000: Provided, That funds may be used to implement a reorganization that is presented to an advisory council in a public meeting and for
            which the Committees on Appropriations of the House of Representatives and the Senate have been notified 30 days in advance.
      
         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),  $73,531,000.
      
         national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications,  $415,665,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30,
             2022: Provided further, That in fiscal year  2021, 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,  $787,703,000: 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
         (Including Transfer of Funds)For carrying out the responsibilities of the Office of the Director, NIH,  $2,086,463,000: 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  $168,763,500 shall be for the Environmental Influences on Child Health Outcomes study: Provided further, That  $583,867,000 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:  Provided further, That amounts available under this heading are also available to establish, operate, and support the Research Policy Board
            authorized by section 2034(f) of the 21st Century Cures 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,  $300,000,000, to remain available through September 30,  2025.
         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, $256,660,000: Provided, That section 947(c) of the
               PHS Act shall not apply in fiscal year 2021: 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, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Cooperative Research and Development Agreements, NIH
                  51
                  68
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  51
                  68
                  51
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  National Institutes of Health
                  â51
                  â68
                  â51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  National Cancer Institute (0849)
                  5,994
                  6,606
                  5,881
               
               
                  0002
                  National Heart, Lung, and Blood Institute (0872)
                  3,482
                  3,625
                  3,298
               
               
                  0003
                  National Institute of Dental and Craniofacial Research (0873)
                  461
                  478
                  435
               
               
                  0004
                  National Institute of Diabetes and Digestive and Kidney Disease (0884)
                  2,025
                  2,115
                  1,924
               
               
                  0005
                  National Institute of Neurological Disorders and Stroke (0886)
                  2,414
                  2,449
                  2,245
               
               
                  0006
                  National Institute of Allergy and Infectious Diseases (0885)
                  5,567
                  5,897
                  5,446
               
               
                  0007
                  National Institute of General Medical Sciences (0851)
                  1,675
                  1,706
                  1,931
               
               
                  0008
                  National Institute of Child Health and Human Development (0844)
                  1,509
                  1,557
                  1,416
               
               
                  0009
                  National Eye Institute (0887)
                  794
                  823
                  749
               
               
                  0010
                  National Institute of Environmental Health Sciences (0862)
                  851
                  884
                  804
               
               
                  0011
                  National Institute on Aging (0843)
                  3,080
                  3,546
                  3,226
               
               
                  0012
                  National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                  603
                  625
                  568
               
               
                  0013
                  National Institute on Deafness and Other Communication Disorder (0890)
                  473
                  491
                  446
               
               
                  0014
                  National Institute of Mental Health (0892)
                  1,870
                  2,045
                  1,845
               
               
                  0015
                  National Institute on Drug Abuse (0893)
                  1,621
                  1,458
                  1,432
               
               
                  0016
                  National Institute on Alcohol Abuse and Alcoholism (0894)
                  525
                  547
                  497
               
               
                  0017
                  National Institute of Nursing Research (0889)
                  163
                  172
                  157
               
               
                  0018
                  National Human Genome Research Institute (0891)
                  575
                  604
                  550
               
               
                  0019
                  National Institute of Biomedical Imaging and Bioengineering (0898)
                  388
                  405
                  368
               
               
                  0021
                  National Center for Complementary and Integrative Health (0896)
                  146
                  152
                  138
               
               
                  0022
                  National Institute on Minority Health and Health Disparities (0897)
                  313
                  336
                  305
               
               
                  0023
                  John E. Fogarty International Center (0819)
                  78
                  81
                  74
               
               
                  0024
                  National Library of Medicine (0807)
                  442
                  457
                  416
               
               
                  0025
                  NIH Office of the Director (0846)
                  1,926
                  2,247
                  2,099
               
               
                  0026
                  NIH Buildings and facilities (0838)
                  211
                  200
                  300
               
               
                  0027
                  NIH Cooperative Research and Development Agreements
                  47
                  68
                  51
               
               
                  0028
                  National Center for Advancing Translational Sciences (0875)
                  847
                  833
                  788
               
               
                  0029
                  National Institute for Research on Safety and Quality
                  
                  
                  257
               
               
                  0031
                  Type 1 Diabetes
                  74
                  297
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  38,154
                  40,704
                  37,646
               
               
                  0801
                  NIH Reimbursable - Other
                  4,360
                  4,520
                  3,909
               
               
                  0802
                  NIH Royalties
                  130
                  129
                  129
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  4,490
                  4,649
                  4,038
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  4,490
                  4,649
                  4,038
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  42,644
                  45,353
                  41,684
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,475
                  1,145
                  754
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1,226
                  862
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  15
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â1700]
                  
                  
                  16
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  94
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,586
                  1,145
                  770
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  37,294
                  39,805
                  37,287
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â124
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â5
                  â5
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5628]
                  515
                  335
                  295
               
               
                  1121
                  Appropriations transferred from other acct [075â5736]
                  13
                  13
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  37,693
                  40,148
                  37,595
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  97
                  
               
               
                  1201
                  Appropriation (special or trust fund)
                  51
                  68
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  201
                  165
                  51
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  3,999
                  4,649
                  4,038
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  317
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,316
                  4,649
                  4,038
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  3
                  
                  
               
               
                  1900
                  Budget authority (total)
                  42,213
                  44,962
                  41,684
               
               
                  1930
                  Total budgetary resources available
                  43,799
                  46,107
                  42,454
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â10
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,145
                  754
                  770
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  37,409
                  40,480
                  43,800
               
               
                  3010
                  New obligations, unexpired accounts
                  42,644
                  45,353
                  41,684
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  389
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â39,069
                  â42,033
                  â43,642
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â94
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â799
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  40,480
                  43,800
                  41,842
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â564
                  â650
                  â650
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â317
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  231
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â650
                  â650
                  â650
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  36,845
                  39,830
                  43,150
               
               
                  3200
                  Obligated balance, end of year
                  39,830
                  43,150
                  41,192
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  42,009
                  44,797
                  41,633
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  12,483
                  14,636
                  13,864
               
               
                  4011
                  Outlays from discretionary balances
                  26,382
                  27,270
                  29,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  38,865
                  41,906
                  43,484
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,906
                  â4,649
                  â4,038
               
               
                  4033
                  Non-Federal sources
                  â298
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,204
                  â4,649
                  â4,038
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â317
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  203
                  
                  
               
               
                  4053
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â112
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  37,693
                  40,148
                  37,595
               
               
                  4080
                  Outlays, net (discretionary)
                  34,661
                  37,257
                  39,446
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  204
                  165
                  51
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  24
                  22
                  13
               
               
                  4101
                  Outlays from mandatory balances
                  180
                  105
                  145
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  204
                  127
                  158
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â3
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  37,894
                  40,313
                  37,646
               
               
                  4190
                  Outlays, net (total)
                  34,862
                  37,384
                  39,604
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  37,894
                  40,313
                  37,646
               
               
                  
                  Outlays
                  34,862
                  37,384
                  39,604
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  53
                  150
               
               
                  
                  Outlays
                  
                  3
                  23
               
               
                  Total:
               
               
                  
                  Budget Authority
                  37,894
                  40,366
                  37,796
               
               
                  
                  Outlays
                  34,862
                  37,387
                  39,627
               
               
                  
                     
                  
               
            
         
      
      
         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 2021 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552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  1,008
                  1,091
                  1,131
               
               
                  11.3
                  Other than full-time permanent
                  527
                  562
                  571
               
               
                  11.5
                  Other personnel compensation
                  49
                  52
                  54
               
               
                  11.7
                  Military personnel
                  18
                  19
                  20
               
               
                  11.8
                  Special personal services payments
                  199
                  210
                  210
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,801
                  1,934
                  1,986
               
               
                  12.1
                  Civilian personnel benefits
                  528
                  600
                  632
               
               
                  12.2
                  Military personnel benefits
                  14
                  15
                  15
               
               
                  21.0
                  Travel and transportation of persons
                  61
                  64
                  54
               
               
                  22.0
                  Transportation of things
                  5
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  24
                  25
                  23
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  20
                  20
                  15
               
               
                  25.1
                  Advisory and assistance services
                  229
                  307
                  236
               
               
                  25.2
                  Other services from non-Federal sources
                  1,502
                  1,567
                  1,216
               
               
                  25.3
                  Other goods and services from Federal sources
                  3,496
                  3,763
                  3,549
               
               
                  25.4
                  Operation and maintenance of facilities
                  232
                  241
                  328
               
               
                  25.5
                  Research and development contracts
                  1,577
                  1,739
                  1,544
               
               
                  25.6
                  Medical care
                  44
                  38
                  34
               
               
                  25.7
                  Operation and maintenance of equipment
                  173
                  174
                  153
               
               
                  26.0
                  Supplies and materials
                  258
                  273
                  230
               
               
                  31.0
                  Equipment
                  188
                  200
                  164
               
               
                  32.0
                  Land and structures
                  
                  41
                  25
               
               
                  41.0
                  Grants, subsidies, and contributions
                  28,002
                  29,697
                  27,436
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  38,155
                  40,704
                  37,646
               
               
                  99.0
                  Reimbursable obligations
                  4,489
                  4,649
                  4,038
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  42,644
                  45,353
                  41,684
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  12,540
                  13,258
                  13,467
               
               
                  1101
                  Direct military average strength employment
                  172
                  173
                  177
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  4,371
                  4,507
                  4,507
               
               
                  2101
                  Reimbursable military average strength employment
                  98
                  98
                  98
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â4â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Type 1 Diabetes
                  
                  53
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  53
                  150
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  53
                  150
               
               
                  1930
                  Total budgetary resources available
                  
                  53
                  150
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  50
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  53
                  150
               
               
                  3020
                  Outlays (gross)
                  
                  â3
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  50
                  177
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  50
               
               
                  3200
                  Obligated balance, end of year
                  
                  50
                  177
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  53
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  3
                  12
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  3
                  23
               
               
                  4180
                  Budget authority, net (total)
                  
                  53
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  3
                  23
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through FY 2021.
      
         Payment to the NIH Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0147â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Payment to NIH Innovation (object class 94.0)
                  711
                  492
                  404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 94.0)
                  711
                  492
                  404
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  711
                  492
                  404
               
               
                  1930
                  Total budgetary resources available
                  711
                  492
                  404
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  711
                  492
                  404
               
               
                  3020
                  Outlays (gross)
                  â711
                  â492
                  â404
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  711
                  492
                  404
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  711
                  492
                  404
               
               
                  4180
                  Budget authority, net (total)
                  711
                  492
                  404
               
               
                  4190
                  Outlays, net (total)
                  711
                  492
                  404
               
               
                  
                     
                  
               
            
         
      
      
         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,  $404,000,000, 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, 2020.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  General Fund Payment, NIH Innovation, CURES Act
                  711
                  492
                  404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  711
                  492
                  404
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  NIH Innovation, Cures Act
                  â711
                  â492
                  â404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  CURES obligations
                  185
                  216
                  109
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  48
                  59
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  711
                  492
                  404
               
               
                  1120
                  Appropriations transferred to other acct [075â9915]
                  â515
                  â335
                  â295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  196
                  157
                  109
               
               
                  1930
                  Total budgetary resources available
                  244
                  216
                  109
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  59
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  95
                  228
                  264
               
               
                  3010
                  New obligations, unexpired accounts
                  185
                  216
                  109
               
               
                  3020
                  Outlays (gross)
                  â52
                  â180
                  â180
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  228
                  264
                  193
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  95
                  228
                  264
               
               
                  3200
                  Obligated balance, end of year
                  228
                  264
                  193
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  196
                  157
                  109
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  17
                  31
                  23
               
               
                  4011
                  Outlays from discretionary balances
                  35
                  149
                  157
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  52
                  180
                  180
               
               
                  4180
                  Budget authority, net (total)
                  196
                  157
                  109
               
               
                  4190
                  Outlays, net (total)
                  52
                  180
                  180
               
               
                  
                     
                  
               
            
         
      
      
         The 21st Century Cures Act was enacted into law on December 13, 2016. The 21st Century 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  5
                  6
                  10
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  6
                  7
                  11
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  3
                  4
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  6
                  1
               
               
                  25.5
                  Research and development contracts
                  3
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  174
                  200
                  93
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  185
                  216
                  109
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  45
                  64
                  89
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         10-Year Pediatric Research Initiative FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  28
                  28
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Transfers from Presidential Election Campaign Fund
                  41
                  13
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  41
                  41
                  28
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  10-Year Pediatric Research Initiative Fund
                  â13
                  â13
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  28
                  28
                  15
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  13
                  13
                  13
               
               
                  1120
                  Appropriations transferred to other accts [075â9915]
                  â13
                  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,  $1,675,106,000: 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 $35,000,000 of the amounts appropriated for subpart I of part B shall be available to support evidence-based
               crisis systems: 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  $225,000,000 shall be available until September 30,  2023 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,  $25,000,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113â93; 42 U.S.C. 290aa 22
            note).
      
         SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
            respect to substance abuse treatment and prevention, and the SUPPORT for Patients and Communities Act,  $3,728,556,000: Provided, That  $1,585,000,000 shall be for State Opioid Response Grants for carrying out activities pertaining to opioids and stimulants 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 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,  $96,985,000.
      
         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,  2022: 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0006
                  Mental Health
                  1,493
                  1,633
                  1,675
               
               
                  0007
                  Substance Abuse Treatment
                  3,738
                  3,757
                  3,729
               
               
                  0008
                  Substance Abuse Prevention
                  205
                  206
                  97
               
               
                  0009
                  Health Surveillance and Program Support
                  132
                  129
                  97
               
               
                  0011
                  SAMHSA Prevention Fund
                  12
                  12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total, direct program
                  5,580
                  5,737
                  5,598
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  5,580
                  5,737
                  5,598
               
               
                  0802
                  SAMHSA Reimbursables
                  121
                  2
                  2
               
               
                  0810
                  SAMHSA Reimbursable:  PHS Evaluation
                  134
                  134
                  143
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  255
                  136
                  145
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  5,835
                  5,873
                  5,743
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  20
                  130
                  178
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  20
                  130
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0116]
                  â8
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  14
                  130
                  178
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  5,597
                  5,736
                  5,598
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â9
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  100
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,688
                  5,736
                  5,598
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [075â0116]
                  12
                  12
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  135
                  173
                  173
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  121
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  256
                  173
                  173
               
               
                  1900
                  Budget authority (total)
                  5,956
                  5,921
                  5,771
               
               
                  1930
                  Total budgetary resources available
                  5,970
                  6,051
                  5,949
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â5
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  130
                  178
                  206
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,125
                  7,309
                  6,618
               
               
                  3010
                  New obligations, unexpired accounts
                  5,835
                  5,873
                  5,743
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  49
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â4,557
                  â6,564
                  â6,157
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â141
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,309
                  6,618
                  6,204
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â164
                  â187
                  â187
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â121
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  98
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â187
                  â187
                  â187
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,961
                  7,122
                  6,431
               
               
                  3200
                  Obligated balance, end of year
                  7,122
                  6,431
                  6,017
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,944
                  5,909
                  5,771
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  976
                  1,649
                  1,610
               
               
                  4011
                  Outlays from discretionary balances
                  3,570
                  4,906
                  4,539
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,546
                  6,555
                  6,149
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â229
                  â171
                  â171
               
               
                  4033
                  Non-Federal sources
                  
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â229
                  â173
                  â173
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â121
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  94
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  5,688
                  5,736
                  5,598
               
               
                  4080
                  Outlays, net (discretionary)
                  4,317
                  6,382
                  5,976
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  12
                  12
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4
                  
               
               
                  4101
                  Outlays from mandatory balances
                  11
                  5
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  11
                  9
                  8
               
               
                  4180
                  Budget authority, net (total)
                  5,700
                  5,748
                  5,598
               
               
                  4190
                  Outlays, net (total)
                  4,328
                  6,391
                  5,984
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  43
                  48
                  49
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  2
                  1
                  1
               
               
                  11.7
                  Military personnel
                  3
                  3
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  50
                  54
                  56
               
               
                  12.1
                  Civilian personnel benefits
                  14
                  15
                  15
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  5
                  5
                  5
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  37
                  34
                  35
               
               
                  25.2
                  Other services from non-Federal sources
                  101
                  95
                  63
               
               
                  25.3
                  Other goods and services from Federal sources
                  39
                  36
                  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
                  5,327
                  5,491
                  5,381
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  5,580
                  5,737
                  5,599
               
               
                  99.0
                  Reimbursable obligations
                  255
                  136
                  144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,835
                  5,873
                  5,743
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  452
                  463
                  467
               
               
                  1101
                  Direct military average strength employment
                  30
                  31
                  32
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  9
                  104
                  108
               
               
                  2101
                  Reimbursable military average strength employment
                  
                  8
                  8
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and QualityFederal Funds
         Healthcare research and quality
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Research on Health Costs, Quality and Outcomes
                  196
                  190
                  
               
               
                  0002
                  Medical Expenditure Panel Survey
                  70
                  70
                  
               
               
                  0003
                  AHRQ Program Support
                  71
                  71
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  337
                  331
                  
               
               
                  0803
                  Research on Health Costs, Quality and Outcomes (Reimbursable)
                  31
                  31
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  31
                  31
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  368
                  362
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  23
                  16
                  16
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1
                  1
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  
                  
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  23
                  16
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  338
                  338
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  337
                  338
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2
                  2
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  14
                  14
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  16
                  16
                  
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  8
                  8
                  
               
               
                  1900
                  Budget authority (total)
                  361
                  362
                  
               
               
                  1930
                  Total budgetary resources available
                  384
                  378
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  16
                  16
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  335
                  344
                  438
               
               
                  3010
                  New obligations, unexpired accounts
                  368
                  362
                  
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â350
                  â268
                  â303
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  344
                  438
                  135
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â35
                  â28
                  â21
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â14
                  â14
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  21
                  21
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â28
                  â21
                  â21
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  300
                  316
                  417
               
               
                  3200
                  Obligated balance, end of year
                  316
                  417
                  114
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  353
                  354
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  127
                  134
                  
               
               
                  4011
                  Outlays from discretionary balances
                  217
                  118
                  303
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  344
                  252
                  303
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â20
                  â20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â20
                  â20
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â14
                  â14
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  18
                  18
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  337
                  338
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  324
                  232
                  303
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8
                  8
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  8
                  
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6
                  16
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â8
                  â8
                  
               
               
                  4180
                  Budget authority, net (total)
                  337
                  338
                  
               
               
                  4190
                  Outlays, net (total)
                  322
                  240
                  303
               
               
                  
                     
                  
               
            
         
      
      
         The FY 2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  30
                  32
                  
               
               
                  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
                  37
                  
               
               
                  12.1
                  Civilian personnel benefits
                  11
                  11
                  
               
               
                  12.2
                  Military personnel benefits
                  
                  1
                  
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  10
                  10
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  22
                  18
                  
               
               
                  25.5
                  Research and development contracts
                  141
                  133
                  
               
               
                  31.0
                  Equipment
                  1
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  113
                  117
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  337
                  331
                  
               
               
                  99.0
                  Reimbursable obligations
                  31
                  31
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  368
                  362
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  251
                  267
                  
               
               
                  1101
                  Direct military average strength employment
                  5
                  5
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1
                  1
                  
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  7
                  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,  $313,904,098,000, to remain available until expended.
       In addition, for carrying out such titles after May 31,  2021, for the last quarter of fiscal year  2021 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  2022, $148,732,315,000, 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  430,962
                  448,384
                  465,149
               
               
                  0002
                  State and local administration
                  23,090
                  22,340
                  23,169
               
               
                  0003
                  Vaccines for Children
                  4,161
                  4,418
                  4,951
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  458,213
                  475,142
                  493,269
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  458,213
                  475,142
                  493,269
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  15,403
                  14,678
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  34,290
                  37,147
                  38,208
               
               
                  1033
                  Recoveries of prior year paid obligations
                  10,932
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  60,625
                  51,825
                  38,208
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  276,236
                  284,243
                  313,904
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  134,848
                  137,932
                  139,903
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1,053
                  1,142
                  1,254
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,182
                  1,142
                  1,254
               
               
                  1900
                  Budget authority (total)
                  412,266
                  423,317
                  455,061
               
               
                  1930
                  Total budgetary resources available
                  472,891
                  475,142
                  493,269
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  14,678
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  46,079
                  48,596
                  38,208
               
               
                  3010
                  New obligations, unexpired accounts
                  458,213
                  475,142
                  493,269
               
               
                  3020
                  Outlays (gross)
                  â421,406
                  â448,383
                  â453,032
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â34,290
                  â37,147
                  â38,208
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  48,596
                  38,208
                  40,237
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â724
                  â853
                  â853
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â853
                  â853
                  â853
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  45,355
                  47,743
                  37,355
               
               
                  3200
                  Obligated balance, end of year
                  47,743
                  37,355
                  39,384
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  412,266
                  423,317
                  455,061
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  379,389
                  414,441
                  448,147
               
               
                  4101
                  Outlays from mandatory balances
                  42,017
                  33,942
                  4,885
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  421,406
                  448,383
                  453,032
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1,053
                  â1,142
                  â1,254
               
               
                  4123
                  Non-Federal sources
                  â10,932
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â11,985
                  â1,142
                  â1,254
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â129
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  10,932
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  10,803
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  411,084
                  422,175
                  453,807
               
               
                  4170
                  Outlays, net (mandatory)
                  409,421
                  447,241
                  451,778
               
               
                  4180
                  Budget authority, net (total)
                  411,084
                  422,175
                  453,807
               
               
                  4190
                  Outlays, net (total)
                  409,421
                  447,241
                  451,778
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  411,084
                  422,175
                  453,807
               
               
                  
                  Outlays
                  409,421
                  447,241
                  451,778
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â3,633
               
               
                  
                  Outlays
                  
                  
                  â3,633
               
               
                  Total:
               
               
                  
                  Budget Authority
                  411,084
                  422,175
                  450,174
               
               
                  
                  Outlays
                  409,421
                  447,241
                  448,145
               
               
                  
                     
                  
               
            
         
      
      
         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
                     2019
                     2020
                     2021
                  
                  
                     
                        
                     
                  
                  
                     Vaccine Purchase
                     3,960
                     4,206
                     4,642
                  
                  
                     Vaccine Stockpile
                     25
                     10
                     98
                  
                  
                     Ordering, Distribution, and Operations
                     176
                     202
                     212
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Obligations
                     4,161
                     4,418
                     4,951
                  
                  
                     
                        
                     
                  
               
            
         
      
         Grants to States for Medicaid
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â4â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  â3,633
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â3,633
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â3,633
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â3,633
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â3,633
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â3,633
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â3,633
               
               
                  3020
                  Outlays (gross)
                  
                  
                  3,633
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â3,633
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â3,633
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â3,633
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â3,633
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0012
                  Medicaid integrity program
                  84
                  111
                  91
               
               
                  0018
                  Money follows the person (MFP) demonstration
                  32
                  215
                  261
               
               
                  0023
                  Grants to improve outreach and enrollment
                  21
                  38
                  3
               
               
                  0028
                  Demo to increase substance use provider under the Medicaid Program
                  48
                  4
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  185
                  368
                  356
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  185
                  368
                  356
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  368
                  663
                  555
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  77
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  456
                  663
                  555
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  397
                  265
                  91
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  392
                  260
                  91
               
               
                  1900
                  Budget authority (total)
                  392
                  260
                  91
               
               
                  1930
                  Total budgetary resources available
                  848
                  923
                  646
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  663
                  555
                  290
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  901
                  695
                  626
               
               
                  3010
                  New obligations, unexpired accounts
                  185
                  368
                  356
               
               
                  3020
                  Outlays (gross)
                  â378
                  â437
                  â429
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  695
                  626
                  553
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  901
                  695
                  626
               
               
                  3200
                  Obligated balance, end of year
                  695
                  626
                  553
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  392
                  260
                  91
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  30
                  27
                  23
               
               
                  4101
                  Outlays from mandatory balances
                  348
                  410
                  406
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  378
                  437
                  429
               
               
                  4180
                  Budget authority, net (total)
                  392
                  260
                  91
               
               
                  4190
                  Outlays, net (total)
                  378
                  437
                  429
               
               
                  
                     
                  
               
            
         
      
      
         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),
            the Medicaid Extenders Act of 2019 (P.L. 116â3), the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116â16),
            the Sustaining Excellence in Medicaid Act of 2019 (P.L. 116â39), the Continuing Appropriations Act, 2020, the Health Extenders
            Act of 2019 (P.L. 116â59), and the Further Consolidated Appropriation Act, 2020 (P.L. 116â94).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent - Medicaid Integrity Program
                  20
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  20
                  20
                  20
               
               
                  12.1
                  Civilian personnel benefits - Medicaid Integrity Program
                  9
                  9
                  9
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid Integrity Program
                  55
                  82
                  62
               
               
                  41.0
                  Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
                  32
                  215
                  261
               
               
                  41.0
                  Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                  21
                  38
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions - Demo to increase substance use provider capacity under Medicaid
                  48
                  4
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  185
                  368
                  356
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  185
                  368
                  356
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  184
                  201
                  201
               
               
                  1101
                  Direct military average strength employment
                  5
                  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,  $439,514,000,000.
      In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
            Act that were not anticipated in budget estimates, such sums as may be necessary.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  271,628
                  304,045
                  325,500
               
               
                  0002
                  Part D benefits (Rx Drug)
                  75,418
                  104,539
                  111,800
               
               
                  0003
                  Part D Federal administration (Rx Drug)
                  642
                  861
                  882
               
               
                  0004
                  General Fund Transfers to HI
                  1,308
                  1,346
                  1,327
               
               
                  0006
                  Federal Bureau of Investigation (HCFAC)
                  138
                  135
                  138
               
               
                  0007
                  Federal payments from taxation of OASDI benefits (HI)
                  23,781
                  26,941
                  29,300
               
               
                  0008
                  Criminal fines (HCFAC)
                  15
                  88
                  36
               
               
                  0009
                  Civil penalties and damages (HCFACâDOJ and CMS administration)
                  37
                  51
                  52
               
               
                  0010
                  Asset Forfeiture
                  64
                  31
                  32
               
               
                  0011
                  State Low Income Determinations
                  4
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  373,035
                  438,042
                  469,072
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  378,344
                  410,796
                  439,514
               
               
                  1200
                  Appropriation (indefinite, permanent)
                  23,781
                  26,941
                  29,300
               
               
                  1200
                  Appropriation (HCFAC for FBI)
                  138
                  135
                  138
               
               
                  1200
                  Appropriation (indefinite for HCFAC)
                  84
                  170
                  120
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  402,347
                  438,042
                  469,072
               
               
                  1930
                  Total budgetary resources available
                  402,347
                  438,042
                  469,072
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â29,312
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  10,525
                  12,667
                  63,114
               
               
                  3010
                  New obligations, unexpired accounts
                  373,035
                  438,042
                  469,072
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  16
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â364,706
                  â387,595
                  â415,989
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6,203
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12,667
                  63,114
                  116,197
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  10,525
                  12,667
                  63,114
               
               
                  3200
                  Obligated balance, end of year
                  12,667
                  63,114
                  116,197
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  402,347
                  438,042
                  469,072
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  364,039
                  375,230
                  367,777
               
               
                  4101
                  Outlays from mandatory balances
                  667
                  12,365
                  48,212
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  364,706
                  387,595
                  415,989
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â4,289
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â1,537
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â5,826
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  5,826
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  402,347
                  438,042
                  469,072
               
               
                  4170
                  Outlays, net (mandatory)
                  358,880
                  387,595
                  415,989
               
               
                  4180
                  Budget authority, net (total)
                  402,347
                  438,042
                  469,072
               
               
                  4190
                  Outlays, net (total)
                  358,880
                  387,595
                  415,989
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  402,347
                  438,042
                  469,072
               
               
                  
                  Outlays
                  358,880
                  387,595
                  415,989
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â7,383
               
               
                  
                  Outlays
                  
                  
                  â7,383
               
               
                  Total:
               
               
                  
                  Budget Authority
                  402,347
                  438,042
                  461,689
               
               
                  
                  Outlays
                  358,880
                  387,595
                  408,606
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  371,053
                  435,726
                  466,859
               
               
                  42.0
                  Insurance claims and indemnities (HI Uninsured Federal)
                  127
                  109
                  95
               
               
                  94.0
                  Financial transfers (Federal admin)
                  1,855
                  2,207
                  2,118
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  373,035
                  438,042
                  469,072
               
               
                  
                     
                  
               
            
         
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â7,383
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â7,383
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â7,383
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â7,383
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â7,383
               
               
                  3020
                  Outlays (gross)
                  
                  
                  7,383
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â7,383
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â7,383
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â7,383
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â7,383
               
               
                  
                     
                  
               
            
         
      
      
          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.
         
      
         Quality Improvement OrganizationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  QIO Clinical Quality Improvement
                  38
                  486
                  
               
               
                  0002
                  QIO Beneficiary and Family Centered Care
                  438
                  
                  
               
               
                  0003
                  QIO Support Contracts
                  421
                  462
                  354
               
               
                  0004
                  QIO Administration
                  62
                  74
                  76
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  959
                  1,022
                  430
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  240
                  202
                  36
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  1,184
                  820
                  393
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,424
                  1,022
                  429
               
               
                  1930
                  Total budgetary resources available
                  1,424
                  1,023
                  430
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â464
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  867
                  886
                  886
               
               
                  3010
                  New obligations, unexpired accounts
                  959
                  1,022
                  430
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â911
                  â1,022
                  â429
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  886
                  886
                  887
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,617
                  â1,799
                  â2,619
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,184
                  â820
                  â393
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1,002
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,799
                  â2,619
                  â3,012
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â750
                  â913
                  â1,733
               
               
                  3200
                  Obligated balance, end of year
                  â913
                  â1,733
                  â2,125
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,424
                  1,022
                  429
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  221
                  411
                  100
               
               
                  4101
                  Outlays from mandatory balances
                  690
                  611
                  329
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  911
                  1,022
                  429
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â933
                  â1,022
                  â429
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,184
                  â820
                  â393
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  693
                  820
                  393
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â491
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â22
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â22
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  50
                  50
                  50
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  25
                  37
                  38
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  26
                  38
                  39
               
               
                  12.1
                  Civilian personnel benefits
                  12
                  21
                  22
               
               
                  12.2
                  Military personnel benefits
                  
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  920
                  958
                  364
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  959
                  1,022
                  430
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  237
                  252
                  257
               
               
                  1101
                  Direct military average strength employment
                  10
                  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  $3,693,548,000, 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  2021 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 shall remain available until September 30, 2022, and shall be
               available for the Survey and Certification Program.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  3,050
                  2,825
                  2,479
               
               
                  0002
                  Federal administration
                  749
                  733
                  773
               
               
                  0003
                  State survey and certification
                  401
                  397
                  442
               
               
                  0004
                  Research, demonstrations, and evaluation projects
                  20
                  20
                  
               
               
                  0007
                  ARRA Medicare/Medicaid HIT
                  27
                  32
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  4,247
                  4,007
                  3,719
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,247
                  4,007
                  3,719
               
               
                  0801
                  Clinical laboratory improvement amendments
                  64
                  69
                  69
               
               
                  0802
                  Sale of data
                  24
                  27
                  27
               
               
                  0803
                  Coordination of benefits
                  32
                  70
                  70
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  76
                  85
                  85
               
               
                  0805
                  Provider enrollment
                  5
                  5
                  5
               
               
                  0806
                  Recovery audit contractors
                  87
                  111
                  119
               
               
                  0808
                  Marketplace User Fees
                  1,364
                  1,341
                  1,120
               
               
                  0810
                  Risk Adjustment Administrative Expenses
                  48
                  58
                  52
               
               
                  0813
                  Other reimbursable program activity
                  
                  24
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,700
                  1,790
                  1,571
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  5,947
                  5,797
                  5,290
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3,123
                  4,475
                  5,069
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  464
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  27
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3,619
                  4,475
                  5,069
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3
                  3
                  3
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,819
                  3,995
                  3,714
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2,212
                  
                  
               
               
                  1710
                  Spending authority from offsetting collections transferred to other accounts [075â1503]
                  â4
                  
                  
               
               
                  1710
                  Spending authority from offsetting collections transferred to other accounts [075â9912]
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,022
                  3,995
                  3,714
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2,333
                  2,412
                  2,294
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  607
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  116
                  122
                  109
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â159
                  â141
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  2,897
                  2,393
                  2,403
               
               
                  1900
                  Budget authority (total)
                  6,922
                  6,391
                  6,120
               
               
                  1930
                  Total budgetary resources available
                  10,541
                  10,866
                  11,189
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â119
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4,475
                  5,069
                  5,899
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,599
                  4,767
                  4,722
               
               
                  3010
                  New obligations, unexpired accounts
                  5,947
                  5,797
                  5,290
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  46
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,569
                  â5,842
                  â6,919
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â27
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â229
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,767
                  4,722
                  3,093
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5,838
                  â6,882
                  â6,882
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  â500
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,819
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,275
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6,882
                  â6,882
                  â6,882
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â1,739
                  â2,115
                  â2,160
               
               
                  3200
                  Obligated balance, end of year
                  â2,115
                  â2,160
                  â3,789
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,022
                  3,995
                  3,714
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,718
                  2,008
                  1,867
               
               
                  4011
                  Outlays from discretionary balances
                  2,065
                  1,193
                  1,986
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,783
                  3,201
                  3,853
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,806
                  â3,975
                  â3,694
               
               
                  4033
                  Non-Federal sources
                  â31
                  â20
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,837
                  â3,995
                  â3,714
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,212
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,018
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â194
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  â9
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â54
                  â794
                  139
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,900
                  2,396
                  2,406
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  36
                  1,337
                  1,266
               
               
                  4101
                  Outlays from mandatory balances
                  1,750
                  1,304
                  1,800
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,786
                  2,641
                  3,066
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â356
                  â54
                  â31
               
               
                  4123
                  Non-Federal sources
                  â2,049
                  â2,358
                  â2,263
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2,405
                  â2,412
                  â2,294
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â607
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  67
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â535
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â40
                  â16
                  112
               
               
                  4170
                  Outlays, net (mandatory)
                  â619
                  229
                  772
               
               
                  4180
                  Budget authority, net (total)
                  â49
                  â16
                  112
               
               
                  4190
                  Outlays, net (total)
                  â673
                  â565
                  911
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  552
                  531
                  550
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â64
                  
                  
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  531
                  550
                  441
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  5
                  69
                  69
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  5
                  69
                  69
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  â49
                  â16
                  112
               
               
                  
                  Outlays
                  â673
                  â565
                  911
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  12
               
               
                  
                  Outlays
                  
                  â4
                  â28
               
               
                  Total:
               
               
                  
                  Budget Authority
                  â49
                  â16
                  124
               
               
                  
                  Outlays
                  â673
                  â569
                  883
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  425
                  401
                  372
               
               
                  11.3
                  Other than full-time permanent
                  12
                  11
                  11
               
               
                  11.5
                  Other personnel compensation
                  6
                  6
                  5
               
               
                  11.7
                  Military personnel
                  15
                  14
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  458
                  432
                  401
               
               
                  12.1
                  Civilian personnel benefits
                  162
                  153
                  142
               
               
                  12.2
                  Military personnel benefits
                  9
                  8
                  8
               
               
                  21.0
                  Travel and transportation of persons
                  5
                  5
                  4
               
               
                  23.1
                  Rental payments to GSA
                  16
                  15
                  14
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  8
                  8
                  7
               
               
                  24.0
                  Printing and reproduction
                  46
                  43
                  40
               
               
                  25.2
                  Other services from non-Federal sources
                  3,014
                  2,843
                  2,640
               
               
                  25.3
                  Other goods and services from Federal sources
                  97
                  92
                  85
               
               
                  25.6
                  Medical care
                  366
                  345
                  320
               
               
                  25.7
                  Operation and maintenance of equipment
                  40
                  38
                  35
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  23
                  22
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,247
                  4,007
                  3,719
               
               
                  99.0
                  Reimbursable obligations
                  1,700
                  1,790
                  1,571
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,947
                  5,797
                  5,290
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4,226
                  4,088
                  4,152
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  141
                  116
                  64
               
               
                  1101
                  Direct military average strength employment
                  144
                  144
                  144
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  257
                  293
                  293
               
               
                  2101
                  Reimbursable military average strength employment
                  16
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Program Management
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  12
               
               
                  0801
                  ACL SHIPs
                  
                  5
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  5
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  5
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  12
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  5
                  53
               
               
                  1900
                  Budget authority (total)
                  
                  5
                  65
               
               
                  1930
                  Total budgetary resources available
                  
                  5
                  65
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  40
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  4
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  5
                  25
               
               
                  3020
                  Outlays (gross)
                  
                  â1
                  â25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  4
                  4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  4
               
               
                  3200
                  Obligated balance, end of year
                  
                  4
                  4
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  5
                  65
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1
                  23
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  1
                  25
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  â5
                  â53
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  12
               
               
                  4190
                  Outlays, net (total)
                  
                  â4
                  â28
               
               
                  
                     
                  
               
            
         
      
      
         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 2021 Budget, a revisit fee for long term care facilities, and
            the National Medicare and You Education Program user fee increase.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  25.3
                  Direct obligations: Other goods and services from Federal sources
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  12
               
               
                  99.0
                  Reimbursable obligations
                  
                  5
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  5
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  17,500
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  17,500
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  17,500
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  17,500
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  17,500
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â17,500
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  17,500
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  17,500
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  17,500
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  17,500
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to states and US territories
                  17,416
                  18,708
                  18,030
               
               
                  0002
                  CHIP Redistribution Funds
                  179
                  
                  
               
               
                  0003
                  Child health quality
                  10
                  31
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  17,605
                  18,739
                  18,064
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  8,251
                  8,237
                  14,065
               
               
                  1011
                  Unobligated balance transfer from other acct [075â5551]
                  
                  4,037
                  4,914
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  29
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  146
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  8,426
                  12,274
                  18,979
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1130
                  Appropriations permanently reduced
                  
                  
                  â8,790
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  22,600
                  23,700
                  24,800
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  
                  6,093
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2,061
                  â3,170
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  20,539
                  20,530
                  30,893
               
               
                  1900
                  Budget authority (total)
                  20,539
                  20,530
                  22,103
               
               
                  1930
                  Total budgetary resources available
                  28,965
                  32,804
                  41,082
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3,123
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  8,237
                  14,065
                  23,018
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,789
                  5,530
                  6,615
               
               
                  3010
                  New obligations, unexpired accounts
                  17,605
                  18,739
                  18,064
               
               
                  3020
                  Outlays (gross)
                  â17,835
                  â17,654
                  â15,778
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â29
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5,530
                  6,615
                  8,901
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,789
                  5,530
                  6,615
               
               
                  3200
                  Obligated balance, end of year
                  5,530
                  6,615
                  8,901
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â8,790
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  20,539
                  20,530
                  30,893
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  12,531
                  10,831
                  9,263
               
               
                  4101
                  Outlays from mandatory balances
                  5,304
                  6,823
                  6,515
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  17,835
                  17,654
                  15,778
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources:
                  â146
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  146
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  20,539
                  20,530
                  30,893
               
               
                  4170
                  Outlays, net (mandatory)
                  17,689
                  17,654
                  15,778
               
               
                  4180
                  Budget authority, net (total)
                  20,539
                  20,530
                  22,103
               
               
                  4190
                  Outlays, net (total)
                  17,689
                  17,654
                  15,778
               
               
                  
                     
                  
               
            
         
      
      
         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. CHIPRA also created a contingency fund in a separate
            account to assist States who project spending above their available allocated CHIP funds. 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Administration
                  349
                  411
                  433
               
               
                  0002
                  Innovation Activities
                  459
                  1,003
                  810
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  808
                  1,414
                  1,243
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,619
                  1,856
                  10,442
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  45
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,664
                  1,856
                  10,442
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  10,000
                  
               
               
                  1930
                  Total budgetary resources available
                  2,664
                  11,856
                  10,442
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,856
                  10,442
                  9,199
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,228
                  1,013
                  1,217
               
               
                  3010
                  New obligations, unexpired accounts
                  808
                  1,414
                  1,243
               
               
                  3020
                  Outlays (gross)
                  â978
                  â1,210
                  â1,203
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â45
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,013
                  1,217
                  1,257
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,228
                  1,013
                  1,217
               
               
                  3200
                  Obligated balance, end of year
                  1,013
                  1,217
                  1,257
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  10,000
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  978
                  1,210
                  1,203
               
               
                  4180
                  Budget authority, net (total)
                  
                  10,000
                  
               
               
                  4190
                  Outlays, net (total)
                  978
                  1,210
                  1,203
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  81
                  61
                  67
               
               
                  11.7
                  Military personnel
                  2
                  3
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  83
                  64
                  71
               
               
                  12.1
                  Civilian personnel benefits
                  20
                  20
                  21
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  3
                  3
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  567
                  860
                  686
               
               
                  41.0
                  Grants, subsidies, and contributions
                  123
                  405
                  401
               
               
                  42.0
                  Insurance claims and indemnities
                  11
                  61
                  60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  808
                  1,414
                  1,243
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  516
                  557
                  557
               
               
                  1101
                  Direct military average strength employment
                  17
                  17
                  17
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  3,132
                  5,609
                  6,093
               
               
                  0198
                  Earnings on investment adjustment
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  3,128
                  5,609
                  6,093
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Interest, Child Enrollment Contingency Fund
                  254
                  173
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  3,382
                  5,782
                  6,168
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Child Enrollment Contingency Fund
                  â254
                  â173
                  â168
               
               
                  2103
                  Child Enrollment Contingency Fund
                  â3,128
                  â5,609
                  â6,093
               
               
                  2135
                  Child Enrollment Contingency Fund
                  3,267
                  6,093
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â115
                  311
                  â6,261
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â115
                  311
                  â6,261
               
               
                  4030
                  Child Enrollment Contingency Fund
                  2,342
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  5,609
                  6,093
                  â93
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and US Territories
                  113
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  113
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,338
                  4,522
                  4,914
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0515]
                  
                  â4,037
                  â4,914
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  4
                  
                  
               
               
                  1035
                  Unobligated balance precluded from obligation (limitation on obligations)(special and trust)
                  â2,342
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  
                  485
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  4,520
                  4,740
                  4,960
               
               
                  1201
                  Appropriation (special or trust fund)
                  254
                  173
                  168
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  3,128
                  5,609
                  6,093
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  
                  
                  â6,093
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  â3,267
                  â6,093
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  4,635
                  4,429
                  5,128
               
               
                  1900
                  Budget authority (total)
                  4,635
                  4,429
                  5,128
               
               
                  1930
                  Total budgetary resources available
                  4,635
                  4,914
                  5,128
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4,522
                  4,914
                  5,128
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  200
                  310
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  113
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3
                  â310
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  310
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  200
                  310
                  
               
               
                  3200
                  Obligated balance, end of year
                  310
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,635
                  4,429
                  5,128
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  310
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  3
                  310
                  
               
               
                  4180
                  Budget authority, net (total)
                  4,635
                  4,429
                  5,128
               
               
                  4190
                  Outlays, net (total)
                  3
                  310
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  
                  
                  15,044
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  
                  15,044
                  10,042
               
               
                  
                     
                  
               
            
         
      
      
         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 and instead fund a restructured Shortfall Fund that will
            be a more accessible safety net for states.  Currently, few states can meet the restrictive eligibility criteria to qualify
            for a Contingency Fund payment. When States do qualify, they do not need to spend the funds on children's health.  This proposal
            has no budget impact. 
         
      
         Medicare Health Information Technology Incentive Payments, Recovery ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0508â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Incentive payments to hospitals
                  37
                  15
                  10
               
               
                  0802
                  Incentive payments to eligible professionals
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 42.0)
                  46
                  15
                  10
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1033
                  Recoveries of prior year paid obligations
                  12
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected from the HI Trust Fund
                  53
                  15
                  10
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â16
                  
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  34
                  15
                  10
               
               
                  1930
                  Total budgetary resources available
                  46
                  15
                  10
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  24
                  15
                  15
               
               
                  3010
                  New obligations, unexpired accounts
                  46
                  15
                  10
               
               
                  3020
                  Outlays (gross)
                  â55
                  â15
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15
                  15
                  15
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â161
                  â145
                  â145
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â145
                  â145
                  â145
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â137
                  â130
                  â130
               
               
                  3200
                  Obligated balance, end of year
                  â130
                  â130
                  â130
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  34
                  15
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  31
                  1
                  10
               
               
                  4101
                  Outlays from mandatory balances
                  24
                  14
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  55
                  15
                  10
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â53
                  â15
                  â10
               
               
                  4123
                  Non-Federal sources
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â65
                  â15
                  â10
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  16
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  28
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â3
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â10
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  â3
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â10
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  141
                  144
                  144
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  144
                  144
                  144
               
               
                  
                     
                  
               
            
         
      
         Rate Review GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0112â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Premium rate review grants
                  
                  
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  26
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  5
                  26
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  
                  16
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  5
                  26
                  26
               
               
                  1930
                  Total budgetary resources available
                  5
                  26
                  26
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  26
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  52
                  18
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  26
               
               
                  3020
                  Outlays (gross)
                  â17
                  â13
                  â5
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â5
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  18
                  
                  21
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  52
                  18
                  
               
               
                  3200
                  Obligated balance, end of year
                  18
                  
                  21
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  17
                  13
                  5
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  17
                  13
                  5
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pre-Existing Condition Insurance Plan Program (Direct)
                  55
                  
                  
               
               
                  0002
                  Administration
                  
                  75
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  55
                  75
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.2)
                  55
                  75
                  75
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  246
                  195
                  120
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  250
                  195
                  120
               
               
                  1930
                  Total budgetary resources available
                  250
                  195
                  120
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  195
                  120
                  45
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  69
                  68
                  71
               
               
                  3010
                  New obligations, unexpired accounts
                  55
                  75
                  75
               
               
                  3020
                  Outlays (gross)
                  â52
                  â72
                  â90
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  68
                  71
                  56
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  69
                  68
                  71
               
               
                  3200
                  Obligated balance, end of year
                  68
                  71
                  56
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  52
                  72
                  90
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  52
                  72
                  90
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  26
                  26
                  36
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  26
                  36
                  36
               
               
                  1930
                  Total budgetary resources available
                  26
                  36
                  36
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  26
                  36
                  36
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  10
                  10
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  10
                  10
                  
               
               
                  3200
                  Obligated balance, end of year
                  10
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  7
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  5
                  
                  
               
               
                  
                  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
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  4
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  4
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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.
         
      
         Cost-sharing ReductionsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Cost Sharing Reductions
                  
                  6,734
                  6,624
               
               
                  0002
                  Basic Health Program
                  
                  1,266
                  1,307
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  8,000
                  7,931
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  8,000
                  7,931
               
               
                  1930
                  Total budgetary resources available
                  
                  8,000
                  7,931
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  8,000
                  7,931
               
               
                  3020
                  Outlays (gross)
                  
                  â8,000
                  â7,931
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  8,000
                  7,931
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  8,000
                  7,931
               
               
                  4180
                  Budget authority, net (total)
                  
                  8,000
                  7,931
               
               
                  4190
                  Outlays, net (total)
                  
                  8,000
                  7,931
               
               
                  
                     
                  
               
            
         
      
      
         Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers. The classification
            of CSRs as an entitlement pursuant to BBEDCA does not determine legal entitlement to a payment or benefit or availability
            of funding.
         
      
         Risk Adjustment Program PaymentsSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  311
                  371
                  328
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Receipts, Risk Adjustment Program
                  5,978
                  5,541
                  5,627
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  6,289
                  5,912
                  5,955
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Risk Adjustment Program Payments
                  â5,978
                  â5,540
                  â5,627
               
               
                  2103
                  Risk Adjustment Program Payments
                  â311
                  â371
                  â327
               
               
                  2132
                  Risk Adjustment Program Payments
                  371
                  327
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â5,918
                  â5,584
                  â5,954
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â5,918
                  â5,584
                  â5,954
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  371
                  328
                  1
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Risk Adjustment Program Payments (Direct)
                  7,397
                  5,584
                  5,954
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  7,397
                  5,584
                  5,954
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,225
                  746
                  746
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  5,978
                  5,540
                  5,627
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  311
                  371
                  327
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â371
                  â327
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  5,918
                  5,584
                  5,954
               
               
                  1930
                  Total budgetary resources available
                  8,143
                  6,330
                  6,700
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  746
                  746
                  746
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,192
                  2,678
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  7,397
                  5,584
                  5,954
               
               
                  3020
                  Outlays (gross)
                  â6,911
                  â8,262
                  â5,954
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,678
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,192
                  2,678
                  
               
               
                  3200
                  Obligated balance, end of year
                  2,678
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5,918
                  5,584
                  5,954
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,494
                  5,584
                  5,954
               
               
                  4101
                  Outlays from mandatory balances
                  4,417
                  2,678
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6,911
                  8,262
                  5,954
               
               
                  4180
                  Budget authority, net (total)
                  5,918
                  5,584
                  5,954
               
               
                  4190
                  Outlays, net (total)
                  6,911
                  8,262
                  5,954
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  25
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Contributions, Transitional Reinsurance Program
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  26
                  
                  
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Transitional Reinsurance Program
                  â1
                  
                  
               
               
                  2103
                  Transitional Reinsurance Program
                  â25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Transitional reinsurance payments
                  237
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  237
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  216
                  5
                  5
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1
                  
                  
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  26
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  242
                  5
                  5
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  5
                  5
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  10
                  212
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  237
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â35
                  â212
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  212
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  10
                  212
                  
               
               
                  3200
                  Obligated balance, end of year
                  212
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  26
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  35
                  212
                  
               
               
                  4180
                  Budget authority, net (total)
                  26
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  35
                  212
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 2019 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0705
                  Reestimates of direct loan subsidy
                  4
                  
                  
               
               
                  0709
                  Administrative expenses
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  5
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  2
                  2
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2
                  2
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  5
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  7
                  2
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  1
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  5
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5
                  
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  1
                  1
               
               
                  3200
                  Obligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  5
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  5
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  5
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135001
                  Startup Loans
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  5
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0705
                  Reestimates of direct loan subsidy
                  231
                  2
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  28
                  
                  
               
               
                  0709
                  Administrative expenses
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  260
                  3
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  1
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  259
                  2
                  
               
               
                  1900
                  Budget authority (total)
                  259
                  2
                  
               
               
                  1930
                  Total budgetary resources available
                  261
                  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
                  2
                  2
                  3
               
               
                  3010
                  New obligations, unexpired accounts
                  260
                  3
                  
               
               
                  3020
                  Outlays (gross)
                  â259
                  â2
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2
                  3
                  3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  2
                  3
               
               
                  3200
                  Obligated balance, end of year
                  2
                  3
                  3
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  259
                  2
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  259
                  2
                  
               
               
                  4180
                  Budget authority, net (total)
                  259
                  2
                  
               
               
                  4190
                  Outlays, net (total)
                  259
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  116
                  
                  
               
               
                  135003
                  Solvency  Loans
                  143
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  259
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      
         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.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  
               
               
                  33.0
                  Investments and loans
                  
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  259
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  260
                  3
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  7
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  7
                  3
                  3
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  22
                  18
                  20
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  9
                  18
                  20
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  3
                  2
                  2
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  272
                  41
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  â259
                  â38
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  13
                  3
                  
               
               
                  1900
                  Budget authority (total)
                  16
                  5
                  2
               
               
                  1930
                  Total budgetary resources available
                  25
                  23
                  22
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  18
                  20
                  19
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  3
               
               
                  3010
                  New obligations, unexpired accounts
                  7
                  3
                  3
               
               
                  3020
                  Outlays (gross)
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  3
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  3
               
               
                  3200
                  Obligated balance, end of year
                  
                  3
                  6
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16
                  5
                  2
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  7
                  
                  
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â259
                  â2
                  
               
               
                  4122
                  Interest on uninvested funds
                  â5
                  â1
                  
               
               
                  4123
                  Non-Federal sources
                  â8
                  â38
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â272
                  â41
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â256
                  â36
                  2
               
               
                  4170
                  Outlays, net (mandatory)
                  â265
                  â41
                  
               
               
                  4180
                  Budget authority, net (total)
                  â256
                  â36
                  2
               
               
                  4190
                  Outlays, net (total)
                  â265
                  â41
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  1,893
                  1,893
                  1,893
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â582
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,893
                  1,893
                  1,311
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2018 actual
                  2019 actual
               
               
                  
                     
                  
               
               
                  
                  Group heading
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  9
                  9
               
               
                  
                  Investments in U.S. securities:
               
               
                  1106
                  Receivables, net
                  259
                  259
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  1,893
                  1,893
               
               
                  1402
                  Interest receivable
                  25
                  25
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â1,778
                  â1,778
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  140
                  140
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  408
                  408
               
               
                  
                  LIABILITIES:
               
               
                  2103
                  Federal liabilities: Debt
                  408
                  408
               
               
                  
                  NET POSITION:
               
               
                  3300
                  Cumulative results of operations
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  408
                  408
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  2
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  8
                  5
                  6
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â3
                  
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  5
                  6
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  3
                  1
                  1
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  6
                  1
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1
                  1
                  
               
               
                  1900
                  Budget authority (total)
                  4
                  2
                  1
               
               
                  1930
                  Total budgetary resources available
                  7
                  7
                  7
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  6
                  6
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  1
                  1
               
               
                  3020
                  Outlays (gross)
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  1
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  1
               
               
                  3200
                  Obligated balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4
                  2
                  1
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  2
                  
                  
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â5
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â6
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â2
                  1
                  1
               
               
                  4170
                  Outlays, net (mandatory)
                  â4
                  â1
                  
               
               
                  4180
                  Budget authority, net (total)
                  â2
                  1
                  1
               
               
                  4190
                  Outlays, net (total)
                  â4
                  â1
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2019 actual
                  2020 est.
                  2021 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
                  2018 actual
                  2019 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  5
                  5
               
               
                  
                  Investments in U.S. securities:
               
               
                  1106
                  Receivables, net
                  5
                  5
               
               
                  1206
                  Non-Federal assets: Receivables, net
                  
                  
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  480
                  480
               
               
                  1402
                  Interest receivable
                  5
                  5
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â429
                  â429
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  56
                  56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  66
                  66
               
               
                  
                  LIABILITIES:
               
               
                  
                  Federal liabilities:
               
               
                  2103
                  Debt
                  65
                  65
               
               
                  2104
                  Resources payable to Treasury
                  
                  
               
               
                  2207
                  Non-Federal liabilities: Other
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total liabilities
                  65
                  65
               
               
                  
                  NET POSITION:
               
               
                  3300
                  Cumulative results of operations
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  66
                  66
               
               
                  
                     
                  
               
            
         
      
      Trust Funds
         Federal Hospital Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  164,161
                  156,175
                  146,288
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  258,083
                  271,553
                  286,235
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  610
                  586
                  619
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  18,879
                  20,005
                  21,268
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  815
                  614
                  575
               
               
                  1130
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  387
                  511
                  573
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  6,231
                  6,100
                  6,150
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  79
                  48
                  48
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,823
                  4,207
                  4,511
               
               
                  1140
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,817
                  4,060
                  4,219
               
               
                  1140
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  662
                  661
                  660
               
               
                  1140
                  FHI Trust Fund, Interest Received by Trust Funds
                  6,927
                  6,129
                  5,688
               
               
                  1140
                  FHI Trust Fund, Taxation on OASDI Benefits
                  23,781
                  26,941
                  29,300
               
               
                  1140
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  138
                  135
                  138
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  15
                  88
                  36
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  64
                  52
                  52
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  37
                  31
                  32
               
               
                  1140
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  24
                  23
                  22
               
               
                  1140
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,177
                  1,293
                  1,306
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  325,549
                  343,039
                  361,434
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â83
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â235
               
               
                  1240
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  
                  247
               
               
                  1240
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â69
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  325,549
                  343,039
                  361,365
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  489,710
                  499,214
                  507,653
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â3,039
                  â2,689
                  â2,789
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â320,420
                  â338,930
                  â357,148
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â765
                  â786
                  â813
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,380
                  â1,406
                  â1,427
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â14,649
                  â9,153
                  â15,814
               
               
                  2132
                  Federal Hospital Insurance Trust Fund
                  6,636
                  
                  
               
               
                  2132
                  Health Care Fraud and Abuse Control Account
                  49
                  49
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â333,568
                  â352,915
                  â377,991
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â247
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  
                  235
               
               
                  2203
                  Federal Hospital Insurance Trust Fund
                  
                  â11
                  
               
               
                  2234
                  Federal Hospital Insurance Trust Fund
                  
                  
                  16,932
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  â11
                  16,920
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â333,568
                  â352,926
                  â361,071
               
               
                  3098
                  Federal Hospital Insurance Trust Fund
                  33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  156,175
                  146,288
                  146,582
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  326,346
                  346,980
                  372,418
               
               
                  0002
                  HIT Incentive Payments
                  44
                  15
                  10
               
               
                  0003
                  Administration, HI
                  4,456
                  2,871
                  2,983
               
               
                  0004
                  Quality improvement organizations, HI
                  636
                  907
                  340
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  331,482
                  350,773
                  375,751
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  331,482
                  350,773
                  375,751
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  
                  1
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  39
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  â33
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  11
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  3,039
                  2,689
                  2,789
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  320,420
                  338,930
                  357,148
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  14,649
                  9,153
                  15,814
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                  â6,636
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  328,433
                  348,083
                  372,962
               
               
                  1900
                  Budget authority (total)
                  331,472
                  350,772
                  375,751
               
               
                  1930
                  Total budgetary resources available
                  331,483
                  350,773
                  375,751
               
               
                  
                  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
                  36,686
                  40,274
                  40,867
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  5
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  331,482
                  350,773
                  375,751
               
               
                  3020
                  Outlays (gross)
                  â327,860
                  â350,180
                  â375,341
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  40,274
                  40,867
                  41,277
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  36,691
                  40,274
                  40,867
               
               
                  3200
                  Obligated balance, end of year
                  40,274
                  40,867
                  41,277
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,039
                  2,689
                  2,789
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,883
                  1,469
                  1,551
               
               
                  4011
                  Outlays from discretionary balances
                  1,062
                  494
                  697
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,945
                  1,963
                  2,248
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  328,433
                  348,083
                  372,962
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  292,819
                  311,142
                  339,784
               
               
                  4101
                  Outlays from mandatory balances
                  32,096
                  37,075
                  33,309
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  324,915
                  348,217
                  373,093
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â5
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  328,433
                  348,083
                  372,962
               
               
                  4170
                  Outlays, net (mandatory)
                  324,910
                  348,217
                  373,093
               
               
                  4180
                  Budget authority, net (total)
                  331,472
                  350,772
                  375,751
               
               
                  4190
                  Outlays, net (total)
                  327,855
                  350,180
                  375,341
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  202,805
                  198,625
                  189,516
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  198,625
                  189,516
                  189,717
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  331,472
                  350,772
                  375,751
               
               
                  
                  Outlays
                  327,855
                  350,180
                  375,341
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  11
                  â17,167
               
               
                  
                  Outlays
                  
                  11
                  â17,167
               
               
                  Total:
               
               
                  
                  Budget Authority
                  331,472
                  350,783
                  358,584
               
               
                  
                  Outlays
                  327,855
                  350,191
                  358,174
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  203,227
                  198,894
                  189,672
               
               
                  0298
                  Adjustment to reconcile to proprietary accounting
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  203,228
                  198,894
                  189,672
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  258,083
                  271,553
                  286,235
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  610
                  586
                  619
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  18,879
                  20,005
                  21,268
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  815
                  614
                  575
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  387
                  511
                  573
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  6,231
                  6,100
                  6,150
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  79
                  48
                  48
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,823
                  4,207
                  4,511
               
               
                  1130
                  Federal Hospital Insurance Trust Fund
                  5
                  
                  
               
               
                  1150
                  FHI Trust Fund, Interest Received by Trust Funds
                  6,927
                  6,129
                  5,688
               
               
                  1150
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  
                  2
                  2
               
               
                  1150
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  24
                  23
                  22
               
               
                  1160
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,817
                  4,060
                  4,219
               
               
                  1160
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  662
                  661
                  660
               
               
                  1160
                  FHI Trust Fund, Taxation on OASDI Benefits
                  23,781
                  26,941
                  29,300
               
               
                  1160
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  138
                  135
                  138
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  15
                  88
                  36
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  64
                  52
                  52
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  37
                  31
                  32
               
               
                  1160
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,177
                  1,293
                  1,306
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  325,554
                  343,039
                  361,434
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â83
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â235
               
               
                  1250
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  
                  247
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â69
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  325,554
                  343,039
                  361,365
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Hospital Insurance Trust Fund [Budget Acct]
                  â327,860
                  â350,180
                  â375,341
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [Budget Acct]
                  â1,965
                  â2,070
                  â2,156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â329,825
                  â352,250
                  â377,497
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Hospital Insurance Trust Fund
                  
                  â11
                  17,167
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  â11
                  17,167
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â329,825
                  â352,261
                  â360,330
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  â11,222
                  â15,376
                  â4,924
               
               
                  3120
                  Interest
                  6,951
                  6,154
                  5,959
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â4,271
                  â9,222
                  1,035
               
               
                  3298
                  Adjustment to reconcile to proprietary accounting
                  â63
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  â63
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  â4,334
                  â9,222
                  1,035
               
               
                  
                  Unexpended balance, end of year:
               
               
                  4100
                  Uninvested balance (net), end of year
                  269
                  156
                  990
               
               
                  4200
                  Federal Hospital Insurance Trust Fund
                  198,625
                  189,516
                  189,717
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  198,894
                  189,672
                  190,707
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activities
                  636
                  907
                  340
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  326,390
                  346,995
                  372,428
               
               
                  94.0
                  Financial transfers
                  4,456
                  2,871
                  2,983
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  331,482
                  350,773
                  375,751
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  247
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  
                  
                  â247
               
               
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â17,185
               
               
                  0003
                  Administration, HI
                  
                  11
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  11
                  â17,167
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  11
                  â17,167
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â235
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  
                  11
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â16,932
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  11
                  â17,167
               
               
                  1900
                  Budget authority (total)
                  
                  11
                  â17,167
               
               
                  1930
                  Total budgetary resources available
                  
                  11
                  â17,167
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  11
                  â17,167
               
               
                  3020
                  Outlays (gross)
                  
                  â11
                  17,167
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  11
                  â17,167
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  11
                  â17,167
               
               
                  4180
                  Budget authority, net (total)
                  
                  11
                  â17,167
               
               
                  4190
                  Outlays, net (total)
                  
                  11
                  â17,167
               
               
                  
                     
                  
               
            
         
      
      
          The Budget includes a package of Medicare proposals designed to eliminate wasteful spending, preserve and expand beneficiary
            access to care, enhance choice and competition, and strengthen Medicare's fiscal sustainability, consistent with the President's
            Executive Order on Protecting and Improving Medicare for Our Nation's Seniors. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â4â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â17,185
               
               
                  94.0
                  Financial transfers
                  
                  11
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  11
                  â17,167
               
               
                  
                     
                  
               
            
         
      
         Health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management,  $813,000,000, to remain available through September 30,  2022, 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  $628,356,426 shall be for the Centers for Medicare & Medicaid Services program integrity activities, of which  $101,643,574 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 $83,000,000 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  2021 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  $496,000,000 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 2021 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare integrity program
                  887
                  915
                  949
               
               
                  0002
                  FBI fraud and abuse control
                  138
                  141
                  154
               
               
                  0003
                  Other fraud and abuse control
                  285
                  301
                  324
               
               
                  0005
                  Undistributed Savings, HCFAC and SSA
                  
                  â31
                  â210
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  1,310
                  1,326
                  1,217
               
               
                  0101
                  CMS discretionary
                  554
                  610
                  628
               
               
                  0102
                  Other discretionary
                  166
                  176
                  185
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total Discretionary
                  720
                  786
                  813
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,030
                  2,112
                  2,030
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  471
                  574
                  605
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  201
                  574
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  512
                  574
                  605
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  765
                  786
                  813
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1,380
                  1,406
                  1,427
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â49
                  â49
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,331
                  1,357
                  1,427
               
               
                  1900
                  Budget authority (total)
                  2,096
                  2,143
                  2,240
               
               
                  1930
                  Total budgetary resources available
                  2,608
                  2,717
                  2,845
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â4
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  574
                  605
                  815
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1951
                  Unobligated balance expiring
                  4
                  
                  
               
               
                  1952
                  Expired unobligated balance, start of year
                  31
                  36
                  36
               
               
                  1953
                  Expired unobligated balance, end of year
                  32
                  36
                  36
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,970
                  1,977
                  2,019
               
               
                  3010
                  New obligations, unexpired accounts
                  2,030
                  2,112
                  2,030
               
               
                  3020
                  Outlays (gross)
                  â1,965
                  â2,070
                  â2,156
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â41
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,977
                  2,019
                  1,893
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,970
                  1,977
                  2,019
               
               
                  3200
                  Obligated balance, end of year
                  1,977
                  2,019
                  1,893
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  765
                  786
                  813
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  107
                  314
                  325
               
               
                  4011
                  Outlays from discretionary balances
                  601
                  109
                  353
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  708
                  423
                  678
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,331
                  1,357
                  1,427
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  415
                  689
                  608
               
               
                  4101
                  Outlays from mandatory balances
                  842
                  958
                  870
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,257
                  1,647
                  1,478
               
               
                  4180
                  Budget authority, net (total)
                  2,096
                  2,143
                  2,240
               
               
                  4190
                  Outlays, net (total)
                  1,965
                  2,070
                  2,156
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent (CMS)
                  42
                  46
                  46
               
               
                  11.7
                  Military personnel
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  44
                  48
                  48
               
               
                  12.1
                  Civilian personnel benefits (CMS)
                  10
                  11
                  11
               
               
                  12.2
                  Military personnel benefits
                  1
                  2
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  11
                  13
                  13
               
               
                  25.2
                  Other services (CMS/Medicaid/Private Insurance)
                  109
                  
                  
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  140
                  145
                  150
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  298
                  303
                  327
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OGC)
                  7
                  7
                  7
               
               
                  25.3
                  Other goods and services from Federal sources (HHS/CMS)
                  
                  15
                  18
               
               
                  25.3
                  Other goods and services from Government accounts (HHS/FDA)
                  6
                  6
                  6
               
               
                  25.6
                  Medical care  (CMS)
                  1,266
                  1,452
                  1,505
               
               
                  92.0
                  Undistributed
                  
                  â31
                  â210
               
               
                  94.0
                  Financial transfers (FBI)
                  138
                  141
                  154
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,030
                  2,112
                  2,030
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  410
                  430
                  430
               
               
                  1101
                  Direct military average strength employment
                  16
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  67,416
                  67,661
                  67,581
               
               
                  0198
                  Adjustment to reconcile to budgetary accounting
                  â580
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  66,836
                  67,661
                  67,581
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  2,437
                  2,800
                  2,800
               
               
                  1130
                  Other Proprietary Interest from the Public, FSMI Fund
                  
                  3
                  3
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  5,542
                  5,780
                  6,338
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  12,154
                  12,478
                  13,255
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  486
                  639
                  725
               
               
                  1130
                  Medicare Refunds, SMI
                  4,961
                  5,011
                  5,061
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  72
                  45
                  45
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  84,468
                  95,004
                  101,235
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  13,290
                  13,409
                  13,683
               
               
                  1140
                  Federal Contributions, FSMI Fund
                  265,819
                  287,016
                  300,234
               
               
                  1140
                  Interest Received by Trust Fund, FSMI Fund
                  2,657
                  1,182
                  1,333
               
               
                  1140
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  5
                  5
               
               
                  1140
                  Interest, Medicare Prescription Drug Account, FSMI
                  65
                  48
                  51
               
               
                  1140
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  1,196
                  861
                  882
               
               
                  1140
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  66,687
                  71,172
                  84,003
               
               
                  1140
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  459,835
                  495,454
                  529,654
               
               
                  
                  Proposed:
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â2,186
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â295
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  
                  
                  â7,383
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â9,864
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  459,835
                  495,454
                  519,790
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  526,671
                  563,115
                  587,371
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â2,998
                  â3,141
                  â3,101
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â371,197
                  â399,303
                  â422,011
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â641
                  â861
                  â882
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â84,998
                  â89,915
                  â102,850
               
               
                  2103
                  Federal Supplementary Medical Insurance Trust Fund
                  â5,987
                  â2,301
                  â5,492
               
               
                  2132
                  Federal Supplementary Medical Insurance Trust Fund
                  7,317
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â458,504
                  â495,521
                  â534,336
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  7,383
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  2,481
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â7,383
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â13
                  â20
               
               
                  2234
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  7,384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  â13
                  9,845
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â458,504
                  â495,534
                  â524,491
               
               
                  3098
                  Federal Supplementary Medical Insurance Trust Fund
                  â41
                  
                  
               
               
                  5098
                  Adjustment to reconcile to budgetary accounting
                  â465
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  67,661
                  67,581
                  62,880
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  371,048
                  398,010
                  425,125
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  
                  1,142
                  1,249
               
               
                  0004
                  Administration, SMI
                  
                  3,133
                  3,101
               
               
                  0005
                  Quality Improvement Organizations, SMI
                  
                  436
                  163
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  371,048
                  402,721
                  429,638
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  371,048
                  402,721
                  429,638
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  34
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  9
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  41
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  55
                  
                  34
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  2,998
                  3,141
                  3,101
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  371,197
                  399,303
                  422,011
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  5,987
                  2,301
                  5,492
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â7,317
                  
                  
               
               
                  1236
                  Appropriations applied to repay debt
                  â1,872
                  â1,990
                  â1,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  367,995
                  399,614
                  426,503
               
               
                  1900
                  Budget authority (total)
                  370,993
                  402,755
                  429,604
               
               
                  1930
                  Total budgetary resources available
                  371,048
                  402,755
                  429,638
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  34
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  27,919
                  31,871
                  32,154
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  505
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  371,048
                  402,721
                  429,638
               
               
                  3020
                  Outlays (gross)
                  â367,592
                  â402,438
                  â429,533
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  31,871
                  32,154
                  32,259
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  28,424
                  31,871
                  32,154
               
               
                  3200
                  Obligated balance, end of year
                  31,871
                  32,154
                  32,259
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,998
                  3,141
                  3,101
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,691
                  2,074
                  2,118
               
               
                  4011
                  Outlays from discretionary balances
                  1,317
                  442
                  691
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,008
                  2,516
                  2,809
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  367,995
                  399,614
                  426,503
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  339,640
                  369,426
                  395,419
               
               
                  4101
                  Outlays from mandatory balances
                  24,944
                  30,496
                  31,305
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  364,584
                  399,922
                  426,724
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â5
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  367,995
                  399,614
                  426,503
               
               
                  4170
                  Outlays, net (mandatory)
                  364,579
                  399,922
                  426,724
               
               
                  4180
                  Budget authority, net (total)
                  370,993
                  402,755
                  429,604
               
               
                  4190
                  Outlays, net (total)
                  367,587
                  402,438
                  429,533
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  98,197
                  104,716
                  105,611
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  104,716
                  105,611
                  102,161
               
               
                  5080
                  Outstanding debt, SOY
                  â5,024
                  â3,152
                  â1,162
               
               
                  5081
                  Outstanding debt, EOY
                  â3,152
                  â1,162
                  â162
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  370,993
                  402,755
                  429,604
               
               
                  
                  Outlays
                  367,587
                  402,438
                  429,533
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  13
                  â9,845
               
               
                  
                  Outlays
                  
                  13
                  â9,845
               
               
                  Total:
               
               
                  
                  Budget Authority
                  370,993
                  402,768
                  419,759
               
               
                  
                  Outlays
                  367,587
                  402,451
                  419,688
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  96,946
                  104,053
                  109,261
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  96,946
                  104,053
                  109,261
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  2,437
                  2,800
                  2,800
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  5,542
                  5,780
                  6,338
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  12,154
                  12,478
                  13,255
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  486
                  639
                  725
               
               
                  1130
                  Medicare Refunds, SMI
                  4,961
                  5,011
                  5,061
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  72
                  45
                  45
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  84,468
                  95,004
                  101,235
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  13,290
                  13,409
                  13,683
               
               
                  1130
                  Federal Supplementary Medical Insurance Trust Fund
                  5
                  
                  
               
               
                  1150
                  Interest Received by Trust Fund, FSMI Fund
                  2,657
                  1,182
                  1,333
               
               
                  1150
                  Other Proprietary Interest from the Public, FSMI Fund
                  
                  3
                  3
               
               
                  1150
                  Interest, Medicare Prescription Drug Account, FSMI
                  65
                  48
                  51
               
               
                  1160
                  Federal Contributions, FSMI Fund
                  265,819
                  287,016
                  300,234
               
               
                  1160
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  5
                  5
               
               
                  1160
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  1,196
                  861
                  882
               
               
                  1160
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  66,687
                  71,172
                  84,003
               
               
                  1160
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  1160
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  2,564
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  459,840
                  498,018
                  529,654
               
               
                  
                  Proposed:
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â2,186
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â295
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  Federal Contributions, FSMI Fund
                  
                  
                  â7,383
               
               
                  1260
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â9,864
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  459,840
                  498,018
                  519,790
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Supplementary Medical Insurance Trust Fund [Budget Acct]
                  â367,592
                  â402,438
                  â429,533
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]
                  â85,140
                  â90,359
                  â103,451
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â452,732
                  â492,797
                  â532,984
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â13
                  9,845
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  â13
                  9,845
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â452,732
                  â492,810
                  â523,139
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  4,386
                  3,975
                  â4,736
               
               
                  3120
                  Interest
                  2,722
                  1,233
                  1,387
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  7,108
                  5,208
                  â3,349
               
               
                  3298
                  Adjustment to reconcile to proprietary accounting
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  7,107
                  5,208
                  â3,349
               
               
                  
                  Unexpended balance, end of year:
               
               
                  4100
                  Uninvested balance (net), end of year
                  â663
                  3,650
                  3,751
               
               
                  4200
                  Federal Supplementary Medical Insurance Trust Fund
                  104,716
                  105,611
                  102,161
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  104,053
                  109,261
                  105,912
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  1
                  1
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activity
                  429
                  436
                  163
               
               
                  42.0
                  Insurance claims and indemnities
                  366,367
                  402,284
                  429,474
               
               
                  94.0
                  Financial transfers
                  4,252
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  371,048
                  402,721
                  429,638
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  371,048
                  402,721
                  429,638
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â7,383
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  
                  
                  7,383
               
               
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  13
                  â9,845
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  13
                  â9,845
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 42.0)
                  
                  13
                  â9,845
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â2,481
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  
                  13
                  20
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â7,384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  13
                  â9,845
               
               
                  1900
                  Budget authority (total)
                  
                  13
                  â9,845
               
               
                  1930
                  Total budgetary resources available
                  
                  13
                  â9,845
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  13
                  â9,845
               
               
                  3020
                  Outlays (gross)
                  
                  â13
                  9,845
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  13
                  â9,845
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  13
                  â9,845
               
               
                  4180
                  Budget authority, net (total)
                  
                  13
                  â9,845
               
               
                  4190
                  Outlays, net (total)
                  
                  13
                  â9,845
               
               
                  
                     
                  
               
            
         
      
      
         The Budget includes a package of Medicare proposals designed to eliminate wasteful spending, preserve and expand beneficiary
            access to care, enhance choice and competition, and strengthen Medicare's fiscal sustainability, consistent with the President's
            Executive Order on Protecting and Improving Medicare for Our Nation's Seniors.  
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  87,561
                  89,915
                  102,850
               
               
                  0002
                  Administrative Costs
                  642
                  861
                  882
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  88,203
                  90,776
                  103,732
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  88,203
                  90,776
                  103,732
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  641
                  861
                  882
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  84,998
                  89,915
                  102,850
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  2,564
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  2,564
                  â2,564
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  2,564
                  
                  
               
               
                  1900
                  Budget authority (total)
                  88,203
                  90,776
                  103,732
               
               
                  1930
                  Total budgetary resources available
                  88,203
                  90,776
                  103,732
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  7,440
                  10,503
                  10,920
               
               
                  3010
                  New obligations, unexpired accounts
                  88,203
                  90,776
                  103,732
               
               
                  3020
                  Outlays (gross)
                  â85,140
                  â90,359
                  â103,451
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10,503
                  10,920
                  11,201
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â225
                  â2,789
                  â225
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,564
                  2,564
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2,789
                  â225
                  â225
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7,215
                  7,714
                  10,695
               
               
                  3200
                  Obligated balance, end of year
                  7,714
                  10,695
                  10,976
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  641
                  861
                  882
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  313
                  295
                  321
               
               
                  4011
                  Outlays from discretionary balances
                  147
                  141
                  273
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  460
                  436
                  594
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  87,562
                  89,915
                  102,850
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  77,992
                  79,914
                  91,850
               
               
                  4101
                  Outlays from mandatory balances
                  6,688
                  10,009
                  11,007
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  84,680
                  89,923
                  102,857
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  
                  â2,564
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,564
                  2,564
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  84,998
                  89,915
                  102,850
               
               
                  4170
                  Outlays, net (mandatory)
                  84,680
                  87,359
                  102,857
               
               
                  4180
                  Budget authority, net (total)
                  85,639
                  90,776
                  103,732
               
               
                  4190
                  Outlays, net (total)
                  85,140
                  87,795
                  103,451
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  642
                  861
                  882
               
               
                  42.0
                  Insurance claims and indemnities
                  87,561
                  89,915
                  102,850
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  88,203
                  90,776
                  103,732
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  88,203
                  90,776
                  103,732
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2019 actual
                  2020 est.
                  2021 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)
         The Budget supports comprehensive drug pricing reform legislation including modernization of the Part D benefit.
      
         Administration for Children and FamiliesFederal Funds
         Temporary Assistance for Needy FamiliesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2019 actual
                  2020 est.
                  2021 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
                  7
                  8
                  8
               
               
                  0009
                  Healthy marriage and responsible fatherhood grants
                  139
                  149
                  150
               
               
                  0010
                  Evaluation Funding and What Works Clearinghouse
                  44
                  45
                  45
               
               
                  0011
                  Census Bureau Research
                  8
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  16,709
                  16,723
                  16,724
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  16,739
                  16,739
                  16,739
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,737
                  16,739
                  16,739
               
               
                  1900
                  Budget authority (total)
                  16,737
                  16,739
                  16,739
               
               
                  1930
                  Total budgetary resources available
                  16,737
                  16,739
                  16,740
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â28
                  â15
                  â15
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  8,070
                  9,283
                  9,900
               
               
                  3010
                  New obligations, unexpired accounts
                  16,709
                  16,723
                  16,724
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â15,497
                  â16,106
                  â16,788
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9,283
                  9,900
                  9,836
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  8,070
                  9,283
                  9,900
               
               
                  3200
                  Obligated balance, end of year
                  9,283
                  9,900
                  9,836
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16,737
                  16,739
                  16,739
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  10,210
                  10,546
                  10,546
               
               
                  4101
                  Outlays from mandatory balances
                  5,287
                  5,560
                  6,242
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  15,497
                  16,106
                  16,788
               
               
                  
                  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)
                  16,737
                  16,739
                  16,739
               
               
                  4170
                  Outlays, net (mandatory)
                  15,496
                  16,106
                  16,788
               
               
                  4180
                  Budget authority, net (total)
                  16,737
                  16,739
                  16,739
               
               
                  4190
                  Outlays, net (total)
                  15,496
                  16,106
                  16,788
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  16,737
                  16,739
                  16,739
               
               
                  
                  Outlays
                  15,496
                  16,106
                  16,788
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,494
               
               
                  
                  Outlays
                  
                  
                  â1,073
               
               
                  Total:
               
               
                  
                  Budget Authority
                  16,737
                  16,739
                  15,245
               
               
                  
                  Outlays
                  15,496
                  16,106
                  15,715
               
               
                  
                     
                  
               
            
         
      
      
         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). TANF's authorization was most recently extended in theFurther Consolidated Appropriations Act,
            2020 (P. L. 116â94).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  9
                  9
                  9
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  10
                  10
                  10
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  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
                  72
                  72
                  72
               
               
                  25.2
                  Other services from non-Federal sources
                  17
                  17
                  17
               
               
                  25.3
                  Other goods and services from Federal sources
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16,604
                  16,618
                  16,619
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  16,709
                  16,723
                  16,724
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  98
                  97
                  100
               
               
                  
                     
                  
               
            
         
      
         Temporary Assistance for Needy Families
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  
                  
                  â1,594
               
               
                  0002
                  Territories - family assistance grants
                  
                  
                  â8
               
               
                  0010
                  Evaluation Funding and What Works Clearinghouse
                  
                  
                  8
               
               
                  0012
                  Opportunity and Economic Mobility Demonstrations
                  
                  
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â1,494
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,494
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â1,494
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,494
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,494
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,073
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â421
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â421
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,494
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,073
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,494
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,073
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes comprehensive reforms to TANF, including phasing out the work participation rate and transitioning to
            employment outcome and engagement measures, and modifying spending rules to refocus the program on core activities.  The Budget
            also continues the proposal to reduce funding for TANF Family Assistance Grants to States, territories, and tribes by 10 percent.
            In addition, the Budget creates a demonstration opportunity for states to grow capacity across public safety net benefit programs
            to reduce dependency.  
         
      
         Contingency FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â609
                  2019 actual
                  2020 est.
                  2021 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
                  55
                  45
                  45
               
               
                  3010
                  New obligations, unexpired accounts
                  608
                  608
                  608
               
               
                  3020
                  Outlays (gross)
                  â600
                  â608
                  â608
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  45
                  45
                  45
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  55
                  45
                  45
               
               
                  3200
                  Obligated balance, end of year
                  45
                  45
                  45
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  608
                  608
                  608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  574
                  563
                  545
               
               
                  4101
                  Outlays from mandatory balances
                  26
                  45
                  63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  600
                  608
                  608
               
               
                  4180
                  Budget authority, net (total)
                  608
                  608
                  608
               
               
                  4190
                  Outlays, net (total)
                  600
                  608
                  608
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  608
                  608
                  608
               
               
                  
                  Outlays
                  600
                  608
                  608
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â608
               
               
                  
                  Outlays
                  
                  
                  â608
               
               
                  Total:
               
               
                  
                  Budget Authority
                  608
                  608
                  
               
               
                  
                  Outlays
                  600
                  608
                  
               
               
                  
                     
                  
               
            
         
      
      
          The TANF Contingency Fund provides a funding reserve of $608 million to assist states that meet certain criteria related
            to the state's unemployment rate and Supplemental Nutrition Assistance Program (SNAP) caseload. In order to qualify for contingency
            funds, States must also meet a higher maintenance-of-effort requirement of 100 percent of historical expenditures. The authorization
            for the Contingency Fund was most recently extended in the Further Consolidated Appropriations Act, 2020 (P.L. 116â94).  
         
      
         Contingency Fund
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â4â1â609
                  2019 actual
                  2020 est.
                  2021 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)
                  
                  
                  608
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â545
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  â63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  
                  â608
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â608
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â608
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to eliminate funding for the Contingency Fund.
      
         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,  $3,039,000,000, to remain available until expended; and for such purposes for the first quarter of fiscal year  2022, $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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  3,979
                  4,032
                  3,988
               
               
                  0002
                  Child support incentive payments
                  571
                  581
                  607
               
               
                  0003
                  Access and visitation grants
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  4,560
                  4,623
                  4,605
               
               
                  0102
                  Payments to territories
                  33
                  33
                  33
               
               
                  0103
                  Repatriation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  34
                  34
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,594
                  4,657
                  4,639
               
               
                  0801
                  Offset obligations (CSE grants to States)
                  13
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  4,607
                  4,658
                  4,639
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  141
                  55
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  251
                  200
                  200
               
               
                  1037
                  Unobligated balance of appropriations withdrawn
                  â52
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  340
                  255
                  200
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,922
                  3,002
                  3,039
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  1,400
                  1,400
                  1,400
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  1
                  
               
               
                  1900
                  Budget authority (total)
                  4,322
                  4,403
                  4,439
               
               
                  1930
                  Total budgetary resources available
                  4,662
                  4,658
                  4,639
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  55
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,383
                  1,622
                  1,755
               
               
                  3010
                  New obligations, unexpired accounts
                  4,607
                  4,658
                  4,639
               
               
                  3020
                  Outlays (gross)
                  â4,117
                  â4,325
                  â4,351
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â251
                  â200
                  â200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,622
                  1,755
                  1,843
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,383
                  1,622
                  1,755
               
               
                  3200
                  Obligated balance, end of year
                  1,622
                  1,755
                  1,843
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,322
                  4,403
                  4,439
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,474
                  3,762
                  3,742
               
               
                  4101
                  Outlays from mandatory balances
                  643
                  563
                  609
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,117
                  4,325
                  4,351
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  â1
                  
               
               
                  4180
                  Budget authority, net (total)
                  4,322
                  4,402
                  4,439
               
               
                  4190
                  Outlays, net (total)
                  4,117
                  4,324
                  4,351
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,322
                  4,402
                  4,439
               
               
                  
                  Outlays
                  4,117
                  4,324
                  4,351
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  19
               
               
                  
                  Outlays
                  
                  
                  19
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,322
                  4,402
                  4,458
               
               
                  
                  Outlays
                  4,117
                  4,324
                  4,370
               
               
                  
                     
                  
               
            
         
      
      
         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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  4,594
                  4,658
                  4,639
               
               
                  99.0
                  Reimbursable obligations
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,607
                  4,658
                  4,639
               
               
                  
                     
                  
               
            
         
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  
                  
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  
                  
                  18
               
               
                  0103
                  Repatriation
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  19
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  19
               
               
                  1900
                  Budget authority (total)
                  
                  
                  19
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  19
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  19
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â19
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  19
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  19
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  19
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  19
               
               
                  
                     
                  
               
            
         
      
      
         The Budget improves establishment and enforcement procedures by closing loopholes and improving Federal processes. Proposals
            promote work programs, increase collections, enhance distribution, and improve program efficiency.
         
      
         Low income home energy assistance
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  LIHEAP Block Grant
                  3,653
                  3,740
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  3
                  3
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  3
                  3
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,690
                  3,740
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,653
                  3,740
                  
               
               
                  1930
                  Total budgetary resources available
                  3,656
                  3,743
                  3
               
               
                  
                  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
                  1,630
                  1,570
                  1,553
               
               
                  3010
                  New obligations, unexpired accounts
                  3,653
                  3,740
                  
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3,696
                  â3,757
                  â1,296
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,570
                  1,553
                  257
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,630
                  1,570
                  1,553
               
               
                  3200
                  Obligated balance, end of year
                  1,570
                  1,553
                  257
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,653
                  3,740
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,308
                  2,308
                  
               
               
                  4011
                  Outlays from discretionary balances
                  1,388
                  1,449
                  1,296
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,696
                  3,757
                  1,296
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,653
                  3,740
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  3,695
                  3,757
                  1,296
               
               
                  4180
                  Budget authority, net (total)
                  3,653
                  3,740
                  
               
               
                  4190
                  Outlays, net (total)
                  3,695
                  3,757
                  1,296
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  3
                  2
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,650
                  3,737
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  3,653
                  3,740
                  
               
               
                  
                     
                  
               
            
         
      
         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,  $2,456,380,000, of which  $2,412,625,000 shall remain available  until expended 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  funds made available in this or any prior Act for the Unaccompanied Alien Children program that are available for the acquisition
               of real property or for construction or improvement of facilities shall be available to make improvements on non-federally
               owned property that is adjacent to facilities utilized by such program, provided that the primary benefit of such improvements
               accrues to such program:  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 purpose of carrying out such sections 462 and 235: Provided further, That other 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Refugee Support Services (RSS) and Transitional & Medical Services (TAMS)
                  513
                  561
                  429
               
               
                  0002
                  Assistance for treatment of torture victims
                  14
                  16
                  16
               
               
                  0003
                  Unaccompanied Children
                  2,617
                  1,303
                  1,983
               
               
                  0005
                  Trafficking Victims program
                  26
                  28
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,170
                  1,908
                  2,456
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  3,170
                  1,908
                  2,456
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  41
                  2,096
                  2,096
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  159
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  200
                  2,096
                  2,096
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Base Appropriation
                  4,787
                  1,908
                  2,456
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â5
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1502]
                  37
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1536]
                  48
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1515]
                  18
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0142]
                  7
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1700]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  14
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0350]
                  21
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  124
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9912]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1362]
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,062
                  1,908
                  2,456
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1711
                  Spending authority from offsetting collections transferred from other accounts [075â0511]
                  4
                  
                  
               
               
                  1900
                  Budget authority (total)
                  5,066
                  1,908
                  2,456
               
               
                  1930
                  Total budgetary resources available
                  5,266
                  4,004
                  4,552
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2,096
                  2,096
                  2,096
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,722
                  2,191
                  1,522
               
               
                  3010
                  New obligations, unexpired accounts
                  3,170
                  1,908
                  2,456
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,529
                  â2,577
                  â2,614
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â159
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,191
                  1,522
                  1,364
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â180
                  â180
                  â180
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â180
                  â180
                  â180
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,542
                  2,011
                  1,342
               
               
                  3200
                  Obligated balance, end of year
                  2,011
                  1,342
                  1,184
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,066
                  1,908
                  2,456
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,406
                  766
                  860
               
               
                  4011
                  Outlays from discretionary balances
                  1,123
                  1,811
                  1,754
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,529
                  2,577
                  2,614
               
               
                  4180
                  Budget authority, net (total)
                  5,066
                  1,908
                  2,456
               
               
                  4190
                  Outlays, net (total)
                  2,529
                  2,577
                  2,614
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  5,066
                  1,908
                  2,456
               
               
                  
                  Outlays
                  2,529
                  2,577
                  2,614
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  200
               
               
                  
                  Outlays
                  
                  
                  130
               
               
                  Total:
               
               
                  
                  Budget Authority
                  5,066
                  1,908
                  2,656
               
               
                  
                  Outlays
                  2,529
                  2,577
                  2,744
               
               
                  
                     
                  
               
            
         
      
      
         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 care and placement of unaccompanied alien children, and for
            the rehabilitation of victims of torture and human trafficking .
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  9
                  15
                  15
               
               
                  11.7
                  Military personnel
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  10
                  17
                  17
               
               
                  12.1
                  Civilian personnel benefits
                  3
                  5
                  5
               
               
                  12.2
                  Military personnel benefits
                  1
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  7
                  7
                  7
               
               
                  25.1
                  Advisory and assistance services
                  16
                  16
                  16
               
               
                  25.2
                  Other services from non-Federal sources
                  621
                  621
                  621
               
               
                  25.3
                  Other goods and services from Federal sources
                  123
                  123
                  123
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,388
                  1,116
                  1,664
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,170
                  1,908
                  2,456
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  3,170
                  1,908
                  2,456
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  97
                  153
                  157
               
               
                  1101
                  Direct military average strength employment
                  13
                  12
                  12
               
               
                  
                     
                  
               
            
         
      
         Refugee and Entrant Assistance
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â4â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0009
                  UAC Contingency Fund, mandatory
                  
                  
                  200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  200
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  200
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  200
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  200
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â130
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  70
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  70
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  200
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  130
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  200
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  130
               
               
                  
                     
                  
               
            
         
      
      
         The Budget requests a mandatory UAC contingency fund capped at $2 billion over a three-year period.
      
         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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  385
                  384
                  370
               
               
                  0002
                  Research, training and technical assistance
                  8
                  10
                  10
               
               
                  0003
                  State court improvement activities
                  30
                  30
                  31
               
               
                  0004
                  Family Connection Grants
                  
                  2
                  2
               
               
                  0005
                  Personal Responsibility Education (PREP)
                  73
                  91
                  1
               
               
                  0006
                  Sexual Risk Abstinence Education (SRAE)
                  69
                  75
                  
               
               
                  0007
                  Family Rec. & Reunification
                  4
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  569
                  595
                  417
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  39
                  53
                  546
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  6
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  40
                  53
                  546
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  100
                  93
                  60
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  510
                  995
                  345
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  489
                  995
                  345
               
               
                  1900
                  Budget authority (total)
                  589
                  1,088
                  405
               
               
                  1930
                  Total budgetary resources available
                  629
                  1,141
                  951
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â7
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  53
                  546
                  534
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  658
                  739
                  635
               
               
                  3010
                  New obligations, unexpired accounts
                  569
                  595
                  417
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  6
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â482
                  â699
                  â856
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  739
                  635
                  196
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  658
                  739
                  635
               
               
                  3200
                  Obligated balance, end of year
                  739
                  635
                  196
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  100
                  93
                  60
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  15
                  22
                  14
               
               
                  4011
                  Outlays from discretionary balances
                  46
                  70
                  63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  61
                  92
                  77
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  489
                  995
                  345
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  88
                  221
                  89
               
               
                  4101
                  Outlays from mandatory balances
                  333
                  386
                  690
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  421
                  607
                  779
               
               
                  4180
                  Budget authority, net (total)
                  589
                  1,088
                  405
               
               
                  4190
                  Outlays, net (total)
                  482
                  699
                  856
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  589
                  1,088
                  405
               
               
                  
                  Outlays
                  482
                  699
                  856
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  220
               
               
                  
                  Outlays
                  
                  
                  22
               
               
                  Total:
               
               
                  
                  Budget Authority
                  589
                  1,088
                  625
               
               
                  
                  Outlays
                  482
                  699
                  878
               
               
                  
                     
                  
               
            
         
      
      
         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.  It also includes the Sexual Risk Avoidance Education program and the Personal Responsibility
            Education Program (PREP).  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  2
               
               
                  25.1
                  Advisory and assistance services
                  27
                  28
                  27
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  4
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions
                  537
                  562
                  384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  569
                  595
                  417
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  14
                  21
                  22
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable Families
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2019 actual
                  2020 est.
                  2021 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22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  198
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  198
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  220
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  22
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  220
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  22
               
               
                  
                     
                  
               
            
         
      
      
         The Budget includes a proposal to expand the Regional Partnership Grants program, to increase funding for the Court Improvement
            Program, and a two-year reauthorization of Sexual Risk Avoidance Education and the Personal Responsibility Education Program
            (PREP).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  23
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  194
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  220
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to StatesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Mandatory child care
                  1,178
                  1,178
                  1,178
               
               
                  0002
                  Matching child care
                  1,708
                  1,651
                  1,651
               
               
                  0003
                  Child Care Training and technical assistance
                  15
                  15
                  15
               
               
                  0004
                  Child care tribal grants
                  43
                  58
                  58
               
               
                  0005
                  Child Care Research
                  15
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,959
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  42
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,917
                  2,917
                  2,917
               
               
                  1930
                  Total budgetary resources available
                  2,959
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,614
                  1,268
                  1,224
               
               
                  3010
                  New obligations, unexpired accounts
                  2,959
                  2,917
                  2,917
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  23
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3,267
                  â2,961
                  â2,960
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â61
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,268
                  1,224
                  1,181
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,614
                  1,268
                  1,224
               
               
                  3200
                  Obligated balance, end of year
                  1,268
                  1,224
                  1,181
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,137
                  2,139
                  2,139
               
               
                  4101
                  Outlays from mandatory balances
                  1,130
                  822
                  821
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  3,267
                  2,961
                  2,960
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â23
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  2,917
                  2,917
                  2,917
               
               
                  4170
                  Outlays, net (mandatory)
                  3,244
                  2,961
                  2,960
               
               
                  4180
                  Budget authority, net (total)
                  2,917
                  2,917
                  2,917
               
               
                  4190
                  Outlays, net (total)
                  3,244
                  2,961
                  2,960
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays
                  3,244
                  2,961
                  2,960
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  1,295
               
               
                  
                  Outlays
                  
                  
                  271
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  4,212
               
               
                  
                  Outlays
                  3,244
                  2,961
                  3,231
               
               
                  
                     
                  
               
            
         
      
      
         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 Further Consolidated
            Appropriations Act, 2020 (P.L.  116â94). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  19
                  19
                  19
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,939
                  2,897
                  2,897
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,959
                  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
                  2019 actual
                  2020 est.
                  2021 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271
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  1,024
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  1,024
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  1,295
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  271
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  1,295
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  271
               
               
                  
                     
                  
               
            
         
      
      
         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.  
         
      
         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"), $5,826,000,000 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, $174,780,000
            shall be for Indian tribes and tribal organizations.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Child Care Block grant payments to States
                  5,234
                  5,800
                  5,800
               
               
                  0004
                  Child Care Research and evaluation fund
                  26
                  26
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  5,260
                  5,826
                  5,826
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  28
                  28
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4
                  28
                  28
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  5,306
                  5,826
                  5,826
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,288
                  5,826
                  5,826
               
               
                  1930
                  Total budgetary resources available
                  5,292
                  5,854
                  5,854
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â4
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  28
                  28
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,791
                  4,115
                  4,646
               
               
                  3010
                  New obligations, unexpired accounts
                  5,260
                  5,826
                  5,826
               
               
                  3020
                  Outlays (gross)
                  â3,918
                  â5,295
                  â6,360
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,115
                  4,646
                  4,112
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,791
                  4,115
                  4,646
               
               
                  3200
                  Obligated balance, end of year
                  4,115
                  4,646
                  4,112
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,288
                  5,826
                  5,826
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,981
                  3,204
                  3,612
               
               
                  4011
                  Outlays from discretionary balances
                  1,937
                  2,091
                  2,748
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,918
                  5,295
                  6,360
               
               
                  4180
                  Budget authority, net (total)
                  5,288
                  5,826
                  5,826
               
               
                  4190
                  Outlays, net (total)
                  3,918
                  5,295
                  6,360
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 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
                  46
                  45
                  45
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  5,210
                  5,775
                  5,775
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,260
                  5,826
                  5,826
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  16
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Social services block grant
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  1,594
                  1,600
                  1,700
               
               
                  0002
                  Health Profession Opportunity Grants
                  83
                  85
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,677
                  1,685
                  1,700
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  30
                  31
                  31
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,785
                  1,785
                  1,700
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â105
                  â100
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,680
                  1,685
                  1,700
               
               
                  1930
                  Total budgetary resources available
                  1,710
                  1,716
                  1,731
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  31
                  31
                  31
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  545
                  566
                  536
               
               
                  3010
                  New obligations, unexpired accounts
                  1,677
                  1,685
                  1,700
               
               
                  3020
                  Outlays (gross)
                  â1,646
                  â1,715
                  â1,712
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  566
                  536
                  524
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  545
                  566
                  536
               
               
                  3200
                  Obligated balance, end of year
                  566
                  536
                  524
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,680
                  1,685
                  1,700
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,212
                  1,331
                  1,360
               
               
                  4101
                  Outlays from mandatory balances
                  434
                  384
                  352
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,646
                  1,715
                  1,712
               
               
                  4180
                  Budget authority, net (total)
                  1,680
                  1,685
                  1,700
               
               
                  4190
                  Outlays, net (total)
                  1,646
                  1,715
                  1,712
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,680
                  1,685
                  1,700
               
               
                  
                  Outlays
                  1,646
                  1,715
                  1,712
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,700
               
               
                  
                  Outlays
                  
                  
                  â1,360
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,680
                  1,685
                  
               
               
                  
                  Outlays
                  1,646
                  1,715
                  352
               
               
                  
                     
                  
               
            
         
      
      
         The Social Services Block Grant (SSBG) account includes funding for SSBG and the Health Profession Opportunity Grants (HPOG)
            programs.  SSBG funds a broad array of social services for children and adults.  The account also provides funding for the
            HPOG demonstration to provide education and training to Temporary Assistance for Needy Families recipients and other low-income
            individuals for health care occupations that pay well and are expected to either experience labor shortages or be in high
            demand.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  10
                  10
                  10
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,665
                  1,673
                  1,689
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,677
                  1,685
                  1,700
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8
                  8
                  
               
               
                  
                     
                  
               
            
         
      
         Social Services Block Grant
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  
                  
                  â1,700
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,700
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,700
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,700
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,360
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â340
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â340
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,700
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,360
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,700
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,360
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to discontinue funding for the Social Services Block Grant.  The Budget does not propose reauthorizing
            the Health Profession Opportunity Grants (HPOG).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  â1
               
               
                  21.0
                  Travel and transportation of persons
                  
                  
                  â1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  â10
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  â1,688
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,700
               
               
                  
                     
                  
               
            
         
      
         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,  $11,856,130,000, of which $75,000,000, to remain available through September 30,  2022, 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,  2021: Provided, That $10,613,095,000 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:
      
       (1) $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; and
      
      
      
       (2) $19,000,000 shall be available to supplement funding otherwise available for research, evaluation, and Federal administrative
            costs:
      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 $175,000,000 shall be for carrying out section 303(a) of the Family Violence Prevention and Services Act, of which
            $7,000,000 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  $4,000,000 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Head Start
                  10,438
                  10,671
                  10,613
               
               
                  0102
                  Preschool Development Grants
                  249
                  515
                  
               
               
                  0103
                  Runaway and homeless youth (basic centers)
                  54
                  63
                  63
               
               
                  0104
                  Transitional living
                  56
                  51
                  51
               
               
                  0106
                  Education grants to reduce sexual abuse of runaway youth
                  17
                  19
                  19
               
               
                  0109
                  Child abuse State grants
                  85
                  90
                  90
               
               
                  0110
                  Child abuse discretionary activities
                  33
                  35
                  51
               
               
                  0111
                  Community-based child abuse prevention
                  40
                  56
                  56
               
               
                  0112
                  Child welfare services
                  268
                  269
                  269
               
               
                  0113
                  Child welfare training, research, or demonstration projects
                  18
                  18
                  21
               
               
                  0114
                  Adoption opportunities
                  39
                  42
                  42
               
               
                  0116
                  Adoption and Legal Guardianship Incentives
                  75
                  75
                  75
               
               
                  0117
                  Independent living education and training vouchers
                  46
                  43
                  43
               
               
                  0124
                  Native American programs
                  54
                  56
                  57
               
               
                  0125
                  Social services and income maintenance research
                  6
                  7
                  6
               
               
                  0128
                  ACF Federal administration
                  202
                  206
                  209
               
               
                  0131
                  Disaster human services case management
                  2
                  2
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Direct program activities, subtotal
                  11,682
                  12,218
                  11,669
               
               
                  0301
                  Community services block grant
                  717
                  740
                  
               
               
                  0303
                  Rural community facilities
                  9
                  10
                  
               
               
                  0304
                  Community economic development
                  20
                  20
                  
               
               
                  0308
                  Domestic violence hotline
                  10
                  12
                  12
               
               
                  0309
                  Family violence prevention and services
                  164
                  175
                  175
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0391
                  Direct program activities, subtotal
                  920
                  957
                  187
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total, direct program
                  12,602
                  13,175
                  11,856
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  12,602
                  13,175
                  11,856
               
               
                  0801
                  Children and Families Services Programs (Reimbursable)
                  31
                  22
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  31
                  22
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  12,633
                  13,197
                  11,878
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,251
                  933
                  685
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1,251
                  933
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  3
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,257
                  933
                  685
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  12,329
                  12,877
                  11,856
               
               
                  1120
                  Appropriations transferred to other accts [075â1503]
                  â48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  12,281
                  12,877
                  11,856
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  26
                  70
                  70
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  28
                  70
                  70
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2
                  1
                  1
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  2
                  2
                  2
               
               
                  1900
                  Budget authority (total)
                  12,311
                  12,949
                  11,928
               
               
                  1930
                  Total budgetary resources available
                  13,568
                  13,882
                  12,613
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  933
                  685
                  735
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  8,884
                  9,739
                  10,767
               
               
                  3010
                  New obligations, unexpired accounts
                  12,633
                  13,197
                  11,878
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  21
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â11,639
                  â12,169
                  â12,622
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â157
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9,739
                  10,767
                  10,023
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â20
                  â17
                  â18
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  â1
                  â1
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â17
                  â18
                  â19
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  8,864
                  9,722
                  10,749
               
               
                  3200
                  Obligated balance, end of year
                  9,722
                  10,749
                  10,004
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  12,309
                  12,947
                  11,926
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,283
                  4,240
                  3,833
               
               
                  4011
                  Outlays from discretionary balances
                  7,353
                  7,929
                  8,789
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  11,636
                  12,169
                  12,622
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â27
                  â70
                  â70
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â29
                  â70
                  â70
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  12,281
                  12,877
                  11,856
               
               
                  4080
                  Outlays, net (discretionary)
                  11,607
                  12,099
                  12,552
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  2
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  3
                  
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â3
                  â2
                  â2
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â1
                  â1
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  â2
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  12,281
                  12,877
                  11,856
               
               
                  4190
                  Outlays, net (total)
                  11,607
                  12,097
                  12,550
               
               
                  
                     
                  
               
            
         
      
      
         The request totals $11.86 billion, including more than $10.6 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  108
                  115
                  114
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  114
                  121
                  120
               
               
                  12.1
                  Civilian personnel benefits
                  36
                  38
                  38
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  4
                  3
               
               
                  23.1
                  Rental payments to GSA
                  5
                  16
                  16
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  244
                  255
                  244
               
               
                  25.2
                  Other services from non-Federal sources
                  19
                  20
                  20
               
               
                  25.3
                  Other goods and services from Federal sources
                  59
                  51
                  53
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  12,119
                  12,666
                  11,358
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  12,602
                  13,175
                  11,856
               
               
                  99.0
                  Reimbursable obligations
                  31
                  22
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  12,633
                  13,197
                  11,878
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,032
                  1,114
                  1,113
               
               
                  1101
                  Direct military average strength employment
                  5
                  6
                  6
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical AssistanceProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Training and technical assistance
                  13
                  17
                  12
               
               
                  0002
                  Federal parent locator service
                  25
                  28
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  38
                  45
                  37
               
               
                  0801
                  Federal Parent Locator Service reimbursable
                  26
                  30
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  26
                  30
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  64
                  75
                  66
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  11
                  11
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  14
                  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
                  26
                  29
                  29
               
               
                  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)
                  26
                  29
                  30
               
               
                  1900
                  Budget authority (total)
                  61
                  64
                  67
               
               
                  1930
                  Total budgetary resources available
                  75
                  75
                  67
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  11
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  24
                  23
                  36
               
               
                  3010
                  New obligations, unexpired accounts
                  64
                  75
                  66
               
               
                  3020
                  Outlays (gross)
                  â62
                  â62
                  â67
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  23
                  36
                  35
               
               
                  
                  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
                  18
                  17
                  30
               
               
                  3200
                  Obligated balance, end of year
                  17
                  30
                  29
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  61
                  64
                  67
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  41
                  45
                  45
               
               
                  4101
                  Outlays from mandatory balances
                  21
                  17
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  62
                  62
                  67
               
               
                  
                  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18
                  â20
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â26
                  â29
                  â29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  35
                  35
                  38
               
               
                  4170
                  Outlays, net (mandatory)
                  36
                  33
                  38
               
               
                  4180
                  Budget authority, net (total)
                  35
                  35
                  38
               
               
                  4190
                  Outlays, net (total)
                  36
                  33
                  38
               
               
                  
                     
                  
               
               
                  
                  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).
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  8
                  9
                  9
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  10
                  13
                  9
               
               
                  25.3
                  Other goods and services from Federal sources
                  6
                  7
                  5
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  7
                  9
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  38
                  45
                  37
               
               
                  99.0
                  Reimbursable obligations
                  26
                  30
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  64
                  75
                  66
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  61
                  68
                  71
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance
         (Legislative proposal, subject to PAYGO)
         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.
            
         
      
         Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, $7,012,000,000.
      For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
            2022, $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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  5,231
                  5,569
                  5,796
               
               
                  0002
                  Independent living
                  142
                  143
                  143
               
               
                  0004
                  Adoption assistance
                  2,993
                  3,430
                  3,802
               
               
                  0005
                  Guardianship
                  189
                  242
                  271
               
               
                  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
                  8,559
                  9,388
                  10,016
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  2
                  2
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2
                  2
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  5,860
                  6,589
                  7,015
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  5,859
                  6,588
                  7,015
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  2,700
                  2,800
                  3,000
               
               
                  1900
                  Budget authority (total)
                  8,559
                  9,388
                  10,015
               
               
                  1930
                  Total budgetary resources available
                  8,561
                  9,390
                  10,017
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2
                  2
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,214
                  1,410
                  1,409
               
               
                  3010
                  New obligations, unexpired accounts
                  8,559
                  9,388
                  10,016
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  359
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â8,619
                  â9,389
                  â9,910
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â103
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,410
                  1,409
                  1,515
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,214
                  1,410
                  1,409
               
               
                  3200
                  Obligated balance, end of year
                  1,410
                  1,409
                  1,515
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8,559
                  9,388
                  10,015
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7,513
                  8,259
                  8,816
               
               
                  4101
                  Outlays from mandatory balances
                  1,106
                  1,130
                  1,094
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8,619
                  9,389
                  9,910
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â20
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  8,559
                  9,388
                  10,015
               
               
                  4170
                  Outlays, net (mandatory)
                  8,599
                  9,389
                  9,910
               
               
                  4180
                  Budget authority, net (total)
                  8,559
                  9,388
                  10,015
               
               
                  4190
                  Outlays, net (total)
                  8,599
                  9,389
                  9,910
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  8,559
                  9,388
                  10,015
               
               
                  
                  Outlays
                  8,599
                  9,389
                  9,910
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  45
               
               
                  
                  Outlays
                  
                  
                  45
               
               
                  Total:
               
               
                  
                  Budget Authority
                  8,559
                  9,388
                  10,060
               
               
                  
                  Outlays
                  8,599
                  9,389
                  9,955
               
               
                  
                     
                  
               
            
         
      
      
         This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, Foster Care Prevention
            Services, and the Chafee Program for Successful Transition to Adulthood, as well as technical assistance and implementation
            services for tribal programs.
         
         Foster CareâThe proposed level will support eligible low-income children who must be placed outside the home. An average of 171,500 children
            per month are estimated to be served in FY 2021.
         
         Adoption AssistanceâThe proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
            An average of 649,400 children per month are estimated to be served in FY 2021.
         
         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 46,300 children per month are estimated to be served in FY 2021.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2019 actual
                  2020 est.
                  2021 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
                  30
                  32
                  34
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  8,526
                  9,353
                  9,979
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  8,559
                  9,388
                  10,016
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  
                  
                  19
               
               
                  0002
                  Independent living
                  
                  
                  12
               
               
                  0004
                  Adoption assistance
                  
                  
                  13
               
               
                  0005
                  Guardianship
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  45
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  45
               
               
                  1900
                  Budget authority (total)
                  
                  
                  45
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  45
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  45
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â45
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  45
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  45
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  45
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  45
               
               
                  
                     
                  
               
            
         
      
      
         The Budget includes proposals to create the Child Welfare Flexible Funding Option for title IV-E agencies, to create a performance
            incentive for improving Child and Family Services Reviews outcomes, and to allow states to pay salaries to foster parents
            who can care for children with complex needs.  The Budget provides new flexibilities and support in the Chafee program for
            youth transitioning out of foster care.  The Family First Improvements proposal streamlines approval of title IV-E prevention
            services and kinship navigator programs and provides additional flexibility to title IV-E tribal agencies in operating the
            title IV-E program.  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.
         
      
         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,  $2,072,092,000, 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 section 321 of the OAA, up to one percent
               of such amounts shall be available for developing and implementing evidence-based practices for enhancing home and community-based
               supportive services: 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,
            including medically-tailored meals: 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  of the amount made available under this heading, $5,000,000 shall be available for a program under which the Secretary may
               make competitive grants to centers for independent living that have received grants under part C of chapter 1 of title VII
               of the Rehabilitation Act of 1973, to develop evidence-based interventions to increase employment of individuals with disabilities: 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Aging Services Programs
                  1,629
                  1,651
                  1,627
               
               
                  0102
                  ACL Program Administration
                  40
                  41
                  42
               
               
                  0103
                  Integrated Aging and Disability Services Programs
                  44
                  53
                  46
               
               
                  0104
                  Disability Services Programs
                  321
                  314
                  267
               
               
                  0105
                  National Institute on Disability, Independent Living & Rehab Research
                  109
                  112
                  90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  2,143
                  2,171
                  2,072
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  2,143
                  2,171
                  2,072
               
               
                  0801
                  ACL Reimbursable Programs
                  94
                  85
                  54
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,237
                  2,256
                  2,126
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  7
                  6
                  28
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  7
                  6
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  11
                  6
                  28
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,120
                  2,171
                  2,072
               
               
                  1120
                  Appropriations transferred to other accts [012â3507]
                  â2
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,111
                  2,171
                  2,072
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â0116]
                  28
                  28
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  11
                  14
                  11
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  58
                  57
                  44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  69
                  71
                  55
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  17
                  
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  8
                  8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  25
                  8
                  
               
               
                  1900
                  Budget authority (total)
                  2,233
                  2,278
                  2,127
               
               
                  1930
                  Total budgetary resources available
                  2,244
                  2,284
                  2,155
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6
                  28
                  29
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,470
                  1,516
                  1,202
               
               
                  3010
                  New obligations, unexpired accounts
                  2,237
                  2,256
                  2,126
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,177
                  â2,570
                  â2,193
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,516
                  1,202
                  1,135
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â190
                  â129
                  â194
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â66
                  â65
                  â44
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  127
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â129
                  â194
                  â238
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,280
                  1,387
                  1,008
               
               
                  3200
                  Obligated balance, end of year
                  1,387
                  1,008
                  897
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,180
                  2,242
                  2,127
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,019
                  1,338
                  1,275
               
               
                  4011
                  Outlays from discretionary balances
                  1,110
                  1,182
                  882
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,129
                  2,520
                  2,157
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â136
                  â55
                  â55
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â58
                  â57
                  â44
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  125
                  41
                  44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  67
                  â16
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  2,111
                  2,171
                  2,072
               
               
                  4080
                  Outlays, net (discretionary)
                  1,993
                  2,465
                  2,102
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  53
                  36
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  3
                  
               
               
                  4101
                  Outlays from mandatory balances
                  46
                  47
                  36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  48
                  50
                  36
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â18
                  â8
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â8
                  â8
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  28
                  28
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  30
                  42
                  36
               
               
                  4180
                  Budget authority, net (total)
                  2,139
                  2,199
                  2,072
               
               
                  4190
                  Outlays, net (total)
                  2,023
                  2,507
                  2,138
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,139
                  2,199
                  2,072
               
               
                  
                  Outlays
                  2,023
                  2,507
                  2,138
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  19
                  25
               
               
                  
                  Outlays
                  
                  4
                  15
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,139
                  2,218
                  2,097
               
               
                  
                  Outlays
                  2,023
                  2,511
                  2,153
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  22
                  22
                  22
               
               
                  12.1
                  Civilian personnel benefits
                  7
                  7
                  7
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  44
                  44
                  44
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,067
                  2,096
                  1,996
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,143
                  2,172
                  2,072
               
               
                  99.0
                  Reimbursable obligations
                  94
                  84
                  54
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,237
                  2,256
                  2,126
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  168
                  177
                  180
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  12
                  11
                  11
               
               
                  
                     
                  
               
            
         
      
         Aging and Disability Services Programs
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  ACL Reimbursable Programs
                  
                  29
                  51
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  â10
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  19
                  25
               
               
                  1900
                  Budget authority (total)
                  
                  19
                  25
               
               
                  1930
                  Total budgetary resources available
                  
                  19
                  15
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  â10
                  â36
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  25
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  29
                  51
               
               
                  3020
                  Outlays (gross)
                  
                  â4
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  25
                  61
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  25
               
               
                  3200
                  Obligated balance, end of year
                  
                  25
                  61
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  19
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4
                  5
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  4
                  15
               
               
                  4180
                  Budget authority, net (total)
                  
                  19
                  25
               
               
                  4190
                  Outlays, net (total)
                  
                  4
                  15
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  1
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  28
                  48
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  29
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  29
                  51
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â506
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  1
                  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 to carry out health or human services research and evaluation activities, including such activities that are similar
               to activities carried out by other components of the Department, $347,105,000, together with  $73,840,000 from the amounts available under section 241 of the PHS Act : Provided, That of this amount, $53,900,000 shall be for minority AIDS prevention and treatment activities:  Provided further, That of the funds made available under this heading,  $2,000,000 shall be for carrying out prize competitions sponsored by the Office of the Secretary to accelerate innovation in the prevention,
            diagnosis, and treatment of kidney diseases (as authorized by section 24 of the Stevenson-Wydler Technology Innovation Act
            of 1980 (15 U.S.C. 3719)).
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  GDM Direct
                  481
                  480
                  347
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct, subtotal
                  481
                  480
                  347
               
               
                  0802
                  GDM Reimbursable (collected)
                  169
                  191
                  182
               
               
                  0803
                  PHS Evaluation Reimbursable (Collected)
                  65
                  65
                  74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  234
                  256
                  256
               
               
                  0811
                  HCFAC Mandatory (R)
                  7
                  7
                  10
               
               
                  0812
                  MACRA Mandatory (R)
                  5
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0819
                  Reimbursable program activities, subtotal
                  12
                  12
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  246
                  268
                  271
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  727
                  748
                  618
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  11
                  13
                  13
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation [GDM Direct]
                  481
                  480
                  347
               
               
                  1120
                  Appropriations transferred â other accts [075â1503]
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  480
                  480
                  347
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  106
                  256
                  260
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  127
                  
                  
               
               
                  1711
                  Spending authority transferred other accounts [075â0511]
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  238
                  256
                  260
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  11
                  12
                  15
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  12
                  12
                  15
               
               
                  1900
                  Budget authority (total)
                  730
                  748
                  622
               
               
                  1930
                  Total budgetary resources available
                  741
                  761
                  635
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  13
                  13
                  17
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  493
                  525
                  527
               
               
                  3010
                  New obligations, unexpired accounts
                  727
                  748
                  618
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  8
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â684
                  â746
                  â694
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  525
                  527
                  451
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â318
                  â248
                  â248
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â128
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  198
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â248
                  â248
                  â248
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  175
                  277
                  279
               
               
                  3200
                  Obligated balance, end of year
                  277
                  279
                  203
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  718
                  736
                  607
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  357
                  352
                  296
               
               
                  4011
                  Outlays from discretionary balances
                  315
                  382
                  383
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  672
                  734
                  679
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â298
                  â256
                  â260
               
               
                  4033
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â299
                  â256
                  â260
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â127
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  193
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  66
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  485
                  480
                  347
               
               
                  4080
                  Outlays, net (discretionary)
                  373
                  478
                  419
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  12
                  12
                  15
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  8
                  12
                  15
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  12
                  12
                  15
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  â14
                  â12
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  485
                  480
                  347
               
               
                  4190
                  Outlays, net (total)
                  371
                  478
                  419
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
            for 2021 . 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  83
                  90
                  87
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  3
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  92
                  98
                  95
               
               
                  12.1
                  Civilian personnel benefits
                  25
                  31
                  30
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  5
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  20
                  21
                  22
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  2
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  22
                  21
                  17
               
               
                  25.2
                  Other services from non-Federal sources
                  35
                  26
                  28
               
               
                  25.3
                  Other goods and services from Federal sources
                  125
                  124
                  88
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  5
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  3
                  3
                  3
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  143
                  141
                  48
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  481
                  480
                  347
               
               
                  99.0
                  Reimbursable obligations
                  246
                  268
                  271
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  727
                  748
                  618
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  836
                  868
                  833
               
               
                  1101
                  Direct military average strength employment
                  25
                  22
                  24
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  491
                  486
                  507
               
               
                  2101
                  Reimbursable military average strength employment
                  15
                  15
                  13
               
               
                  
                     
                  
               
            
         
      
         Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         State Response to the Opioid Abuse Crisis, Cures Act
         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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office for Civil Rights (Direct)
                  39
                  39
                  30
               
               
                  0801
                  Office for Civil Rights (Reimbursable)
                  7
                  14
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  46
                  53
                  57
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  34
                  53
                  49
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  37
                  53
                  49
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  39
                  39
                  30
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  23
                  10
                  10
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  
                  1
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  23
                  10
                  10
               
               
                  1900
                  Budget authority (total)
                  62
                  49
                  40
               
               
                  1930
                  Total budgetary resources available
                  99
                  102
                  89
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  53
                  49
                  32
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  23
                  15
                  4
               
               
                  3010
                  New obligations, unexpired accounts
                  46
                  53
                  57
               
               
                  3020
                  Outlays (gross)
                  â51
                  â64
                  â48
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15
                  4
                  13
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  23
                  15
                  4
               
               
                  3200
                  Obligated balance, end of year
                  15
                  4
                  13
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  39
                  39
                  30
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  34
                  31
                  24
               
               
                  4011
                  Outlays from discretionary balances
                  6
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  40
                  39
                  32
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  23
                  10
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1
                  1
               
               
                  4101
                  Outlays from mandatory balances
                  11
                  24
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  11
                  25
                  16
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â23
                  â10
                  â10
               
               
                  4180
                  Budget authority, net (total)
                  39
                  39
                  30
               
               
                  4190
                  Outlays, net (total)
                  28
                  54
                  38
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  16
                  17
                  15
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  18
                  16
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  6
                  6
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  4
                  4
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  2
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  8
                  5
               
               
                  31.0
                  Equipment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  39
                  30
               
               
                  99.0
                  Reimbursable obligations
                  7
                  14
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  46
                  53
                  57
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  138
                  150
                  140
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1
                  2
                  1
               
               
                  
                     
                  
               
            
         
      
         Office of the national coordinator for health information technologyFor expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts,
            and cooperative agreements for the development and advancement of interoperable health information technology,  $50,717,000.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health information technology (IT)
                  60
                  60
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  60
                  60
                  51
               
               
                  0801
                  Office of the National Coordinator for Health IT (ONC): Reimbursable
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  66
                  66
                  57
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  10
                  19
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  11
                  10
                  19
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  60
                  51
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  15
                  15
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  5
                  15
                  15
               
               
                  1900
                  Budget authority (total)
                  65
                  75
                  66
               
               
                  1930
                  Total budgetary resources available
                  76
                  85
                  85
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  10
                  19
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  68
                  54
                  13
               
               
                  3010
                  New obligations, unexpired accounts
                  66
                  66
                  57
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â69
                  â107
                  â68
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â9
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  54
                  13
                  2
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â20
                  â10
                  â10
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â5
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â10
                  â10
                  â10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  48
                  44
                  3
               
               
                  3200
                  Obligated balance, end of year
                  44
                  3
                  â8
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  65
                  75
                  66
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  41
                  64
                  56
               
               
                  4011
                  Outlays from discretionary balances
                  28
                  43
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  69
                  107
                  68
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â14
                  â15
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â14
                  â15
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â5
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  60
                  60
                  51
               
               
                  4080
                  Outlays, net (discretionary)
                  55
                  92
                  53
               
               
                  4180
                  Budget authority, net (total)
                  60
                  60
                  51
               
               
                  4190
                  Outlays, net (total)
                  55
                  92
                  53
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  19
                  19
                  19
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  21
                  21
                  21
               
               
                  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
                  13
                  13
                  11
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  11
                  9
               
               
                  41.0
                  Grants, subsidies, and contributions
                  6
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  59
                  59
                  49
               
               
                  99.0
                  Reimbursable obligations
                  5
                  5
                  5
               
               
                  99.5
                  Adjustment for rounding
                  2
                  2
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  66
                  66
                  57
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  156
                  162
                  162
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Medicare Hearings and AppealsFor expenses necessary for Medicare hearings and appeals in the Office of the Secretary,  $196,381,000 shall remain available until September 30,  2022, 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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Medicare Hearings and Appeals (Direct)
                  164
                  192
                  196
               
               
                  0002
                  Proposed User Fees
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  164
                  192
                  198
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  164
                  192
                  198
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  37
                  56
                  56
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  40
                  56
                  56
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  127
                  192
                  196
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  55
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  182
                  192
                  196
               
               
                  1900
                  Budget authority (total)
                  182
                  192
                  196
               
               
                  1930
                  Total budgetary resources available
                  222
                  248
                  252
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  56
                  56
                  54
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  55
                  57
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  164
                  192
                  198
               
               
                  3020
                  Outlays (gross)
                  â158
                  â248
                  â196
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  57
                  1
                  3
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â106
                  â156
                  â156
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â55
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â156
                  â156
                  â156
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â51
                  â99
                  â155
               
               
                  3200
                  Obligated balance, end of year
                  â99
                  â155
                  â153
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  182
                  192
                  196
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  98
                  192
                  196
               
               
                  4011
                  Outlays from discretionary balances
                  60
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  158
                  192
                  196
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â130
                  â192
                  â196
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â55
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â52
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  28
                  
                  
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  56
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  28
                  56
                  
               
               
                  
                     
                  
               
            
         
      
      
         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, and the Medicare appeals related operations of the Departmental
            Appeals Board (DAB). 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. The Departmental Appeals Board for Medicare provides final HHS
            administrative review of claims for Medicare entitlement, payment, and coverage.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  77
                  107
                  119
               
               
                  11.5
                  Other personnel compensation
                  
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  77
                  109
                  121
               
               
                  12.1
                  Civilian personnel benefits
                  27
                  35
                  36
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  
                  
               
               
                  22.0
                  Transportation of things
                  1
                  
                  
               
               
                  23.1
                  Rental payments to GSA
                  5
                  11
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  4
                  8
                  8
               
               
                  25.2
                  Other services from non-Federal sources
                  13
                  13
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  19
                  10
                  12
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  2
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  2
                  3
               
               
                  26.0
                  Supplies and materials
                  3
                  1
                  1
               
               
                  31.0
                  Equipment
                  8
                  1
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  164
                  192
                  198
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  164
                  192
                  198
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  853
                  1,376
                  1,339
               
               
                  
                     
                  
               
            
         
      
         Medicare Hearings and Appeals
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.2)
                  
                  
                  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 Office of Medicare Hearings and Appeals (OMHA) and the Departmental Appeals Board (DAB)
            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,  $1,081,465,000, of which $561,700,000 shall remain available through September 30,  2022, 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,  2023: Provided further, That $20,000,000 of the amounts made available to the National Disaster Medical System shall remain
               available through September 30, 2022, 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),  $535,000,000, to remain available until expended.
      For expenses necessary to carry out section 319F-2(a) of the PHS Act, $705,000,000, to remain available until expended.
      For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic,  $310,000,000; of which  $275,000,000 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. 
      For an additional amount to supplement amounts otherwise available for programs in the Department to provide authorized assistance
               or services to individuals who are homeless or who have experienced homelessness, $10,000,000: Provided, That such funds may
               be transferred to other accounts in the Department for such purposes: Provided further, That the transfer authority provided
               in the previous proviso is in addition to any other transfer authority available to the Department.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Public Health and Social Services Emergency Fund
                  2,916
                  2,737
                  2,641
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct program activities, subtotal
                  2,916
                  2,737
                  2,641
               
               
                  0801
                  Reimbursable program (FEMA)
                  91
                  98
                  98
               
               
                  0802
                  Reimbursable program activity (OPP)
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  93
                  100
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  3,009
                  2,837
                  2,741
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  437
                  694
                  1,126
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0343]
                  â2
                  â3
                  â3
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â15
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0943]
                  â10
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  50
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  425
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0116]
                  16
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  88
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  989
                  691
                  1,123
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,222
                  3,272
                  2,641
               
               
                  1120
                  Appropriations transferred to other acct [075â0350]
                  â80
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â1
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1362]
                  â100
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0943]
                  â20
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  604
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,625
                  3,272
                  2,641
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  4
                  
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  87
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  91
                  
                  
               
               
                  1900
                  Budget authority (total)
                  2,716
                  3,272
                  2,641
               
               
                  1930
                  Total budgetary resources available
                  3,705
                  3,963
                  3,764
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  694
                  1,126
                  1,023
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,480
                  4,967
                  4,746
               
               
                  3010
                  New obligations, unexpired accounts
                  3,009
                  2,837
                  2,741
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  19
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,658
                  â3,058
                  â3,332
               
               
                  3031
                  Unpaid obligations transferred from other accts [075â0943]
                  242
                  
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â88
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,967
                  4,746
                  4,155
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â198
                  â203
                  â203
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â87
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  82
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â203
                  â203
                  â203
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4,282
                  4,764
                  4,543
               
               
                  3200
                  Obligated balance, end of year
                  4,764
                  4,543
                  3,952
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,716
                  3,272
                  2,641
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  431
                  617
                  581
               
               
                  4011
                  Outlays from discretionary balances
                  2,227
                  2,441
                  2,751
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,658
                  3,058
                  3,332
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â86
                  
                  
               
               
                  4033
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â87
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â87
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  83
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  2,625
                  3,272
                  2,641
               
               
                  4080
                  Outlays, net (discretionary)
                  2,571
                  3,058
                  3,332
               
               
                  4180
                  Budget authority, net (total)
                  2,625
                  3,272
                  2,641
               
               
                  4190
                  Outlays, net (total)
                  2,571
                  3,058
                  3,332
               
               
                  
                     
                  
               
            
         
      
      
         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 and Advancing Innovation Act of 2019. 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, the U.S. Public
            Health Service Commissioned Corps, and the Medical Reserve Corps.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  96
                  110
                  115
               
               
                  11.3
                  Other than full-time permanent
                  14
                  
                  
               
               
                  11.7
                  Military personnel
                  9
                  10
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  119
                  120
                  126
               
               
                  12.1
                  Civilian personnel benefits
                  32
                  31
                  33
               
               
                  12.2
                  Military personnel benefits
                  4
                  5
                  5
               
               
                  21.0
                  Travel and transportation of persons
                  13
                  9
                  16
               
               
                  22.0
                  Transportation of things
                  3
                  6
                  8
               
               
                  23.1
                  Rental payments to GSA
                  6
                  6
                  7
               
               
                  23.2
                  Rental payments to others
                  9
                  10
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  5
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  900
                  1,057
                  967
               
               
                  25.2
                  Other services from non-Federal sources
                  183
                  150
                  150
               
               
                  25.3
                  Other goods and services from Federal sources
                  157
                  106
                  107
               
               
                  25.4
                  Operation and maintenance of facilities
                  14
                  25
                  25
               
               
                  25.5
                  Research and development contracts
                  45
                  40
                  40
               
               
                  25.7
                  Operation and maintenance of equipment
                  31
                  31
                  33
               
               
                  26.0
                  Supplies and materials
                  1,092
                  801
                  752
               
               
                  31.0
                  Equipment
                  6
                  2
                  3
               
               
                  32.0
                  Land and structures
                  
                  35
                  35
               
               
                  41.0
                  Grants, subsidies, and contributions
                  297
                  300
                  320
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,916
                  2,737
                  2,641
               
               
                  99.0
                  Reimbursable obligations
                  93
                  100
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  3,009
                  2,837
                  2,741
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  821
                  935
                  963
               
               
                  1101
                  Direct military average strength employment
                  80
                  77
                  81
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  AHRQ
                  52
                  106
                  
               
               
                  0002
                  Office of the Secretary
                  26
                  27
                  25
               
               
                  0003
                  NIRSQ
                  
                  
                  98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  78
                  133
                  123
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  127
                  195
                  195
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  128
                  195
                  195
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  145
                  133
                  123
               
               
                  1930
                  Total budgetary resources available
                  273
                  328
                  318
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  195
                  195
                  195
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  118
                  116
                  168
               
               
                  3010
                  New obligations, unexpired accounts
                  78
                  133
                  123
               
               
                  3020
                  Outlays (gross)
                  â79
                  â81
                  â152
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  116
                  168
                  139
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  118
                  116
                  168
               
               
                  3200
                  Obligated balance, end of year
                  116
                  168
                  139
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  145
                  133
                  123
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4
                  4
               
               
                  4101
                  Outlays from mandatory balances
                  79
                  77
                  148
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  79
                  81
                  152
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â145
                  â133
                  â123
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â66
                  â52
                  29
               
               
                  
                     
                  
               
            
         
      
      
         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). In FY 2020, PCORTF was extended through FY 2029. 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 2021 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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  54
                  27
                  25
               
               
                  41.0
                  Grants, subsidies, and contributions
                  24
                  106
                  98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  78
                  133
                  123
               
               
                  
                     
                  
               
            
         
      
         Nonrecurring Expenses FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Nonrecurring Expenses Fund Projects
                  505
                  665
                  105
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,116
                  1,024
                  609
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  792
                  600
                  600
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,929
                  1,624
                  1,209
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â400
                  â350
                  â500
               
               
                  1930
                  Total budgetary resources available
                  1,529
                  1,274
                  709
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,024
                  609
                  604
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  543
                  792
                  796
               
               
                  3010
                  New obligations, unexpired accounts
                  505
                  665
                  105
               
               
                  3020
                  Outlays (gross)
                  â235
                  â661
                  185
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  792
                  796
                  1,086
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  543
                  792
                  796
               
               
                  3200
                  Obligated balance, end of year
                  792
                  796
                  1,086
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  â400
                  â350
                  â500
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â52
                  â75
               
               
                  4011
                  Outlays from discretionary balances
                  235
                  713
                  â110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  235
                  661
                  â185
               
               
                  4180
                  Budget authority, net (total)
                  â400
                  â350
                  â500
               
               
                  4190
                  Outlays, net (total)
                  235
                  661
                  â185
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  8
                  11
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  144
                  90
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  90
                  119
                  
               
               
                  25.4
                  Operation and maintenance of facilities
                  121
                  160
                  
               
               
                  25.5
                  Research and development contracts
                  3
                  4
                  
               
               
                  25.7
                  Operation and maintenance of equipment
                  51
                  67
                  
               
               
                  31.0
                  Equipment
                  14
                  18
                  
               
               
                  32.0
                  Land and structures
                  73
                  196
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  504
                  665
                  105
               
               
                  99.5
                  Adjustment for rounding
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  505
                  665
                  105
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  3
                  3
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  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
                  3
                  3
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  22
                  15
                  13
               
               
                  3020
                  Outlays (gross)
                  â5
                  â2
                  â2
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15
                  13
                  11
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  22
                  15
                  13
               
               
                  3200
                  Obligated balance, end of year
                  15
                  13
                  11
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  5
                  2
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  5
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  6
                  6
                  6
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  â16
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0350]
                  8
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â1362]
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6
                  6
                  6
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  900
                  950
                  950
               
               
                  1220
                  Appropriations transferred to other accts [075â0142]
                  â28
                  â28
                  
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â805
                  â854
                  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55
                  â56
                  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 2021, $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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pregnancy Assistance Fund (Direct)
                  23
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  25
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  23
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  23
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  29
                  26
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  23
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â21
                  â25
                  â1
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  26
                  1
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  29
                  26
                  1
               
               
                  3200
                  Obligated balance, end of year
                  26
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  23
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  20
                  25
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  21
                  25
                  1
               
               
                  4180
                  Budget authority, net (total)
                  23
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  21
                  25
                  1
               
               
                  
                     
                  
               
            
         
      
      
         This appropriation funds competitive grants to States to assist pregnant and parenting teens and women. Annual funding for
            this program expired 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  23
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  2
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Section 241 Evaluation Transactions AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â3902â0â1â552
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Section 241 Evaluation Transactions Account (Reimbursable)
                  516
                  584
                  667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  516
                  584
                  667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.3)
                  516
                  584
                  667
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  84
                  584
                  667
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  432
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  516
                  584
                  667
               
               
                  1930
                  Total budgetary resources available
                  516
                  584
                  667
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  633
                  790
                  324
               
               
                  3010
                  New obligations, unexpired accounts
                  516
                  584
                  667
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â321
                  â1,050
                  â861
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  790
                  324
                  130
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â629
                  â787
                  â787
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â432
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  274
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â787
                  â787
                  â787
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4
                  3
                  â463
               
               
                  3200
                  Obligated balance, end of year
                  3
                  â463
                  â657
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  516
                  584
                  667
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  84
                  584
                  667
               
               
                  4011
                  Outlays from discretionary balances
                  237
                  466
                  194
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  321
                  1,050
                  861
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â317
                  â584
                  â667
               
               
                  4033
                  Non-Federal sources
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â320
                  â584
                  â667
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â432
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  236
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â196
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  1
                  466
                  194
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  466
                  194
               
               
                  
                     
                  
               
            
         
      
      
         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, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Retirement payments
                  488
                  506
                  525
               
               
                  0002
                  Survivors' benefits
                  31
                  31
                  32
               
               
                  0003
                  Medical care
                  104
                  100
                  96
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  623
                  637
                  653
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  624
                  637
                  653
               
               
                  1930
                  Total budgetary resources available
                  624
                  638
                  654
               
               
                  
                  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
                  102
                  93
                  30
               
               
                  3010
                  New obligations, unexpired accounts
                  623
                  637
                  653
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  12
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â618
                  â700
                  â652
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  93
                  30
                  31
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  102
                  93
                  30
               
               
                  3200
                  Obligated balance, end of year
                  93
                  30
                  31
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  624
                  637
                  653
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  558
                  605
                  620
               
               
                  4101
                  Outlays from mandatory balances
                  60
                  95
                  32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  618
                  700
                  652
               
               
                  
                  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)
                  624
                  637
                  653
               
               
                  4170
                  Outlays, net (mandatory)
                  617
                  700
                  652
               
               
                  4180
                  Budget authority, net (total)
                  624
                  637
                  653
               
               
                  4190
                  Outlays, net (total)
                  617
                  700
                  652
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2019
                     2020
                     2021
                  
                  
                     
                        
                     
                  
                  
                     Active Duty:
                     
                     
                     
                  
                  
                     HHS
                     4,876 
                     4,859
                     4,676
                  
                  
                     DOJ, BOP
                     787
                     787
                     754
                  
                  
                     Homeland Security
                     400 
                     400
                     492
                  
                  
                     EPA
                     55
                     55 
                     53
                  
                  
                     All Other
                     294 
                     312 
                     326
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Active Duty
                     6,412 
                     6,411
                     6,301
                  
                  
                     
                     
                     
                     
                  
                  
                     Retirees & Survivors:
                     
                     
                     
                  
                  
                     Retirees
                     6,150 
                     6,300 
                     6,380
                  
                  
                     Retiree family members and survivors
                     1,125 
                     1,100
                     1,120
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Retirement Pay
                     7,275 
                     7,400 
                     7,500
                  
                  
                     Total Beneficiaries (active duty, retirees, survivors)
                     13,687 
                     13,811 
                     13,801
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  13.0
                  Benefits for former personnel
                  519
                  537
                  557
               
               
                  25.6
                  Medical care
                  104
                  100
                  96
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  623
                  637
                  653
               
               
                  
                     
                  
               
            
         
      
         Retirement Pay and Medical Benefits for Commissioned Officers
         (Legislative proposal, subject to PAYGO)
         The Budget includes a mandatory proposal, effective FY 2022, 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  29
                  29
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 12.2)
                  29
                  29
                  31
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  29
                  29
                  31
               
               
                  1900
                  Budget authority (total)
                  29
                  29
                  31
               
               
                  1930
                  Total budgetary resources available
                  29
                  29
                  31
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  29
                  29
                  31
               
               
                  3020
                  Outlays (gross)
                  â29
                  â29
                  â31
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  29
                  29
                  31
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  29
                  29
                  31
               
               
                  4180
                  Budget authority, net (total)
                  29
                  29
                  31
               
               
                  4190
                  Outlays, net (total)
                  29
                  29
                  31
               
               
                  
                     
                  
               
            
         
      
      
         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 2022, 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
                  2019 actual
                  2020 est.
                  2021 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Program Support Center
                  1,025
                  1,280
                  880
               
               
                  0802
                  OS activities
                  477
                  505
                  505
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,502
                  1,785
                  1,385
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  204
                  216
                  629
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  35
                  250
                  250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  239
                  466
                  879
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,621
                  1,948
                  1,948
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â142
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,479
                  1,948
                  1,948
               
               
                  1930
                  Total budgetary resources available
                  1,718
                  2,414
                  2,827
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  216
                  629
                  1,442
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,265
                  1,012
                  1,081
               
               
                  3010
                  New obligations, unexpired accounts
                  1,502
                  1,785
                  1,385
               
               
                  3020
                  Outlays (gross)
                  â1,720
                  â1,466
                  â1,464
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â35
                  â250
                  â250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,012
                  1,081
                  752
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â673
                  â531
                  â531
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  142
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â531
                  â531
                  â531
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  592
                  481
                  550
               
               
                  3200
                  Obligated balance, end of year
                  481
                  550
                  221
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,479
                  1,948
                  1,948
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  885
                  980
                  980
               
               
                  4011
                  Outlays from discretionary balances
                  835
                  486
                  484
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,720
                  1,466
                  1,464
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â1,618
                  â1,948
                  â1,948
               
               
                  4033
                  Non-Federal sources
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,621
                  â1,948
                  â1,948
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  142
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  99
                  â482
                  â484
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  99
                  â482
                  â484
               
               
                  
                     
                  
               
            
         
      
      
         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,
            acquisition reform, 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  103
                  117
                  123
               
               
                  11.3
                  Other than full-time permanent
                  3
                  3
                  3
               
               
                  11.5
                  Other personnel compensation
                  4
                  3
                  3
               
               
                  11.7
                  Military personnel
                  5
                  8
                  8
               
               
                  11.8
                  Special personal services payments
                  10
                  10
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  125
                  141
                  149
               
               
                  12.1
                  Civilian personnel benefits
                  34
                  38
                  42
               
               
                  12.2
                  Military personnel benefits
                  2
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  2
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  21
                  18
                  18
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  9
                  9
                  9
               
               
                  24.0
                  Printing and reproduction
                  5
                  6
                  6
               
               
                  25.1
                  Advisory and assistance services
                  136
                  197
                  197
               
               
                  25.2
                  Other services from non-Federal sources
                  933
                  1,194
                  782
               
               
                  25.3
                  Other goods and services from Federal sources
                  65
                  21
                  21
               
               
                  25.4
                  Operation and maintenance of facilities
                  22
                  14
                  14
               
               
                  25.6
                  Medical care
                  20
                  32
                  32
               
               
                  25.7
                  Operation and maintenance of equipment
                  71
                  51
                  51
               
               
                  26.0
                  Supplies and materials
                  54
                  50
                  50
               
               
                  31.0
                  Equipment
                  1
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,502
                  1,785
                  1,385
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  934
                  1,191
                  1,191
               
               
                  2101
                  Reimbursable military average strength employment
                  55
                  71
                  71
               
               
                  3101
                  Allocation account military average strength employment
                  1,455
                  1,472
                  1,572
               
               
                  
                     
                  
               
            
         
      
      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 2022, 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 2022, 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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  2
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Contributions, Indian Health Facilities
                  3
                  3
                  3
               
               
                  1130
                  Contributions, N.I.H., Unconditional Gift Fund
                  2
                  3
                  3
               
               
                  1130
                  Centers for Disease Control, Gifts and Donations
                  26
                  26
                  26
               
               
                  1130
                  Contributions, N.I.H., Conditional Gift Fund
                  40
                  40
                  40
               
               
                  1130
                  Contributions to the Indian Health Service Gift Fund
                  
                  1
                  1
               
               
                  1140
                  Interest, Miscellaneous Trust Funds
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  72
                  74
                  74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  72
                  74
                  74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  72
                  74
                  76
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Miscellaneous Trust Funds
                  â72
                  â72
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  2
                  4
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Gifts
                  97
                  62
                  62
               
               
                  0003
                  Contributions, Indian Health Facilities
                  
                  36
                  36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  97
                  98
                  98
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  188
                  172
                  154
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  9
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  197
                  180
                  162
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  72
                  72
                  72
               
               
                  1930
                  Total budgetary resources available
                  269
                  252
                  234
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  172
                  154
                  136
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  100
                  110
                  40
               
               
                  3010
                  New obligations, unexpired accounts
                  97
                  98
                  98
               
               
                  3020
                  Outlays (gross)
                  â78
                  â160
                  â85
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â9
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  110
                  40
                  45
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  100
                  110
                  40
               
               
                  3200
                  Obligated balance, end of year
                  110
                  40
                  45
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  72
                  72
                  72
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  20
                  26
                  26
               
               
                  4101
                  Outlays from mandatory balances
                  58
                  134
                  59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  78
                  160
                  85
               
               
                  4180
                  Budget authority, net (total)
                  72
                  72
                  72
               
               
                  4190
                  Outlays, net (total)
                  78
                  160
                  85
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  37
                  35
                  35
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  35
                  35
                  35
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  3
                  3
                  3
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.8
                  Special personal services payments
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  7
                  7
                  7
               
               
                  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
                  12
                  12
                  12
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  25.5
                  Research and development contracts
                  3
                  3
                  3
               
               
                  25.6
                  Medical care
                  1
                  1
                  1
               
               
                  25.8
                  Subsistence and support of persons
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  6
                  6
                  6
               
               
                  31.0
                  Equipment
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  53
                  54
                  54
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  97
                  98
                  98
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  33
                  33
                  33
               
               
                  
                     
                  
               
            
         
      
         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,  $90,000,000: 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: Provided further, That of the amount appropriated under this heading, $5,300,000 shall be available through September 30,
               2022, for activities authorized under section 3022 of the Public Health Service Act relating to information blocking.
      (Department of Health and Human Services Appropriations Act, 2020.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Inspector General (Direct)
                  86
                  86
                  90
               
               
                  0801
                  Office of Inspector General HCFAC Trust Fund
                  240
                  212
                  228
               
               
                  0802
                  Office of Inspector General (Direct Reimbursable)
                  14
                  21
                  21
               
               
                  0803
                  Office of Inspector General HCFAC Discretionary
                  87
                  93
                  101
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  341
                  326
                  350
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  427
                  412
                  440
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  41
                  30
                  31
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  37
                  30
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  45
                  32
                  31
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  80
                  80
                  90
               
               
                  1121
                  Appropriations transferred from other acct [075â9911]
                  2
                  2
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  5
                  5
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1503]
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  93
                  87
                  90
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  96
                  111
                  111
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  99
                  111
                  111
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  221
                  213
                  228
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â1
                  
                  
               
               
                  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)
                  220
                  213
                  229
               
               
                  1900
                  Budget authority (total)
                  412
                  411
                  430
               
               
                  1930
                  Total budgetary resources available
                  457
                  443
                  461
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  30
                  31
                  21
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  97
                  101
                  56
               
               
                  3010
                  New obligations, unexpired accounts
                  427
                  412
                  440
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â418
                  â455
                  â430
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  â2
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  101
                  56
                  66
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â135
                  â128
                  â128
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â128
                  â128
                  â128
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â38
                  â27
                  â72
               
               
                  3200
                  Obligated balance, end of year
                  â27
                  â72
                  â62
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  192
                  198
                  201
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  156
                  179
                  183
               
               
                  4011
                  Outlays from discretionary balances
                  26
                  19
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  182
                  198
                  201
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â105
                  â111
                  â111
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  93
                  87
                  90
               
               
                  4080
                  Outlays, net (discretionary)
                  77
                  87
                  90
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  220
                  213
                  229
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  160
                  194
                  208
               
               
                  4101
                  Outlays from mandatory balances
                  76
                  63
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  236
                  257
                  229
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â211
                  â213
                  â216
               
               
                  4123
                  Non-Federal sources
                  â10
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â221
                  â225
                  â228
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  
                  12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  1
                  12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  
                  1
               
               
                  4170
                  Outlays, net (mandatory)
                  15
                  32
                  1
               
               
                  4180
                  Budget authority, net (total)
                  93
                  87
                  91
               
               
                  4190
                  Outlays, net (total)
                  92
                  119
                  91
               
               
                  
                     
                  
               
               
                  
                  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
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  40
                  40
                  43
               
               
                  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
                  45
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  16
                  17
               
               
                  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
                  5
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  12
                  12
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  4
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  86
                  86
                  90
               
               
                  99.0
                  Reimbursable obligations
                  341
                  326
                  350
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  427
                  412
                  440
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,624
                  1,640
                  1,666
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  7
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions
         GENERAL FUND RECEIPT ACCOUNTS(in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2019 actual
                  2020 est.
                  2021 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  120
                  90
                  90
               
               
                  075â275830
                  Downward Reestimates of Subsidies, Health Centers
                  1
                  
                  
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  526
                  634
                  562
               
               
                  075â310700
                  Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO
                  
                  
                  4
               
               
                  075â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                  511
                  34
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Offsetting receipts from the public
                  1,158
                  758
                  690
               
               
                  
                     
                  
               
            
         
      
      
          
      
         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  2021 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  2021:
      (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.
      '
      			
      (transfer of funds)SEC. 214. Not to exceed  1 percent of funds appropriated by this Act to the offices, institutes, and centers of the National Institutes of Health may be  transferred to and merged with funds appropriated under the heading "National Institutes of Health-Buildings and Facilities":
         Provided, That the use of such transferred funds shall be subject to a centralized prioritization and governance process:
         Provided further, That the Director of the National Institutes of Health shall notify the Committees on Appropriations of
         the House of Representatives and the Senate at least 15 days in advance of any such transfer: Provided further, That this
         transfer authority is in addition to any other transfer authority provided by law.'
      			
      (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.
      SEC. 217. Effective during the period beginning on November 1, 2015 and ending January 1, 2022, 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 of the House of Representatives and the Senate: Provided, That the transfer authority provided in the previous proviso is in addition to any other transfer authority provided by
      law.SEC. 219. 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. 220. 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 and medical goods and services, which may include early childhood developmental screenings, school supplies, toys, clothing, and
      any other items and services intended to promote the wellbeing of such children.SEC. 221. Funds appropriated in this Act that are available for salaries and expenses of employees of the Centers for Disease Control
      and Prevention shall also be available for the primary and secondary schooling of eligible dependents of personnel stationed
      in a U.S. territory as defined in section 229 of this Act at costs not in excess of those paid for or reimbursed by the Department
      of Defense.SEC. 222.  Amounts made available in section 238 of division A of Public Law 116â94 shall remain available until September 30, 2024 for
         installation expenses, including moving expenses, related to the Centers for Disease Control and Prevention's Chamblee Campus. SEC. 223. Of the funds provided under the heading "CDC-Wide Activities and Program Support",  $50,000,000, to remain available until expended, shall be available to the Director of the CDC for deposit in the Infectious Diseases
      Rapid Response Reserve Fund established by section 231 of division B of Public Law 115â245: Provided, That such amount may be available for Ebola preparedness and response activities without regard to the limitations in the
      third proviso in such section 231.'
      			
      (cancellation)
      SEC. 224. Of the unobligated balances available in the "Nonrecurring Expenses Fund" established in section 223 of division G of Public Law 110â161,  $500,000,000 are hereby  permanently cancelled.SEC. 225.   (a)   IN GENERAL. Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
            the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
            within the Department or of another agency under which â (1)   the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
               or cooperative agreement on behalf of the ordering agency or unit; 
         (2)   the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or
               unit; and 
         (3)   the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
               and for the service of executing or managing the grant or cooperative agreement. 
      
      (b)   CONDITIONS. The conditions for making an agreement described in subsection (a) are that â (1)   amounts are available; 
         (2)   the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and 
         (3)   the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service. 
      
      (c)   PAYMENT. Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
            agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
            any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
            request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
            shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
            and the actual cost of service provided. 
      (d)   LIMITATIONS ON FUNDS. A condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
            agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement. 
      (e)   OBLIGATION OF APPROPRIATIONS. An agreement made under this section obligates an appropriation of the ordering agency or unit.
            The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
            before the end of the period of availability of the appropriation, inâ (1)   awarding the grant or cooperative agreement; or 
         (2)   providing the agreed-on services. 
      
      (f)   NO EFFECT ON OTHER LAWS. This section does not affect other laws about reimbursable agreements. SEC. 226.   (a)   IN GENERAL. A State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
            of Health and Human Services, Administration for Community Living, Aging and Disability Services Programs" to carry out programs
            under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
            the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
            or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
            limitations on such transfers under the OAA or such heading. 
      (b)   NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL. A State or tribal organization which elects to make a transfer under
            subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
            of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
            the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
            the Secretary determines that such transfer is not consistent with the objectives of the OAA. 
      (c)   RULES OF CONSTRUCTION. No transfer of grant funds by a State or tribal organization under this section shall be 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. 227.  Funds appropriated in this Act to accounts that received appropriations in title II of division A of Public Law 116â94 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. 228.   Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended â (a)   in subsection (a)(5)(C) â (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE. A covered entity shall
               permit"; and 
         (2)  by inserting at the end the following: 
         
            "(ii) USE OF SAVINGS. 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 appropriate to carry out the
               provisions of this section.".
      SEC. 229.  For fiscal year 2021, 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. 230.  Any assessment or user fee charged pursuant to section 1311(d)(5)(A) of the Patient Protection and Affordable Care Act credited
         to the "Centers for Medicare and Medicaid Services, Program Management" account 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, and shall remain available until expended for the purposes described in this section. '
      			
      (including transfer of funds)SEC. 231.  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 such amounts as are necessary from
         any discretionary amounts (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985) appropriated in this
         Act, 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 the fiscal year on the unobligated
         balances in the Fund and all actual obligations incurred for the 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. '
      			
      (including transfer of funds)SEC. 232.   (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 for 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. 233.   Section 2813 of the Public Health Service Act (42 U.S.C. 300hh-15) is amended â (1)  by redesignating subsection (i) as subsection (j); and 
      (2)  by inserting after subsection (h) the following new subsection: 
      
         "(i) TORT CLAIMS AND WORK INJURY COMPENSATION COVERAGE FOR CORPS VOLUNTEERS. â
         
            "(1) IN GENERAL â If under section 223 and regulations pursuant to such section, and through an agreement entered into in
                  accordance with such regulations, the Secretary accepts, from an individual in the Corps, services for a specified period
                  that are volunteer and without compensation other than reasonable reimbursement or allowance for expenses actually incurred,
                  such individual shall, during such period, have the coverages described in paragraphs (2) and (3).
         
         
            "(2) FEDERAL TORT CLAIMS ACT COVERAGE. â Such individual shall, while performing such services during such period â
            
               "(A) be deemed to be an employee of the Department of Health and Human Services, for purposes of claims under sections 1346(b)
                     and 2672 of title 28, United States Code, for money damages for personal injury, including death, resulting from the performance
                     of functions under such agreement; and
            
            
               "(B) be deemed to be an employee of the Public Health Service performing medical, surgical, dental, or related functions,
                     for purposes of having the remedy provided by such sections of title 28 be exclusive of any other civil action or proceeding
                     by reason of the same subject matter against such individual or against the estate of such individual.
            
         
         
            "(3) COMPENSATION FOR WORK INJURIES. Such individual shall, while performing such services during such period, be deemed to
                  be an employee of the Department of Health and Human Services, and an injury sustained by such an individual shall be deemed
                  'in the performance of duty' for purposes of chapter 81 of title 5, United States Code, pertaining to compensation for work
                  injuries.".
         
      SEC. 234.  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. (Department of Health and Human Services Appropriations Act, 2020.)