[Appendix]
[Detailed Budget Estimates by Agency]
[Department of Health and Human Services]
[From the U.S. Government Publishing Office, www.gpo.gov]
<h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES</h1>
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
Federal Funds
Salaries and expenses
For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration
which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; 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 114–255); 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 107–188; $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 facilities
For plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities
of or used by the Food and Drug Administration, where not otherwise provided, $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 075–9911–0–1–554
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
–1
–2
–2
5099
Balance, end of year
1
2
3
Program and Financing (in millions of dollars)
Identification code 075–9911–0–1–554
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 [075–0128]
–2
–2
1121
Appropriations transferred from other acct [075–5629]
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
–22
1702
Offsetting collections (previously unavailable)
772
1725
Spending authority from offsetting collections precluded from obligation (limitation on obligations)
–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)
–5,615
–5,806
–6,294
3040
Recoveries of prior year unpaid obligations, unexpired
–57
3041
Recoveries of prior year unpaid obligations, expired
–100
3050
Unpaid obligations, end of year
2,867
2,993
2,735
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–70
–66
–44
3070
Change in uncollected pymts, Fed sources, unexpired
–28
22
3071
Change in uncollected pymts, Fed sources, expired
32
3090
Uncollected pymts, Fed sources, end of year
–66
–44
–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:
–35
–22
4033
Non-Federal sources:
–2,557
–2,660
–2,743
4040
Offsets against gross budget authority and outlays (total)
–2,592
–2,682
–2,743
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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:
–6
4123
Non-Federal sources:
–1
4130
Offsets against gross budget authority and outlays (total)
–1
–6
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–6
4142
Offsetting collections credited to expired accounts
6
4150
Additional offsets against budget authority only (total)
–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 075–9911–0–1–554
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 075–9911–0–1–554
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 075–9911–2–1–554
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)
–156
Budget authority and outlays, net:
Discretionary:
4000
Budget authority, gross
156
Outlays, gross:
4010
Outlays from new discretionary authority
156
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033
Non-Federal sources:
–156
4040
Offsets against gross budget authority and outlays (total)
–156
4180
Budget authority, net (total)
4190
Outlays, net (total)
The FY 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 075–9911–2–1–554
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 075–9911–2–1–554
2019 actual
2020 est.
2021 est.
2001
Reimbursable civilian full-time equivalent employment
52
FDA Working Capital Fund
Program and Financing (in millions of dollars)
Identification code 075–4613–0–4–554
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)
–376
–824
–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
–609
–619
–619
4180
Budget authority, net (total)
4190
Outlays, net (total)
–233
205
Object Classification (in millions of dollars)
Identification code 075–4613–0–4–554
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 075–4613–0–4–554
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 Act
Program and Financing (in millions of dollars)
Identification code 075–0148–0–1–554
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)
–70
–75
–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 075–5629–0–2–554
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
–70
–75
–70
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5629–0–2–554
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 [075–9911]
–75
–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)
–43
–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 075–5629–0–2–554
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 075–5629–0–2–554
2019 actual
2020 est.
2021 est.
1001
Direct civilian full-time equivalent employment
136
Revolving Fund for Certification and Other Services
Program and Financing (in millions of dollars)
Identification code 075–4309–0–3–554
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
–1
–1
1850
Spending auth from offsetting collections, mand (total)
9
10
11
1900
Budget authority (total)
9
10
11
1930
Total budgetary resources available
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)
–8
–13
–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
–9
–10
–10
4180
Budget authority, net (total)
1
4190
Outlays, net (total)
–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 075–4309–0–3–554
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 075–4309–0–3–554
2019 actual
2020 est.
2021 est.
2001
Reimbursable civilian full-time equivalent employment
33
37
37
Health Resources and Services Administration
Federal Funds
Primary health care
For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
to primary health care and the Native Hawaiian Health Care Act of 1988, $1,728,522,000: 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 workforce
For 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 health
For 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 program
For 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 systems
For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
Research Act of 2005, $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 health
For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act, $246,834,000.
Family Planning
For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $286,479,000:
Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling
shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution
of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for
public office.
program management
For program support in the Health Resources and Services Administration, $151,993,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings
"Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Care Systems",
and "Rural Health".
(Department of Health and Human Services Appropriations Act, 2020.)
Program and Financing (in millions of dollars)
Identification code 075–0350–0–1–550
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 [075–0116]
–8
1010
Unobligated balance transfer to other accts [015–5606]
–5
–5
–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 [075–1503]
–21
1121
Appropriations transferred from other acct [075–0140]
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
–2
–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
–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)
–11,002
–10,459
–8,565
3040
Recoveries of prior year unpaid obligations, unexpired
–72
3041
Recoveries of prior year unpaid obligations, expired
–107
3050
Unpaid obligations, end of year
8,278
8,025
5,845
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–16
–16
–16
3070
Change in uncollected pymts, Fed sources, unexpired
–10
3071
Change in uncollected pymts, Fed sources, expired
10
3090
Uncollected pymts, Fed sources, end of year
–16
–16
–16
Memorandum (non-add) entries:
3100
Obligated balance, start of year
7,953
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
–12
–12
–25
4033
Non-Federal sources
–23
–19
–43
4040
Offsets against gross budget authority and outlays (total)
–35
–31
–68
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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
–27
–20
–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 075–0350–0–1–550
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
–1
235999
Total guaranteed loan reestimates
–1
Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training,
maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical
malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free
clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.
HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL),
Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts
(Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are
awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans, the program's revolving
account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If
the program's revolving account has excess funds that will not be used to provide new loans, these excess funds are returned
to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects
Academic Year 2018–2019 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 075–0350–0–1–550
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 075–0350–0–1–550
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 075–0350–4–1–550
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)
–689
–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 075–0350–4–1–550
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 075–0350–4–1–550
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 Compensation
Program and Financing (in millions of dollars)
Identification code 075–0320–0–1–551
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
–2
Additional offsets against gross budget authority only:
4143
Recoveries of prior year paid obligations, unexpired accounts
2
4170
Outlays, net (mandatory)
–2
4180
Budget authority, net (total)
4190
Outlays, net (total)
–2
The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203 and serves as
a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
in the Vaccine Injury Compensation Program trust fund account.
Covered Countermeasure Process Fund
Program and Financing (in millions of dollars)
Identification code 075–0343–0–1–551
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 [075–0140]
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)
–2
–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 109–148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108–20).
Object Classification (in millions of dollars)
Identification code 075–0343–0–1–551
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 075–0343–0–1–551
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 Programs
Program and Financing (in millions of dollars)
Identification code 075–0321–0–1–551
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
–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)
–384
–386
–392
3040
Recoveries of prior year unpaid obligations, unexpired
–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 075–0321–0–1–551
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 075–0321–0–1–551
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 Account
Program and Financing (in millions of dollars)
Identification code 075–4442–0–3–551
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)
–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 075–4442–0–3–551
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
–888
–828
–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
–26
–10
–10
Adjustments:
2263
Terminations for default that result in claim payments
–1
–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 104–299, Public Law 104–208, and Public Law 115–141 authorize Health Resources and Services Administration (HRSA)
to guarantee up to $1 billion in private loans to health centers for the costs of developing and operating managed care networks
or plans and for the construction, renovation, and modernization of medical facilities. The program account for this activity
is displayed in the Health Resources and Services account (75–0350) as a line in the program and financing schedule.
Balance Sheet (in millions of dollars)
Identification code 075–4442–0–3–551
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 Fund
Status of Direct Loans (in millions of dollars)
Identification code 075–9931–0–3–551
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 075–9931–0–3–551
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 fund
For payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $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 075–8175–0–7–551
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
–28
–32
–45
2101
Vaccine Injury Compensation Program Trust Fund
–346
–260
–266
2135
Vaccine Injury Compensation Program Trust Fund
120
2199
Total current law appropriations
–254
–292
–311
2999
Total appropriations
–254
–292
–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 075–8175–0–7–551
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
–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)
–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)
–260
–305
–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
–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 99–660 and Public Law 100–203 and serves as
a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
for vaccine-related injury or death occurring after October 1, 1988.
Object Classification (in millions of dollars)
Identification code 075–8175–0–7–551
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 075–8175–0–7–551
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 Service
Federal Funds
Indian health service
For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education
Assistance Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect
to the Indian Health Service, $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 93–638, such individually identifiable health information relating to disabled children
as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
U.S.C. 1400 et seq.): Provided further, That 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 075–0390–0–1–551
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
–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)
–5,670
–6,549
–6,341
3040
Recoveries of prior year unpaid obligations, unexpired
–192
3041
Recoveries of prior year unpaid obligations, expired
–15
3050
Unpaid obligations, end of year
1,199
767
704
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–106
–109
–109
3070
Change in uncollected pymts, Fed sources, unexpired
–4
3071
Change in uncollected pymts, Fed sources, expired
1
3090
Uncollected pymts, Fed sources, end of year
–109
–109
–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
–437
–436
–436
4033
Non-Federal sources
–1,302
–1,365
–1,432
4040
Offsets against gross budget authority and outlays (total)
–1,739
–1,801
–1,868
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–4
4052
Offsetting collections credited to expired accounts
1
4060
Additional offsets against budget authority only (total)
–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 075–0390–0–1–551
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 075–0390–0–1–551
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 075–0390–4–1–551
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)
–51
–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 075–0390–4–1–551
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 075–0390–4–1–551
2019 actual
2020 est.
2021 est.
1001
Direct civilian full-time equivalent employment
23
Contract support costs
For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education
Assistance Act agreements with the Indian Health Service for fiscal year 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 075–0344–0–1–551
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)
–830
–877
–892
3041
Recoveries of prior year unpaid obligations, expired
–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 075–0344–0–1–551
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 075–0200–0–1–551
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)
–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 facilities
For 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 075–0391–0–1–551
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
–8
–9
–9
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–0391–0–1–551
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)
–725
–913
–926
3040
Recoveries of prior year unpaid obligations, unexpired
–14
3050
Unpaid obligations, end of year
862
990
842
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–18
–18
–18
3090
Uncollected pymts, Fed sources, end of year
–18
–18
–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
–31
–59
–59
4040
Offsets against gross budget authority and outlays (total)
–31
–59
–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 075–0391–0–1–551
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 075–0391–0–1–551
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 PROVISIONS—INDIAN HEALTH SERVICE
Administrative provisions-indian health service
Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
in the field, when authorized under regulations approved by the Secretary of Health and Human Services; uniforms or allowances
therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities
of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility
providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public
Law 93–638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
by the Department of Health and Human Services unless identified in the budget justification and provided in this Act: 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 Prevention
Federal Funds
Immunization and respiratory diseases
For carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $527,160,000.
HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention
For carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
diseases, and tuberculosis prevention, $1,552,556,000.
Emerging and zoonotic infectious diseases
For carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $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 promotion
For 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 health
For 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 Services
For 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 health
For carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $182,000,000.
Injury prevention and control
For 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 Health
For carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal
Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22
of the Occupational Safety and Health Act, with respect to occupational safety and health, $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 program
For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of
division B, title I of Public Law 106–554.
Global health
For 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 response
For carrying out titles II, III, and XVII of the PHS Act with respect to public health preparedness and response, and for
expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats
to civilian populations, $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 112–74: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under
this heading and in all other accounts of the CDC: Provided further, That of the amounts made available under this heading, $50,000,000 shall be transferred to and merged with
the Infectious Diseases Rapid Response Reserve Fund established by section 231 of division B of Public Law 115–245: Provided
further, That any 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 075–0943–0–1–999
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
–1
–1
–1
5099
Balance, end of year
1
2
Program and Financing (in millions of dollars)
Identification code 075–0943–0–1–999
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 [075–0960]
–7
1010
Unobligated balance transfer to other accts [075–0140]
–425
1010
Unobligated balance transfer to other accts [075–0140]
–50
1011
Unobligated balance transfer from other acct [075–0140]
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 [075–1503]
–14
1120
Appropriations transferred to other acct [075–0140]
–604
1120
Appropriations transferred to other acct [075–4553]
–9
1120
Appropriations transferred to other acct [075–0945]
–50
–85
–50
1121
Appropriations transferred from other acct [075–0140]
20
1160
Appropriation, discretionary (total)
6,401
6,730
5,485
Appropriations, mandatory:
1200
Appropriation (075–0954 - EEOICPA)
55
55
55
1201
Appropriation (075–5146 CRADA)
1
1
1
1221
Appropriations transferred from other acct PPHF [075–0116]
805
854
894
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–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
–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)
–7,395
–7,574
–7,879
3030
Unpaid obligations transferred to other accts [075–0140]
–242
3040
Recoveries of prior year unpaid obligations, unexpired
–111
3041
Recoveries of prior year unpaid obligations, expired
–269
3050
Unpaid obligations, end of year
6,671
7,189
6,193
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–127
–108
–108
3070
Change in uncollected pymts, Fed sources, unexpired
–24
3071
Change in uncollected pymts, Fed sources, expired
43
3090
Uncollected pymts, Fed sources, end of year
–108
–108
–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
–167
–366
–399
4033
Non-Federal sources
–12
4040
Offsets against gross budget authority and outlays (total)
–179
–366
–399
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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
–4
–3
–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 075–0943–0–1–999
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 075–0943–0–1–999
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 075–0960–0–1–551
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 [075–0943]
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)
–35
–60
–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 075–0960–0–1–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–4553–0–4–551
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 [075–0943]
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)
–567
–582
–550
3040
Recoveries of prior year unpaid obligations, unexpired
–12
3050
Unpaid obligations, end of year
210
197
216
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–2
–3
–3
3070
Change in uncollected pymts, Fed sources, unexpired
–1
3090
Uncollected pymts, Fed sources, end of year
–3
–3
–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
–573
–588
–532
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–1
4070
Budget authority, net (discretionary)
9
4080
Outlays, net (discretionary)
–6
–6
18
4180
Budget authority, net (total)
9
4190
Outlays, net (total)
–6
–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 075–4553–0–4–551
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 075–4553–0–4–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0945–0–1–551
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 [075–0943]
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)
–50
–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 health
For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
and section 3019 of the Solid Waste Disposal Act, $62,000,000: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA,
the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation,
biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall
not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological
profiles pursuant to section 104(i) of CERCLA during fiscal year 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 075–0944–0–1–551
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 [097–0100]
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)
–81
–84
–69
3041
Recoveries of prior year unpaid obligations, expired
–3
3050
Unpaid obligations, end of year
70
48
41
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–15
–12
–12
3070
Change in uncollected pymts, Fed sources, unexpired
–2
3071
Change in uncollected pymts, Fed sources, expired
5
3090
Uncollected pymts, Fed sources, end of year
–12
–12
–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
–6
–3
–3
4040
Offsets against gross budget authority and outlays (total)
–6
–3
–3
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–2
4052
Offsetting collections credited to expired accounts
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 075–0944–0–1–551
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 075–0944–0–1–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0946–0–1–551
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
World Trade Center Health Program—Federal Share (CDC/NIOSH)
530
541
540
0002
World Trade Center Health Program—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 (WTC—NYC DHSS—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)
–483
–400
–479
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–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. 111–347)
on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2020 and 2021 in
the Budget reflect estimated Federal obligations for the WTC Health Program.
Object Classification (in millions of dollars)
Identification code 075–0946–0–1–551
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 075–0946–0–1–551
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 Health
Federal Funds
national cancer institute
For 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 institute
For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
and blood products, $3,298,004,000.
national institute of dental and craniofacial research
For 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 diseases
For 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 stroke
For 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 diseases
For 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 sciences
For 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 development
For 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 institute
For 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 sciences
For 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 sciences
For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and
section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $73,688,000.
(Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020.)
national institute on aging
For 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 diseases
For 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 disorders
For 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 research
For 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 alcoholism
For 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 abuse
For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $1,431,770,000.
national institute of mental health
For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,794,865,000.
national human genome research institute
For 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 bioengineering
For 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 health
For 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 disparities
For 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 center
For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
of the PHS Act), $73,531,000.
national library of medicine
For 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 sciences
For 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 facilities
For 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 QUALITY
For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003, $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 075–9915–0–1–552
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
–51
–68
–51
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–9915–0–1–552
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 [075–0140]
15
1011
Unobligated balance transfer from other acct [075–1700]
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 [075–1503]
–124
1120
Appropriations transferred to other acct [075–0128]
–5
–5
1121
Appropriations transferred from other acct [075–5628]
515
335
295
1121
Appropriations transferred from other acct [075–5736]
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
–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)
–39,069
–42,033
–43,642
3040
Recoveries of prior year unpaid obligations, unexpired
–94
3041
Recoveries of prior year unpaid obligations, expired
–799
3050
Unpaid obligations, end of year
40,480
43,800
41,842
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–564
–650
–650
3070
Change in uncollected pymts, Fed sources, unexpired
–317
3071
Change in uncollected pymts, Fed sources, expired
231
3090
Uncollected pymts, Fed sources, end of year
–650
–650
–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
–3,906
–4,649
–4,038
4033
Non-Federal sources
–298
4040
Offsets against gross budget authority and outlays (total)
–4,204
–4,649
–4,038
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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)
–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
–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 075–9915–0–1–552
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 075–9915–0–1–552
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 075–9915–4–1–552
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)
–3
–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 Act
Program and Financing (in millions of dollars)
Identification code 075–0147–0–1–552
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)
–711
–492
–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 075–5628–0–2–552
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
–711
–492
–404
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5628–0–2–552
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 [075–9915]
–515
–335
–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)
–52
–180
–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 075–5628–0–2–552
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 075–5628–0–2–552
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 Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5736–0–2–552
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
–13
–13
–13
5099
Balance, end of year
28
28
15
Program and Financing (in millions of dollars)
Identification code 075–5736–0–2–552
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 [075–9915]
–13
–13
–13
4180
Budget authority, net (total)
4190
Outlays, net (total)
This special fund was created by the Gabriella Miller Kids First Research Act, enacted on April 3, 2014. This fund receives
transfers from the Presidential Election Campaign Fund, which are then appropriated to the NIH Common Fund to support pediatric
research.
Substance Abuse and Mental Health Services Administration
Federal Funds
MENTAL HEALTH
For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
Individuals with Mental Illness Act, $1,675,106,000: 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 113–93: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading, $25,000,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22
note).
SUBSTANCE ABUSE TREATMENT
For carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
respect to substance abuse treatment and prevention, 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 PREVENTION
For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $96,985,000.
HEALTH SURVEILLANCE AND PROGRAM SUPPORT
For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act 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 075–1362–0–1–551
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 [075–0116]
–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 [075–1503]
–9
1121
Appropriations transferred from other acct [075–0140]
100
1160
Appropriation, discretionary (total)
5,688
5,736
5,598
Appropriations, mandatory:
1221
Appropriations transferred from the Prevention and Public Health Fund [075–0116]
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
–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)
–4,557
–6,564
–6,157
3040
Recoveries of prior year unpaid obligations, unexpired
–2
3041
Recoveries of prior year unpaid obligations, expired
–141
3050
Unpaid obligations, end of year
7,309
6,618
6,204
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–164
–187
–187
3070
Change in uncollected pymts, Fed sources, unexpired
–121
3071
Change in uncollected pymts, Fed sources, expired
98
3090
Uncollected pymts, Fed sources, end of year
–187
–187
–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
–229
–171
–171
4033
Non-Federal sources
–2
–2
4040
Offsets against gross budget authority and outlays (total)
–229
–173
–173
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–121
4052
Offsetting collections credited to expired accounts
94
4060
Additional offsets against budget authority only (total)
–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 075–1362–0–1–551
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 075–1362–0–1–551
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 Quality
Federal Funds
Healthcare research and quality
(Department of Health and Human Services Appropriations Act, 2020.)
Program and Financing (in millions of dollars)
Identification code 075–1700–0–1–552
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 [075–9915]
–16
1050
Unobligated balance (total)
23
16
Budget authority:
Appropriations, discretionary:
1100
Appropriation
338
338
1120
Appropriations transferred to other acct [075–1503]
–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)
–350
–268
–303
3041
Recoveries of prior year unpaid obligations, expired
–12
3050
Unpaid obligations, end of year
344
438
135
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–35
–28
–21
3070
Change in uncollected pymts, Fed sources, unexpired
–14
–14
3071
Change in uncollected pymts, Fed sources, expired
21
21
3090
Uncollected pymts, Fed sources, end of year
–28
–21
–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
–20
–20
4040
Offsets against gross budget authority and outlays (total)
–20
–20
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–14
–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
–8
–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 075–1700–0–1–552
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 075–1700–0–1–552
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 Services
Federal Funds
Grants to states for medicaid
For 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 075–0512–0–1–551
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)
–421,406
–448,383
–453,032
3040
Recoveries of prior year unpaid obligations, unexpired
–34,290
–37,147
–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
–724
–853
–853
3070
Change in uncollected pymts, Fed sources, unexpired
–129
3090
Uncollected pymts, Fed sources, end of year
–853
–853
–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
–1,053
–1,142
–1,254
4123
Non-Federal sources
–10,932
4130
Offsets against gross budget authority and outlays (total)
–11,985
–1,142
–1,254
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–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
–3,633
Outlays
–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 075–0512–4–1–551
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Medicaid Vendor Payments
–3,633
0799
Total direct obligations
–3,633
0900
Total new obligations, unexpired accounts (object class 41.0)
–3,633
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–3,633
1900
Budget authority (total)
–3,633
1930
Total budgetary resources available
–3,633
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–3,633
3020
Outlays (gross)
3,633
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–3,633
Outlays, gross:
4100
Outlays from new mandatory authority
–3,633
4180
Budget authority, net (total)
–3,633
4190
Outlays, net (total)
–3,633
This schedule reflects the Administration's Medicaid proposals.
State Grants and Demonstrations
Program and Financing (in millions of dollars)
Identification code 075–0516–0–1–551
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
–5
–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)
–378
–437
–429
3040
Recoveries of prior year unpaid obligations, unexpired
–11
3041
Recoveries of prior year unpaid obligations, expired
–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. 106–170), the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance
Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), the Health
Care and Education Reconciliation Act of 2010 (P.L. 111–152), the Protecting Access to Medicare Act of 2014 (P.L. 113–93),
and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10). The account also includes funding for grant programs
enacted in the HEALTHY KIDS Act (P.L. 115–120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123),
the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115–271),
the Medicaid Extenders Act of 2019 (P.L. 116–3), the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116–16),
the Sustaining Excellence in Medicaid Act of 2019 (P.L. 116–39), the Continuing Appropriations Act, 2020, the Health Extenders
Act of 2019 (P.L. 116–59), and the Further Consolidated Appropriation Act, 2020 (P.L. 116–94).
Object Classification (in millions of dollars)
Identification code 075–0516–0–1–551
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 075–0516–0–1–551
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 funds
For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the
Social Security Act, $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 075–0580–0–1–571
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 (HCFAC—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
–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)
–364,706
–387,595
–415,989
3041
Recoveries of prior year unpaid obligations, expired
–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
–4,289
4123
Non-Federal sources
–1,537
4130
Offsets against gross budget authority and outlays (total)
–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
–7,383
Outlays
–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 075–0580–0–1–571
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 075–0580–2–1–571
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Federal contribution to match premiums (SMI)
–7,383
0900
Total new obligations, unexpired accounts (object class 41.0)
–7,383
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation (definite, annual)
–7,383
1930
Total budgetary resources available
–7,383
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–7,383
3020
Outlays (gross)
7,383
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–7,383
Outlays, gross:
4100
Outlays from new mandatory authority
–7,383
4180
Budget authority, net (total)
–7,383
4190
Outlays, net (total)
–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 Organizations
Program and Financing (in millions of dollars)
Identification code 075–0519–0–1–571
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
–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)
–911
–1,022
–429
3041
Recoveries of prior year unpaid obligations, expired
–31
3050
Unpaid obligations, end of year
886
886
887
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–1,617
–1,799
–2,619
3070
Change in uncollected pymts, Fed sources, unexpired
–1,184
–820
–393
3071
Change in uncollected pymts, Fed sources, expired
1,002
3090
Uncollected pymts, Fed sources, end of year
–1,799
–2,619
–3,012
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–750
–913
–1,733
3200
Obligated balance, end of year
–913
–1,733
–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
–933
–1,022
–429
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–1,184
–820
–393
4142
Offsetting collections credited to expired accounts
693
820
393
4150
Additional offsets against budget authority only (total)
–491
4170
Outlays, net (mandatory)
–22
4180
Budget authority, net (total)
4190
Outlays, net (total)
–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. 97–248), provides
the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to
promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure
that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance
Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO
Program was established to improve budgetary operations.
Object Classification (in millions of dollars)
Identification code 075–0519–0–1–571
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 075–0519–0–1–571
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 management
For 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 075–0511–0–1–550
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 [075–1503]
–4
1710
Spending authority from offsetting collections transferred to other accounts [075–9912]
–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
–159
–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
–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)
–5,569
–5,842
–6,919
3040
Recoveries of prior year unpaid obligations, unexpired
–27
3041
Recoveries of prior year unpaid obligations, expired
–229
3050
Unpaid obligations, end of year
4,767
4,722
3,093
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–5,838
–6,882
–6,882
3061
Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
–500
3070
Change in uncollected pymts, Fed sources, unexpired
–2,819
3071
Change in uncollected pymts, Fed sources, expired
2,275
3090
Uncollected pymts, Fed sources, end of year
–6,882
–6,882
–6,882
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–1,739
–2,115
–2,160
3200
Obligated balance, end of year
–2,115
–2,160
–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
–3,806
–3,975
–3,694
4033
Non-Federal sources
–31
–20
–20
4040
Offsets against gross budget authority and outlays (total)
–3,837
–3,995
–3,714
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–2,212
4052
Offsetting collections credited to expired accounts
2,018
4060
Additional offsets against budget authority only (total)
–194
4070
Budget authority, net (discretionary)
–9
4080
Outlays, net (discretionary)
–54
–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
–356
–54
–31
4123
Non-Federal sources
–2,049
–2,358
–2,263
4130
Offsets against gross budget authority and outlays (total)
–2,405
–2,412
–2,294
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–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)
–535
4160
Budget authority, net (mandatory)
–40
–16
112
4170
Outlays, net (mandatory)
–619
229
772
4180
Budget authority, net (total)
–49
–16
112
4190
Outlays, net (total)
–673
–565
911
Memorandum (non-add) entries:
5090
Unexpired unavailable balance, SOY: Offsetting collections
552
531
550
5091
Expiring unavailable balance: Offsetting collections
–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
–49
–16
112
Outlays
–673
–565
911
Legislative proposal, subject to PAYGO:
Budget Authority
12
Outlays
–4
–28
Total:
Budget Authority
–49
–16
124
Outlays
–673
–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 075–0511–0–1–550
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 075–0511–0–1–550
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 075–0511–4–1–550
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)
–1
–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
–5
–53
4180
Budget authority, net (total)
12
4190
Outlays, net (total)
–4
–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 075–0511–4–1–550
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 075–0514–4–1–551
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)
–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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0515–0–1–551
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 [075–5551]
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
–8,790
Appropriations, mandatory:
1200
Appropriation
22,600
23,700
24,800
1221
Appropriations transferred from other acct [075–5551]
6,093
1230
Appropriations and/or unobligated balance of appropriations permanently reduced
–2,061
–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
–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)
–17,835
–17,654
–15,778
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–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:
–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. 105–33) established the Children's Health Insurance Program (CHIP) under title XXI of
the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured
children from low-income families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured
children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health
Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding
for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and
territories, and support for child health quality and outreach activities. 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. 111–148) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended CHIP funding
through fiscal year 2015 and 2017, respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders,
and Social Services Act (P.L. 115–123) extended CHIP funding through fiscal year 2023 and 2027, respectively.
Center for Medicare and Medicaid Innovation
Program and Financing (in millions of dollars)
Identification code 075–0522–0–1–551
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)
–978
–1,210
–1,203
3040
Recoveries of prior year unpaid obligations, unexpired
–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 075–0522–0–1–551
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 075–0522–0–1–551
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 Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5551–0–2–551
2019 actual
2020 est.
2021 est.
0100
Balance, start of year
3,132
5,609
6,093
0198
Earnings on investment adjustment
–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
–254
–173
–168
2103
Child Enrollment Contingency Fund
–3,128
–5,609
–6,093
2135
Child Enrollment Contingency Fund
3,267
6,093
2199
Total current law appropriations
–115
311
–6,261
2999
Total appropriations
–115
311
–6,261
4030
Child Enrollment Contingency Fund
2,342
5099
Balance, end of year
5,609
6,093
–93
Program and Financing (in millions of dollars)
Identification code 075–5551–0–2–551
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 [075–0515]
–4,037
–4,914
1020
Adjustment of unobligated bal brought forward, Oct 1
4
1035
Unobligated balance precluded from obligation (limitation on obligations)(special and trust)
–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 [075–0515]
–6,093
1235
Appropriations precluded from obligation (special or trust)
–3,267
–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)
–3
–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. 111–3) established the Child Enrollment Contingency
Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Medicare
Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended the Contingency Fund through fiscal years 2015 and 2017,
respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L.
115–123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.
The Fund receives an appropriation equal to 20 percent of the CHIP national allotment appropriation under section 2104(a)
of the Social Security Act. The Contingency Fund is invested in interest bearing securities of the United States, and the
income derived from these investments constitutes a part of the fund.
Child Enrollment Contingency Fund
(Legislative proposal, subject to PAYGO)
The Budget proposes to repeal the Child Enrollment Contingency Fund 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 Act
Program and Financing (in millions of dollars)
Identification code 075–0508–0–1–551
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
–16
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–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)
–55
–15
–10
3050
Unpaid obligations, end of year
15
15
15
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–161
–145
–145
3070
Change in uncollected pymts, Fed sources, unexpired
16
3090
Uncollected pymts, Fed sources, end of year
–145
–145
–145
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–137
–130
–130
3200
Obligated balance, end of year
–130
–130
–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
–53
–15
–10
4123
Non-Federal sources
–12
4130
Offsets against gross budget authority and outlays (total)
–65
–15
–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)
–3
4170
Outlays, net (mandatory)
–10
4180
Budget authority, net (total)
–3
4190
Outlays, net (total)
–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 Grants
Program and Financing (in millions of dollars)
Identification code 075–0112–0–1–551
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)
–17
–13
–5
3040
Recoveries of prior year unpaid obligations, unexpired
–5
3041
Recoveries of prior year unpaid obligations, expired
–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. 111–148) added section 2794 to the Public Health Service Act and provided
that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
insurance reform activities consistent with section 2794(c)(2)(B).
Pre-Existing Condition Insurance Plan Program
Program and Financing (in millions of dollars)
Identification code 075–0113–0–1–551
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)
–52
–72
–90
3040
Recoveries of prior year unpaid obligations, unexpired
–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.
111–148). The PCIP program ended in fiscal year 2014, and outlays in subsequent fiscal years reflect program close out and
claims run out costs, as well as allowable administrative costs in the current year.
Early Retiree Reinsurance Program
Program and Financing (in millions of dollars)
Identification code 075–0114–0–1–551
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
–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. 111–148) authorized and appropriated $5 billion for the Early Retiree
Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
sponsors.
Affordable Insurance Exchange Grants
Program and Financing (in millions of dollars)
Identification code 075–0115–0–1–551
2019 actual
2020 est.
2021 est.
Change in obligated balance:
Unpaid obligations:
3000
Unpaid obligations, brought forward, Oct 1
7
3020
Outlays (gross)
–5
3041
Recoveries of prior year unpaid obligations, expired
–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
–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. 111–148) provided amounts necessary to enable the Secretary to award
grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
round of grants was awarded to States in December 2014.
Cost-sharing Reductions
Program and Financing (in millions of dollars)
Identification code 075–0126–0–1–551
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)
–8,000
–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 Payments
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5733–0–2–551
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
–5,978
–5,540
–5,627
2103
Risk Adjustment Program Payments
–311
–371
–327
2132
Risk Adjustment Program Payments
371
327
2199
Total current law appropriations
–5,918
–5,584
–5,954
2999
Total appropriations
–5,918
–5,584
–5,954
5099
Balance, end of year
371
328
1
Program and Financing (in millions of dollars)
Identification code 075–5733–0–2–551
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
–371
–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)
–6,911
–8,262
–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. 111–148) established a permanent risk adjustment program
for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
they are calculated.
Transitional Reinsurance Program
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–5735–0–2–551
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
–1
2103
Transitional Reinsurance Program
–25
2199
Total current law appropriations
–26
2999
Total appropriations
–26
5099
Balance, end of year
Program and Financing (in millions of dollars)
Identification code 075–5735–0–2–551
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)
–35
–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. 111–148) established a transitional three-year reinsurance
program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015, and 2016.
The Centers for Medicare & Medicaid Services assessed contributing entities a per enrollee fee to fund the reinsurance program
and made payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold, up to
a reinsurance cap. Reinsurance collections and payments were made in the year following the plan year for which they were
applicable. Reinsurance collections ended in FY 2019 and outlays in subsequent fiscal years reflect remaining payments, refunds,
and allowable administrative activities.
Consumer Operated and Oriented Plan Program Contingency Fund
Program and Financing (in millions of dollars)
Identification code 075–0524–0–1–551
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)
–5
3040
Recoveries of prior year unpaid obligations, unexpired
–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 075–0524–0–1–551
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.
112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148).
Consumer Operated and Oriented Plan Program Account
Program and Financing (in millions of dollars)
Identification code 075–0118–0–1–551
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)
–259
–2
3040
Recoveries of prior year unpaid obligations, unexpired
–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 075–0118–0–1–551
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. 111–148) authorized and appropriated funding for the
Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
markets in the States. The Secretary awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which
enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.
Object Classification (in millions of dollars)
Identification code 075–0118–0–1–551
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 Account
Program and Financing (in millions of dollars)
Identification code 075–4418–0–3–551
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
–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
–259
–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)
–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
–259
–2
4122
Interest on uninvested funds
–5
–1
4123
Non-Federal sources
–8
–38
4130
Offsets against gross budget authority and outlays (total)
–272
–41
4160
Budget authority, net (mandatory)
–256
–36
2
4170
Outlays, net (mandatory)
–265
–41
4180
Budget authority, net (total)
–256
–36
2
4190
Outlays, net (total)
–265
–41
Status of Direct Loans (in millions of dollars)
Identification code 075–4418–0–3–551
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
–582
1290
Outstanding, end of year
1,893
1,893
1,311
Balance Sheet (in millions of dollars)
Identification code 075–4418–0–3–551
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 (-)
–1,778
–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 Account
Program and Financing (in millions of dollars)
Identification code 075–4482–0–3–551
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
–3
1023
Unobligated balances applied to repay debt
–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
–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)
–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
–5
4123
Non-Federal sources
–1
–1
4130
Offsets against gross budget authority and outlays (total)
–6
–1
4160
Budget authority, net (mandatory)
–2
1
1
4170
Outlays, net (mandatory)
–4
–1
4180
Budget authority, net (total)
–2
1
1
4190
Outlays, net (total)
–4
–1
Status of Direct Loans (in millions of dollars)
Identification code 075–4482–0–3–551
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
–139
1290
Outstanding, end of year
480
480
341
Balance Sheet (in millions of dollars)
Identification code 075–4482–0–3–551
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 (-)
–429
–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 Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–8005–0–7–571
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)
–83
1230
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
–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
–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
–3,039
–2,689
–2,789
2101
Federal Hospital Insurance Trust Fund
–320,420
–338,930
–357,148
2101
Health Care Fraud and Abuse Control Account
–765
–786
–813
2101
Health Care Fraud and Abuse Control Account
–1,380
–1,406
–1,427
2103
Federal Hospital Insurance Trust Fund
–14,649
–9,153
–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
–333,568
–352,915
–377,991
Proposed:
2201
Federal Hospital Insurance Trust Fund
–247
2201
Federal Hospital Insurance Trust Fund
235
2203
Federal Hospital Insurance Trust Fund
–11
2234
Federal Hospital Insurance Trust Fund
16,932
2299
Total proposed appropriations
–11
16,920
2999
Total appropriations
–333,568
–352,926
–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 075–8005–0–7–571
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
–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)
–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)
–327,860
–350,180
–375,341
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–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
–17,167
Outlays
11
–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 075–8005–0–7–571
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)
–83
Offsetting receipts (proprietary):
1230
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
–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
–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]
–327,860
–350,180
–375,341
2100
Health Care Fraud and Abuse Control Account [Budget Acct]
–1,965
–2,070
–2,156
2199
Outgo under current law
–329,825
–352,250
–377,497
Proposed:
2200
Federal Hospital Insurance Trust Fund
–11
17,167
2299
Outgo under proposed legislation
–11
17,167
2999
Total cash outgo (-)
–329,825
–352,261
–360,330
Surplus or deficit:
3110
Excluding interest
–11,222
–15,376
–4,924
3120
Interest
6,951
6,154
5,959
3199
Subtotal, surplus or deficit
–4,271
–9,222
1,035
3298
Adjustment to reconcile to proprietary accounting
–63
3299
Total adjustments
–63
3999
Total change in fund balance
–4,334
–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 075–8005–0–7–571
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 075–8005–0–7–571
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 075–8005–2–7–571
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)
–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 075–8005–4–7–571
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Benefit payments, HI
–17,185
0003
Administration, HI
11
18
0799
Total direct obligations
11
–17,167
0900
Total new obligations, unexpired accounts
11
–17,167
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
–235
1203
Appropriation (previously unavailable)(special or trust)
11
1234
Appropriations precluded from obligation
–16,932
1260
Appropriations, mandatory (total)
11
–17,167
1900
Budget authority (total)
11
–17,167
1930
Total budgetary resources available
11
–17,167
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
11
–17,167
3020
Outlays (gross)
–11
17,167
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
11
–17,167
Outlays, gross:
4100
Outlays from new mandatory authority
11
–17,167
4180
Budget authority, net (total)
11
–17,167
4190
Outlays, net (total)
11
–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 075–8005–4–7–571
2019 actual
2020 est.
2021 est.
Direct obligations:
42.0
Insurance claims and indemnities (benefits)
–17,185
94.0
Financial transfers
11
18
99.9
Total new obligations, unexpired accounts
11
–17,167
Health care fraud and abuse control account
In 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 075–8393–0–7–571
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
–31
–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
–49
–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
–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)
–1,965
–2,070
–2,156
3040
Recoveries of prior year unpaid obligations, unexpired
–41
3041
Recoveries of prior year unpaid obligations, expired
–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. 104–191) established the Health Care Fraud and Abuse
Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
(HHS), the Department of Justice, and other agencies.
The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
in the Analytical Perspectives volume.
Object Classification (in millions of dollars)
Identification code 075–8393–0–7–571
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
–31
–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 075–8393–0–7–571
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 Fund
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–8004–0–7–571
2019 actual
2020 est.
2021 est.
0100
Balance, start of year
67,416
67,661
67,581
0198
Adjustment to reconcile to budgetary accounting
–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
–2,186
1230
Premiums Collected for the Disabled, FSMI Fund
–295
1240
Federal Contributions, FSMI Fund
–7,383
1299
Total proposed receipts
–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
–2,998
–3,141
–3,101
2101
Federal Supplementary Medical Insurance Trust Fund
–371,197
–399,303
–422,011
2101
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
–641
–861
–882
2101
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
–84,998
–89,915
–102,850
2103
Federal Supplementary Medical Insurance Trust Fund
–5,987
–2,301
–5,492
2132
Federal Supplementary Medical Insurance Trust Fund
7,317
2199
Total current law appropriations
–458,504
–495,521
–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
–7,383
2203
Federal Supplementary Medical Insurance Trust Fund
–13
–20
2234
Federal Supplementary Medical Insurance Trust Fund
7,384
2299
Total proposed appropriations
–13
9,845
2999
Total appropriations
–458,504
–495,534
–524,491
3098
Federal Supplementary Medical Insurance Trust Fund
–41
5098
Adjustment to reconcile to budgetary accounting
–465
5099
Balance, end of year
67,661
67,581
62,880
Program and Financing (in millions of dollars)
Identification code 075–8004–0–7–571
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
–7,317
1236
Appropriations applied to repay debt
–1,872
–1,990
–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)
–367,592
–402,438
–429,533
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–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
–5,024
–3,152
–1,162
5081
Outstanding debt, EOY
–3,152
–1,162
–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
–9,845
Outlays
13
–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 075–8004–0–7–571
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
–2,186
1230
Premiums Collected for the Disabled, FSMI Fund
–295
Offsetting governmental receipts:
1260
Federal Contributions, FSMI Fund
–7,383
1260
Federal Contributions for Benefits, Prescription Drug Account, SMI
1299
Income proposed
–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]
–367,592
–402,438
–429,533
2100
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]
–85,140
–90,359
–103,451
2199
Outgo under current law
–452,732
–492,797
–532,984
Proposed:
2200
Federal Supplementary Medical Insurance Trust Fund
–13
9,845
2299
Outgo under proposed legislation
–13
9,845
2999
Total cash outgo (-)
–452,732
–492,810
–523,139
Surplus or deficit:
3110
Excluding interest
4,386
3,975
–4,736
3120
Interest
2,722
1,233
1,387
3199
Subtotal, surplus or deficit
7,108
5,208
–3,349
3298
Adjustment to reconcile to proprietary accounting
–1
3299
Total adjustments
–1
3999
Total change in fund balance
7,107
5,208
–3,349
Unexpended balance, end of year:
4100
Uninvested balance (net), end of year
–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 075–8004–0–7–571
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 075–8004–0–7–571
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 075–8004–2–7–571
2019 actual
2020 est.
2021 est.
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
–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 075–8004–4–7–571
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Benefit payments, SMI
13
–9,845
0799
Total direct obligations
13
–9,845
0900
Total new obligations, unexpired accounts (object class 42.0)
13
–9,845
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1201
Appropriation (special or trust fund)
–2,481
1203
Appropriation (previously unavailable)(special or trust)
13
20
1234
Appropriations precluded from obligation
–7,384
1260
Appropriations, mandatory (total)
13
–9,845
1900
Budget authority (total)
13
–9,845
1930
Total budgetary resources available
13
–9,845
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
13
–9,845
3020
Outlays (gross)
–13
9,845
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
13
–9,845
Outlays, gross:
4100
Outlays from new mandatory authority
13
–9,845
4180
Budget authority, net (total)
13
–9,845
4190
Outlays, net (total)
13
–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 Fund
Program and Financing (in millions of dollars)
Identification code 075–8308–0–7–571
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
–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)
–85,140
–90,359
–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
–225
–2,789
–225
3070
Change in uncollected pymts, Fed sources, unexpired
–2,564
2,564
3090
Uncollected pymts, Fed sources, end of year
–2,789
–225
–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:
–2,564
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–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 075–8308–0–7–571
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 075–8308–0–7–571
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 Families
Federal Funds
Temporary Assistance for Needy Families
Program and Financing (in millions of dollars)
Identification code 075–1552–0–1–609
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
–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
–28
–15
–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)
–15,497
–16,106
–16,788
3041
Recoveries of prior year unpaid obligations, expired
–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
–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
–1,494
Outlays
–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. 104–193), as amended by the Deficit Reduction
Act of 2005 (P.L. 109–171). TANF's authorization was most recently extended in theFurther Consolidated Appropriations Act,
2020 (P. L. 116–94).
Object Classification (in millions of dollars)
Identification code 075–1552–0–1–609
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 075–1552–0–1–609
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 075–1552–4–1–609
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
State family assistance grant
–1,594
0002
Territories - family assistance grants
–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)
–1,494
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–1,494
1900
Budget authority (total)
–1,494
1930
Total budgetary resources available
–1,494
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–1,494
3020
Outlays (gross)
1,073
3050
Unpaid obligations, end of year
–421
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–421
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–1,494
Outlays, gross:
4100
Outlays from new mandatory authority
–1,073
4180
Budget authority, net (total)
–1,494
4190
Outlays, net (total)
–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 Fund
Program and Financing (in millions of dollars)
Identification code 075–1522–0–1–609
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)
–600
–608
–608
3041
Recoveries of prior year unpaid obligations, expired
–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
–608
Outlays
–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. 116–94).
Contingency Fund
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 075–1522–4–1–609
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Contingency Fund for State Welfare Programs
–608
0900
Total new obligations, unexpired accounts (object class 41.0)
–608
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–608
1930
Total budgetary resources available
–608
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–608
3020
Outlays (gross)
608
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–608
Outlays, gross:
4100
Outlays from new mandatory authority
–545
4101
Outlays from mandatory balances
–63
4110
Outlays, gross (total)
–608
4180
Budget authority, net (total)
–608
4190
Outlays, net (total)
–608
The Budget proposes to eliminate funding for the Contingency Fund.
Payments to states for child support enforcement and family support programs
For 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 075–1501–0–1–609
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
–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)
–4,117
–4,325
–4,351
3040
Recoveries of prior year unpaid obligations, unexpired
–251
–200
–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
–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 075–1501–0–1–609
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 075–1501–4–1–609
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)
–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 075–1502–0–1–609
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 [075–1503]
–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)
–3,696
–3,757
–1,296
3041
Recoveries of prior year unpaid obligations, expired
–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
–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 075–1502–0–1–609
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 075–1503–0–1–609
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 [075–0128]
–5
1121
Appropriations transferred from other acct [075–1502]
37
1121
Appropriations transferred from other acct [075–1536]
48
1121
Appropriations transferred from other acct [075–1515]
18
1121
Appropriations transferred from other acct [075–0142]
7
1121
Appropriations transferred from other acct [075–1700]
1
1121
Appropriations transferred from other acct [075–0943]
14
1121
Appropriations transferred from other acct [075–0350]
21
1121
Appropriations transferred from other acct [075–9915]
124
1121
Appropriations transferred from other acct [075–9912]
1
1121
Appropriations transferred from other acct [075–1362]
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 [075–0511]
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)
–2,529
–2,577
–2,614
3040
Recoveries of prior year unpaid obligations, unexpired
–159
3041
Recoveries of prior year unpaid obligations, expired
–14
3050
Unpaid obligations, end of year
2,191
1,522
1,364
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–180
–180
–180
3090
Uncollected pymts, Fed sources, end of year
–180
–180
–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 075–1503–0–1–609
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 075–1503–0–1–609
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 075–1503–4–1–609
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)
–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 Families
For 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 075–1512–0–1–506
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
–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
–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)
–482
–699
–856
3040
Recoveries of prior year unpaid obligations, unexpired
–1
3041
Recoveries of prior year unpaid obligations, expired
–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 075–1512–0–1–506
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 075–1512–0–1–506
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 075–1512–4–1–506
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)
–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 075–1512–4–1–506
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 States
Program and Financing (in millions of dollars)
Identification code 075–1550–0–1–609
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)
–3,267
–2,961
–2,960
3041
Recoveries of prior year unpaid obligations, expired
–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
–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. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Further Consolidated
Appropriations Act, 2020 (P.L. 116–94).
Object Classification (in millions of dollars)
Identification code 075–1550–0–1–609
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 075–1550–4–1–609
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)
–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 grant
For 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 075–1515–0–1–609
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 [075–1503]
–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
–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)
–3,918
–5,295
–6,360
3041
Recoveries of prior year unpaid obligations, expired
–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 075–1515–0–1–609
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 075–1515–0–1–609
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 075–1534–0–1–506
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
–105
–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
–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)
–1,646
–1,715
–1,712
3041
Recoveries of prior year unpaid obligations, expired
–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
–1,700
Outlays
–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 075–1534–0–1–506
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 075–1534–0–1–506
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 075–1534–4–1–506
2019 actual
2020 est.
2021 est.
Obligations by program activity:
0001
Social Services Block Grant
–1,700
Budgetary resources:
Budget authority:
Appropriations, mandatory:
1200
Appropriation
–1,700
1930
Total budgetary resources available
–1,700
Change in obligated balance:
Unpaid obligations:
3010
New obligations, unexpired accounts
–1,700
3020
Outlays (gross)
1,360
3050
Unpaid obligations, end of year
–340
Memorandum (non-add) entries:
3200
Obligated balance, end of year
–340
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
–1,700
Outlays, gross:
4100
Outlays from new mandatory authority
–1,360
4180
Budget authority, net (total)
–1,700
4190
Outlays, net (total)
–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 075–1534–4–1–506
2019 actual
2020 est.
2021 est.
Direct obligations:
11.1
Personnel compensation: Full-time permanent
–1
21.0
Travel and transportation of persons
–1
25.1
Advisory and assistance services
–10
41.0
Grants, subsidies, and contributions
–1,688
99.9
Total new obligations, unexpired accounts
–1,700
Children and families services programs
For 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 075–1536–0–1–506
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 [075–1503]
–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
–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)
–11,639
–12,169
–12,622
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3041
Recoveries of prior year unpaid obligations, expired
–157
3050
Unpaid obligations, end of year
9,739
10,767
10,023
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–20
–17
–18
3070
Change in uncollected pymts, Fed sources, unexpired
–2
–1
–1
3071
Change in uncollected pymts, Fed sources, expired
5
3090
Uncollected pymts, Fed sources, end of year
–17
–18
–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
–27
–70
–70
4033
Non-Federal sources
–2
4040
Offsets against gross budget authority and outlays (total)
–29
–70
–70
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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
–3
–2
–2
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–1
–1
4142
Offsetting collections credited to expired accounts
1
1
1
4150
Additional offsets against budget authority only (total)
1
4170
Outlays, net (mandatory)
–2
–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 075–1536–0–1–506
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 075–1536–0–1–506
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 Assistance
Program and Financing (in millions of dollars)
Identification code 075–1553–0–1–609
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
–2
–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
–1
–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)
–62
–62
–67
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3050
Unpaid obligations, end of year
23
36
35
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–6
–6
–6
3090
Uncollected pymts, Fed sources, end of year
–6
–6
–6
Memorandum (non-add) entries:
3100
Obligated balance, start of year
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
–8
–9
–9
4123
Non-Federal sources
–18
–20
–20
4130
Offsets against gross budget authority and outlays (total)
–26
–29
–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. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
Object Classification (in millions of dollars)
Identification code 075–1553–0–1–609
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 075–1553–0–1–609
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 permanency
For 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 075–1545–0–1–609
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
–1
–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)
–8,619
–9,389
–9,910
3041
Recoveries of prior year unpaid obligations, expired
–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
–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 Care—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 Assistance—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 Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
in foster care. An average of 46,300 children per month are estimated to be served in FY 2021.
Object Classification (in millions of dollars)
Identification code 075–1545–0–1–609
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 075–1545–0–1–609
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 075–1545–4–1–609
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)
–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 Living
Federal Funds
aging and disability services programs
(including transfer of funds)
For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), 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 075–0142–0–1–506
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 [012–3507]
–2
1120
Appropriations transferred to other acct [075–1503]
–7
1160
Appropriation, discretionary (total)
2,111
2,171
2,072
Appropriations, mandatory:
1221
PPHF Appropriations transferred from other accounts [075–0116]
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
–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)
–2,177
–2,570
–2,193
3040
Recoveries of prior year unpaid obligations, unexpired
–4
3041
Recoveries of prior year unpaid obligations, expired
–14
3050
Unpaid obligations, end of year
1,516
1,202
1,135
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–190
–129
–194
3070
Change in uncollected pymts, Fed sources, unexpired
–66
–65
–44
3071
Change in uncollected pymts, Fed sources, expired
127
3090
Uncollected pymts, Fed sources, end of year
–129
–194
–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
–136
–55
–55
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–58
–57
–44
4052
Offsetting collections credited to expired accounts
125
41
44
4060
Additional offsets against budget authority only (total)
67
–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
–18
–8
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–8
–8
4142
Offsetting collections credited to expired accounts
1
8
4150
Additional offsets against budget authority only (total)
–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 075–0142–0–1–506
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 075–0142–0–1–506
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 075–0142–4–1–506
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
–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
–10
–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)
–4
–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 075–0142–4–1–506
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 075–0142–4–1–506
2019 actual
2020 est.
2021 est.
2001
Reimbursable civilian full-time equivalent employment
1
4
Departmental Management
Federal Funds
General departmental management
For 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 075–9912–0–1–551
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 — other accts [075–1503]
–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 [075–0511]
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
–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)
–684
–746
–694
3041
Recoveries of prior year unpaid obligations, expired
–19
3050
Unpaid obligations, end of year
525
527
451
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–318
–248
–248
3070
Change in uncollected pymts, Fed sources, unexpired
–128
3071
Change in uncollected pymts, Fed sources, expired
198
3090
Uncollected pymts, Fed sources, end of year
–248
–248
–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:
–298
–256
–260
4033
Non-Federal sources:
–1
4040
Offsets against gross budget authority and outlays (total)
–299
–256
–260
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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:
–14
–12
–15
Additional offsets against gross budget authority only:
4140
Change in uncollected pymts, Fed sources, unexpired
–1
4142
Offsetting collections credited to expired accounts
3
4150
Additional offsets against budget authority only (total)
2
4170
Outlays, net (mandatory)
–2
4180
Budget authority, net (total)
485
480
347
4190
Outlays, net (total)
371
478
419
Note.—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 075–9912–0–1–551
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 075–9912–0–1–551
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 rights
For 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 075–0135–0–1–751
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
–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)
–51
–64
–48
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–23
–10
–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 075–0135–0–1–751
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 075–0135–0–1–751
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 technology
For 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 075–0130–0–1–551
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)
–69
–107
–68
3040
Recoveries of prior year unpaid obligations, unexpired
–9
3041
Recoveries of prior year unpaid obligations, expired
–4
3050
Unpaid obligations, end of year
54
13
2
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–20
–10
–10
3070
Change in uncollected pymts, Fed sources, unexpired
–5
3071
Change in uncollected pymts, Fed sources, expired
15
3090
Uncollected pymts, Fed sources, end of year
–10
–10
–10
Memorandum (non-add) entries:
3100
Obligated balance, start of year
48
44
3
3200
Obligated balance, end of year
44
3
–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:
–14
–15
–15
4040
Offsets against gross budget authority and outlays (total)
–14
–15
–15
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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.
111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255), for the purpose of addressing strategic planning, coordination,
and the analysis of key technical, economic and other issues related to the public and private adoption of health information
technology.
Object Classification (in millions of dollars)
Identification code 075–0130–0–1–551
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 075–0130–0–1–551
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 Appeals
For 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 075–0139–0–1–551
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
–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)
–158
–248
–196
3040
Recoveries of prior year unpaid obligations, unexpired
–3
3041
Recoveries of prior year unpaid obligations, expired
–1
3050
Unpaid obligations, end of year
57
1
3
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–106
–156
–156
3070
Change in uncollected pymts, Fed sources, unexpired
–55
3071
Change in uncollected pymts, Fed sources, expired
5
3090
Uncollected pymts, Fed sources, end of year
–156
–156
–156
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–51
–99
–155
3200
Obligated balance, end of year
–99
–155
–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
–130
–192
–196
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–55
4052
Offsetting collections credited to expired accounts
3
4060
Additional offsets against budget authority only (total)
–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 075–0139–0–1–551
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 075–0139–0–1–551
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 075–0139–4–1–551
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)
–2
Budget authority and outlays, net:
Mandatory:
4090
Budget authority, gross
2
Outlays, gross:
4100
Outlays from new mandatory authority
2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120
Federal sources
–2
4180
Budget authority, net (total)
4190
Outlays, net (total)
This legislative proposal provides the 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 fund
For 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 075–0140–0–1–551
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 [075–0343]
–2
–3
–3
1010
Unobligated balance transfer to other accts [075–9915]
–15
1010
Unobligated balance transfer to other accts [075–0943]
–10
1011
Unobligated balance transfer from other acct [075–0943]
50
1011
Unobligated balance transfer from other acct [075–0943]
425
1011
Unobligated balance transfer from other acct [075–0116]
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 [075–0350]
–80
1120
Appropriations transferred to other acct [075–0128]
–1
1120
Appropriations transferred to other acct [075–1362]
–100
1120
Appropriations transferred to other acct [075–0943]
–20
1121
Appropriations transferred from other acct [075–0943]
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
–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)
–2,658
–3,058
–3,332
3031
Unpaid obligations transferred from other accts [075–0943]
242
3040
Recoveries of prior year unpaid obligations, unexpired
–88
3041
Recoveries of prior year unpaid obligations, expired
–37
3050
Unpaid obligations, end of year
4,967
4,746
4,155
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–198
–203
–203
3070
Change in uncollected pymts, Fed sources, unexpired
–87
3071
Change in uncollected pymts, Fed sources, expired
82
3090
Uncollected pymts, Fed sources, end of year
–203
–203
–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
–86
4033
Non-Federal sources:
–1
4040
Offsets against gross budget authority and outlays (total)
–87
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–87
4052
Offsetting collections credited to expired accounts
83
4060
Additional offsets against budget authority only (total)
–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 075–0140–0–1–551
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 075–0140–0–1–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0145–0–1–552
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)
–79
–81
–152
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–145
–133
–123
4180
Budget authority, net (total)
4190
Outlays, net (total)
–66
–52
29
Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
20 percent of the funds appropriated or credited to the PCORTF was transferred each year to the Department of Health and Human
Services (HHS). 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 075–0145–0–1–552
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0125–0–1–551
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
–400
–350
–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)
–235
–661
185
3040
Recoveries of prior year unpaid obligations, unexpired
–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
–400
–350
–500
Outlays, gross:
4010
Outlays from new discretionary authority
–52
–75
4011
Outlays from discretionary balances
235
713
–110
4020
Outlays, gross (total)
235
661
–185
4180
Budget authority, net (total)
–400
–350
–500
4190
Outlays, net (total)
235
661
–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 075–0125–0–1–551
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 075–0125–0–1–551
2019 actual
2020 est.
2021 est.
1001
Direct civilian full-time equivalent employment
4
4
4
Health Insurance Reform Implementation Fund
Program and Financing (in millions of dollars)
Identification code 075–0119–0–1–551
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)
–5
–2
–2
3040
Recoveries of prior year unpaid obligations, unexpired
–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. 111–152) appropriated $1,000,000,000 to the
Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.
Prevention and Public Health Fund
Program and Financing (in millions of dollars)
Identification code 075–0116–0–1–551
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 [075–0140]
–16
1011
Unobligated balance transfer from other acct [075–0350]
8
1011
Unobligated balance transfer from other acct [075–1362]
8
1050
Unobligated balance (total)
6
6
6
Budget authority:
Appropriations, mandatory:
1200
Appropriation
900
950
950
1220
Appropriations transferred to other accts [075–0142]
–28
–28
1220
Appropriations transferred to other accts [075–0943]
–805
–854
–894
1220
Appropriations transferred to other accts [075–1362]
–12
–12
1230
Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
–55
–56
–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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0117–0–1–551
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
–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)
–21
–25
–1
3041
Recoveries of prior year unpaid obligations, expired
–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 075–0117–0–1–551
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 075–0117–0–1–551
2019 actual
2020 est.
2021 est.
1001
Direct civilian full-time equivalent employment
2
Section 241 Evaluation Transactions Account
Program and Financing (in millions of dollars)
Identification code 075–3902–0–1–552
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)
–321
–1,050
–861
3041
Recoveries of prior year unpaid obligations, expired
–41
3050
Unpaid obligations, end of year
790
324
130
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–629
–787
–787
3070
Change in uncollected pymts, Fed sources, unexpired
–432
3071
Change in uncollected pymts, Fed sources, expired
274
3090
Uncollected pymts, Fed sources, end of year
–787
–787
–787
Memorandum (non-add) entries:
3100
Obligated balance, start of year
4
3
–463
3200
Obligated balance, end of year
3
–463
–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
–317
–584
–667
4033
Non-Federal sources
–3
4040
Offsets against gross budget authority and outlays (total)
–320
–584
–667
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–432
4052
Offsetting collections credited to expired accounts
236
4060
Additional offsets against budget authority only (total)
–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 Center
Federal Funds
Retirement pay and medical benefits for commissioned officers
For 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 075–0379–0–1–551
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)
–618
–700
–652
3041
Recoveries of prior year unpaid obligations, expired
–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
–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 075–0379–0–1–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–0170–0–1–551
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)
–29
–29
–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. 108–375, section 725).
General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
(Legislative proposal, not subject to PAYGO)
Beginning FY 2022, this account would support the unfunded liability of U.S. Public Health Service Commissioned Corps retirement
pay and survivor benefits costs.
Health Activities Funds
Program and Financing (in millions of dollars)
Identification code 075–9913–0–1–551
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 Fund
Program and Financing (in millions of dollars)
Identification code 075–9941–0–4–551
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
–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)
–1,720
–1,466
–1,464
3040
Recoveries of prior year unpaid obligations, unexpired
–35
–250
–250
3050
Unpaid obligations, end of year
1,012
1,081
752
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–673
–531
–531
3070
Change in uncollected pymts, Fed sources, unexpired
142
3090
Uncollected pymts, Fed sources, end of year
–531
–531
–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
–1,618
–1,948
–1,948
4033
Non-Federal sources
–3
4040
Offsets against gross budget authority and outlays (total)
–1,621
–1,948
–1,948
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
142
4080
Outlays, net (discretionary)
99
–482
–484
4180
Budget authority, net (total)
4190
Outlays, net (total)
99
–482
–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 075–9941–0–4–551
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 075–9941–0–4–551
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 Funds
Special and Trust Fund Receipts (in millions of dollars)
Identification code 075–9971–0–7–551
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
–72
–72
–72
5099
Balance, end of year
2
4
Program and Financing (in millions of dollars)
Identification code 075–9971–0–7–551
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)
–78
–160
–85
3040
Recoveries of prior year unpaid obligations, unexpired
–9
–8
–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 075–9971–0–7–551
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 075–9971–0–7–551
2019 actual
2020 est.
2021 est.
1001
Direct civilian full-time equivalent employment
33
33
33
Office of the Inspector General
Federal Funds
Office of inspector general
For 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 075–0128–0–1–551
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 [075–9911]
2
2
1121
Appropriations transferred from other acct [075–0140]
1
1121
Appropriations transferred from other acct [075–9915]
5
5
1121
Appropriations transferred from other acct [075–1503]
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
–1
1802
Offsetting collections (previously unavailable)
1
1
1
1823
New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
–1
–1
1850
Spending auth from offsetting collections, mand (total)
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)
–418
–455
–430
3040
Recoveries of prior year unpaid obligations, unexpired
–4
–2
3041
Recoveries of prior year unpaid obligations, expired
–3
3050
Unpaid obligations, end of year
101
56
66
Uncollected payments:
3060
Uncollected pymts, Fed sources, brought forward, Oct 1
–135
–128
–128
3070
Change in uncollected pymts, Fed sources, unexpired
–2
3071
Change in uncollected pymts, Fed sources, expired
9
3090
Uncollected pymts, Fed sources, end of year
–128
–128
–128
Memorandum (non-add) entries:
3100
Obligated balance, start of year
–38
–27
–72
3200
Obligated balance, end of year
–27
–72
–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
–105
–111
–111
Additional offsets against gross budget authority only:
4050
Change in uncollected pymts, Fed sources, unexpired
–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
–211
–213
–216
4123
Non-Federal sources
–10
–12
–12
4130
Offsets against gross budget authority and outlays (total)
–221
–225
–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 075–0128–0–1–551
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 075–0128–0–1–551
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:
075–143500
General Fund Proprietary Interest Receipts, not Otherwise Classified
120
90
90
075–275830
Downward Reestimates of Subsidies, Health Centers
1
075–310700
Federal Share of Child Support Collections
526
634
562
075–310700
Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO
4
075–322000
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 PROVISIONS
SEC. 201. Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
when specifically approved by the Secretary.SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a 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.—Notwithstanding any other provision of law, the Director of NIH ("Director") may use funds authorized under section 402(b)(12)
of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry out research
identified pursuant to or research and activities described in such section 402(b)(12).
(b) Peer review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
Act.
'
(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)), if—
(1) funds are available and obligated—
(A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
(B) for the estimated costs associated with a necessary termination of the contract; and
(2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
(b) A contract entered into under this section—
(1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
(2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
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 if—
(1) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to
breast cancer screening, mammography, and prevention last issued before 2009; and
(2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social
Security Act (42 U.S.C. 1395x(jj)).
'
(transfer of funds)
SEC. 218. The NIH Director may transfer discretionary amounts identified by the Director as funding for opioid addiction, opioid alternatives, pain management, and addiction treatment among Institutes and Centers of the NIH to be used for the same purpose 15 days after notifying the Committees on Appropriations 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 116–94 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 115–245: 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 110–161, $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 —
(1) the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
or cooperative agreement on behalf of the ordering agency or unit;
(2) the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or
unit; and
(3) the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
and for the service of executing or managing the grant or cooperative agreement.
(b) CONDITIONS. The conditions for making an agreement described in subsection (a) are that —
(1) amounts are available;
(2) the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
(3) the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.
(c) PAYMENT. Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
and the actual cost of service provided.
(d) LIMITATIONS ON FUNDS. A condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement.
(e) OBLIGATION OF APPROPRIATIONS. An agreement made under this section obligates an appropriation of the ordering agency or unit.
The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
before the end of the period of availability of the appropriation, in—
(1) awarding the grant or cooperative agreement; or
(2) providing the agreed-on services.
(f) NO EFFECT ON OTHER LAWS. This section does not affect other laws about reimbursable agreements.
SEC. 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 construed—
(1) as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
by the Secretary; or
(2) to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
funds.
SEC. 227. Funds appropriated in this Act to accounts that received appropriations in title II of division A of Public Law 116–94 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 — (a) in subsection (a)(5)(C) —
(1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE. A covered entity shall
permit"; and
(2) by inserting at the end the following:
"(ii) USE OF SAVINGS. — A covered entity shall permit the Secretary to audit, at the Secretary's expense, the records of the
entity to determine how net income from purchases under this section are used by the covered entity.
"(iii) RECORDS RETENTION. — Covered entities shall retain such records and provide such records and reports as deemed necessary
by the Secretary for carrying out this subparagraph.".
(b) by adding at the end the following new subsection:
"(f) REGULATIONS. — The Secretary may promulgate such regulations as the Secretary determines 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 — (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. —
"(1) IN GENERAL — 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. — Such individual shall, while performing such services during such period —
"(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.)