Appendix - Department of Health and Human Services

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; $6,250,157,000: Provided, That of the amount provided under this heading, $1,141,861,000 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; $241,431,000 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; $527,848,000 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; $43,116,000 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; $33,836,000 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; $23,137,000 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 of the total amount appropriated: (1) $1,182,625,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs, of which no less than $15,000,000 shall be used for inspections of foreign seafood manufacturers and field examinations of imported seafood; (2) $2,120,173,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs; (3) $457,889,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $284,566,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $657,633,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $76,994,000 shall be for the National Center for Toxicological Research; (7) $680,812,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) $210,485,000 shall be for Rent and Related activities, of which $55,892,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) $235,348,000 shall be for payments to the General Services Administration for rent; and (10) $343,632,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Food Policy and Response, the Office of Operations, the Office of the Chief Scientist, and central services for these offices: 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 of the amounts that are made available under this heading for "other activities", and that are not derived from user fees, $1,500,000 shall be transferred to and merged with the appropriation for "Department of Health and Human Services—Office of Inspector General" for oversight of the programs and operations of the Food and Drug Administration and shall be in addition to funds otherwise made available for oversight of the Food and Drug Administration: Provided further, That funds may be transferred from one specified activity to another with the prior notification 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), medical countermeasure priority review voucher user fees authorized by 21 U.S.C. 360bbb-4a, and fees relating to over-the-counter monograph drugs authorized by 21 U.S.C. 379j-72 shall be credited to this account, to remain available until expended.

(Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021.)

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, $30,788,000, to remain available until expended.

(Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021.)


Identification code 075–9911–0–1–554		2020 actual	2021 est.	2022 est.

0100	Balance, start of year	1		1
0198	Reconciliation adjustment	–1

0199	Balance, start of year			1
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, FDA	3	3	3

2000	Total: Balances and receipts	3	3	4
	Appropriations:
	Current law:
2101	Salaries and Expenses	–3	–2	–2

5099	Balance, end of year		1	2


Identification code 075–9911–0–1–554		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Foods	1,087	1,100	1,182
0002	Human Drugs	683	689	775
0003	Devices and Radiological Health	395	408	452
0004	National Center for Toxicological Research	67	67	77
0005	FDA Other Activities (FDA Headquaters)	185	193	221
0006	FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)	126	130	151
0007	FDA GSA Rental Payments	171	167	166
0008	FDA Buildings and Facilities	43	13	31
0009	Cooperative Research and Development (CRADA)	1	2	2
0010	Animal Drugs and Food	191	192	232
0011	Biologics	252	254	270
0015	CURES Activities		70	50
0017	Opioids - IMF	48
0018	FDA HCFAC Wedge Fund	6
0019	Coronavirus Emergency Funding Supplemental	42
0020	COVID-19 Supplemental 5		55

0799	Total direct obligations	3,297	3,340	3,609
0801	FDA Reimbursable program (User fees)	2,742	2,755	2,806
0802	FDA Reimbursable program (Federal sources)	44

0899	Total reimbursable obligations	2,786	2,755	2,806

0900	Total new obligations, unexpired accounts	6,083	6,095	6,415

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,022	1,129	1,631
1001	Discretionary unobligated balance brought fwd, Oct 1	1,016
1021	Recoveries of prior year unpaid obligations	139

1050	Unobligated balance (total)	1,161	1,129	1,631
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,332	3,215	3,559
1100	Appropriation, Discretionary, Emergency pursuant to 2011 Budget Control Act		55
1120	Appropriations transferred to other accts [075–0128]	–2
1121	Appropriations transferred from other acct [075–5629]		70	50
1121	Appropriations transferred from other acct [075–0140]	22

1160	Appropriation, discretionary (total)	3,352	3,340	3,609
	Appropriations, mandatory:
1200	Appropriation		500
1201	Appropriation (special or trust fund)	3	2	2

1260	Appropriations, mandatory (total)	3	502	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,786	2,755	2,810
1700	Collected	13	31
1701	Change in uncollected payments, Federal sources	31	–31
1702	Offsetting collections (previously unavailable)	774
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–914

1750	Spending auth from offsetting collections, disc (total)	2,690	2,755	2,810
	Spending authority from offsetting collections, mandatory:
1800	Collected	7
1900	Budget authority (total)	6,052	6,597	6,421
1930	Total budgetary resources available	7,213	7,726	8,052
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	1,129	1,631	1,637

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,867	3,043	1,953
3010	New obligations, unexpired accounts	6,083	6,095	6,415
3011	Obligations ("upward adjustments"), expired accounts	128
3020	Outlays (gross)	–5,709	–7,185	–6,617
3040	Recoveries of prior year unpaid obligations, unexpired	–139
3041	Recoveries of prior year unpaid obligations, expired	–187

3050	Unpaid obligations, end of year	3,043	1,953	1,751
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–66	–63	–32
3070	Change in uncollected pymts, Fed sources, unexpired	–31	31
3071	Change in uncollected pymts, Fed sources, expired	34

3090	Uncollected pymts, Fed sources, end of year	–63	–32	–32
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,801	2,980	1,921
3200	Obligated balance, end of year	2,980	1,921	1,719

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,042	6,095	6,419
	Outlays, gross:
4010	Outlays from new discretionary authority	3,485	4,875	5,091
4011	Outlays from discretionary balances	2,217	1,994	1,404

4020	Outlays, gross (total)	5,702	6,869	6,495
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–39	–31
4033	Non-Federal sources:	–2,796	–2,755	–2,810

4040	Offsets against gross budget authority and outlays (total)	–2,835	–2,786	–2,810
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–31	31
4052	Offsetting collections credited to expired accounts	36

4060	Additional offsets against budget authority only (total)	5	31

4070	Budget authority, net (discretionary)	3,212	3,340	3,609
4080	Outlays, net (discretionary)	2,867	4,083	3,685
	Mandatory:
4090	Budget authority, gross	10	502	2
	Outlays, gross:
4100	Outlays from new mandatory authority	6	316	2
4101	Outlays from mandatory balances	1		120

4110	Outlays, gross (total)	7	316	122
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:	–12
4123	Non-Federal sources:	–1

4130	Offsets against gross budget authority and outlays (total)	–13
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	6

4160	Budget authority, net (mandatory)	3	502	2
4170	Outlays, net (mandatory)	–6	316	122
4180	Budget authority, net (total)	3,215	3,842	3,611
4190	Outlays, net (total)	2,861	4,399	3,807

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	806	946	946
5092	Unexpired unavailable balance, EOY: Offsetting collections	946	946	946

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 2022 Budget includes $6.2 billion in total resources for FDA. The Budget invests in priority activities such as data modernization and enhanced technologies, food safety efforts such as infant and maternal health and nutrition, shortages and supply chain, capacity building, and infrastructure.


Identification code 075–9911–0–1–554		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	919	961	1,027
11.3	Other than full-time permanent	84	90	96
11.5	Other personnel compensation	48	52	55
11.7	Military personnel	87	91	94
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	1,139	1,195	1,273
12.1	Civilian personnel benefits	367	385	412
12.2	Military personnel benefits	9	9	10
21.0	Travel and transportation of persons	24	23	26
22.0	Transportation of things	4	4	4
23.1	Rental payments to GSA	174	167	166
23.3	Communications, utilities, and miscellaneous charges	18	16	19
24.0	Printing and reproduction	2	2	2
25.1	Advisory and assistance services	57	51	58
25.2	Other services from non-Federal sources	494	521	532
25.3	Other goods and services from Federal sources	416	396	453
25.4	Operation and maintenance of facilities	75	72	82
25.5	Research and development contracts	40	37	42
25.7	Operation and maintenance of equipment	45	42	48
26.0	Supplies and materials	43	41	46
31.0	Equipment	111	105	121
32.0	Land and structures	75	66	76
41.0	Grants, subsidies, and contributions	204	208	238
42.0	Insurance claims and indemnities			1

99.0	Direct obligations	3,297	3,340	3,609
99.0	Reimbursable obligations	2,786	2,755	2,806

99.9	Total new obligations, unexpired accounts	6,083	6,095	6,415


Identification code 075–9911–0–1–554		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	8,374	8,731	8,919
1101	Direct military average strength employment	618	618	618
2001	Reimbursable civilian full-time equivalent employment	6,734	7,195	7,306
2101	Reimbursable military average strength employment	497	497	497
3001	Allocation account civilian full-time equivalent employment	35	35	35
3101	Allocation account military average strength employment	2	2	2

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, 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.


Identification code 075–9911–2–1–554		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0801	FDA Reimbursable program (Tobacco user fee increase)			100

0899	Total reimbursable obligations			100

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			100
1900	Budget authority (total)			100
1930	Total budgetary resources available			100

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			100
3020	Outlays (gross)			–100

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			100
	Outlays, gross:
4010	Outlays from new discretionary authority			100
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources:			–100

4040	Offsets against gross budget authority and outlays (total)			–100
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Budget 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.


Identification code 075–9911–2–1–554		2020 actual	2021 est.	2022 est.

	Reimbursable obligations:
21.0	Travel and transportation of persons			1
23.1	Rental payments to GSA			5
25.1	Advisory and assistance services			4
25.2	Other services from non-Federal sources			38
25.3	Other goods and services from Federal sources			30
25.4	Operation and maintenance of facilities			2
25.5	Research and development contracts			4
25.7	Operation and maintenance of equipment			3
26.0	Supplies and materials			1
31.0	Equipment			3
32.0	Land and structures			1
41.0	Grants, subsidies, and contributions			8

99.0	Reimbursable obligations			100

99.9	Total new obligations, unexpired accounts			100


Identification code 075–4613–0–4–554		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Direct program activity		324	324
0801	Reimbursable program activity	632	295	295

0900	Total new obligations, unexpired accounts	632	619	619

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	32	32	32
1021	Recoveries of prior year unpaid obligations	6

1050	Unobligated balance (total)	38	32	32
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	626	619	619
1900	Budget authority (total)	626	619	619
1930	Total budgetary resources available	664	651	651
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	32	32	32

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	205	237	12
3010	New obligations, unexpired accounts	632	619	619
3020	Outlays (gross)	–594	–844	–619
3040	Recoveries of prior year unpaid obligations, unexpired	–6

3050	Unpaid obligations, end of year	237	12	12
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	205	237	12
3200	Obligated balance, end of year	237	12	12

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	626	619	619
	Outlays, gross:
4010	Outlays from new discretionary authority	399	619	619
4011	Outlays from discretionary balances	195	225

4020	Outlays, gross (total)	594	844	619
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–626	–619	–619
4180	Budget authority, net (total)
4190	Outlays, net (total)	–32	225


Identification code 075–4613–0–4–554		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent		73	73
11.3	Other than full-time permanent		1	1
11.5	Other personnel compensation		2	2
11.7	Military personnel		1	1

11.9	Total personnel compensation		77	77
12.1	Civilian personnel benefits		26	26
12.2	Military personnel benefits		1	1
21.0	Travel and transportation of persons		1	1
23.3	Communications, utilities, and miscellaneous charges		6	6
24.0	Printing and reproduction		1	1
25.1	Advisory and assistance services		15	15
25.2	Other services from non-Federal sources		77	77
25.3	Other goods and services from Federal sources		54	54
25.4	Operation and maintenance of facilities		3	3
25.7	Operation and maintenance of equipment		56	56
26.0	Supplies and materials		4	4
31.0	Equipment		1	1
41.0	Grants, subsidies, and contributions		1	1
42.0	Insurance claims and indemnities		1	1

99.0	Direct obligations		324	324
	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	138	58	58
11.3	Other than full-time permanent	3	1	1
11.5	Other personnel compensation	3	1	1
11.7	Military personnel	2	1	1

11.9	Total personnel compensation	146	61	61
12.1	Civilian personnel benefits	52	20	20
13.0	Benefits for former personnel	1
21.0	Travel and transportation of persons	1	1	1
23.3	Communications, utilities, and miscellaneous charges	12	5	5
24.0	Printing and reproduction	2	1	1
25.1	Advisory and assistance services	26	12	12
25.2	Other services from non-Federal sources	156	63	63
25.3	Other goods and services from Federal sources	98	81	81
25.4	Operation and maintenance of facilities	2	2	2
25.7	Operation and maintenance of equipment	110	44	44
26.0	Supplies and materials	6	3	3
31.0	Equipment	12
32.0	Land and structures	6
41.0	Grants, subsidies, and contributions	2	1	1
43.0	Interest and dividends		1	1

99.0	Reimbursable obligations	632	295	295

99.9	Total new obligations, unexpired accounts	632	619	619


Identification code 075–4613–0–4–554		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment		685	685
1101	Direct military average strength employment		8	8
2001	Reimbursable civilian full-time equivalent employment	1,165	480	480
2101	Reimbursable military average strength employment	14	6	6


Identification code 075–0148–0–1–554		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Direct program activity	75	70	50

0900	Total new obligations, unexpired accounts (object class 94.0)	75	70	50

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	75	70	50
1930	Total budgetary resources available	75	70	50

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	75	70	50
3020	Outlays (gross)	–75	–70	–50

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	75	70	50
	Outlays, gross:
4100	Outlays from new mandatory authority	75	70	50
4180	Budget authority, net (total)	75	70	50
4190	Outlays, net (total)	75	70	50

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

For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition to amounts available for such purposes under the heading "Salaries and Expenses", $50,000,000, 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, 2021.)


Identification code 075–5629–0–2–554		2020 actual	2021 est.	2022 est.

0100	Balance, start of year
	Receipts:
	Current law:
1140	General Fund Payment, FDA Innovation, CURES Act	75	70	50

2000	Total: Balances and receipts	75	70	50
	Appropriations:
	Current law:
2101	FDA Innovation, Cures Act	–75	–70	–50

5099	Balance, end of year


Identification code 075–5629–0–2–554		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	New Obligations for CURES Activities	65

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	38	48	48
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	75	70	50
1120	Appropriations transferred to other acct [075–9911]		–70	–50

1160	Appropriation, discretionary (total)	75
1930	Total budgetary resources available	113	48	48
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	48	48	48

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	43	49	2
3010	New obligations, unexpired accounts	65
3020	Outlays (gross)	–59	–47

3050	Unpaid obligations, end of year	49	2	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	43	49	2
3200	Obligated balance, end of year	49	2	2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	75
	Outlays, gross:
4010	Outlays from new discretionary authority	22
4011	Outlays from discretionary balances	37	47

4020	Outlays, gross (total)	59	47
4180	Budget authority, net (total)	75
4190	Outlays, net (total)	59	47

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.


Identification code 075–5629–0–2–554		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	20
11.3	Other than full-time permanent	4
11.5	Other personnel compensation	3
11.7	Military personnel	1

11.9	Total personnel compensation	28
12.1	Civilian personnel benefits	9
25.1	Advisory and assistance services	1
25.2	Other services from non-Federal sources	11
26.0	Supplies and materials	1
31.0	Equipment	1
41.0	Grants, subsidies, and contributions	14

99.9	Total new obligations, unexpired accounts	65


Identification code 075–5629–0–2–554		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	180
1101	Direct military average strength employment	7


Identification code 075–4309–0–3–554		2020 actual	2021 est.	2022 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	2	2
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	10	11
1802	Offsetting collections (previously unavailable)	1	1	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1	–1	–1

1850	Spending auth from offsetting collections, mand (total)	8	10	11
1900	Budget authority (total)	8	10	11
1930	Total budgetary resources available	11	12	13
	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	4	5
3010	New obligations, unexpired accounts	9	10	11
3020	Outlays (gross)	–8	–15	–11

3050	Unpaid obligations, end of year	5
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4	5
3200	Obligated balance, end of year	5

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	10	11
	Outlays, gross:
4100	Outlays from new mandatory authority	6	10	11
4101	Outlays from mandatory balances	2	5

4110	Outlays, gross (total)	8	15	11
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–10	–11
4180	Budget authority, net (total)
4190	Outlays, net (total)		5

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	1	1	1
5092	Unexpired unavailable balance, EOY: Offsetting collections	1	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.


Identification code 075–4309–0–3–554		2020 actual	2021 est.	2022 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	3	4	4
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	4	5	5
12.1	Civilian personnel benefits	1	1	2
23.1	Rental payments to GSA	1	1	1
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	1	1	1
31.0	Equipment	1	1	1

99.9	Total new obligations, unexpired accounts	9	10	11


Identification code 075–4309–0–3–554		2020 actual	2021 est.	2022 est.

2001	Reimbursable civilian full-time equivalent employment	34	37	37

Federal Funds

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, $1,733,772,000: 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.

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, $1,380,384,000: Provided, That sections 751(j)(2) 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 for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as the "Secretary") may hereafter waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act: 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 $180,000,000 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.

Of the funds made available under this heading, $50,000,000 shall remain available until expended for grants to public institutions of higher education to expand or support graduate education for physicians provided by such institutions: Provided, That, in awarding such grants, the Secretary shall give priority to public institutions of higher education located in States with a projected primary care provider shortage in 2025, as determined by the Secretary: Provided further, That grants so awarded are limited to such public institutions of higher education in States in the top quintile of States with a projected primary care provider shortage in 2025, as determined by the Secretary: Provided further, That the minimum amount of a grant so awarded to such an institution shall be not less than $1,000,000 per year: Provided further, That such a grant may be awarded for a period not to exceed 5 years: Provided further, That amounts made available in this paragraph shall be awarded as supplemental grants to recipients of grants awarded for this purpose in fiscal years 2020 and 2021, pursuant to the terms and conditions of each institution's initial grant agreement, in an amount for each institution that will result in every institution being awarded the same total grant amount over fiscal years 2020 through 2022, provided the institution can justify the expenditure of such funds: Provided further, That such a grant awarded with respect to a year to such an institution shall be subject to a matching requirement of non-Federal funds in an amount that is not less than 10 percent of the total amount of Federal funds provided in the grant to such institution with respect to such year.

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, $1,100,084,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $220,116,000 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.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,554,781,000, of which $2,010,881,000 shall remain available to the Secretary through September 30, 2024, 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 $190,000,000, 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.

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, $136,093,000, of which $122,000 shall be available until expended for facilities renovations and other facilities-related expenses of the National Hansen's Disease Program.

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, $400,209,000, of which $57,509,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program: Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, $20,942,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and up to $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) available for the purchase and implementation of telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, $12,500,000 shall be available for State Offices of Rural Health: Provided further, That $12,700,000 shall remain available through September 30, 2024, to support the Rural Residency Development Program.

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $340,000,000: 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.

For program support in the Health Resources and Services Administration, $167,971,000: 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".


Identification code 075–0350–0–1–550		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0005	Primary Health Care (Health Centers, Free Clinics)	2,391	1,685	1,734
0010	Primary Health Care (Mandatory)	5,275	11,561	3,945
0015	Health Workforce	1,220	1,317	1,380
0020	Health Workforce (Mandatory)	474	1,014	1,384
0025	Maternal and Child Health	944	976	1,100
0030	Maternal and Child Health (Mandatory)	6	21	70
0035	Ryan White HIV/AIDS	2,503	2,428	2,555
0040	Health Care Systems	128	129	136
0045	Rural Health	515	338	400
0050	Family Planning	286	286	340
0051	Family Planning (Mandatory)			50
0055	HRSA Program Management	155	155	168

0091	Direct program activities, subtotal	13,897	19,910	13,262

0300	Total direct programs	13,897	19,910	13,262
	Credit program obligations:
0702	Loan guarantee subsidy		1	2

0799	Total direct obligations	13,897	19,911	13,264
0801	Health Resources and Services (Reimbursable)	67	63	63

0899	Total reimbursable obligations	67	63	63

0900	Total new obligations, unexpired accounts	13,964	19,974	13,327

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	458	442	1,478
1001	Discretionary unobligated balance brought fwd, Oct 1	369
1010	Unobligated balance transfer to other accts [015–5606]	–5	–5	–5
1021	Recoveries of prior year unpaid obligations	75

1050	Unobligated balance (total)	528	437	1,473
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	7,037	7,207	7,813
1121	Appropriations transferred from other acct [075–0140]	975

1160	Appropriation, discretionary (total)	8,012	7,207	7,813
	Appropriations, mandatory:
1200	Appropriation	5,763	4,443	4,443
1200	Appropriation [American Rescue Plan]		9,280
1230	Appropriations and/or unobligated balance of appropriations permanently reduced			–120

1260	Appropriations, mandatory (total)	5,763	13,723	4,323
	Spending authority from offsetting collections, discretionary:
1700	Collected	13	30	30
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	23	30	30
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	86	52	52
1802	Offsetting collections (previously unavailable)	2	5	2
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–5	–2	–2

1850	Spending auth from offsetting collections, mand (total)	83	55	52
1900	Budget authority (total)	13,881	21,015	12,218
1930	Total budgetary resources available	14,409	21,452	13,691
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	442	1,478	364

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8,277	10,500	13,641
3010	New obligations, unexpired accounts	13,964	19,974	13,327
3011	Obligations ("upward adjustments"), expired accounts	15
3020	Outlays (gross)	–11,591	–16,833	–16,902
3040	Recoveries of prior year unpaid obligations, unexpired	–75
3041	Recoveries of prior year unpaid obligations, expired	–90

3050	Unpaid obligations, end of year	10,500	13,641	10,066
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–16	–17	–17
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	9

3090	Uncollected pymts, Fed sources, end of year	–17	–17	–17
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8,261	10,483	13,624
3200	Obligated balance, end of year	10,483	13,624	10,049

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	8,035	7,237	7,843
	Outlays, gross:
4010	Outlays from new discretionary authority	2,471	2,356	2,539
4011	Outlays from discretionary balances	4,389	5,312	5,041

4020	Outlays, gross (total)	6,860	7,668	7,580
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–10	–10	–10
4033	Non-Federal sources	–12	–20	–20

4040	Offsets against gross budget authority and outlays (total)	–22	–30	–30
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	9

4060	Additional offsets against budget authority only (total)	–1

4070	Budget authority, net (discretionary)	8,012	7,207	7,813
4080	Outlays, net (discretionary)	6,838	7,638	7,550
	Mandatory:
4090	Budget authority, gross	5,846	13,778	4,375
	Outlays, gross:
4100	Outlays from new mandatory authority	2,168	5,878	1,878
4101	Outlays from mandatory balances	2,563	3,287	7,444

4110	Outlays, gross (total)	4,731	9,165	9,322
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–86	–52	–52
4180	Budget authority, net (total)	13,772	20,933	12,136
4190	Outlays, net (total)	11,483	16,751	16,820

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	2	5	2
5092	Unexpired unavailable balance, EOY: Offsetting collections	5	2	2
5103	Unexpired unavailable balance, SOY: Fulfilled purpose	1	1
5104	Unexpired unavailable balance, EOY: Fulfilled purpose	1

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


Identification code 075–0350–0–1–550		2020 actual	2021 est.	2022 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels	2	40	72

215999	Total loan guarantee levels	2	40	72
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.57	2.78	2.93

232999	Weighted average subsidy rate	2.57	2.78	2.93
	Guaranteed loan subsidy budget authority:
233001	Health centers: Facilities renovation loan guarantee levels		1	2

233999	Total subsidy budget authority		1	2

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 2019–2020 data reported in the Annual Operating Report.


Program	Account Balance


HPSL	435,986,003
NSL	199,692,945
PCL	168,904,435
LDS	198,835,512

Total	1,003,418,895


Identification code 075–0350–0–1–550		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	218	249	268
11.3	Other than full-time permanent	5	5	5
11.5	Other personnel compensation	5	5	5
11.7	Military personnel	28	30	31

11.9	Total personnel compensation	256	289	309
12.1	Civilian personnel benefits	76	87	104
12.2	Military personnel benefits	3	4	4
13.0	Benefits for former personnel	2	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	18	18	18
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	6	7	6
25.1	Advisory and assistance services	15	16	16
25.2	Other services from non-Federal sources	274	273	279
25.3	Other goods and services from Federal sources	297	287	286
25.4	Operation and maintenance of facilities	1	1	1
25.5	Research and development contracts	11	11	11
25.6	Medical care	3	3	3
25.7	Operation and maintenance of equipment	14	13	14
26.0	Supplies and materials	1	1	1
31.0	Equipment	11	10	10
41.0	Grants, subsidies, and contributions	12,813	18,779	12,090
42.0	Insurance claims and indemnities	94	108	108

99.0	Direct obligations	13,897	19,911	13,264
99.0	Reimbursable obligations	67	63	63

99.9	Total new obligations, unexpired accounts	13,964	19,974	13,327


Identification code 075–0350–0–1–550		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	1,862	2,179	2,337
1101	Direct military average strength employment	181	197	197
2001	Reimbursable civilian full-time equivalent employment	54	68	68
2101	Reimbursable military average strength employment	2	2	2


Identification code 075–0320–0–1–551		2020 actual	2021 est.	2022 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	35	36	36
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	36	36	36
1930	Total budgetary resources available	36	36	36
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	36	36	36

	Budget authority and outlays, net:
	Mandatory:
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–1
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	1
4170	Outlays, net (mandatory)	–1
4180	Budget authority, net (total)
4190	Outlays, net (total)	–1

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.

For carrying out section 319F-4 of the PHS Act, $5,000,000, to remain available until expended.


Identification code 075–0343–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Claims		1	4
0103	Admin Expense	2	5	5

0900	Total new obligations, unexpired accounts	2	6	9

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	2
1011	Unobligated balance transfer from other acct [075–0140]	2	4	4

1050	Unobligated balance (total)	3	6	4
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			5
1121	Appropriations transferred from other acct [075–0140]	1

1160	Appropriation, discretionary (total)	1		5
1930	Total budgetary resources available	4	6	9
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1	1	4
3010	New obligations, unexpired accounts	2	6	9
3020	Outlays (gross)	–2	–3	–4

3050	Unpaid obligations, end of year	1	4	9
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	1	4
3200	Obligated balance, end of year	1	4	9

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1		5
	Outlays, gross:
4010	Outlays from new discretionary authority			4
4011	Outlays from discretionary balances	2	3

4020	Outlays, gross (total)	2	3	4
4180	Budget authority, net (total)	1		5
4190	Outlays, net (total)	2	3	4

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).


Identification code 075–0343–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			1
25.2	Other services from non-Federal sources	1	5	3
42.0	Insurance claims and indemnities		1	5

99.0	Direct obligations	1	6	9
99.5	Adjustment for rounding	1

99.9	Total new obligations, unexpired accounts	2	6	9


Identification code 075–0343–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	2	3	11
1101	Direct military average strength employment	2	2	2


Identification code 075–0321–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	400	450	478

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	26	24	102
1021	Recoveries of prior year unpaid obligations	22	1

1050	Unobligated balance (total)	48	25	102
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	400	400	400
1200	Appropriation [American Rescue Plan]		150
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–24	–23	–23

1260	Appropriations, mandatory (total)	376	527	377
1930	Total budgetary resources available	424	552	479
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	24	102	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	757	746	788
3010	New obligations, unexpired accounts	400	450	478
3020	Outlays (gross)	–389	–407	–430
3040	Recoveries of prior year unpaid obligations, unexpired	–22	–1

3050	Unpaid obligations, end of year	746	788	836
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	757	746	788
3200	Obligated balance, end of year	746	788	836

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	376	527	377
	Outlays, gross:
4100	Outlays from new mandatory authority	10	21	15
4101	Outlays from mandatory balances	379	386	415

4110	Outlays, gross (total)	389	407	430
4180	Budget authority, net (total)	376	527	377
4190	Outlays, net (total)	389	407	430

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


Identification code 075–0321–0–1–551		2020 actual	2021 est.	2022 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent	5	6	7

11.9	Total personnel compensation	5	6	7
12.1	Civilian personnel benefits	2	2	2
25.1	Advisory and assistance services	29	41	33
41.0	Grants, subsidies, and contributions	364	401	436

99.9	Total new obligations, unexpired accounts	400	450	478


Identification code 075–0321–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	36	42	50
1101	Direct military average strength employment	2	3	3


Identification code 075–4442–0–3–551		2020 actual	2021 est.	2022 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)


Identification code 075–4442–0–3–551		2020 actual	2021 est.	2022 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	886	846
2143	Uncommitted limitation carried forward	–886	–846	–774

2150	Total guaranteed loan commitments	2	40	72
2199	Guaranteed amount of guaranteed loan commitments	1	32	58

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	34	27	56
2231	Disbursements of new guaranteed loans	2	40	72
2251	Repayments and prepayments	–9	–10	–10
	Adjustments:
2263	Terminations for default that result in claim payments		–1
2264	Other adjustments, net

2290	Outstanding, end of year	27	56	118

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	19	42	92

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.


Identification code 075–4442–0–3–551		2019 actual	2020 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


Identification code 075–9931–0–3–551		2020 actual	2021 est.	2022 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.


Identification code 075–9931–0–3–551		2019 actual	2020 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

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.


Identification code 075–8175–0–7–551		2020 actual	2021 est.	2022 est.

0100	Balance, start of year	3,818	3,965	4,001
	Receipts:
	Current law:
1110	Deposits, Vaccine Injury Compensation Trust Fund	310	317	323
1140	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	83	68	78

1199	Total current law receipts	393	385	401

1999	Total receipts	393	385	401

2000	Total: Balances and receipts	4,211	4,350	4,402
	Appropriations:
	Current law:
2101	Vaccine Injury Compensation Program Trust Fund	–361	–311	–317
2101	Vaccine Injury Compensation Program Trust Fund	–32	–38	–48
2135	Vaccine Injury Compensation Program Trust Fund	143

2199	Total current law appropriations	–250	–349	–365

2999	Total appropriations	–250	–349	–365
4030	Vaccine Injury Compensation Program Trust Fund	4

5099	Balance, end of year	3,965	4,001	4,037


Identification code 075–8175–0–7–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	218	311	317
0103	Claims processing (Claims Court)	9	10	10
0104	Claims processing (HRSA)	10	11	16
0105	Claims processing (Dept. of Justice)	13	17	22

0191	Direct program activities, subtotal	32	38	48

0900	Total new obligations, unexpired accounts	250	349	365

	Budgetary resources:
	Unobligated balance:
1033	Recoveries of prior year paid obligations	4
1035	Unobligated balance of appropriations withdrawn	–4
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	32	38	48
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	361	311	317
1235	Appropriations precluded from obligation (special or trust)	–143

1260	Appropriations, mandatory (total)	218	311	317
1900	Budget authority (total)	250	349	365
1930	Total budgetary resources available	250	349	365

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	12	18	9
3010	New obligations, unexpired accounts	250	349	365
3020	Outlays (gross)	–244	–358	–374

3050	Unpaid obligations, end of year	18	9
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	12	18	9
3200	Obligated balance, end of year	18	9

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	32	38	48
	Outlays, gross:
4010	Outlays from new discretionary authority	21	38	48
4011	Outlays from discretionary balances	5	9	9

4020	Outlays, gross (total)	26	47	57
	Mandatory:
4090	Budget authority, gross	218	311	317
	Outlays, gross:
4100	Outlays from new mandatory authority	218	311	317
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–4
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	4

4160	Budget authority, net (mandatory)	218	311	317
4170	Outlays, net (mandatory)	214	311	317
4180	Budget authority, net (total)	250	349	365
4190	Outlays, net (total)	240	358	374

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	3,849	3,967	4,042
5001	Total investments, EOY: Federal securities: Par value	3,967	4,042	4,126

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.


Identification code 075–8175–0–7–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
12.1	Civilian personnel benefits	1	1	1
25.3	Other goods and services from Federal sources	6	6	6
42.0	Insurance claims and indemnities	241	340	356

99.9	Total new obligations, unexpired accounts	250	349	365


Identification code 075–8175–0–7–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	13	15	15
1101	Direct military average strength employment	5	5	5

Federal Funds

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, $5,678,336,000 to remain available until September 30, 2023, except as otherwise provided herein; and, in addition, $6,152,680,000, which shall become available on October 1, 2022 and remain available through September 30, 2024, except as otherwise provided herein; together with payments received during each 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 $2,500,000 shall be available for each of fiscal years 2022 and 2023 for grants or contracts with public or private institutions to provide alcohol or drug treatment services to Indians, including alcohol detoxification services: Provided further, That of the total amount of funds provided, $2,409,883,000 shall remain available until expended for Purchased/Referred Care, of which $1,218,059,000 shall be from funds that become available on October 1, 2022: Provided further, That of the total amount specified in the preceding proviso for Purchased/Referred Care, $106,000,000 shall be for the Indian Catastrophic Health Emergency Fund, of which $53,000,000 shall be from funds that become available on October 1, 2022: Provided further, That for each of fiscal years 2022 and 2023, up to $66,000,000 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 total amount of funds provided, $116,000,000, including $58,000,000 from funds that become available on October 1, 2022, 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 for each of fiscal years 2022 and 2023 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 the 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, for improving 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 a maternal health initiative, for the Telebehaviorial Health Center of Excellence, for Alzheimer's activities, for Village Built Clinics, 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 that are available for two fiscal years may be used in their second year of availability for annual contracts that fall within 2 fiscal years, provided the total obligation is recorded in such second year of availability: 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 total amount of funds provided, $637,138,000, including $319,832,000 from the amounts that become available on October 1, 2022, 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, 2021.)


Identification code 075–0390–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Clinical services	4,568	8,565	6,225
0002	Preventive health	173	261	235
0003	Urban health	56	84	76
0004	Indian health professions	60	90	80
0005	Tribal management	1	1	1
0006	Direct operations	40	60	54
0007	Self-governance	5	7	6
0009	Diabetes funds	135	142	145

0799	Total direct obligations	5,038	9,210	6,822
0801	Indian Health Services (Reimbursable)	1,969	1,861	1,860

0900	Total new obligations, unexpired accounts	7,007	11,071	8,682

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,510	2,109	4,051
1001	Discretionary unobligated balance brought fwd, Oct 1	1,484
1021	Recoveries of prior year unpaid obligations	239	200

1050	Unobligated balance (total)	1,749	2,309	4,051
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,411	4,301	5,678
1120	Appropriations transferred to other acct [075–0391]	–125
1121	Appropriations transferred from other acct [075–0943]		210
1121	Appropriations transferred from other acct [075–0140]		790

1160	Appropriation, discretionary (total)	5,286	5,301	5,678
	Appropriations, mandatory:
1200	Appropriation (Diabetes)	150	150	150
1200	Appropriation (American Rescue Plan)		5,494
1230	Appropriations and/or unobligated balance of appropriations permanently reduced			–3

1260	Appropriations, mandatory (total)	150	5,644	147
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,953	1,868	1,868
1701	Change in uncollected payments, Federal sources	–3

1750	Spending auth from offsetting collections, disc (total)	1,950	1,868	1,868
1900	Budget authority (total)	7,386	12,813	7,693
1930	Total budgetary resources available	9,135	15,122	11,744
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–19
1941	Unexpired unobligated balance, end of year	2,109	4,051	3,062

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,199	1,385	1,557
3010	New obligations, unexpired accounts	7,007	11,071	8,682
3011	Obligations ("upward adjustments"), expired accounts	36
3020	Outlays (gross)	–6,596	–10,699	–10,192
3040	Recoveries of prior year unpaid obligations, unexpired	–239	–200
3041	Recoveries of prior year unpaid obligations, expired	–22

3050	Unpaid obligations, end of year	1,385	1,557	47
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–109	–105	–105
3070	Change in uncollected pymts, Fed sources, unexpired	3
3071	Change in uncollected pymts, Fed sources, expired	1

3090	Uncollected pymts, Fed sources, end of year	–105	–105	–105
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,090	1,280	1,452
3200	Obligated balance, end of year	1,280	1,452	–58

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	7,236	7,169	7,546
	Outlays, gross:
4010	Outlays from new discretionary authority	5,342	6,395	6,524
4011	Outlays from discretionary balances	1,115	1,407	774

4020	Outlays, gross (total)	6,457	7,802	7,298
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–325	–436	–436
4033	Non-Federal sources	–1,630	–1,432	–1,432

4040	Offsets against gross budget authority and outlays (total)	–1,955	–1,868	–1,868
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	3
4052	Offsetting collections credited to expired accounts	2

4060	Additional offsets against budget authority only (total)	5

4070	Budget authority, net (discretionary)	5,286	5,301	5,678
4080	Outlays, net (discretionary)	4,502	5,934	5,430
	Mandatory:
4090	Budget authority, gross	150	5,644	147
	Outlays, gross:
4100	Outlays from new mandatory authority	45	2,891	141
4101	Outlays from mandatory balances	94	6	2,753

4110	Outlays, gross (total)	139	2,897	2,894
4180	Budget authority, net (total)	5,436	10,945	5,825
4190	Outlays, net (total)	4,641	8,831	8,324

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. More than $3.3 billion, primarily through self-determination contracts and compacts, will be administered by tribal governments in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Indian Health Services account.


Identification code 075–0390–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	419	422	423
11.3	Other than full-time permanent	18	18	19
11.5	Other personnel compensation	95	97	100
11.7	Military personnel	63	63	63

11.9	Total personnel compensation	595	600	605
12.1	Civilian personnel benefits	180	181	185
12.2	Military personnel benefits	13	13	13
13.0	Benefits for former personnel	13	13	13
21.0	Travel and transportation of persons	3	5	4
21.0	Patient travel	32	59	44
22.0	Transportation of things	6	11	8
23.1	Rental payments to GSA	16	29	22
23.2	Rental payments to others	9	16	12
23.3	Communications, utilities, and miscellaneous charges	17	31	23
25.1	Advisory and assistance services	5	9	7
25.2	Other services from non-Federal sources	170	311	232
25.3	Other goods and services from Federal sources	106	194	149
25.4	Operation and maintenance of facilities	2	4	3
25.6	Medical care	432	790	530
25.8	Subsistence and support of persons	63	115	86
26.0	Supplies and materials	98	180	134
31.0	Equipment	24	44	33
32.0	Land and structures	13	24	18
41.0	Grants, subsidies, and contributions	3,240	6,580	4,700
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	5,038	9,210	6,822
99.0	Reimbursable obligations	1,969	1,861	1,860

99.9	Total new obligations, unexpired accounts	7,007	11,071	8,682


Identification code 075–0390–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	6,678	6,797	7,490
1101	Direct military average strength employment	518	732	810
2001	Reimbursable civilian full-time equivalent employment	5,914	6,146	6,143
2101	Reimbursable military average strength employment	893	661	664

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 2022, such sums as may be necessary; and, in addition, for fiscal year 2023, such sums as may be necessary, which shall become available on October 1, 2022 and shall remain available through September 30, 2023: 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, 2021.)


Identification code 075–0344–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Contract Support Costs	909	916	1,142

0900	Total new obligations, unexpired accounts (object class 41.0)	909	916	1,142

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	909	916	1,142
1900	Budget authority (total)	909	916	1,142
1930	Total budgetary resources available	909	916	1,142

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	60	130	7
3010	New obligations, unexpired accounts	909	916	1,142
3011	Obligations ("upward adjustments"), expired accounts	37
3020	Outlays (gross)	–839	–1,039	–1,142
3041	Recoveries of prior year unpaid obligations, expired	–37

3050	Unpaid obligations, end of year	130	7	7
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	60	130	7
3200	Obligated balance, end of year	130	7	7

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	909	916	1,142
	Outlays, gross:
4010	Outlays from new discretionary authority	812	916	1,142
4011	Outlays from discretionary balances	27	123

4020	Outlays, gross (total)	839	1,039	1,142
4180	Budget authority, net (total)	909	916	1,142
4190	Outlays, net (total)	839	1,039	1,142

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 $1.1 billion in contract support costs funds will be provided to tribal governments and tribal organizations in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Contract Support Costs account.

The FY 2022 Budget proposes reclassification of the appropriations for Contract Support Costs (CSCs) and Section 105(l) leases beginning in FY 2023. Specifically, the Budget proposes that, beginning in FY 2023, the IHS CSCs and Section 105(l) lease accounts will continue to be funded through the Appropriations process but will be reclassified as mandatory funding. The Budget is proposing analogous reclassifications for CSCs and Section 105(l) lease accounts within the Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE).

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 2022, such sums as may be necessary; and, in addition, for fiscal year 2023, such sums as may be necessary, which shall become available on October 1, 2022 and shall remain available through September 30, 2023: Provided, That notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer to another budget account.

(Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021.)


Identification code 075–0200–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Payments for Tribal Leases		101	150

0900	Total new obligations, unexpired accounts (object class 41.0)		101	150

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation		101	150
1900	Budget authority (total)		101	150
1930	Total budgetary resources available		101	150

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		101	150
3020	Outlays (gross)		–101	–150

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		101	150
	Outlays, gross:
4010	Outlays from new discretionary authority		101	150
4180	Budget authority, net (total)		101	150
4190	Outlays, net (total)		101	150

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 $150 million in lease funds will be provided to tribal governments and tribal organizations in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Payment for Tribal Leases account.

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, $1,500,943,000, to remain available until expended; and, in addition, $1,526,599,000, which shall become available on October 1, 2022, and 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 for each of fiscal years 2022 and 2023 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, 2021.)


Identification code 075–0391–0–1–551		2020 actual	2021 est.	2022 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Rent and Charges for Quarters, Indian Health Service	11	9	9

2000	Total: Balances and receipts	11	9	9
	Appropriations:
	Current law:
2101	Indian Health Facilities	–11	–9	–9

5099	Balance, end of year


Identification code 075–0391–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Maintenance	232	468	168
0002	Sanitation Facilities Construction	170	443	193
0003	Facilities and environmental health	254	259	259
0004	Equipment	83	74	24
0005	Health Care Facilities Construction	12	125	125

0100	Total direct program	751	1,369	769

0799	Total direct obligations	751	1,369	769
0801	Indian Health Facilities (Reimbursable)	43	57	57

0900	Total new obligations, unexpired accounts	794	1,426	826

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	630	944	1,105
1001	Discretionary unobligated balance brought fwd, Oct 1	617
1021	Recoveries of prior year unpaid obligations	14

1050	Unobligated balance (total)	644	944	1,105
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	912	918	1,501
1121	Appropriations transferred from other acct [075–0390]	125

1160	Appropriation, discretionary (total)	1,037	918	1,501
	Appropriations, mandatory:
1200	Appropriation (American Rescue Plan)		600
1201	Appropriation (special or trust fund)	11	9	9

1260	Appropriations, mandatory (total)	11	609	9
	Spending authority from offsetting collections, discretionary:
1700	Collected	46	60	59
1900	Budget authority (total)	1,094	1,587	1,569
1930	Total budgetary resources available	1,738	2,531	2,674
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	944	1,105	1,848

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	862	892	1,167
3010	New obligations, unexpired accounts	794	1,426	826
3020	Outlays (gross)	–750	–1,151	–1,394
3040	Recoveries of prior year unpaid obligations, unexpired	–14

3050	Unpaid obligations, end of year	892	1,167	599
	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	844	874	1,149
3200	Obligated balance, end of year	874	1,149	581

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,083	978	1,560
	Outlays, gross:
4010	Outlays from new discretionary authority	421	335	509
4011	Outlays from discretionary balances	319	627	636

4020	Outlays, gross (total)	740	962	1,145
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–46	–60	–59

4040	Offsets against gross budget authority and outlays (total)	–46	–60	–59
	Mandatory:
4090	Budget authority, gross	11	609	9
	Outlays, gross:
4100	Outlays from new mandatory authority	3	189	9
4101	Outlays from mandatory balances	7		240

4110	Outlays, gross (total)	10	189	249
4180	Budget authority, net (total)	1,048	1,527	1,510
4190	Outlays, net (total)	704	1,091	1,335

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. More than $585 million, primarily through self-determination contracts and compacts, will be administered by tribal governments in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Indian Health Facilities account.


Identification code 075–0391–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	55	56	56
11.3	Other than full-time permanent	3	3	3
11.5	Other personnel compensation	4	4	4
11.7	Military personnel	28	28	29

11.9	Total personnel compensation	90	91	92
12.1	Civilian personnel benefits	21	22	22
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	2	2	2
22.0	Transportation of things	4	4	4
23.1	Rental payments to GSA	1	4	4
23.3	Communications, utilities, and miscellaneous charges	13	13	13
25.1	Advisory and assistance services	3	3	3
25.2	Other services from non-Federal sources	174	178	178
25.3	Other goods and services from Federal sources	2	2	2
25.4	Operation and maintenance of facilities	10	310	10
25.7	Operation and maintenance of equipment	5	255	5
25.8	Subsistence and support of persons	2	2	2
26.0	Supplies and materials	7	7	7
31.0	Equipment	14	64	14
32.0	Land and structures	28	29	28
41.0	Grants, subsidies, and contributions	372	381	381
42.0	Insurance claims and indemnities	1

99.0	Direct obligations	751	1,369	769
99.0	Reimbursable obligations	43	57	57

99.9	Total new obligations, unexpired accounts	794	1,426	826


Identification code 075–0391–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	886	960	1,007
1101	Direct military average strength employment	216	203	208
2001	Reimbursable civilian full-time equivalent employment	46	46	46

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 such assessments or charges are identified in the budget justification and provided in this Act, or are notified to the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450 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 the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations.

(Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021.)

Federal Funds

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, $526,580,000.

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, $1,420,556,000.

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, $626,272,000: 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.

For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health promotion, $1,197,714,000: Provided, 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 of the funds made available under this heading, $15,000,000 shall be available to continue and expand community specific extension and outreach programs to combat obesity in counties with the highest levels of obesity: 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.

For carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, $172,810,000.

For carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics, and workforce development, $609,997,000: Provided, That in addition to amounts provided herein, $132,000,000 is available to this appropriation, for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act.

For carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $308,850,000: Provided, That of the amounts appropriated under this heading, up to $3,000,000 may remain available until expended for carrying out the Vessel Sanitation Program, to the extent that user fee collections are insufficient: Provided further, That, in addition to amounts provided herein, $7,000,000 is available to this appropriation, for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act.

For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $1,103,169,000.

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, $345,300,000.

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.

For carrying out titles II, III, and XVII of the PHS Act with respect to global health, $697,843,000, of which: (1) $128,421,000 shall remain available through September 30, 2023 for international HIV/AIDS; and (2) $303,200,000 shall remain available through September 30, 2024 for global public health protection: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.

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, $842,200,000.

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, $548,570,000, of which $400,000,000 shall remain available through September 30, 2023, for public health infrastructure and capacity: 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, $35,000,000, 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 further, That funds appropriated under this heading may be used to support a contract for the operation and maintenance of an aircraft in direct support of activities throughout CDC to ensure the agency is prepared to address public health preparedness emergencies: Provided further, That any amounts made available by this Act to the Centers for Disease Control and Prevention may be used for the salaries and expenses of any CDC employee or fellow responding to an emergency or other urgent public health crisis: 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, 2023.


Identification code 075–0943–0–1–999		2020 actual	2021 est.	2022 est.

0100	Balance, start of year			1
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, Centers for Disease Control	3	2	2

2000	Total: Balances and receipts	3	2	3
	Appropriations:
	Current law:
2101	CDC-wide Activities and Program Support	–3	–1	–1

5099	Balance, end of year		1	2


Identification code 075–0943–0–1–999		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (0958)	161	168	173
0002	CDC-Wide Activities and Program Support (0943)	4,303	274	674
0004	Chronic Disease Prevention and Health Promotion (0948)	1,285	1,277	1,453
0005	Emerging and Zoonotic Infectious Diseases (0949)	624	648	678
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)	51	51	51
0007	Environmental Health (0947)	224	223	326
0008	Global Health (0955)	583	593	698
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)	1,273	1,314	1,421
0013	Immunization and Respiratory Diseases (0951)	813	821	946
0015	Injury Prevention and Control (0952)	677	683	1,103
0016	Occupational Safety and Health (0953)	343	345	345
0019	Public Health Preparedness and Response (0956)	850	842	842
0020	Public Health Scientific Services (0959)	555	592	742
0021	Cooperative Research and Development Agreements (CRADA) (5146)	2	1
0024	CDC-Wide Activities and Program Support (User and Other Similar Fees)	74

0799	Total direct obligations	11,818	7,832	9,452
0802	CDC-Wide Activities and Program Support (Reimbursable)	197	653	653

0809	Reimbursable program activities, subtotal	197	653	653

0900	Total new obligations, unexpired accounts	12,015	8,485	10,105

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	306	3,157	22,582
1001	Discretionary unobligated balance brought fwd, Oct 1	172
1010	Unobligated balance transfer to other accts [075–0140]	–8
1011	Unobligated balance transfer from other acct [075–0945]	30
1021	Recoveries of prior year unpaid obligations	43
1033	Recoveries of prior year paid obligations	1

1050	Unobligated balance (total)	372	3,157	22,582
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	13,315	15,683	8,400
1120	Appropriations transferred to other acct [075–0390]		–210
1120	Appropriations transferred to other acct [075–4553]	–5
1120	Appropriations transferred to other acct [075–0945]	–685	–10	–35
1121	Appropriations transferred from other acct [075–0140]	1,000

1160	Appropriation, discretionary (total)	13,625	15,463	8,365
	Appropriations, mandatory:
1200	Appropriation (075–0954 - EEOICPA)	55	55	55
1200	Appropriation (075–0943 American Rescue Plan)		11,520
1201	Appropriation (075–5146 CRADA)	3	1	1
1221	Appropriations transferred from other acct PPHF [075–0116]	854	856	903
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–4	–4	–4

1260	Appropriations, mandatory (total)	908	12,428	955
	Spending authority from offsetting collections, discretionary:
1700	Collected	181	17	181
1701	Change in uncollected payments, Federal sources	90

1750	Spending auth from offsetting collections, disc (total)	271	17	181
	Spending authority from offsetting collections, mandatory:
1800	Collected	4	2	2
1900	Budget authority (total)	14,808	27,910	9,503
1930	Total budgetary resources available	15,180	31,067	32,085
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	3,157	22,582	21,980

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,672	10,154	5,560
3010	New obligations, unexpired accounts	12,015	8,485	10,105
3011	Obligations ("upward adjustments"), expired accounts	40
3020	Outlays (gross)	–8,370	–13,079	–15,665
3040	Recoveries of prior year unpaid obligations, unexpired	–43
3041	Recoveries of prior year unpaid obligations, expired	–160

3050	Unpaid obligations, end of year	10,154	5,560
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–108	–129	–129
3070	Change in uncollected pymts, Fed sources, unexpired	–90
3071	Change in uncollected pymts, Fed sources, expired	69

3090	Uncollected pymts, Fed sources, end of year	–129	–129	–129
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,564	10,025	5,431
3200	Obligated balance, end of year	10,025	5,431	–129

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	13,896	15,480	8,546
	Outlays, gross:
4010	Outlays from new discretionary authority	3,484	3,843	2,303
4011	Outlays from discretionary balances	4,022	5,565	7,581

4020	Outlays, gross (total)	7,506	9,408	9,884
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–237	–17	–181
4033	Non-Federal sources	–12

4040	Offsets against gross budget authority and outlays (total)	–249	–17	–181
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–90
4052	Offsetting collections credited to expired accounts	68

4060	Additional offsets against budget authority only (total)	–22

4070	Budget authority, net (discretionary)	13,625	15,463	8,365
4080	Outlays, net (discretionary)	7,257	9,391	9,703
	Mandatory:
4090	Budget authority, gross	912	12,430	957
	Outlays, gross:
4100	Outlays from new mandatory authority	131	2,978	223
4101	Outlays from mandatory balances	733	693	5,558

4110	Outlays, gross (total)	864	3,671	5,781
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–5	–2	–2
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	1

4160	Budget authority, net (mandatory)	908	12,428	955
4170	Outlays, net (mandatory)	859	3,669	5,779
4180	Budget authority, net (total)	14,533	27,891	9,320
4190	Outlays, net (total)	8,116	13,060	15,482

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 2022 Budget includes $400 million for new, dedicated funding to invest in public health infrastructure and capacity, and an additional $183 million to support a range of violence prevention and research activities. The FY 2022 Budget also provides $275 million for CDC to undertake the third year of the Ending the HIV Epidemic in the U.S. initative, and an additional $100 million to continue CDC's Public Health Data Modernization efforts. The FY 2022 Budget provides an additional $100 million for global public health protection 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.


Identification code 075–0943–0–1–999		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	830	459	523
11.3	Other than full-time permanent	108	60	66
11.5	Other personnel compensation	45	37	40
11.7	Military personnel	71	56	62
11.8	Special personal services payments	5	3	3

11.9	Total personnel compensation	1,059	615	694
12.1	Civilian personnel benefits	324	192	200
12.2	Military personnel benefits	57	20	20
13.0	Benefits for former personnel	3
21.0	Travel and transportation of persons	76	26	28
22.0	Transportation of things	11	4	5
23.1	Rental payments to GSA	37	3	3
23.2	Rental payments to others	2	1	1
23.3	Communications, utilities, and miscellaneous charges	22	3	3
24.0	Printing and reproduction	3	1	2
25.1	Advisory and assistance services	816	867	1,317
25.2	Other services from non-Federal sources	274	45	65
25.3	Other goods and services from Federal sources	440	906	1,342
25.4	Operation and maintenance of facilities	61	12	18
25.5	Research and development contracts	35	39	61
25.6	Medical care	26	2	3
25.7	Operation and maintenance of equipment	81	28	43
25.8	Subsistence and support of persons	4
26.0	Supplies and materials	3,271	149	200
31.0	Equipment	74	41	44
32.0	Land and structures	122	14	14
41.0	Grants, subsidies, and contributions	4,778	4,862	5,387
42.0	Insurance claims and indemnities	242	2	2

99.0	Direct obligations	11,818	7,832	9,452
99.0	Reimbursable obligations	197	653	653

99.9	Total new obligations, unexpired accounts	12,015	8,485	10,105


Identification code 075–0943–0–1–999		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	8,836	10,575	11,135
1101	Direct military average strength employment	776	783	783
2001	Reimbursable civilian full-time equivalent employment	325
2101	Reimbursable military average strength employment	28

The Budget includes a request for a total of $2.5 billion mandatory funding to support a Community Violence Intervention initiative at CDC, beginning in FY 2023 and continuing through FY 2029. This complements a similar investment in the Department of Justice for a government-wide total of $5 billion from FYs 2023–2029.

For any cost related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities, $55,000,000, which shall remain available until September 30, 2026: Provided, That funds made available to this account in this or any prior Act 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, provided that any improvements that are not adjacent to federally owned property do not exceed $2,500,000, and that the primary benefit of such improvements accrues to CDC: Provided further, That funds previously set-aside by CDC for repair and upgrade of the Lake Lynn Experimental Mine and Laboratory shall be used to acquire a replacement mine safety research facility: Provided further, That in addition, the prior year unobligated balance of any amounts assigned to former employees in accounts of CDC made available for Individual Learning Accounts shall be credited to and merged with the amounts made available under this heading to support the replacement of the mine safety research facility.


Identification code 075–0960–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	CDC Buildings and Facilities (0960)	33	30	55

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	384	376	376
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	29	30	55
1131	Unobligated balance of appropriations permanently reduced	–4

1160	Appropriation, discretionary (total)	25	30	55
1930	Total budgetary resources available	409	406	431
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	376	376	376

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	145	59
3010	New obligations, unexpired accounts	33	30	55
3020	Outlays (gross)	–119	–89	–39

3050	Unpaid obligations, end of year	59		16
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	145	59
3200	Obligated balance, end of year	59		16

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	25	30	55
	Outlays, gross:
4010	Outlays from new discretionary authority	1	12	21
4011	Outlays from discretionary balances	118	77	18

4020	Outlays, gross (total)	119	89	39
4180	Budget authority, net (total)	25	30	55
4190	Outlays, net (total)	119	89	39


Identification code 075–0960–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
25.1	Advisory and assistance services	1	1	1
25.4	Operation and maintenance of facilities	6	6	6
31.0	Equipment	1	1	1
32.0	Land and structures	25	22	47

99.9	Total new obligations, unexpired accounts	33	30	55


Identification code 075–4553–0–4–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0801	CDC Working Capital Fund (Reimbursable)	655	569	569

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	54	126	225
1021	Recoveries of prior year unpaid obligations	13

1050	Unobligated balance (total)	67	126	225
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–0943]	5
	Spending authority from offsetting collections, discretionary:
1700	Collected	709	668	532
1900	Budget authority (total)	714	668	532
1930	Total budgetary resources available	781	794	757
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	126	225	188

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	209	240	164
3010	New obligations, unexpired accounts	655	569	569
3020	Outlays (gross)	–611	–645	–575
3040	Recoveries of prior year unpaid obligations, unexpired	–13

3050	Unpaid obligations, end of year	240	164	158
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2	–2	–2

3090	Uncollected pymts, Fed sources, end of year	–2	–2	–2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	207	238	162
3200	Obligated balance, end of year	238	162	156

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	714	668	532
	Outlays, gross:
4010	Outlays from new discretionary authority	442	441	351
4011	Outlays from discretionary balances	169	204	224

4020	Outlays, gross (total)	611	645	575
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–709	–668	–532
4180	Budget authority, net (total)	5
4190	Outlays, net (total)	–98	–23	43

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.


Identification code 075–4553–0–4–551		2020 actual	2021 est.	2022 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	155	155	155
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	5	5	5
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	168	168	168
12.1	Civilian personnel benefits	56	56	56
12.2	Military personnel benefits	1	1	1
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	33	33	33
23.3	Communications, utilities, and miscellaneous charges	22	22	22
25.1	Advisory and assistance services	50	45	45
25.2	Other services from non-Federal sources	88	55	55
25.3	Other goods and services from Federal sources	90	55	55
25.4	Operation and maintenance of facilities	78	65	65
25.7	Operation and maintenance of equipment	45	45	45
26.0	Supplies and materials	1	1	1
31.0	Equipment	15	15	15
32.0	Land and structures	7	7	7

99.9	Total new obligations, unexpired accounts	655	569	569


Identification code 075–4553–0–4–551		2020 actual	2021 est.	2022 est.

2001	Reimbursable civilian full-time equivalent employment	1,498	1,498	1,498
2101	Reimbursable military average strength employment	30	30	30


Identification code 075–0945–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Direct program activity	104	10	35

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	50	601	601
1010	Unobligated balance transfer to other accts [075–0943]	–30

1050	Unobligated balance (total)	20	601	601
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–0943]	685	10	35
1930	Total budgetary resources available	705	611	636
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	601	601	601

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		37	6
3010	New obligations, unexpired accounts	104	10	35
3020	Outlays (gross)	–67	–41	–26

3050	Unpaid obligations, end of year	37	6	15
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		37	6
3200	Obligated balance, end of year	37	6	15

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	685	10	35
	Outlays, gross:
4010	Outlays from new discretionary authority	55	6	22
4011	Outlays from discretionary balances	12	35	4

4020	Outlays, gross (total)	67	41	26
4180	Budget authority, net (total)	685	10	35
4190	Outlays, net (total)	67	41	26

The FY 2022 Budget provides $35 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.


Identification code 075–0945–0–1–551		2020 actual	2021 est.	2022 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent	1

11.9	Total personnel compensation	1
12.1	Civilian personnel benefits	1
21.0	Travel and transportation of persons	4	3	3
23.2	Rental payments to others	1	1	1
25.1	Advisory and assistance services	57	5	30
25.2	Other services from non-Federal sources	1	1	1
25.3	Other goods and services from Federal sources	33
25.7	Operation and maintenance of equipment	1
26.0	Supplies and materials	3
31.0	Equipment	2

99.9	Total new obligations, unexpired accounts	104	10	35


Identification code 075–0945–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	17
1101	Direct military average strength employment	2

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, $81,750,000: 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 2022, and existing profiles may be updated as necessary.

(Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021.)


Identification code 075–0944–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Agency for Toxic Substances and Disease Registry, Toxic Substance (Direct)	102	78	82
0801	Agency for Toxic Substances and Disease Registry, Toxic Substance (Reimbursable)	2	15

0900	Total new obligations, unexpired accounts	104	93	82

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	17	33	19
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	89	78	82
1121	Appropriations transferred from other acct [097–0100]	10

1160	Appropriation, discretionary (total)	99	78	82
	Appropriations, mandatory:
1200	Appropriation	20
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–1

1260	Appropriations, mandatory (total)	19
	Spending authority from offsetting collections, discretionary:
1700	Collected	2
1701	Change in uncollected payments, Federal sources		1

1750	Spending auth from offsetting collections, disc (total)	2	1
1900	Budget authority (total)	120	79	82
1930	Total budgetary resources available	137	112	101
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	33	19	19

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	70	79	57
3010	New obligations, unexpired accounts	104	93	82
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–96	–115	–77
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	79	57	62
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–12	–7	–8
3070	Change in uncollected pymts, Fed sources, unexpired		–1
3071	Change in uncollected pymts, Fed sources, expired	5

3090	Uncollected pymts, Fed sources, end of year	–7	–8	–8
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	58	72	49
3200	Obligated balance, end of year	72	49	54

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	101	79	82
	Outlays, gross:
4010	Outlays from new discretionary authority	51	52	53
4011	Outlays from discretionary balances	42	63	24

4020	Outlays, gross (total)	93	115	77
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–9

4040	Offsets against gross budget authority and outlays (total)	–9
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired		–1
4052	Offsetting collections credited to expired accounts	7

4060	Additional offsets against budget authority only (total)	7	–1

4070	Budget authority, net (discretionary)	99	78	82
4080	Outlays, net (discretionary)	84	115	77
	Mandatory:
4090	Budget authority, gross	19
	Outlays, gross:
4101	Outlays from mandatory balances	3
4180	Budget authority, net (total)	118	78	82
4190	Outlays, net (total)	87	115	77


Identification code 075–0944–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	23	22	22
11.3	Other than full-time permanent	1	2	2
11.5	Other personnel compensation		1	1
11.7	Military personnel	4	3	3

11.9	Total personnel compensation	28	28	28
12.1	Civilian personnel benefits	8	8	8
12.2	Military personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
25.1	Advisory and assistance services	16	5	5
25.2	Other services from non-Federal sources	3	4	4
25.3	Other goods and services from Federal sources	14	7	7
25.7	Operation and maintenance of equipment		1	1
26.0	Supplies and materials		1	1
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	30	21	25

99.0	Direct obligations	102	78	82
99.0	Reimbursable obligations	2	15

99.9	Total new obligations, unexpired accounts	104	93	82


Identification code 075–0944–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	221	198	198
1101	Direct military average strength employment	34	31	31
2001	Reimbursable civilian full-time equivalent employment	23
2101	Reimbursable military average strength employment	4


Identification code 075–0946–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	World Trade Center Health Program—Federal Share (CDC/NIOSH)	473	551	641
0002	World Trade Center Health Program—NYC	53	61	71

0900	Total new obligations, unexpired accounts	526	612	712

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	798	928	873
1012	Unobligated balance transfers between expired and unexpired accounts	1
1021	Recoveries of prior year unpaid obligations	91
1033	Recoveries of prior year paid obligations	25

1050	Unobligated balance (total)	915	928	873
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	489	501	518
1200	Appropriation (WTC—NYC DHSS—CDC)		56	58

1260	Appropriations, mandatory (total)	489	557	576
	Spending authority from offsetting collections, mandatory:
1800	Collected	50
1900	Budget authority (total)	539	557	576
1930	Total budgetary resources available	1,454	1,485	1,449
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	928	873	737

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	326	256	351
3010	New obligations, unexpired accounts	526	612	712
3020	Outlays (gross)	–505	–517	–441
3040	Recoveries of prior year unpaid obligations, unexpired	–91

3050	Unpaid obligations, end of year	256	351	622
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	326	256	351
3200	Obligated balance, end of year	256	351	622

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	539	557	576
	Outlays, gross:
4100	Outlays from new mandatory authority		256	265
4101	Outlays from mandatory balances	505	261	176

4110	Outlays, gross (total)	505	517	441
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–75
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	25

4160	Budget authority, net (mandatory)	489	557	576
4170	Outlays, net (mandatory)	430	517	441
4180	Budget authority, net (total)	489	557	576
4190	Outlays, net (total)	430	517	441

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 2021 and 2022 in the Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 075–0946–0–1–551		2020 actual	2021 est.	2022 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	336	422	522

99.9	Total new obligations, unexpired accounts	526	612	712


Identification code 075–0946–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	40	47	47
1101	Direct military average strength employment	8	8	8

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $6,539,302,000, 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.

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, $3,845,681,000.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $516,197,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $2,219,298,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $2,707,300,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $6,245,926,000.

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $3,096,103,000, of which $1,271,505,000 shall be from funds available under section 241 of the PHS Act: Provided, That not less than $410,453,000 is provided for the Institutional Development Awards program.

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,942,117,000.

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $858,535,000.

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $937,107,000.

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, $83,540,000.

(Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021.)

For carrying out section 301 and title IV of the PHS Act with respect to aging, $4,035,591,000.

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $680,186,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $511,792,000.

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $199,755,000.

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $570,165,000.

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $1,852,503,000.

For carrying out section 301 and title IV of the PHS Act with respect to mental health, $2,137,574,000.

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $632,973,000.

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $422,039,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $184,323,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $652,244,000.

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), $96,322,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $474,864,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2023: Provided further, That in fiscal year 2022, 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").

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $878,957,000: 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.

For carrying out the responsibilities of the Office of the Director, NIH, $2,237,259,000: 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 $645,939,000 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 up to $30,000,000 shall be used to carry out section 404I of the PHS Act (42 U.S.C. 283k) with respect to the National Primate Research Centers and Caribbean Primate Research Center: Provided further, That $5,000,000 shall be transferred to and merged with the appropriation for the "Office of Inspector General" for oversight of grant programs and operations of the NIH, including agency efforts to ensure the integrity of its grant application evaluation and selection processes, and shall be in addition to funds otherwise made available for oversight of the NIH: Provided further, That the funds provided in the previous proviso may be transferred from one specified activity to another with 15 days prior notification to the Committees on Appropriations of the House of Representatives and the Senate: Provided further, That the Inspector General shall consult with the Committees on Appropriations of the House of Representatives and the Senate before submitting to the Committees an audit plan for fiscal years 2022 and 2023 no later than 30 days after the date of enactment of this 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 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, of which $3,000,000 shall be derived from the 10-year Pediatric Research Initiative Fund described in section 9008 of title 26, United States Code.

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, $250,000,000, to remain available through September 30, 2026.

For carrying out section 301 and title IV of the PHS Act with respect to advanced research projects for health, $6,500,000,000, to remain available through September 30, 2024.


Identification code 075–9915–0–1–552		2020 actual	2021 est.	2022 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, NIH	56	72	72

2000	Total: Balances and receipts	56	72	72
	Appropriations:
	Current law:
2101	National Institutes of Health	–56	–72	–72

5099	Balance, end of year


Identification code 075–9915–0–1–552		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	6,499	6,980	6,733
0002	National Heart, Lung, and Blood Institute (0872)	3,678	3,715	3,846
0003	National Institute of Dental and Craniofacial Research (0873)	478	485	516
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	2,115	2,132	2,219
0005	National Institute of Neurological Disorders and Stroke (0886)	2,443	2,517	2,783
0006	National Institute of Allergy and Infectious Diseases (0885)	6,598	6,899	6,246
0007	National Institute of General Medical Sciences (0851)	1,706	1,720	1,825
0008	National Institute of Child Health and Human Development (0844)	1,557	1,593	1,942
0009	National Eye Institute (0887)	823	836	859
0010	National Institute of Environmental Health Sciences (0862)	890	900	1,021
0011	National Institute on Aging (0843)	3,546	3,900	4,035
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	625	634	680
0013	National Institute on Deafness and Other Communication Disorder (0890)	491	498	512
0014	National Institute of Mental Health (0892)	2,045	2,108	2,214
0015	National Institute on Drug Abuse (0893)	1,458	1,480	1,853
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	547	555	570
0017	National Institute of Nursing Research (0889)	172	175	200
0018	National Human Genome Research Institute (0891)	604	616	633
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	764	612	422
0021	National Center for Complementary and Integrative Health (0896)	152	154	184
0022	National Institute on Minority Health and Health Disparities (0897)	336	392	652
0023	John E. Fogarty International Center (0819)	81	84	96
0024	National Library of Medicine (0807)	462	466	475
0025	NIH Office of the Director (0846)	2,538	4,409	2,250
0026	NIH Buildings and facilities (0838)	109	200	250
0027	NIH Cooperative Research and Development Agreements	43	72	72
0028	National Center for Advancing Translational Sciences (0875)	855	870	879
0029	Advanced Research Projects Agency for Health			6,500
0031	Type 1 Diabetes	106	395	141

0799	Total direct obligations	41,721	45,397	50,608
0801	NIH Reimbursable - Other	5,025	5,286	5,458
0802	NIH Royalties	116	116	116

0809	Reimbursable program activities, subtotal	5,141	5,402	5,574

0899	Total reimbursable obligations	5,141	5,402	5,574

0900	Total new obligations, unexpired accounts	46,862	50,799	56,182

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,144	3,304	784
1001	Discretionary unobligated balance brought fwd, Oct 1	846
1010	Unobligated balance transfer to other accts [075–0140]	–32
1021	Recoveries of prior year unpaid obligations	77
1033	Recoveries of prior year paid obligations	2

1050	Unobligated balance (total)	1,191	3,304	784
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	41,586	42,352	50,046
1120	Appropriations transferred to other acct [075–0128]	–5	–5
1121	Appropriations transferred from other acct [075–5628]	335	295	346
1121	Appropriations transferred from other acct [075–5736]	13	13	3
1121	Appropriations transferred from other acct [075–0140]	1,806

1160	Appropriation, discretionary (total)	43,735	42,655	50,395
	Appropriations, mandatory:
1200	Appropriation	150	150	150
1201	Appropriation (special or trust fund)	56	72	72
1230	Appropriations and/or unobligated balance of appropriations permanently reduced			–9

1260	Appropriations, mandatory (total)	206	222	213
	Spending authority from offsetting collections, discretionary:
1700	Collected	4,617	5,402	5,574
1701	Change in uncollected payments, Federal sources	424

1750	Spending auth from offsetting collections, disc (total)	5,041	5,402	5,574
	Spending authority from offsetting collections, mandatory:
1800	Collected	2
1900	Budget authority (total)	48,984	48,279	56,182
1930	Total budgetary resources available	50,175	51,583	56,966
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–9
1941	Unexpired unobligated balance, end of year	3,304	784	784

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	40,481	46,469	51,153
3010	New obligations, unexpired accounts	46,862	50,799	56,182
3011	Obligations ("upward adjustments"), expired accounts	300
3020	Outlays (gross)	–40,498	–46,115	–50,119
3040	Recoveries of prior year unpaid obligations, unexpired	–77
3041	Recoveries of prior year unpaid obligations, expired	–599

3050	Unpaid obligations, end of year	46,469	51,153	57,216
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–650	–969	–969
3070	Change in uncollected pymts, Fed sources, unexpired	–424
3071	Change in uncollected pymts, Fed sources, expired	105

3090	Uncollected pymts, Fed sources, end of year	–969	–969	–969
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	39,831	45,500	50,184
3200	Obligated balance, end of year	45,500	50,184	56,247

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	48,776	48,057	55,969
	Outlays, gross:
4010	Outlays from new discretionary authority	13,041	13,442	15,146
4011	Outlays from discretionary balances	27,283	32,512	34,773

4020	Outlays, gross (total)	40,324	45,954	49,919
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–4,411	–5,402	–5,574
4033	Non-Federal sources	–324

4040	Offsets against gross budget authority and outlays (total)	–4,735	–5,402	–5,574
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–424
4052	Offsetting collections credited to expired accounts	116
4053	Recoveries of prior year paid obligations, unexpired accounts	2

4060	Additional offsets against budget authority only (total)	–306

4070	Budget authority, net (discretionary)	43,735	42,655	50,395
4080	Outlays, net (discretionary)	35,589	40,552	44,345
	Mandatory:
4090	Budget authority, gross	208	222	213
	Outlays, gross:
4100	Outlays from new mandatory authority	16	26	28
4101	Outlays from mandatory balances	158	135	172

4110	Outlays, gross (total)	174	161	200
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–2
4180	Budget authority, net (total)	43,941	42,877	50,608
4190	Outlays, net (total)	35,761	40,713	44,545

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 2022 Budget creates a new Advanced Research Projects Agency for Health within the National Institutes of Health. With an initial focus on cancer and other diseases such as diabetes and Alzheimer's, ARPA-H would drive transformational innovation in health research and speed application and implementation of health breakthroughs.


Identification code 075–9915–0–1–552		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	1,067	1,121	1,184
11.3	Other than full-time permanent	548	568	588
11.5	Other personnel compensation	56	58	60
11.7	Military personnel	17	17	18
11.8	Special personal services payments	206	213	218

11.9	Total personnel compensation	1,894	1,977	2,068
12.1	Civilian personnel benefits	593	642	691
12.2	Military personnel benefits	13	14	14
21.0	Travel and transportation of persons	27	21	22
22.0	Transportation of things	7	8	7
23.1	Rental payments to GSA	25	26	25
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	25	26	26
25.1	Advisory and assistance services	1,332	1,423	1,454
25.2	Other services from non-Federal sources	1,772	1,668	1,509
25.3	Other goods and services from Federal sources	2,978	3,206	3,198
25.4	Operation and maintenance of facilities	70	68	69
25.5	Research and development contracts	1,838	2,135	1,639
25.6	Medical care	39	43	39
25.7	Operation and maintenance of equipment	166	164	166
26.0	Supplies and materials	253	264	237
31.0	Equipment	231	261	285
32.0	Land and structures	123	216	217
41.0	Grants, subsidies, and contributions	30,334	33,234	38,941

99.0	Direct obligations	41,721	45,397	50,608
99.0	Reimbursable obligations	5,141	5,402	5,574

99.9	Total new obligations, unexpired accounts	46,862	50,799	56,182


Identification code 075–9915–0–1–552		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	12,588	13,854	14,314
1101	Direct military average strength employment	147	147	150
2001	Reimbursable civilian full-time equivalent employment	4,724	4,692	4,747
2101	Reimbursable military average strength employment	95	88	88


Identification code 075–0147–0–1–552		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Payment to NIH Innovation (object class 94.0)	492	404	496

0900	Total new obligations, unexpired accounts (object class 94.0)	492	404	496

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	492	404	496
1930	Total budgetary resources available	492	404	496

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	492	404	496
3020	Outlays (gross)	–492	–404	–496

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	492	404	496
	Outlays, gross:
4100	Outlays from new mandatory authority	492	404	496
4180	Budget authority, net (total)	492	404	496
4190	Outlays, net (total)	492	404	496

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

For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition to amounts available for such purposes in the appropriations provided to the NIH in this Act, $496,000,000, 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.


Identification code 075–5628–0–2–552		2020 actual	2021 est.	2022 est.

0100	Balance, start of year
	Receipts:
	Current law:
1140	General Fund Payment, NIH Innovation, CURES Act	492	404	496

2000	Total: Balances and receipts	492	404	496
	Appropriations:
	Current law:
2101	NIH Innovation, Cures Act	–492	–404	–496

5099	Balance, end of year


Identification code 075–5628–0–2–552		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	CURES obligations	153	172	150

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	59	63
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	492	404	496
1120	Appropriations transferred to other acct [075–9915]	–335	–295	–346

1160	Appropriation, discretionary (total)	157	109	150
1930	Total budgetary resources available	216	172	150
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	63

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	226	245	246
3010	New obligations, unexpired accounts	153	172	150
3020	Outlays (gross)	–134	–171	–172

3050	Unpaid obligations, end of year	245	246	224
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	226	245	246
3200	Obligated balance, end of year	245	246	224

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	157	109	150
	Outlays, gross:
4010	Outlays from new discretionary authority	18	19	28
4011	Outlays from discretionary balances	116	152	144

4020	Outlays, gross (total)	134	171	172
4180	Budget authority, net (total)	157	109	150
4190	Outlays, net (total)	134	171	172

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.


Identification code 075–5628–0–2–552		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	7
11.3	Other than full-time permanent	1

11.9	Total personnel compensation	8
12.1	Civilian personnel benefits	3
25.3	Other goods and services from Federal sources	7	6	6
25.5	Research and development contracts		6
41.0	Grants, subsidies, and contributions	135	160	144

99.9	Total new obligations, unexpired accounts	153	172	150


Identification code 075–5628–0–2–552		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	64
1101	Direct military average strength employment	1


Identification code 075–5736–0–2–552		2020 actual	2021 est.	2022 est.

0100	Balance, start of year	28	17	4
0198	Reconciliation adjustment	1

0199	Balance, start of year	29	17	4
	Receipts:
	Current law:
1140	Transfers from Presidential Election Campaign Fund	1

2000	Total: Balances and receipts	30	17	4
	Appropriations:
	Current law:
2101	10-Year Pediatric Research Initiative Fund	–13	–13	–3

5099	Balance, end of year	17	4	1


Identification code 075–5736–0–2–552		2020 actual	2021 est.	2022 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	13	13	3
1120	Appropriations transferred to other accts [075–9915]	–13	–13	–3
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.

Federal Funds

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, $2,903,489,000: Provided further, 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 of the funds made available under this heading for subpart I of part B of title XIX of the PHS Act, $75,000,000 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 section 520E(b)(2) of the PHS Act shall not apply to funds appropriated in this Act for fiscal year 2022: Provided further, That $375,000,000 shall be available until September 30, 2024 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, $21,420,000 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).

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, $6,327,743,000: Provided, That $2,250,000,000 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 $75,000,000 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, the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000 to supplement funds otherwise available for substance abuse treatment activities 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; and (2) $2,000,000 to evaluate substance abuse treatment programs: Provided further, That each State that receives funds appropriated under this heading in this Act for carrying out subpart II of part B of title XIX of the PHS Act shall expend not less than 10 percent of such funds for recovery support services: 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.

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $216,667,000.

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, $138,945,000: Provided, That in addition to amounts provided herein, $31,428,000 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, 2023: 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".


Identification code 075–1362–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0006	Mental Health	1,671	1,759	2,903
0007	Substance Abuse Treatment	3,756	3,773	6,328
0008	Substance Abuse Prevention	206	208	217
0009	Health Surveillance and Program Support	651	4,378	139
0011	SAMHSA Prevention Fund	12	12	12

0100	Total, direct program	6,296	10,130	9,599

0799	Total direct obligations	6,296	10,130	9,599
0802	SAMHSA Reimbursables	307	269	269
0810	SAMHSA Reimbursable: PHS Evaluation	134	134	134

0899	Total reimbursable obligations	441	403	403

0900	Total new obligations, unexpired accounts	6,737	10,533	10,002

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	131	7	3,569
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	133	7	3,569
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,162	10,120	9,587
	Appropriations, mandatory:
1200	Appropriation		3,560
1221	Appropriations transferred from the Prevention and Public Health Fund [075–0116]	12	12	12

1260	Appropriations, mandatory (total)	12	3,572	12
	Spending authority from offsetting collections, discretionary:
1700	Collected	70	403	173
1701	Change in uncollected payments, Federal sources	372

1750	Spending auth from offsetting collections, disc (total)	442	403	173
1900	Budget authority (total)	6,616	14,095	9,772
1930	Total budgetary resources available	6,749	14,102	13,341
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–5
1941	Unexpired unobligated balance, end of year	7	3,569	3,339

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,308	8,569	11,983
3010	New obligations, unexpired accounts	6,737	10,533	10,002
3011	Obligations ("upward adjustments"), expired accounts	65
3020	Outlays (gross)	–5,376	–7,119	–9,824
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–163

3050	Unpaid obligations, end of year	8,569	11,983	12,161
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–187	–449	–449
3070	Change in uncollected pymts, Fed sources, unexpired	–372
3071	Change in uncollected pymts, Fed sources, expired	110

3090	Uncollected pymts, Fed sources, end of year	–449	–449	–449
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,121	8,120	11,534
3200	Obligated balance, end of year	8,120	11,534	11,712

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,604	10,523	9,760
	Outlays, gross:
4010	Outlays from new discretionary authority	947	1,960	3,015
4011	Outlays from discretionary balances	4,416	5,064	6,079

4020	Outlays, gross (total)	5,363	7,024	9,094
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–170	–401	–171
4033	Non-Federal sources		–2	–2

4040	Offsets against gross budget authority and outlays (total)	–170	–403	–173
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–372
4052	Offsetting collections credited to expired accounts	100

4060	Additional offsets against budget authority only (total)	–272

4070	Budget authority, net (discretionary)	6,162	10,120	9,587
4080	Outlays, net (discretionary)	5,193	6,621	8,921
	Mandatory:
4090	Budget authority, gross	12	3,572	12
	Outlays, gross:
4100	Outlays from new mandatory authority	2	87	4
4101	Outlays from mandatory balances	11	8	726

4110	Outlays, gross (total)	13	95	730
4180	Budget authority, net (total)	6,174	13,692	9,599
4190	Outlays, net (total)	5,206	6,716	9,651

This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective substance misuse 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 misuse and mental illness on America's communities.


Identification code 075–1362–0–1–551		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	48	49	49
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	3	4

11.9	Total personnel compensation	54	55	56
12.1	Civilian personnel benefits	15	16	16
12.2	Military personnel benefits	1	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	35	36	37
25.2	Other services from non-Federal sources	70	94	92
25.3	Other goods and services from Federal sources	21	33	34
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	6,090	9,884	9,352

99.0	Direct obligations	6,296	10,130	9,599
99.0	Reimbursable obligations	441	403	403

99.9	Total new obligations, unexpired accounts	6,737	10,533	10,002


Identification code 075–1362–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	319	353	475
1101	Direct military average strength employment	33	31	40
2001	Reimbursable civilian full-time equivalent employment	100	100	100

Federal Funds

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, $353,000,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2022: Provided further, That, in addition to amounts provided herein, $27,000,000 shall be available to this appropriation, for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act: 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 September 30, 2023.


Identification code 075–1700–0–1–552		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Research on Health Costs, Quality and Outcomes	197	195	210
0002	Medical Expenditure Panel Survey	70	72	72
0003	AHRQ Program Support	71	71	71

0799	Total direct obligations	338	338	353
0803	Research on Health Costs, Quality and Outcomes (Reimbursable)	16	16	41
0804	Medical Expenditure Panel Survey (Reimbursable)	11	11	11
0805	AHRQ Program Support (Reimbursable)			2

0899	Total reimbursable obligations	27	27	54

0900	Total new obligations, unexpired accounts	365	365	407

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	16	14	12
1001	Discretionary unobligated balance brought fwd, Oct 1	8
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	338	338	353
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	3	27
1701	Change in uncollected payments, Federal sources	16	16	16

1750	Spending auth from offsetting collections, disc (total)	19	19	43
	Spending authority from offsetting collections, mandatory:
1800	Collected	6	6
1900	Budget authority (total)	363	363	396
1930	Total budgetary resources available	379	377	408
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	14	12	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	344	340	375
3010	New obligations, unexpired accounts	365	365	407
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–357	–330	–387
3041	Recoveries of prior year unpaid obligations, expired	–13

3050	Unpaid obligations, end of year	340	375	395
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–28	–28	–28
3070	Change in uncollected pymts, Fed sources, unexpired	–16	–16	–16
3071	Change in uncollected pymts, Fed sources, expired	16	16	16

3090	Uncollected pymts, Fed sources, end of year	–28	–28	–28
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	316	312	347
3200	Obligated balance, end of year	312	347	367

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	357	357	396
	Outlays, gross:
4010	Outlays from new discretionary authority	124	137	167
4011	Outlays from discretionary balances	224	187	220

4020	Outlays, gross (total)	348	324	387
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–18	–18	–27
4030	Federal sources			–16

4040	Offsets against gross budget authority and outlays (total)	–18	–18	–43
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–16	–16	–16
4052	Offsetting collections credited to expired accounts	15	15	16

4060	Additional offsets against budget authority only (total)	–1	–1

4070	Budget authority, net (discretionary)	338	338	353
4080	Outlays, net (discretionary)	330	306	344
	Mandatory:
4090	Budget authority, gross	6	6
	Outlays, gross:
4100	Outlays from new mandatory authority		6
4101	Outlays from mandatory balances	9

4110	Outlays, gross (total)	9	6
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–6	–6
4180	Budget authority, net (total)	338	338	353
4190	Outlays, net (total)	333	306	344

AHRQ's mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.


Identification code 075–1700–0–1–552		2020 actual	2021 est.	2022 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	30	33	30
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	1		1
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	36	38	36
12.1	Civilian personnel benefits	11	11	11
23.1	Rental payments to GSA	3	3	3
25.2	Other services from non-Federal sources	10	10	10
25.3	Other goods and services from Federal sources	25	18	20
25.5	Research and development contracts	135	139	154
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	117	118	118

99.0	Direct obligations	338	338	353
99.0	Reimbursable obligations	27	27	54

99.9	Total new obligations, unexpired accounts	365	365	407


Identification code 075–1700–0–1–552		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	245	264	270
1101	Direct military average strength employment	4	6	6
2001	Reimbursable civilian full-time equivalent employment	2	1	1
3001	Allocation account civilian full-time equivalent employment	5	8	20

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $368,666,106,000, to remain available until expended.

In addition, for carrying out such titles after May 31, 2022, for the last quarter of fiscal year 2022 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 2023, $165,722,018,000, 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.


Identification code 075–0512–0–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments	490,831	538,883	536,237
0

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

(INCLUDING TRANSFERS OF FUNDS)

BUILDINGS AND FACILITIES

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

FDA Working Capital Fund

Payment to the FDA Innovation Account, CURES Act

FDA INNOVATION ACCOUNT, CURES ACT

(INCLUDING TRANSFER OF FUNDS)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

PRIMARY HEALTH CARE

HEALTH WORKFORCE

MATERNAL AND CHILD HEALTH

RYAN WHITE HIV/AIDS PROGRAM

HEALTH CARE SYSTEMS

RURAL HEALTH

FAMILY PLANNING

PROGRAM MANAGEMENT

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Health Center Guaranteed Loan Financing Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Indian Health Service

Federal Funds

Indian Health Services

CONTRACT SUPPORT COSTS

Contract Support Costs

(Legislative proposal, not subject to PAYGO)

PAYMENTS FOR TRIBAL LEASES

Payments for Tribal Leases

(Legislative proposal, not subject to PAYGO)

INDIAN HEALTH FACILITIES

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

Centers for Disease Control and Prevention

Federal Funds

IMMUNIZATION AND RESPIRATORY DISEASES

HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS PREVENTION

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

PUBLIC HEALTH SCIENTIFIC SERVICES

ENVIRONMENTAL HEALTH

INJURY PREVENTION AND CONTROL

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

GLOBAL HEALTH

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

(INCLUDING TRANSFER OF FUNDS)

CDC-wide Activities and Program Support

(Legislative proposal, subject to PAYGO)

BUILDINGS AND FACILITIES

(INCLUDING TRANSFER OF FUNDS)

CDC Working Capital Fund

Infectious Diseases Rapid Response Reserve Fund

TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

NATIONAL CANCER INSTITUTE

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

NATIONAL EYE INSTITUTE

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE ON AGING