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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES
         Food and Drug AdministrationFederal Funds
         Salaries and Expenses
         (INCLUDING TRANSFERS OF FUNDS)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 92â313 for programs and activities of the Food and Drug Administration
            which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; in addition
            to amounts appropriated to the FDA Innovation Account, for carrying out the activities described in section 1002(b)(4) of
            the 21st Century Cures Act (Public Law 114â255); for miscellaneous and emergency expenses of enforcement activities, authorized
            and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding
            section 521 of Public Law 107â188;  $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 Servicesâ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.)
      
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
         BUILDINGS AND FACILITIESFor plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities
            of or used by the Food and Drug Administration, where not otherwise provided,  $30,788,000, to remain available until expended.
      (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  1
                  
                  1
               
               
                  0198
                  Reconciliation adjustment
                  â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
                  â3
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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 [075â0128]
                  â2
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5629]
                  
                  70
                  50
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â31
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  774
                  
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â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
                  â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)
                  â5,709
                  â7,185
                  â6,617
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â139
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â187
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,043
                  1,953
                  1,751
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â66
                  â63
                  â32
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  31
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  34
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â63
                  â32
                  â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:
                  â39
                  â31
                  
               
               
                  4033
                  Non-Federal sources:
                  â2,796
                  â2,755
                  â2,810
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â2,835
                  â2,786
                  â2,810
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  31
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  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:
                  â12
                  
                  
               
               
                  4123
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses 
         (Legislative proposal, not subject to PAYGO)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.
       
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â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)
                  
                  
                  â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:
                  
                  
                  â100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â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
               
               
                  
                     
                  
               
            
         
      
         FDA Working Capital FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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)
                  â594
                  â844
                  â619
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â626
                  â619
                  â619
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â32
                  225
                  
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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
               
               
                  
                     
                  
               
            
         
      
         Payment to the FDA Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0148â0â1â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)
                  â75
                  â70
                  â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.
         
      
         FDA INNOVATION ACCOUNT, CURES ACT
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes under the heading "Salaries and Expenses",  $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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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
                  â75
                  â70
                  â50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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 [075â9911]
                  
                  â70
                  â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)
                  â59
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  180
                  
                  
               
               
                  1101
                  Direct military average strength employment
                  7
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other ServicesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â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
                  â1
                  â1
                  â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)
                  â8
                  â15
                  â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
                  â8
                  â10
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  34
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services AdministrationFederal Funds
         PRIMARY HEALTH CAREFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
            to primary health care and the Native Hawaiian Health Care Act of 1988,  $1,733,772,000: 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.
      
         HEALTH WORKFORCEFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of
            the Social Security Act, and the Health Care Quality Improvement Act of 1986,  $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.
      
         MATERNAL AND CHILD HEALTHFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health and title V of the
            Social Security Act,  $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.
      
         RYAN WHITE HIV/AIDS PROGRAMFor 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.
      
         HEALTH CARE SYSTEMSFor carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
            Research Act of 2005,  $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.
      
         RURAL HEALTHFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
            and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act,  $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.
      
         FAMILY PLANNINGFor 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. 
      
         PROGRAM MANAGEMENTFor 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".
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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 [015â5606]
                  â5
                  â5
                  â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 [075â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
                  
                  
                  â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
                  â5
                  â2
                  â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
                  â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)
                  â11,591
                  â16,833
                  â16,902
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â75
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â90
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10,500
                  13,641
                  10,066
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â16
                  â17
                  â17
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â17
                  â17
                  â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
                  â10
                  â10
                  â10
               
               
                  4033
                  Non-Federal sources
                  â12
                  â20
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â22
                  â30
                  â30
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â86
                  â52
                  â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 075â0350â0â1â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 2019â2020 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     435,986,003
                  
                  
                     NSL
                     199,692,945
                  
                  
                     PCL
                     168,904,435
                  
                  
                     LDS
                     198,835,512
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     1,003,418,895
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury CompensationProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0320â0â1â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
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â1
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process Fund  
         For carrying out section 319F-4 of the PHS Act, $5,000,000, to remain available until expended. 
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â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 [075â0140]
                  2
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  6
                  4
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  5
               
               
                  1121
                  Appropriations transferred from other acct [075â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)
                  â2
                  â3
                  â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 109â148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
            resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
            has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
            claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting ProgramsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
                  â24
                  â23
                  â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)
                  â389
                  â407
                  â430
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â22
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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
                  â886
                  â846
                  â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
                  â9
                  â10
                  â10
               
               
                  
                  Adjustments:
               
               
                  2263
                  Terminations for default that result in claim payments
                  
                  â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 104â299, Public Law 104â208, and Public Law 115â141 authorize Health Resources and Services Administration (HRSA)
            to guarantee up to $1 billion in private loans to health centers for the costs of developing and operating managed care networks
            or plans and for the construction, renovation, and modernization of medical facilities. The program account for this activity
            is displayed in the Health Resources and Services account (75â0350) as a line in the program and financing schedule.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  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
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan FundStatus of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â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.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â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
         VACCINE INJURY COMPENSATION PROGRAM TRUST FUNDFor payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
            claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
            to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed  $16,200,000 shall be available from the Trust Fund to the Secretary.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â361
                  â311
                  â317
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â32
                  â38
                  â48
               
               
                  2135
                  Vaccine Injury Compensation Program Trust Fund
                  143
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â250
                  â349
                  â365
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â250
                  â349
                  â365
               
               
                  4030
                  Vaccine Injury Compensation Program Trust Fund
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  3,965
                  4,001
                  4,037
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â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)
                  â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)
                  â244
                  â358
                  â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
                  â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 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
            for vaccine-related injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health ServiceFederal Funds
         Indian Health ServicesFor expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education
            Assistance Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect
            to the Indian Health Service,  $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 93â638, such individually identifiable health information relating to disabled children
            as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
            U.S.C. 1400 et seq.): Provided further, That of the 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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 [075â0391]
                  â125
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  
                  210
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  
                  â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
                  â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
                  â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)
                  â6,596
                  â10,699
                  â10,192
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â239
                  â200
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,385
                  1,557
                  47
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â109
                  â105
                  â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
                  â105
                  â105
                  â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
                  â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
                  â325
                  â436
                  â436
               
               
                  4033
                  Non-Federal sources
                  â1,630
                  â1,432
                  â1,432
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,955
                  â1,868
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
         CONTRACT SUPPORT COSTSFor payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education
            Assistance Act agreements with the Indian Health Service for fiscal year   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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â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)
                  â839
                  â1,039
                  â1,142
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
         Contract Support Costs
         (Legislative proposal, not subject to PAYGO)
          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).
         
      
         PAYMENTS FOR TRIBAL LEASESFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0200â0â1â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)
                  
                  â101
                  â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.
         
      
         Payments for Tribal Leases
         (Legislative proposal, not subject to PAYGO)
          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).
         
      
         INDIAN HEALTH FACILITIESFor construction, repair, maintenance, demolition, improvement, and equipment of health and related auxiliary facilities,
            including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection
            of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians,
            as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian
            Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health
            Service Act with respect to environmental health and facilities support activities of the Indian Health Service,  $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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
                  â11
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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 [075â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)
                  â750
                  â1,151
                  â1,394
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  892
                  1,167
                  599
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â18
                  â18
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â18
                  â18
                  â18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â46
                  â60
                  â59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â46
                  â60
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONSâINDIAN HEALTH SERVICE
         ADMINISTRATIVE PROVISIONSâINDIAN HEALTH SERVICEAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
            3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
            5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation,
            and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
            in the field, when authorized under regulations approved by the Secretary of Health and Human Services; uniforms, or allowances
            therefor as authorized by 5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities
            of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
            care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
            recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
            providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
            to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
            Law 93â638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
            purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
            by the Department of Health and Human Services unless 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.)
         Centers for Disease Control and PreventionFederal Funds
         IMMUNIZATION AND RESPIRATORY DISEASESFor carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
            Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases,  $526,580,000.
      
         HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS PREVENTIONFor carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
            diseases, and tuberculosis prevention,  $1,420,556,000.
      
         EMERGING AND ZOONOTIC INFECTIOUS DISEASESFor carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
            Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases,  $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.
      
         CHRONIC DISEASE PREVENTION AND HEALTH PROMOTIONFor carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health
            promotion,  $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.
      
         BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTHFor carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities
            and health,  $172,810,000.
      
         PUBLIC HEALTH SCIENTIFIC SERVICESFor carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics,
            and workforce development,  $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.
      
         ENVIRONMENTAL HEALTHFor 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. 
      
         INJURY PREVENTION AND CONTROLFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control,  $1,103,169,000.
      
         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTHFor carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal
            Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22
            of the Occupational Safety and Health Act, with respect to occupational safety and health, $345,300,000.
      
         ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAMFor necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
            available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of
            division B, title I of Public Law 106â554.
      
         GLOBAL HEALTHFor carrying out titles II, III, and XVII of the PHS Act with respect to global health,  $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.
      
         PUBLIC HEALTH PREPAREDNESS AND RESPONSEFor carrying out titles II, III, and XVII of the PHS Act with respect to public health preparedness and response, and for
            expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats
            to civilian populations, $842,200,000.
      
         CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
         (INCLUDING TRANSFER OF FUNDS)For carrying out titles II, III, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program
            support for activities funded in other appropriations included in this Act for the Centers for Disease Control and Prevention,
             $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 115â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.
      (Department of Health and Human Services Appropriations Act, 2021.)
           
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
                  â3
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  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 [075â0140]
                  â8
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â0390]
                  
                  â210
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â4553]
                  â5
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0945]
                  â685
                  â10
                  â35
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  1,000
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  13,625
                  15,463
                  8,365
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1200
                  Appropriation (075â0943 American Rescue Plan)
                  
                  11,520
                  
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  3
                  1
                  1
               
               
                  1221
                  Appropriations transferred from other acct PPHF [075â0116]
                  854
                  856
                  903
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â4
                  â4
                  â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
                  â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)
                  â8,370
                  â13,079
                  â15,665
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â43
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â160
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10,154
                  5,560
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â108
                  â129
                  â129
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â90
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  69
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â129
                  â129
                  â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
                  â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
                  â237
                  â17
                  â181
               
               
                  4033
                  Non-Federal sources
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â249
                  â17
                  â181
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â90
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  68
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â5
                  â2
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
         CDC-wide Activities and Program Support
         (Legislative proposal, subject to PAYGO)
         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 2023â2029.
         
      
         BUILDINGS AND FACILITIES
         (INCLUDING TRANSFER OF FUNDS)For any cost related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities,  $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.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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
                  â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)
                  â119
                  â89
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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 [075â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)
                  â611
                  â645
                  â575
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  240
                  164
                  158
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â2
                  â2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â709
                  â668
                  â532
               
               
                  4180
                  Budget authority, net (total)
                  5
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â98
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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
               
               
                  
                     
                  
               
            
         
      
         Infectious Diseases Rapid Response Reserve FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â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 [075â0943]
                  â30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  20
                  601
                  601
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other acct [075â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)
                  â67
                  â41
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  17
                  
                  
               
               
                  1101
                  Direct military average strength employment
                  2
                  
                  
               
               
                  
                     
                  
               
            
         
      
         TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTHFor necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
            in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
            and section 3019 of the Solid Waste Disposal Act,  $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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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 [097â0100]
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  99
                  78
                  82
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  20
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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)
                  â96
                  â115
                  â77
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  79
                  57
                  62
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â12
                  â7
                  â8
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â1
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â7
                  â8
                  â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
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â9
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â1
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  7
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  World Trade Center Health ProgramâFederal Share (CDC/NIOSH)
                  473
                  551
                  641
               
               
                  0002
                  World Trade Center Health Programâ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 (WTCâNYC DHSSâ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)
                  â505
                  â517
                  â441
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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. 111â347)
            on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
            Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
            health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
            2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
            Compensation Reauthorization Act of 2015 (P.L. 114â113, Division O, Title III). The amounts included for 2021 and 2022 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â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
               
               
                  
                     
                  
               
            
         
      
         National Institutes of HealthFederal Funds
         NATIONAL CANCER INSTITUTEFor 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 InstituteâFrederick
            Federally Funded Research and Development Center in Frederick, Maryland.
      
         NATIONAL HEART, LUNG, AND BLOOD INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
            and blood products,  $3,845,681,000.
      
         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCHFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases,  $516,197,000.
      
         NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease,  $2,219,298,000.
      
         NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKEFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke,  $2,707,300,000.
      
         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases,  $6,245,926,000.
      
         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCESFor 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.
      
         EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENTFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development,  $1,942,117,000.
      
         NATIONAL EYE INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders,  $858,535,000.
      
         NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCESFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences,  $937,107,000.
      (Department of Health and Human Services Appropriations Act, 2021.)
         NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCESFor necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
            section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and
            section 126(g) of the Superfund Amendments and Reauthorization Act of 1986,  $83,540,000.
      (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021.)
         NATIONAL INSTITUTE ON AGINGFor carrying out section 301 and title IV of the PHS Act with respect to aging,  $4,035,591,000.
      
         NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
             $680,186,000.
      
         NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERSFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders,  $511,792,000.
      
         NATIONAL INSTITUTE OF NURSING RESEARCHFor carrying out section 301 and title IV of the PHS Act with respect to nursing research,  $199,755,000.
      
         NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISMFor carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism,  $570,165,000.
      
         NATIONAL INSTITUTE ON DRUG ABUSEFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse,  $1,852,503,000.
      
         NATIONAL INSTITUTE OF MENTAL HEALTHFor carrying out section 301 and title IV of the PHS Act with respect to mental health,  $2,137,574,000.
      
         NATIONAL HUMAN GENOME RESEARCH INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to human genome research,  $632,973,000.
      
         NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERINGFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research,  $422,039,000.
      
         NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTHFor carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health,  $184,323,000.
      
         NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIESFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
             $652,244,000.
      
         JOHN E. FOGARTY INTERNATIONAL CENTERFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
            of the PHS Act),  $96,322,000.
      
         NATIONAL LIBRARY OF MEDICINEFor 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").
      
         NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCESFor 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.
      
         OFFICE OF THE DIRECTOR
         (INCLUDING TRANSFER OF FUNDS)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.
           
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
         BUILDINGS AND FACILITIESFor the study of, construction of, demolition of, renovation of, and acquisition of equipment for, facilities of or used by
            NIH, including the acquisition of real property,  $250,000,000, to remain available through September 30,  2026.
         Advanced Research Projects Agency for HealthFor 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. 
       
      (Department of Health and Human Services Appropriations Act, 2021.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
                  â56
                  â72
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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 [075â0140]
                  â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 [075â0128]
                  â5
                  â5
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5628]
                  335
                  295
                  346
               
               
                  1121
                  Appropriations transferred from other acct [075â5736]
                  13
                  13
                  3
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  
                  â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
                  â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)
                  â40,498
                  â46,115
                  â50,119
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â77
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â599
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  46,469
                  51,153
                  57,216
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â650
                  â969
                  â969
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â424
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  105
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â969
                  â969
                  â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
                  â4,411
                  â5,402
                  â5,574
               
               
                  4033
                  Non-Federal sources
                  â324
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,735
                  â5,402
                  â5,574
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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)
                  â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
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Payment to the NIH Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0147â0â1â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)
                  â492
                  â404
                  â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.
         
      
         NIH INNOVATION ACCOUNT, CURES ACT
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes in the appropriations provided to the NIH in this Act,  $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.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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
                  â492
                  â404
                  â496
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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 [075â9915]
                  â335
                  â295
                  â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)
                  â134
                  â171
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â552
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  64
                  
                  
               
               
                  1101
                  Direct military average strength employment
                  1
                  
                  
               
               
                  
                     
                  
               
            
         
      
         10-Year Pediatric Research Initiative FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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
                  â13
                  â13
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  17
                  4
                  1
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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 [075â9915]
                  â13
                  â13
                  â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. 
         
      
         Substance Abuse and Mental Health Services AdministrationFederal Funds
         MENTAL HEALTHFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
            Individuals with Mental Illness Act,  $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 113â93: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading,  $21,420,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113â93; 42 U.S.C. 290aa 22
            note).
      
         SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
            respect to substance abuse treatment and prevention, and the SUPPORT for Patients and Communities Act,  $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.
      
         SUBSTANCE ABUSE PREVENTIONFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention,  $216,667,000.
      
         HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
            Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act and the Protection
            and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration,  $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".
      (Department of Health and Human Services Appropriations Act, 2021.)
       
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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 [075â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
                  â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)
                  â5,376
                  â7,119
                  â9,824
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â163
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,569
                  11,983
                  12,161
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â187
                  â449
                  â449
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â372
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  110
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â449
                  â449
                  â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
                  â170
                  â401
                  â171
               
               
                  4033
                  Non-Federal sources
                  
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â170
                  â403
                  â173
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â372
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  100
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and QualityFederal Funds
         HEALTHCARE RESEARCH AND QUALITY For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
            Medicare Prescription Drug, Improvement, and Modernization Act of 2003,  $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.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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)
                  â357
                  â330
                  â387
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  340
                  375
                  395
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â28
                  â28
                  â28
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â16
                  â16
                  â16
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  16
                  16
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â28
                  â28
                  â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
                  â18
                  â18
                  â27
               
               
                  4030
                  Federal sources
                  
                  
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â18
                  â18
                  â43
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â16
                  â16
                  â16
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  15
                  15
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â1
                  â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
                  â6
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Centers for Medicare and Medicaid ServicesFederal Funds
         GRANTS TO STATES FOR MEDICAIDFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act,  $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.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  490,831
                  538,883
                  536,237
               
               
                  0002
                  State and local administration
                  23,598
                  22,895
                  22,290
               
               
                  0003
                  Vaccines for Children
                  4,578
                  5,468
                  5,140
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  519,007
                  567,246
                  563,667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  519,007
                  567,246
                  563,667
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  14,679
                  311
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  21,623
                  45,850
                  44,955
               
               
                  1033
                  Recoveries of prior year paid obligations
                  14,155
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  50,457
                  46,161
                  44,955
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  329,637
                  380,015
                  368,666
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  137,932
                  139,903
                  148,732
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1,062
                  1,167
                  1,314
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  230
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,292
                  1,167
                  1,314
               
               
                  1900
                  Budget authority (total)
                  468,861
                  521,085
                  518,712
               
               
                  1930
                  Total budgetary resources available
                  519,318
                  567,246
                  563,667
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  311
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  48,595
                  72,294
                  71,396
               
               
                  3010
                  New obligations, unexpired accounts
                  519,007
                  567,246
                  563,667
               
               
                  3020
                  Outlays (gross)
                  â473,685
                  â522,294
                  â519,024
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â21,623
                  â45,850
                  â44,955
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  72,294
                  71,396
                  71,084
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â853
                  â1,083
                  â1,083
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â230
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,083
                  â1,083
                  â1,083
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  47,742
                  71,211
                  70,313
               
               
                  3200
                  Obligated balance, end of year
                  71,211
                  70,313
                  70,001
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  468,861
                  521,085
                  518,712
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  425,189
                  483,086
                  514,436
               
               
                  4101
                  Outlays from mandatory balances
                  48,496
                  39,208
                  4,588
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  473,685
                  522,294
                  519,024
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1,062
                  â1,167
                  â1,314
               
               
                  4123
                  Non-Federal sources
                  â14,155
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â15,217
                  â1,167
                  â1,314
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â230
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  14,155
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  13,925
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  467,569
                  519,918
                  517,398
               
               
                  4170
                  Outlays, net (mandatory)
                  458,468
                  521,127
                  517,710
               
               
                  4180
                  Budget authority, net (total)
                  467,569
                  519,918
                  517,398
               
               
                  4190
                  Outlays, net (total)
                  458,468
                  521,127
                  517,710
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  467,569
                  519,918
                  517,398
               
               
                  
                  Outlays
                  458,468
                  521,127
                  517,710
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â23
               
               
                  
                  Outlays
                  
                  
                  â23
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  53,000
               
               
                  
                  Outlays
                  
                  
                  53,000
               
               
                  Total:
               
               
                  
                  Budget Authority
                  467,569
                  519,918
                  570,375
               
               
                  
                  Outlays
                  458,468
                  521,127
                  570,687
               
               
                  
                     
                  
               
            
         
      
      
         Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under
            title XIX of the Social Security Act to States with approved plans.
         
         Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).
         Authorized as part of title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children.
            VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.
         
         Vaccines for Children (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     Obligations
                     2020
                     2021
                     2022
                  
                  
                     
                        
                     
                  
                  
                     Vaccine Purchase
                     4,369
                     5,207
                     4,821
                  
                  
                     Vaccine Stockpile
                     10
                     10
                     99
                  
                  
                     Ordering, Distribution, and Operations
                     199
                     251
                     220
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Obligations
                     4,578
                     5,468
                     5,140
                  
                  
                     
                        
                     
                  
               
            
         
      
         Grants to States for Medicaid
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â2â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â23
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â23
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â23
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â23
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â23
               
               
                  3020
                  Outlays (gross)
                  
                  
                  23
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â23
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â23
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â23
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â23
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the non-PAYGO impacts on Medicaid resulting from the proposed allocation adjustment for the Social
            Security Administration.  Please refer to the narrative in the Limitation on Administrative Expenses (Social Security Administration)
            account for more information. 
         
      
         Grants to States for Medicaid
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â4â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  53,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  53,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  53,000
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  53,000
               
               
                  1900
                  Budget authority (total)
                  
                  
                  53,000
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  53,000
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  53,000
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â53,000
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  53,000
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  53,000
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  53,000
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  53,000
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
         State Grants and DemonstrationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0012
                  Medicaid integrity program
                  93
                  109
                  87
               
               
                  0018
                  Money follows the person (MFP) demonstration
                  176
                  831
                  564
               
               
                  0019
                  MFP evaluations and technical support
                  
                  2
                  2
               
               
                  0023
                  Grants to improve outreach and enrollment
                  18
                  21
                  50
               
               
                  0028
                  Demo to increase substance use provider under the Medicaid Program
                  4
                  2
                  
               
               
                  0029
                  Community-based mobile crisis intervention services
                  
                  15
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  291
                  980
                  703
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  291
                  980
                  703
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  661
                  798
                  576
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  6
                  232
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  667
                  1,030
                  576
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  427
                  531
                  542
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â5
                  â31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  422
                  526
                  511
               
               
                  1900
                  Budget authority (total)
                  422
                  526
                  511
               
               
                  1930
                  Total budgetary resources available
                  1,089
                  1,556
                  1,087
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  798
                  576
                  384
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  696
                  419
                  860
               
               
                  3010
                  New obligations, unexpired accounts
                  291
                  980
                  703
               
               
                  3020
                  Outlays (gross)
                  â332
                  â307
                  â364
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  â232
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â230
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  419
                  860
                  1,199
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  696
                  419
                  860
               
               
                  3200
                  Obligated balance, end of year
                  419
                  860
                  1,199
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  422
                  526
                  511
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  34
                  45
                  51
               
               
                  4101
                  Outlays from mandatory balances
                  298
                  262
                  313
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  332
                  307
                  364
               
               
                  4180
                  Budget authority, net (total)
                  422
                  526
                  511
               
               
                  4190
                  Outlays, net (total)
                  332
                  307
                  364
               
               
                  
                     
                  
               
            
         
      
      
         State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including
            the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10). The account also includes funding for grant programs
            enacted in the HEALTHY KIDS Act (P.L. 115â120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115â123),
            the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115â271),
            the Medicaid Extenders Act of 2019 (P.L. 116â3), the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116â16),
            the Sustaining Excellence in Medicaid Act of 2019 (P.L. 116â39), the Continuing Appropriations Act, 2020, the Health Extenders
            Act of 2019 (P.L. 116â59), the Further Consolidated Appropriation Act, 2020 (P.L. 116â94), the Consolidated Appropriations
            Act, 2021 (P.L. 116â260), and the American Rescue Plan Act of 2021 (P.L. 117â2). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent - Medicaid Integrity Program
                  31
                  28
                  28
               
               
                  11.7
                  Military personnel - Medicaid Integrity Program
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  32
                  28
                  28
               
               
                  12.1
                  Civilian personnel benefits - Medicaid Integrity Program
                  8
                  7
                  7
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid Integrity Program
                  53
                  74
                  52
               
               
                  41.0
                  Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
                  176
                  831
                  564
               
               
                  41.0
                  Grants, subsidies, and contributions - MFP evaluations and technical support
                  
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                  18
                  21
                  50
               
               
                  41.0
                  Grants, subsidies, and contributions - Demo to increase substance use provider capacity under Medicaid
                  4
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  15
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  291
                  980
                  703
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  291
                  980
                  703
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  194
                  209
                  209
               
               
                  1101
                  Direct military average strength employment
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
         PAYMENTS TO THE HEALTH CARE TRUST FUNDSFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
            under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
            of 1965, section 278(d)(3) of Public Law 97â248, and for administrative expenses incurred pursuant to section 201(g) of the
            Social Security Act,  $487,862,000,000.
      In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
            Act that were not anticipated in budget estimates, such sums as may be necessary.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  293,409
                  325,500
                  384,646
               
               
                  0002
                  Part D benefits (Rx Drug)
                  83,952
                  111,800
                  100,969
               
               
                  0003
                  Part D Federal administration (Rx Drug)
                  861
                  882
                  882
               
               
                  0004
                  General Fund Transfers to HI
                  1,347
                  1,327
                  1,360
               
               
                  0006
                  Federal Bureau of Investigation (HCFAC)
                  141
                  148
                  158
               
               
                  0007
                  Federal payments from taxation of OASDI benefits (HI)
                  26,941
                  29,437
                  29,946
               
               
                  0008
                  Criminal fines (HCFAC)
                  2
                  36
                  34
               
               
                  0009
                  Civil penalties and damages (HCFACâDOJ and CMS administration)
                  26
                  52
                  53
               
               
                  0010
                  Asset Forfeiture
                  701
                  32
                  33
               
               
                  0011
                  State Low Income Determinations
                  5
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  407,385
                  469,219
                  518,086
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  410,796
                  439,514
                  487,862
               
               
                  1200
                  Appropriation (indefinite, permanent)
                  26,941
                  29,437
                  29,946
               
               
                  1200
                  Appropriation (HCFAC for FBI)
                  141
                  148
                  158
               
               
                  1200
                  Appropriation (indefinite for HCFAC)
                  730
                  120
                  120
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  438,608
                  469,219
                  518,086
               
               
                  1930
                  Total budgetary resources available
                  438,608
                  469,219
                  518,086
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â31,223
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  12,668
                  16,873
                  
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  679
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  407,385
                  469,219
                  518,086
               
               
                  3020
                  Outlays (gross)
                  â394,754
                  â486,092
                  â454,720
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â9,105
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  16,873
                  
                  63,366
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  13,347
                  16,873
                  
               
               
                  3200
                  Obligated balance, end of year
                  16,873
                  
                  63,366
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  438,608
                  469,219
                  518,086
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  394,552
                  469,219
                  392,388
               
               
                  4101
                  Outlays from mandatory balances
                  202
                  16,873
                  62,332
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  394,754
                  486,092
                  454,720
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â3,102
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â3,129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â6,231
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  6,231
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  438,608
                  469,219
                  518,086
               
               
                  4170
                  Outlays, net (mandatory)
                  388,523
                  486,092
                  454,720
               
               
                  4180
                  Budget authority, net (total)
                  438,608
                  469,219
                  518,086
               
               
                  4190
                  Outlays, net (total)
                  388,523
                  486,092
                  454,720
               
               
                  
                     
                  
               
            
         
      
      
         Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general
            fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries and administrative expenses that are
            properly chargeable to the general fund.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  405,068
                  466,771
                  515,561
               
               
                  42.0
                  Insurance claims and indemnities (HI Uninsured Federal)
                  109
                  95
                  82
               
               
                  94.0
                  Financial transfers (Federal admin)
                  2,208
                  2,353
                  2,443
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  407,385
                  469,219
                  518,086
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement OrganizationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  QIO Clinical Quality Improvement
                  451
                  144
                  90
               
               
                  0003
                  QIO Support Contracts
                  407
                  424
                  460
               
               
                  0004
                  QIO Administration
                  70
                  73
                  81
               
               
                  0005
                  American Rescue Plan Act - SNF Infection Control Support
                  
                  200
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  928
                  841
                  631
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  200
                  
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  286
                  167
                  174
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  825
                  474
                  457
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,111
                  641
                  631
               
               
                  1900
                  Budget authority (total)
                  1,111
                  841
                  631
               
               
                  1930
                  Total budgetary resources available
                  1,111
                  841
                  631
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â183
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  887
                  1,105
                  1,105
               
               
                  3010
                  New obligations, unexpired accounts
                  928
                  841
                  631
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  100
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â642
                  â841
                  â631
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â168
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,105
                  1,105
                  1,105
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,799
                  â2,006
                  â2,480
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â825
                  â474
                  â457
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  618
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2,006
                  â2,480
                  â2,937
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â912
                  â901
                  â1,375
               
               
                  3200
                  Obligated balance, end of year
                  â901
                  â1,375
                  â1,832
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,111
                  841
                  631
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  266
                  403
                  170
               
               
                  4101
                  Outlays from mandatory balances
                  376
                  438
                  461
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  642
                  841
                  631
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â653
                  â641
                  â631
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â825
                  â474
                  â457
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  367
                  474
                  457
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â458
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  200
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â11
                  200
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  200
                  
               
               
                  4190
                  Outlays, net (total)
                  â11
                  200
                  
               
               
                  
                     
                  
               
            
         
      
      
         Part B of title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982 (P.L. 97â248), provides
            the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to
            promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure
            that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance
            Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO
            Program was established to improve budgetary operations.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  32
                  33
                  36
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  34
                  35
                  38
               
               
                  12.1
                  Civilian personnel benefits
                  11
                  11
                  11
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  9
                  10
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  853
                  763
                  549
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  12
                  12
               
               
                  25.4
                  Operation and maintenance of facilities
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  928
                  841
                  631
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  274
                  262
                  262
               
               
                  1101
                  Direct military average strength employment
                  8
                  8
                  8
               
               
                  
                     
                  
               
            
         
      
         PROGRAM MANAGEMENTFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
            XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
            Medicare & Medicaid Services, not to exceed $4,315,843,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
            as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353
            of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 1893(h)
            of the Social Security Act, and such sums as may be collected from authorized user fees and the sale of data, which shall
            be credited to this account and remain available until expended: Provided, That all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the PHS Act
            shall be credited to and available for carrying out the purposes of this appropriation: Provided further, That the Secretary is directed to collect fees in fiscal year  2022 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations
            with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act: Provided further, That of the amount made available under this heading, $472,163,000 shall remain available until September 30, 2023, and shall be available for the Survey and Certification Program.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  3,011
                  3,473
                  3,067
               
               
                  0002
                  Federal administration
                  800
                  773
                  864
               
               
                  0003
                  State survey and certification
                  419
                  474
                  478
               
               
                  0004
                  Research, demonstrations, and evaluation projects
                  20
                  20
                  
               
               
                  0007
                  ARRA Medicare/Medicaid HIT
                  23
                  27
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  4,273
                  4,767
                  4,436
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,273
                  4,767
                  4,436
               
               
                  0801
                  Clinical laboratory improvement amendments
                  62
                  74
                  79
               
               
                  0802
                  Sale of data
                  22
                  27
                  27
               
               
                  0803
                  Coordination of benefits
                  33
                  39
                  45
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  144
                  96
                  99
               
               
                  0805
                  Provider enrollment
                  21
                  68
                  68
               
               
                  0806
                  Recovery audit contractors
                  124
                  191
                  182
               
               
                  0808
                  Marketplace User Fees
                  1,311
                  1,471
                  1,569
               
               
                  0810
                  Risk Adjustment Administrative Expenses
                  25
                  60
                  49
               
               
                  0813
                  Other reimbursable program activity
                  1
                  18
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,743
                  2,044
                  2,131
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  6,016
                  6,811
                  6,567
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4,474
                  3,214
                  3,384
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  112
                  
                  
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â1,555
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  125
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3,044
                  3,214
                  3,384
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  200
                  
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (General Fund Total)
                  3
                  540
                  3
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,819
                  4,000
                  4,343
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2,206
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,025
                  4,000
                  4,343
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2,109
                  2,437
                  2,496
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â130
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  120
                  98
                  89
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â103
                  â94
                  â129
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,996
                  2,441
                  2,456
               
               
                  1900
                  Budget authority (total)
                  6,224
                  6,981
                  6,802
               
               
                  1930
                  Total budgetary resources available
                  9,268
                  10,195
                  10,186
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â38
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3,214
                  3,384
                  3,619
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,765
                  4,717
                  4,752
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  â74
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  6,016
                  6,811
                  6,567
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,640
                  â6,776
                  â6,895
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â125
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â235
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,717
                  4,752
                  4,424
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6,881
                  â4,810
                  â4,810
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  1,874
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,076
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,273
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â4,810
                  â4,810
                  â4,810
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â316
                  â93
                  â58
               
               
                  3200
                  Obligated balance, end of year
                  â93
                  â58
                  â386
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,225
                  4,000
                  4,343
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,739
                  2,013
                  2,185
               
               
                  4011
                  Outlays from discretionary balances
                  2,115
                  2,072
                  2,233
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,854
                  4,085
                  4,418
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,849
                  â3,975
                  â4,316
               
               
                  4033
                  Non-Federal sources
                  â29
                  â25
                  â27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,878
                  â4,000
                  â4,343
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,206
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,059
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â147
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  200
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â24
                  85
                  75
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,999
                  2,981
                  2,459
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  17
                  1,450
                  1,200
               
               
                  4101
                  Outlays from mandatory balances
                  1,769
                  1,241
                  1,277
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,786
                  2,691
                  2,477
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â315
                  â82
                  â63
               
               
                  4123
                  Non-Federal sources
                  â1,821
                  â2,355
                  â2,433
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2,136
                  â2,437
                  â2,496
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  130
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  157
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  20
                  544
                  â37
               
               
                  4170
                  Outlays, net (mandatory)
                  â350
                  254
                  â19
               
               
                  4180
                  Budget authority, net (total)
                  220
                  544
                  â37
               
               
                  4190
                  Outlays, net (total)
                  â374
                  339
                  56
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  286
                  224
                  220
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â45
                  
                  
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  224
                  220
                  260
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  70
                  115
                  115
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  70
                  115
                  115
               
               
                  
                     
                  
               
            
         
      
      
         Program management activities include funding for program operations, survey and certification, the Clinical Laboratory Improvement
            Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts, and other administrative
            costs. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  444
                  495
                  461
               
               
                  11.3
                  Other than full-time permanent
                  13
                  15
                  13
               
               
                  11.5
                  Other personnel compensation
                  8
                  9
                  8
               
               
                  11.7
                  Military personnel
                  15
                  17
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  480
                  536
                  498
               
               
                  12.1
                  Civilian personnel benefits
                  180
                  201
                  187
               
               
                  12.2
                  Military personnel benefits
                  9
                  10
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  12
                  13
                  12
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  21
                  23
                  22
               
               
                  24.0
                  Printing and reproduction
                  55
                  61
                  57
               
               
                  25.2
                  Other services from non-Federal sources
                  2,952
                  3,294
                  3,065
               
               
                  25.3
                  Other goods and services from Federal sources
                  140
                  156
                  145
               
               
                  25.6
                  Medical care
                  382
                  426
                  397
               
               
                  25.7
                  Operation and maintenance of equipment
                  15
                  17
                  16
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  23
                  26
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,273
                  4,767
                  4,436
               
               
                  99.0
                  Reimbursable obligations
                  1,743
                  2,044
                  2,131
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  6,016
                  6,811
                  6,567
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4,204
                  4,108
                  4,253
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  109
                  60
                  55
               
               
                  1101
                  Direct military average strength employment
                  134
                  137
                  137
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  290
                  445
                  445
               
               
                  2101
                  Reimbursable military average strength employment
                  14
                  14
                  14
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to states and US territories
                  18,549
                  16,044
                  16,261
               
               
                  0002
                  CHIP Redistribution Funds
                  4
                  
                  
               
               
                  0003
                  Child health quality
                  6
                  23
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  18,559
                  16,067
                  16,289
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  8,237
                  12,251
                  15,986
               
               
                  1011
                  Unobligated balance transfer from other acct [075â5551]
                  4,037
                  1
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  12,276
                  12,252
                  15,986
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1130
                  Appropriations permanently reduced
                  
                  
                  â5,299
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  23,700
                  24,800
                  25,900
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  1
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3,170
                  â1,000
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â15
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â4,000
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  20,515
                  19,801
                  25,900
               
               
                  1900
                  Budget authority (total)
                  20,515
                  19,801
                  20,601
               
               
                  1930
                  Total budgetary resources available
                  32,791
                  32,053
                  36,587
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1,981
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  12,251
                  15,986
                  20,298
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,530
                  6,809
                  5,656
               
               
                  3010
                  New obligations, unexpired accounts
                  18,559
                  16,067
                  16,289
               
               
                  3020
                  Outlays (gross)
                  â16,880
                  â17,220
                  â17,142
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â398
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,809
                  5,656
                  4,803
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,530
                  6,809
                  5,656
               
               
                  3200
                  Obligated balance, end of year
                  6,809
                  5,656
                  4,803
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â5,299
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  20,515
                  19,801
                  25,900
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  11,984
                  12,457
                  10,285
               
               
                  4101
                  Outlays from mandatory balances
                  4,896
                  4,763
                  6,857
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  16,880
                  17,220
                  17,142
               
               
                  4180
                  Budget authority, net (total)
                  20,515
                  19,801
                  20,601
               
               
                  4190
                  Outlays, net (total)
                  16,880
                  17,220
                  17,142
               
               
                  
                     
                  
               
            
         
      
      
         The Balanced Budget Act of 1997 (P.L. 105â33) established the Children's Health Insurance Program (CHIP) under title XXI of
            the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured
            children from low-income families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured
            children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health
            Insurance Program Reauthorization Act of 2009 (P.L. 111â3, CHIPRA) reauthorized the CHIP program and appropriated funding
            for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and
            territories, and support for child health quality and outreach activities. CHIPRA also created a contingency fund in a separate
            account to assist States who project spending above their available allocated CHIP funds. The Patient Protection and Affordable
            Care Act of 2010 (P.L. 111â148) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended CHIP funding
            through fiscal year 2015 and 2017, respectively.  The HEALTHY KIDS Act (P.L. 115â120) and the Advancing Chronic Care, Extenders,
            and Social Services Act (P.L. 115â123) extended CHIP funding through fiscal year 2023 and 2027, respectively.
         
      
         Center for Medicare and Medicaid InnovationProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Administration
                  316
                  425
                  444
               
               
                  0002
                  Innovation Activities
                  568
                  833
                  724
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  884
                  1,258
                  1,168
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,855
                  10,460
                  9,202
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  79
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,934
                  10,460
                  9,202
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  10,000
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â590
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  9,410
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  11,344
                  10,460
                  9,202
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  10,460
                  9,202
                  8,034
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,015
                  1,028
                  1,220
               
               
                  3010
                  New obligations, unexpired accounts
                  884
                  1,258
                  1,168
               
               
                  3020
                  Outlays (gross)
                  â792
                  â1,066
                  â1,105
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â79
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,028
                  1,220
                  1,283
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,015
                  1,028
                  1,220
               
               
                  3200
                  Obligated balance, end of year
                  1,028
                  1,220
                  1,283
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  9,410
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  180
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  612
                  1,066
                  1,105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  792
                  1,066
                  1,105
               
               
                  4180
                  Budget authority, net (total)
                  9,410
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  792
                  1,066
                  1,105
               
               
                  
                     
                  
               
            
         
      
      
         The Center for Medicare and Medicaid Innovation ("Innovation Center") was established by section 1115A of the Social Security
            Act (as added by section 3021 of the Patient Protection and Affordable Care Act). The Innovation Center is tasked with testing
            innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of
            care provided to individuals under Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The statute provides
            $10 billion in mandatory funding for these purposes for fiscal years 2011 through 2019 and each subsequent 10-year fiscal
            period (beginning with the 10-year fiscal period beginning with fiscal year 2020).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  85
                  79
                  81
               
               
                  11.7
                  Military personnel
                  1
                  1
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  86
                  80
                  83
               
               
                  12.1
                  Civilian personnel benefits
                  21
                  16
                  17
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  2
               
               
                  23.1
                  Rental payments to GSA
                  2
                  3
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  673
                  1,035
                  938
               
               
                  25.3
                  Other goods and services from Federal sources
                  6
                  7
                  8
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  3
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions
                  91
                  107
                  107
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  883
                  1,258
                  1,168
               
               
                  99.5
                  Adjustment for rounding
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  884
                  1,258
                  1,168
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  512
                  536
                  536
               
               
                  1101
                  Direct military average strength employment
                  16
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  5,609
                  6,093
                  14,000
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Interest, Child Enrollment Contingency Fund
                  174
                  14
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  5,783
                  6,107
                  14,006
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Child Enrollment Contingency Fund
                  â173
                  â14
                  â6
               
               
                  2103
                  Child Enrollment Contingency Fund
                  â5,609
                  â6,093
                  â14,000
               
               
                  2135
                  Child Enrollment Contingency Fund
                  
                  
                  19,002
               
               
                  2135
                  Child Enrollment Contingency Fund
                  5,609
                  11,006
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â173
                  4,899
                  4,996
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â173
                  4,899
                  4,996
               
               
                  4030
                  Child Enrollment Contingency Fund
                  484
                  2,994
                  
               
               
                  5098
                  Rounding adjustment
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  6,093
                  14,000
                  19,002
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and US Territories
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4,522
                  4,913
                  1,978
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0515]
                  â4,037
                  â1
                  
               
               
                  1035
                  Unobligated balance precluded from obligation (limitation on obligations)(special and trust)
                  â484
                  â2,994
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  1,918
                  1,978
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1135
                  Appropriations precluded from obligation (special or trust)
                  
                  
                  â19,002
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  4,740
                  4,960
                  5,180
               
               
                  1201
                  Appropriation (special or trust fund)
                  173
                  14
                  6
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  5,609
                  6,093
                  14,000
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  
                  â1
                  
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  â5,609
                  â11,006
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  4,913
                  60
                  19,186
               
               
                  1900
                  Budget authority (total)
                  4,913
                  60
                  184
               
               
                  1930
                  Total budgetary resources available
                  4,914
                  1,978
                  2,162
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4,913
                  1,978
                  2,162
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  310
                  309
                  15
               
               
                  3010
                  New obligations, unexpired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2
                  â294
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  309
                  15
                  15
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  310
                  309
                  15
               
               
                  3200
                  Obligated balance, end of year
                  309
                  15
                  15
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â19,002
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,913
                  60
                  19,186
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  2
                  294
                  
               
               
                  4180
                  Budget authority, net (total)
                  4,913
                  60
                  184
               
               
                  4190
                  Outlays, net (total)
                  2
                  294
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  
                  
                  15,979
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  
                  15,979
                  15,985
               
               
                  
                     
                  
               
            
         
      
      
         The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111â3) established the Child Enrollment Contingency
            Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
            it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
            number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) and the Medicare
            Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended the Contingency Fund through fiscal years 2015 and 2017,
            respectively. The HEALTHY KIDS Act (P.L. 115â120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L.
            115â123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.
         
         The Fund receives an appropriation equal to 20 percent of the CHIP national allotment appropriation under section 2104(a)
            of the Social Security Act. The Contingency Fund is invested in interest bearing securities of the United States, and the
            income derived from these investments constitutes a part of the fund.
         
      
         Medicare Health Information Technology Incentive Payments, Recovery ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0508â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Incentive payments to hospitals
                  20
                  10
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 42.0)
                  20
                  10
                  5
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  59
                  59
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4
                  59
                  59
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected from the HI Trust Fund
                  18
                  10
                  5
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  75
                  10
                  5
               
               
                  1930
                  Total budgetary resources available
                  79
                  69
                  64
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  59
                  59
                  59
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  16
                  14
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  20
                  10
                  5
               
               
                  3020
                  Outlays (gross)
                  â18
                  â23
                  â5
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  14
                  1
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â145
                  â59
                  â59
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  143
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â59
                  â59
                  â59
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  14
                  â45
                  â58
               
               
                  3200
                  Obligated balance, end of year
                  â45
                  â58
                  â58
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  75
                  10
                  5
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6
                  10
                  5
               
               
                  4101
                  Outlays from mandatory balances
                  12
                  13
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  18
                  23
                  5
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â18
                  â10
                  â5
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â57
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  13
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  13
                  
               
               
                  
                     
                  
               
            
         
      
         Rate Review GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0112â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Premium rate review grants
                  
                  9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  9
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  8
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  8
                  9
                  
               
               
                  1930
                  Total budgetary resources available
                  8
                  9
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  8
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  19
                  9
                  12
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  9
                  
               
               
                  3020
                  Outlays (gross)
                  â7
                  â5
                  â5
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9
                  12
                  7
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  19
                  9
                  12
               
               
                  3200
                  Obligated balance, end of year
                  9
                  12
                  7
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  7
                  5
                  5
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  7
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act (P.L. 111â148) added section 2794 to the Public Health Service Act and provided
            that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
            program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
            2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
            insurance reform activities consistent with section 2794(c)(2)(B).
         
      
         Pre-Existing Condition Insurance Plan ProgramProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Administration
                  57
                  70
                  71
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  57
                  70
                  71
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.2)
                  57
                  70
                  71
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  195
                  141
                  74
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  198
                  144
                  74
               
               
                  1930
                  Total budgetary resources available
                  198
                  144
                  74
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  141
                  74
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  69
                  70
                  82
               
               
                  3010
                  New obligations, unexpired accounts
                  57
                  70
                  71
               
               
                  3020
                  Outlays (gross)
                  â53
                  â55
                  â54
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  70
                  82
                  99
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  69
                  70
                  82
               
               
                  3200
                  Obligated balance, end of year
                  70
                  82
                  99
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  53
                  55
                  54
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  53
                  55
                  54
               
               
                  
                     
                  
               
            
         
      
      
         This account funded the Pre-Existing Condition Insurance Plan program (PCIP), which made health insurance available to people
            who had been unable to purchase insurance due to a pre-existing condition. Enrollees paid monthly premiums similar to those
            charged in the commercial individual market, and the Federal government paid for remaining costs that exceeded enrollee contributions.
            The funding for this program, including operating costs, was provided in the Patient Protection and Affordable Care Act (P.L.
            111â148). The PCIP program ended in fiscal year 2014, and outlays in subsequent fiscal years reflect program close out and
            claims run out costs, as well as allowable administrative costs in the current year.
         
      
         Early Retiree Reinsurance ProgramProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  27
                  33
                  38
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  6
                  5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  33
                  38
                  38
               
               
                  1930
                  Total budgetary resources available
                  33
                  38
                  38
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  33
                  38
                  38
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  11
                  5
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  â5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  11
                  5
                  
               
               
                  3200
                  Obligated balance, end of year
                  5
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated $5 billion for the Early Retiree
            Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
            sponsors.
         
      
         Affordable Insurance Exchange GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0003
                  Modernization Grants
                  
                  20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  20
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  20
                  
               
               
                  1930
                  Total budgetary resources available
                  
                  20
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  1
                  6
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  20
                  
               
               
                  3020
                  Outlays (gross)
                  
                  â15
                  â5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  6
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  1
                  6
               
               
                  3200
                  Obligated balance, end of year
                  1
                  6
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  20
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  15
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  15
                  5
               
               
                  4180
                  Budget authority, net (total)
                  
                  20
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  15
                  5
               
               
                  
                     
                  
               
            
         
      
      
          Section 1311 of the Patient Protection and Affordable Care Act (P.L. 111â148) provided amounts necessary to enable the Secretary
            to award grants to States to implement Health Insurance Exchanges beginning no later than March 23, 2011, and allowed for
            renewal of grants through January 1, 2015. The final round of grants was awarded to States in December 2014. The American
            Rescue Plan Act of 2021 (P.L. 117â2) created a grant program for state-based Marketplaces established under section 1311(b)
            of the Patient Protection and Affordable Care Act. $20 million has been appropriated and is available until September 30,
            2022 to enable state-based Marketplaces to modernize or update any system, program, or technology required to be compliant
            with applicable federal requirements.
         
      
         Cost-sharing ReductionsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Cost Sharing Reductions
                  
                  7,650
                  6,045
               
               
                  0002
                  Basic Health Program
                  
                  1,541
                  1,621
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  9,191
                  7,666
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  9,747
                  8,129
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â556
                  â463
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  9,191
                  7,666
               
               
                  1930
                  Total budgetary resources available
                  
                  9,191
                  7,666
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  9,191
                  7,666
               
               
                  3020
                  Outlays (gross)
                  
                  â9,191
                  â7,665
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  9,191
                  7,666
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  9,191
                  7,665
               
               
                  4180
                  Budget authority, net (total)
                  
                  9,191
                  7,666
               
               
                  4190
                  Outlays, net (total)
                  
                  9,191
                  7,665
               
               
                  
                     
                  
               
            
         
      
      
         Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers. The classification
            of CSRs as an entitlement pursuant to BBEDCA does not determine legal entitlement to a payment or benefit or availability
            of funding.
         
      
         Risk Adjustment Program PaymentsSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  371
                  348
                  336
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Receipts, Risk Adjustment Program
                  5,892
                  5,898
                  6,324
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  6,263
                  6,246
                  6,660
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Risk Adjustment Program Payments
                  â5,892
                  â5,898
                  â6,324
               
               
                  2103
                  Risk Adjustment Program Payments
                  â371
                  â348
                  â336
               
               
                  2132
                  Risk Adjustment Program Payments
                  348
                  336
                  360
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â5,915
                  â5,910
                  â6,300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â5,915
                  â5,910
                  â6,300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  348
                  336
                  360
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Risk Adjustment Program Payments (Direct)
                  6,251
                  5,909
                  6,300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  6,251
                  5,909
                  6,300
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  747
                  411
                  412
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  5,892
                  5,898
                  6,324
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  371
                  348
                  336
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â348
                  â336
                  â360
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  5,915
                  5,910
                  6,300
               
               
                  1930
                  Total budgetary resources available
                  6,662
                  6,321
                  6,712
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  411
                  412
                  412
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,677
                  3,054
                  2,107
               
               
                  3010
                  New obligations, unexpired accounts
                  6,251
                  5,909
                  6,300
               
               
                  3020
                  Outlays (gross)
                  â5,874
                  â6,856
                  â8,253
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,054
                  2,107
                  154
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,677
                  3,054
                  2,107
               
               
                  3200
                  Obligated balance, end of year
                  3,054
                  2,107
                  154
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5,915
                  5,910
                  6,300
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,450
                  5,909
                  6,299
               
               
                  4101
                  Outlays from mandatory balances
                  3,424
                  947
                  1,954
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  5,874
                  6,856
                  8,253
               
               
                  4180
                  Budget authority, net (total)
                  5,915
                  5,910
                  6,300
               
               
                  4190
                  Outlays, net (total)
                  5,874
                  6,856
                  8,253
               
               
                  
                     
                  
               
            
         
      
      
         Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111â148) established a permanent risk adjustment program
            for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
            and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
            with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
            a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
            they are calculated.
         
      
         Transitional Reinsurance ProgramSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Contributions, Transitional Reinsurance Program
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  2
                  
                  
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Transitional Reinsurance Program
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  7
                  7
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  2
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  7
                  7
                  7
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7
                  7
                  7
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  212
                  212
                  
               
               
                  3020
                  Outlays (gross)
                  
                  â212
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  212
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  212
                  212
                  
               
               
                  3200
                  Obligated balance, end of year
                  212
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  212
                  
               
               
                  4180
                  Budget authority, net (total)
                  2
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  212
                  
               
               
                  
                     
                  
               
            
         
      
      
         Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111â148) established a transitional three-year reinsurance
            program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015, and 2016.
            The Centers for Medicare & Medicaid Services assessed contributing entities a per enrollee fee to fund the reinsurance program
            and made payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold, up to
            a reinsurance cap. Reinsurance collections and payments were made in the year following the plan year for which they were
            applicable. Reinsurance collections ended in FY 2019 and outlays in subsequent fiscal years reflect remaining payments, refunds,
            and allowable administrative activities. 
         
      
         Consumer Operated and Oriented Plan Program Contingency FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0709
                  Administrative expenses
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.2)
                  2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  2
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  2
                  
               
               
                  3200
                  Obligated balance, end of year
                  2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  1
                  2
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135001
                  Startup Loans
                  
                  â10
                  
               
               
                  135002
                  Solvency Loans
                  
                  â36
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  
                  â46
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
            112â240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
            loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
         Consumer Operated and Oriented Plan Program AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0705
                  Reestimates of direct loan subsidy
                  2
                  
                  
               
               
                  0709
                  Administrative expenses
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2
                  
                  
               
               
                  1900
                  Budget authority (total)
                  2
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  3
                  1
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  2
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  1
                  
               
               
                  3020
                  Outlays (gross)
                  â2
                  â2
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2
                  1
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  2
                  1
               
               
                  3200
                  Obligated balance, end of year
                  2
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  2
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2
                  2
                  1
               
               
                  4180
                  Budget authority, net (total)
                  2
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  2
                  2
                  1
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  
                  â77
                  
               
               
                  135003
                  Solvency  Loans
                  2
                  â219
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  2
                  â296
                  
               
               
                  
                     
                  
               
            
         
      
      
         Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated funding for the
            Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
            insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
            markets in the States. The Secretary awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which
            enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  
               
               
                  33.0
                  Investments and loans
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2
                  1
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  3
                  8
                  9
               
               
                  0742
                  Downward reestimates paid to receipt accounts
                  
                  249
                  
               
               
                  0743
                  Interest on downward reestimates
                  
                  47
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  3
                  304
                  9
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  18
                  23
                  19
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  15
                  23
                  19
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  
                  300
                  3
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  11
                  107
                  460
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â107
                  â460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  11
                  
                  
               
               
                  1900
                  Budget authority (total)
                  11
                  300
                  3
               
               
                  1930
                  Total budgetary resources available
                  26
                  323
                  22
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  23
                  19
                  13
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  304
               
               
                  3010
                  New obligations, unexpired accounts
                  3
                  304
                  9
               
               
                  3020
                  Outlays (gross)
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  304
                  313
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  304
               
               
                  3200
                  Obligated balance, end of year
                  
                  304
                  313
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  11
                  300
                  3
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  3
                  
                  
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â2
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â9
                  â107
                  â460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â11
                  â107
                  â460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  193
                  â457
               
               
                  4170
                  Outlays, net (mandatory)
                  â8
                  â107
                  â460
               
               
                  4180
                  Budget authority, net (total)
                  
                  193
                  â457
               
               
                  4190
                  Outlays, net (total)
                  â8
                  â107
                  â460
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  1,893
                  1,893
                  1,893
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,893
                  1,893
                  1,412
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2019 actual
                  2020 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  9
                  9
               
               
                  
                  Investments in U.S. securities:
               
               
                  1106
                  Receivables, net
                  259
                  259
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  1,893
                  1,893
               
               
                  1402
                  Interest receivable
                  25
                  25
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â1,778
                  â1,778
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  140
                  140
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  408
                  408
               
               
                  
                  LIABILITIES:
               
               
                  2103
                  Federal liabilities: Debt
                  408
                  408
               
               
                  
                  NET POSITION:
               
               
                  3300
                  Cumulative results of operations
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  408
                  408
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  2
                  2
                  2
               
               
                  0742
                  Downward reestimates paid to receipt accounts
                  
                  40
                  
               
               
                  0743
                  Interest on downward reestimates
                  
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2
                  48
                  2
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  
                  1
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  
                  1
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  1
                  49
                  2
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  38
                  116
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â38
                  â116
               
               
                  1900
                  Budget authority (total)
                  1
                  49
                  2
               
               
                  1930
                  Total budgetary resources available
                  2
                  49
                  3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  48
               
               
                  3010
                  New obligations, unexpired accounts
                  2
                  48
                  2
               
               
                  3020
                  Outlays (gross)
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  48
                  50
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  48
               
               
                  3200
                  Obligated balance, end of year
                  
                  48
                  50
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1
                  49
                  2
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  2
                  
                  
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  â38
                  â116
               
               
                  4180
                  Budget authority, net (total)
                  1
                  11
                  â114
               
               
                  4190
                  Outlays, net (total)
                  2
                  â38
                  â116
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  480
                  480
                  480
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â122
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  480
                  480
                  358
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2019 actual
                  2020 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  5
                  5
               
               
                  
                  Investments in U.S. securities:
               
               
                  1106
                  Receivables, net
                  5
                  5
               
               
                  1206
                  Non-Federal assets: Receivables, net
                  
                  
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  480
                  480
               
               
                  1402
                  Interest receivable
                  5
                  5
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â429
                  â429
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  56
                  56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  66
                  66
               
               
                  
                  LIABILITIES:
               
               
                  
                  Federal liabilities:
               
               
                  2103
                  Debt
                  65
                  65
               
               
                  2104
                  Resources payable to Treasury
                  
                  
               
               
                  2207
                  Non-Federal liabilities: Other
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total liabilities
                  65
                  65
               
               
                  
                  NET POSITION:
               
               
                  3300
                  Cumulative results of operations
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  66
                  66
               
               
                  
                     
                  
               
            
         
      
      Trust Funds
         Federal Hospital Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  156,175
                  95,439
                  74,534
               
               
                  0198
                  Reconciliation adjustment
                  â141
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  156,034
                  95,439
                  74,534
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  271,226
                  266,151
                  292,901
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  583
                  468
                  455
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  19,969
                  20,530
                  21,007
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  837
                  680
                  658
               
               
                  1130
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  345
                  378
                  419
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  9,140
                  7,394
                  7,444
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  78
                  48
                  48
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,975
                  4,369
                  4,739
               
               
                  1140
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  4,059
                  4,280
                  4,500
               
               
                  1140
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  660
                  598
                  593
               
               
                  1140
                  FHI Trust Fund, Interest Received by Trust Funds
                  5,297
                  2,359
                  2,382
               
               
                  1140
                  FHI Trust Fund, Taxation on OASDI Benefits
                  26,941
                  27,054
                  29,946
               
               
                  1140
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  141
                  154
                  158
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  2
                  11
                  8
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  28
                  52
                  53
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  701
                  32
                  33
               
               
                  1140
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  24
                  16
                  19
               
               
                  1140
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,250
                  1,312
                  1,362
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  345,256
                  335,888
                  366,727
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  13,733
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  30,567
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  44,300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  345,256
                  335,888
                  411,027
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  501,290
                  431,327
                  485,561
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â2,607
                  â2,802
                  â3,074
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â340,483
                  â330,888
                  â361,386
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,406
                  â1,393
                  â2,399
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â786
                  â807
                  â873
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â64,534
                  â20,928
                  â3,474
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â82
                  
                  
               
               
                  2132
                  Federal Hospital Insurance Trust Fund
                  4,006
                  25
                  5,206
               
               
                  2132
                  Health Care Fraud and Abuse Control Account
                  29
                  
                  37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â405,863
                  â356,793
                  â365,963
               
               
                  
                  Proposed:
               
               
                  2201
                  Health Care Fraud and Abuse Control Account
                  
                  
                  1,127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â405,863
                  â356,793
                  â364,836
               
               
                  3098
                  Federal Hospital Insurance Trust Fund
                  â44
                  
                  
               
               
                  5098
                  Reconciliation adjustment
                  56
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  95,439
                  74,534
                  120,725
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  400,795
                  351,087
                  359,017
               
               
                  0002
                  HIT Incentive Payments
                  15
                  10
                  5
               
               
                  0003
                  Administration, HI
                  2,735
                  2,949
                  3,225
               
               
                  0004
                  Quality improvement organizations, HI
                  848
                  489
                  481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  404,393
                  354,535
                  362,728
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  404,393
                  354,535
                  362,728
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  58
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  626
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  19
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  44
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  693
                  
                  58
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  2,607
                  2,802
                  3,074
               
               
                  1103
                  Appropriation (previously unavailable)(special or trust)
                  82
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,689
                  2,802
                  3,074
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  340,483
                  330,888
                  361,386
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  64,534
                  20,928
                  3,474
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                  â4,006
                  â25
                  â5,206
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  401,011
                  351,791
                  359,654
               
               
                  1900
                  Budget authority (total)
                  403,700
                  354,593
                  362,728
               
               
                  1930
                  Total budgetary resources available
                  404,393
                  354,593
                  362,786
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  58
                  58
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  40,273
                  36,279
                  36,264
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  â626
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  404,393
                  354,535
                  362,728
               
               
                  3020
                  Outlays (gross)
                  â407,742
                  â354,550
                  â362,747
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  36,279
                  36,264
                  36,245
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  39,647
                  36,279
                  36,264
               
               
                  3200
                  Obligated balance, end of year
                  36,279
                  36,264
                  36,245
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,689
                  2,802
                  3,074
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,874
                  1,735
                  1,972
               
               
                  4011
                  Outlays from discretionary balances
                  762
                  961
                  1,095
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,636
                  2,696
                  3,067
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  401,011
                  351,791
                  359,654
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  370,451
                  318,437
                  325,288
               
               
                  4101
                  Outlays from mandatory balances
                  34,655
                  33,417
                  34,392
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  405,106
                  351,854
                  359,680
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â4
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  401,011
                  351,791
                  359,654
               
               
                  4170
                  Outlays, net (mandatory)
                  405,102
                  351,854
                  359,680
               
               
                  4180
                  Budget authority, net (total)
                  403,700
                  354,593
                  362,728
               
               
                  4190
                  Outlays, net (total)
                  407,738
                  354,550
                  362,747
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  198,625
                  133,735
                  119,999
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  133,735
                  119,999
                  121,288
               
               
                  
                     
                  
               
            
         
      
      
         The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
            disabled persons.
         
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  198,894
                  134,361
                  113,499
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  198,894
                  134,361
                  113,499
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  271,226
                  266,151
                  292,901
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  583
                  468
                  455
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  19,969
                  20,530
                  21,007
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  837
                  680
                  658
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  345
                  378
                  419
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  9,140
                  7,394
                  7,444
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  78
                  48
                  48
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,975
                  4,369
                  4,739
               
               
                  1130
                  Federal Hospital Insurance Trust Fund
                  4
                  
                  
               
               
                  1130
                  Health Care Fraud and Abuse Control Account
                  1
                  
                  
               
               
                  1150
                  FHI Trust Fund, Interest Received by Trust Funds
                  5,297
                  2,359
                  2,382
               
               
                  1150
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  
                  2
                  2
               
               
                  1150
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  24
                  16
                  19
               
               
                  1160
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  4,059
                  4,280
                  4,500
               
               
                  1160
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  660
                  598
                  593
               
               
                  1160
                  FHI Trust Fund, Taxation on OASDI Benefits
                  26,941
                  27,054
                  29,946
               
               
                  1160
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  141
                  154
                  158
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  2
                  11
                  8
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  28
                  52
                  53
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  701
                  32
                  33
               
               
                  1160
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,250
                  1,312
                  1,362
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  345,261
                  335,888
                  366,727
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  30,567
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  13,733
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  44,300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  345,261
                  335,888
                  411,027
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Hospital Insurance Trust Fund [Budget Acct]
                  â407,742
                  â354,550
                  â362,747
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [Budget Acct]
                  â2,052
                  â2,200
                  â2,186
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â409,794
                  â356,750
                  â364,933
               
               
                  
                  Proposed:
               
               
                  2200
                  Health Care Fraud and Abuse Control Account
                  
                  
                  1,127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  1,127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â409,794
                  â356,750
                  â363,806
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  â69,854
                  â23,239
                  44,818
               
               
                  3120
                  Interest
                  5,321
                  2,377
                  2,403
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â64,533
                  â20,862
                  47,221
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  â64,533
                  â20,862
                  47,221
               
               
                  
                  Unexpended balance, end of year:
               
               
                  4100
                  Uninvested balance (net), end of year
                  626
                  â6,500
                  39,432
               
               
                  4200
                  Federal Hospital Insurance Trust Fund
                  133,735
                  119,999
                  121,288
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  134,361
                  113,499
                  160,720
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activities
                  848
                  489
                  481
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  396,016
                  351,097
                  359,022
               
               
                  94.0
                  Financial transfers
                  7,529
                  2,949
                  3,225
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  404,393
                  354,535
                  362,728
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNTIn addition to amounts otherwise available for program integrity and program management,  $872,793,000, to remain available through September 30,  2023, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
            as authorized by section 201(g) of the Social Security Act, of which  $675,726,000 shall be for the Centers for Medicare & Medicaid Services program integrity activities, of which  $102,145,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities
            authorized by section 1817(k)(3) of such Act, and of which  $94,922,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act:
            Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year  2022 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and
            CHIP programs for the funds provided by this appropriation: Provided further, That of the amount provided under this heading,  $317,000,000 is provided to meet the terms of  a concurrent resolution on the budget for health care fraud and abuse control activities, and  $555,793,000 is additional new budget authority specified for purposes of  a concurrent resolution on the budget for additional health care fraud and abuse control activities: Provided further, That the Secretary shall provide not less than $20,000,000 from amounts made available under this heading and amounts made
            available for fiscal year  2022 under section 1817(k)(3)(A) of the Social Security Act for the Senior Medicare Patrol program to combat health care fraud
            and abuse.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare integrity program
                  956
                  941
                  944
               
               
                  0002
                  FBI fraud and abuse control
                  141
                  152
                  149
               
               
                  0003
                  Other fraud and abuse control
                  318
                  322
                  314
               
               
                  0005
                  Undistributed Savings, Medicare SSA CDRs
                  
                  â22
                  â131
               
               
                  0006
                  Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment
                  
                  
                  1,086
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  1,415
                  1,393
                  2,362
               
               
                  0101
                  CMS discretionary
                  636
                  616
                  676
               
               
                  0102
                  Other discretionary
                  176
                  191
                  197
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total Discretionary
                  812
                  807
                  873
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,227
                  2,200
                  3,235
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  573
                  556
                  556
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  242
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  621
                  556
                  556
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  786
                  807
                  873
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1,406
                  1,393
                  2,399
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â29
                  
                  â37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,377
                  1,393
                  2,362
               
               
                  1900
                  Budget authority (total)
                  2,163
                  2,200
                  3,235
               
               
                  1930
                  Total budgetary resources available
                  2,784
                  2,756
                  3,791
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  556
                  556
                  556
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1951
                  Unobligated balance expiring
                  1
                  
                  
               
               
                  1952
                  Expired unobligated balance, start of year
                  36
                  69
                  69
               
               
                  1953
                  Expired unobligated balance, end of year
                  68
                  69
                  69
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,978
                  2,062
                  2,062
               
               
                  3010
                  New obligations, unexpired accounts
                  2,227
                  2,200
                  3,235
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,052
                  â2,200
                  â2,186
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â48
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â44
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,062
                  2,062
                  3,111
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,978
                  2,062
                  2,062
               
               
                  3200
                  Obligated balance, end of year
                  2,062
                  2,062
                  3,111
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  786
                  807
                  873
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  176
                  322
                  349
               
               
                  4011
                  Outlays from discretionary balances
                  537
                  485
                  524
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  713
                  807
                  873
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  786
                  807
                  873
               
               
                  4080
                  Outlays, net (discretionary)
                  712
                  807
                  873
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,377
                  1,393
                  2,362
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  528
                  686
                  591
               
               
                  4101
                  Outlays from mandatory balances
                  811
                  707
                  722
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,339
                  1,393
                  1,313
               
               
                  4180
                  Budget authority, net (total)
                  2,163
                  2,200
                  3,235
               
               
                  4190
                  Outlays, net (total)
                  2,051
                  2,200
                  2,186
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,163
                  2,200
                  3,235
               
               
                  
                  Outlays
                  2,051
                  2,200
                  2,186
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,127
               
               
                  
                  Outlays
                  
                  
                  â1,127
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,163
                  2,200
                  2,108
               
               
                  
                  Outlays
                  2,051
                  2,200
                  1,059
               
               
                  
                     
                  
               
            
         
      
      
         The Health Insurance Portability and Accountability Act of 1996 (P.L. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Concpets chapter
            in the Analytical Perspectives volume.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent (CMS)
                  45
                  51
                  51
               
               
                  11.7
                  Military personnel
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  46
                  53
                  53
               
               
                  12.1
                  Civilian personnel benefits (CMS)
                  12
                  12
                  12
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  12
                  13
                  13
               
               
                  25.2
                  Other services (CMS/Medicaid/Private Insurance)
                  149
                  161
                  161
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  146
                  159
                  160
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  330
                  333
                  331
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OGC)
                  7
                  7
                  7
               
               
                  25.3
                  Other goods and services from Federal sources (HHS/ASPE)
                  5
                  3
                  3
               
               
                  25.3
                  Other goods and services from Government accounts (HHS/FDA)
                  6
                  6
                  6
               
               
                  25.3
                  Other goods and services from Federal sources (HHS Wedge)
                  
                  2
                  1
               
               
                  25.6
                  Medical care  (CMS)
                  1,372
                  1,320
                  1,383
               
               
                  92.0
                  Undistributed (SSA CDR Medicare baseline Savings)
                  
                  â22
                  â131
               
               
                  92.0
                  Undistributed (Medicare baseline impact attributable to HCFAC Cap/Allocation Adjustment)
                  
                  
                  1,086
               
               
                  94.0
                  Financial transfers (FBI)
                  141
                  152
                  149
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,227
                  2,200
                  3,235
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  423
                  464
                  464
               
               
                  1101
                  Direct military average strength employment
                  14
                  14
                  14
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â2â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0005
                  Undistributed Savings, SSA Medicare CDRs
                  
                  
                  â41
               
               
                  0006
                  Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment
                  
                  
                  â1,086
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  
                  
                  â1,127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,127
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â1,127
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â1,127
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,127
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,127
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,127
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,127
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,127
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,127
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,127
               
               
                  
                     
                  
               
            
         
      
      
          
         This schedule reflects the non-PAYGO impacts on Medicare and Medicaid spending resulting from the proposed allocation adjustment
            to further support the Centers for Medicare and Medicaid Services (CMS) program integrity work. This additional investment
            results in savings to the Medicare and Medicaid programs.
         
          This schedule also reflects the non-PAYGO impacts on Medicare resulting from the proposed allocation adjustment for the Social
            Security Administration. Please refer to the narrative in the Limitation on Administrative Expenses (Social Security Administration)
            account for more information. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â2â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  92.0
                  Undistributed (SSA CDR Medicare Savings)
                  
                  
                  â41
               
               
                  92.0
                  Undistributed (Medicare impact attributable to HCFAC Cap/Allocation Adjustment)
                  
                  
                  â1,086
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,127
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  67,661
                  52,946
                  138,883
               
               
                  0198
                  Reconciliation adjustment
                  â41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  67,620
                  52,946
                  138,883
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  3,167
                  2,677
                  2,800
               
               
                  1130
                  Other Proprietary Interest from the Public, FSMI Fund
                  
                  3
                  3
               
               
                  1130
                  Gifts, Medicare Prescription Drug Accounts, FSMI
                  
                  544
                  531
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  5,757
                  5,660
                  6,043
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  11,720
                  11,417
                  13,562
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  453
                  502
                  556
               
               
                  1130
                  Gifts, FSMI Fund
                  
                  1
                  1
               
               
                  1130
                  Medicare Refunds, SMI
                  5,369
                  5,419
                  5,469
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  98
                  45
                  45
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  92,498
                  100,304
                  112,698
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  13,758
                  13,422
                  14,246
               
               
                  1140
                  Federal Contributions, FSMI Fund
                  287,182
                  375,181
                  334,474
               
               
                  1140
                  Interest Received by Trust Fund, FSMI Fund
                  2,166
                  2,356
                  4,938
               
               
                  1140
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  5
                  5
               
               
                  1140
                  Interest, Medicare Prescription Drug Account, FSMI
                  48
                  30
                  33
               
               
                  1140
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  861
                  882
                  882
               
               
                  1140
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  71,422
                  81,408
                  87,798
               
               
                  1140
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  494,500
                  599,857
                  584,085
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  494,500
                  599,857
                  584,085
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  562,120
                  652,803
                  722,968
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â3,031
                  â3,265
                  â3,640
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â401,726
                  â501,085
                  â464,377
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â860
                  â881
                  â881
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â88,884
                  â98,523
                  â115,825
               
               
                  2103
                  Federal Supplementary Medical Insurance Trust Fund
                  â111
                  
                  
               
               
                  2103
                  Federal Supplementary Medical Insurance Trust Fund
                  â18,784
                  â8
                  â7,383
               
               
                  2132
                  Federal Supplementary Medical Insurance Trust Fund
                  4,305
                  8
                  7,383
               
               
                  2132
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  133
               
               
                  2135
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  89,834
                  8,517
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â509,091
                  â513,920
                  â576,073
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â509,091
                  â513,920
                  â576,073
               
               
                  3098
                  Federal Supplementary Medical Insurance Trust Fund
                  â113
                  
                  
               
               
                  3098
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  52,946
                  138,883
                  146,895
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  414,044
                  408,707
                  450,834
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  1,142
                  1,162
                  1,309
               
               
                  0004
                  Administration, SMI
                  3,031
                  3,265
                  3,640
               
               
                  0005
                  Quality Improvement Organizations, SMI
                  263
                  152
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  418,480
                  413,286
                  455,933
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  418,480
                  413,286
                  455,933
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  76
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  982
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  25
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  113
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,131
                  
                  76
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  3,031
                  3,265
                  3,640
               
               
                  1103
                  Appropriation (previously unavailable)(special or trust)
                  111
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,142
                  3,265
                  3,640
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  401,726
                  501,085
                  464,377
               
               
                  1203
                  Appropriation (previously unavailable)(special or trust)
                  18,784
                  8
                  7,383
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â4,305
                  â8
                  â7,383
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  
                  â89,834
                  â8,517
               
               
                  1236
                  Appropriations applied to repay debt
                  â1,998
                  â1,154
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  414,207
                  410,097
                  455,860
               
               
                  1900
                  Budget authority (total)
                  417,349
                  413,362
                  459,500
               
               
                  1930
                  Total budgetary resources available
                  418,480
                  413,362
                  459,576
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  76
                  3,643
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  31,871
                  29,334
                  28,403
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  â982
                  
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  418,480
                  413,286
                  455,933
               
               
                  3020
                  Outlays (gross)
                  â420,010
                  â414,217
                  â459,530
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  29,334
                  28,403
                  24,806
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  30,889
                  29,334
                  28,403
               
               
                  3200
                  Obligated balance, end of year
                  29,334
                  28,403
                  24,806
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,142
                  3,265
                  3,640
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,783
                  2,516
                  2,406
               
               
                  4011
                  Outlays from discretionary balances
                  1,752
                  1,500
                  1,225
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,535
                  4,016
                  3,631
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  414,207
                  410,097
                  455,860
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  388,273
                  384,458
                  423,725
               
               
                  4101
                  Outlays from mandatory balances
                  28,202
                  25,743
                  32,174
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  416,475
                  410,201
                  455,899
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â11
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  414,207
                  410,097
                  455,860
               
               
                  4170
                  Outlays, net (mandatory)
                  416,464
                  410,201
                  455,899
               
               
                  4180
                  Budget authority, net (total)
                  417,349
                  413,362
                  459,500
               
               
                  4190
                  Outlays, net (total)
                  419,999
                  414,217
                  459,530
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  104,716
                  87,477
                  187,005
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  87,477
                  187,005
                  192,047
               
               
                  5080
                  Outstanding debt, SOY
                  â3,152
                  â1,154
                  
               
               
                  5081
                  Outstanding debt, EOY
                  â1,154
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician
            care and certain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees.
            SMI costs are generally financed by premium payments from enrollees and contributions from the general revenues.
         
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  104,053
                  88,909
                  179,311
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  104,053
                  88,909
                  179,311
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  3,167
                  2,677
                  2,800
               
               
                  1130
                  Gifts, Medicare Prescription Drug Accounts, FSMI
                  
                  544
                  531
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  5,757
                  5,660
                  6,043
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  11,720
                  11,417
                  13,562
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  453
                  502
                  556
               
               
                  1130
                  Gifts, FSMI Fund
                  
                  1
                  1
               
               
                  1130
                  Medicare Refunds, SMI
                  5,369
                  5,419
                  5,469
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  98
                  45
                  45
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  92,498
                  100,304
                  112,698
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  13,758
                  13,422
                  14,246
               
               
                  1130
                  Federal Supplementary Medical Insurance Trust Fund
                  11
                  
                  
               
               
                  1130
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  4
                  
                  
               
               
                  1150
                  Interest Received by Trust Fund, FSMI Fund
                  2,166
                  2,356
                  4,938
               
               
                  1150
                  Other Proprietary Interest from the Public, FSMI Fund
                  
                  3
                  3
               
               
                  1150
                  Interest, Medicare Prescription Drug Account, FSMI
                  48
                  30
                  33
               
               
                  1160
                  Federal Contributions, FSMI Fund
                  287,182
                  375,181
                  334,474
               
               
                  1160
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  5
                  5
               
               
                  1160
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  861
                  882
                  882
               
               
                  1160
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  71,422
                  81,408
                  87,798
               
               
                  1160
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  1160
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  3,659
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  494,515
                  603,516
                  584,085
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  494,515
                  603,516
                  584,085
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Supplementary Medical Insurance Trust Fund [Budget Acct]
                  â420,010
                  â414,217
                  â459,530
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]
                  â89,650
                  â98,897
                  â116,575
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â509,660
                  â513,114
                  â576,105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â509,660
                  â513,114
                  â576,105
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  â17,359
                  88,013
                  3,006
               
               
                  3120
                  Interest
                  2,214
                  2,389
                  4,974
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â15,145
                  90,402
                  7,980
               
               
                  3298
                  Reconciliation adjustment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  â15,144
                  90,402
                  7,980
               
               
                  
                  Unexpended balance, end of year:
               
               
                  4100
                  Uninvested balance (net), end of year
                  1,432
                  â7,694
                  â4,756
               
               
                  4200
                  Federal Supplementary Medical Insurance Trust Fund
                  87,477
                  187,005
                  192,047
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  88,909
                  179,311
                  187,291
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activity
                  263
                  152
                  150
               
               
                  42.0
                  Insurance claims and indemnities
                  413,388
                  413,133
                  455,782
               
               
                  94.0
                  Financial transfers
                  4,828
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  418,480
                  413,286
                  455,933
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  418,480
                  413,286
                  455,933
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  6
                  2
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  92,545
                  98,523
                  115,691
               
               
                  0002
                  Administrative Costs
                  861
                  882
                  882
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  93,406
                  99,405
                  116,573
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  93,406
                  99,405
                  116,573
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  30
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  â30
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust)
                  860
                  881
                  881
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  88,884
                  98,523
                  115,825
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  
                  
                  â133
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  88,884
                  98,523
                  115,692
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  3,659
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  3,659
                  â3,659
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  3,659
                  
                  
               
               
                  1900
                  Budget authority (total)
                  93,403
                  99,404
                  116,573
               
               
                  1930
                  Total budgetary resources available
                  93,407
                  99,405
                  116,573
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  10,503
                  14,229
                  14,737
               
               
                  3010
                  New obligations, unexpired accounts
                  93,406
                  99,405
                  116,573
               
               
                  3020
                  Outlays (gross)
                  â89,650
                  â98,897
                  â116,575
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  14,229
                  14,737
                  14,735
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2,789
                  â6,448
                  â2,789
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3,659
                  3,659
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6,448
                  â2,789
                  â2,789
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7,714
                  7,781
                  11,948
               
               
                  3200
                  Obligated balance, end of year
                  7,781
                  11,948
                  11,946
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  860
                  881
                  881
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  297
                  264
                  536
               
               
                  4011
                  Outlays from discretionary balances
                  122
                  100
                  345
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  419
                  364
                  881
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  92,543
                  98,523
                  115,692
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  79,670
                  85,730
                  103,691
               
               
                  4101
                  Outlays from mandatory balances
                  9,561
                  12,803
                  12,003
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  89,231
                  98,533
                  115,694
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  
                  â3,659
                  
               
               
                  4123
                  Non-Federal sources
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â4
                  â3,659
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â3,659
                  3,659
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â3,655
                  3,659
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  88,884
                  98,523
                  115,692
               
               
                  4170
                  Outlays, net (mandatory)
                  89,227
                  94,874
                  115,694
               
               
                  4180
                  Budget authority, net (total)
                  89,744
                  99,404
                  116,573
               
               
                  4190
                  Outlays, net (total)
                  89,646
                  95,238
                  116,575
               
               
                  
                     
                  
               
            
         
      
      
         Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
            benefit. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  861
                  882
                  882
               
               
                  42.0
                  Insurance claims and indemnities
                  92,545
                  98,523
                  115,691
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  93,406
                  99,405
                  116,573
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  93,406
                  99,405
                  116,573
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Administration for Children and FamiliesFederal Funds
         Temporary Assistance for Needy FamiliesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  16,436
                  16,433
                  16,433
               
               
                  0002
                  Territories - family assistance grants
                  78
                  78
                  78
               
               
                  0006
                  Tribal work programs
                  5
                  8
                  8
               
               
                  0009
                  Healthy marriage and responsible fatherhood grants
                  147
                  149
                  149
               
               
                  0010
                  Evaluation Funding and What Works Clearinghouse
                  44
                  45
                  45
               
               
                  0011
                  Census Bureau Research
                  9
                  10
                  10
               
               
                  0012
                  Pandemic Emergency Assistance
                  
                  999
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  16,719
                  17,722
                  16,724
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  16,739
                  17,739
                  16,739
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,738
                  17,738
                  16,738
               
               
                  1900
                  Budget authority (total)
                  16,738
                  17,738
                  16,738
               
               
                  1930
                  Total budgetary resources available
                  16,738
                  17,738
                  16,739
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â19
                  â15
                  â15
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  9,284
                  9,449
                  10,501
               
               
                  3010
                  New obligations, unexpired accounts
                  16,719
                  17,722
                  16,724
               
               
                  3020
                  Outlays (gross)
                  â16,554
                  â16,670
                  â17,270
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9,449
                  10,501
                  9,955
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  9,284
                  9,449
                  10,501
               
               
                  3200
                  Obligated balance, end of year
                  9,449
                  10,501
                  9,955
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16,738
                  17,738
                  16,738
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  10,668
                  10,645
                  10,545
               
               
                  4101
                  Outlays from mandatory balances
                  5,886
                  6,025
                  6,725
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  16,554
                  16,670
                  17,270
               
               
                  4180
                  Budget authority, net (total)
                  16,738
                  17,738
                  16,738
               
               
                  4190
                  Outlays, net (total)
                  16,554
                  16,670
                  17,270
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funding for the Temporary Assistance for Needy Families (TANF) block grant and related activities authorized
            by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171). TANF's authorization was most recently extended in the Consolidated Appropriations Act, 2021 (P.
            L. 116â260).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  10
                  10
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  10
                  10
                  11
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  59
                  60
                  60
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  4
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16,644
                  17,646
                  16,647
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  16,719
                  17,722
                  16,724
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  88
                  102
                  108
               
               
                  
                     
                  
               
            
         
      
         Contingency FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency Fund for State Welfare Programs
                  608
                  608
                  608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  608
                  608
                  608
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  608
                  608
                  608
               
               
                  1930
                  Total budgetary resources available
                  608
                  608
                  608
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  45
                  9
                  9
               
               
                  3010
                  New obligations, unexpired accounts
                  608
                  608
                  608
               
               
                  3020
                  Outlays (gross)
                  â628
                  â608
                  â608
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9
                  9
                  9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  45
                  9
                  9
               
               
                  3200
                  Obligated balance, end of year
                  9
                  9
                  9
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  608
                  608
                  608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  606
                  599
                  608
               
               
                  4101
                  Outlays from mandatory balances
                  22
                  9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  628
                  608
                  608
               
               
                  4180
                  Budget authority, net (total)
                  608
                  608
                  608
               
               
                  4190
                  Outlays, net (total)
                  628
                  608
                  608
               
               
                  
                     
                  
               
            
         
      
      
          The TANF Contingency Fund provides a funding reserve of $608 million to assist states that meet certain criteria related
            to the state's unemployment rate and Supplemental Nutrition Assistance Program (SNAP) caseload. In order to qualify for contingency
            funds, States must also meet a higher maintenance-of-effort requirement of 100 percent of historical expenditures. The authorization
            for the Contingency Fund was most recently extended in the Consolidated Appropriations Act, 2021 (P.L. 116â260).  
         
      
         PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT PROGRAMSFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
            of July 5, 1960,  $2,795,000,000, to remain available until expended; and for such purposes for the first quarter of fiscal year  2023, $1,300,000,000, to remain available until expended.
      For carrying out, after May 31 of the current fiscal year, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI
            of the Social Security Act and the Act of July 5, 1960, for the last 3 months of the current fiscal year for unanticipated
            costs, incurred for the current fiscal year, such sums as may be necessary.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  4,352
                  3,872
                  3,724
               
               
                  0002
                  Child support incentive payments
                  597
                  623
                  617
               
               
                  0003
                  Access and visitation grants
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  4,959
                  4,505
                  4,351
               
               
                  0102
                  Payments to territories
                  33
                  33
                  33
               
               
                  0103
                  Repatriation
                  1
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  34
                  43
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,993
                  4,548
                  4,394
               
               
                  0801
                  Offset obligations (CSE grants to States)
                  
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  4,993
                  4,550
                  4,394
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  55
                  1
                  292
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  388
                  400
                  200
               
               
                  1037
                  Unobligated balance of appropriations withdrawn
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  428
                  401
                  492
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3,166
                  3,039
                  2,795
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  3,166
                  3,039
                  2,794
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  1,400
                  1,400
                  1,400
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  2
                  
               
               
                  1900
                  Budget authority (total)
                  4,566
                  4,441
                  4,194
               
               
                  1930
                  Total budgetary resources available
                  4,994
                  4,842
                  4,686
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  292
                  292
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,622
                  1,803
                  1,563
               
               
                  3010
                  New obligations, unexpired accounts
                  4,993
                  4,550
                  4,394
               
               
                  3020
                  Outlays (gross)
                  â4,424
                  â4,390
                  â4,157
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â388
                  â400
                  â200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,803
                  1,563
                  1,600
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,622
                  1,803
                  1,563
               
               
                  3200
                  Obligated balance, end of year
                  1,803
                  1,563
                  1,600
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,566
                  4,441
                  4,194
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,640
                  3,663
                  3,534
               
               
                  4101
                  Outlays from mandatory balances
                  784
                  727
                  623
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,424
                  4,390
                  4,157
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  â2
                  
               
               
                  4180
                  Budget authority, net (total)
                  4,566
                  4,439
                  4,194
               
               
                  4190
                  Outlays, net (total)
                  4,424
                  4,388
                  4,157
               
               
                  
                     
                  
               
            
         
      
      
         This account provides for payments to States for child support enforcement and other family support programs, including access
            and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
            account. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  7
                  7
               
               
                  41.0
                  Grants, subsidies, and contributions
                  4,993
                  4,540
                  4,386
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,993
                  4,548
                  4,394
               
               
                  99.0
                  Reimbursable obligations
                  
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,993
                  4,550
                  4,394
               
               
                  
                     
                  
               
            
         
      
         LOW INCOME HOME ENERGY ASSISTANCEFor making payments under subsections (b) and (d) of section 2602 of the Low-Income Home Energy Assistance Act of 1981 (42
            U.S.C. 8621 et seq.),   $3,850,304,000: Provided, That notwithstanding section 2609A(a) of such Act, not more than $3,500,000 may be reserved by the Secretary of Health and
            Human Services for technical assistance, training, and monitoring of program activities for compliance with internal controls,
            policies and procedures and the Secretary may, in addition to the authorities provided in section 2609A(a)(1), use such funds
            through contracts with private entities that do not qualify as nonprofit organizations: Provided further, That all but $760,000,000 of the amount appropriated under this heading shall be allocated as though the total appropriation
            for such payments for fiscal year   2022 was less than $1,975,000,000: Provided further, That, after applying all applicable provisions of section 2604 of such Act and the previous proviso, each State or territory
            that would otherwise receive an allocation that is less than 97 percent of the amount that it received under this heading
            for fiscal year 2020 from amounts appropriated in Public Law 116â94 shall have its allocation increased to that 97 percent
            level, with the portions of other States' and territories' allocations that would exceed 100 percent of the amounts they respectively
            received in such fashion for fiscal year 2020 being ratably reduced.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  LIHEAP Block Grant
                  4,641
                  8,250
                  3,850
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  1
                  1
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  4,640
                  3,750
                  3,850
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  4,500
                  
               
               
                  1900
                  Budget authority (total)
                  4,640
                  8,250
                  3,850
               
               
                  1930
                  Total budgetary resources available
                  4,642
                  8,251
                  3,851
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,572
                  2,382
                  3,454
               
               
                  3010
                  New obligations, unexpired accounts
                  4,641
                  8,250
                  3,850
               
               
                  3020
                  Outlays (gross)
                  â3,812
                  â7,178
                  â5,260
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,382
                  3,454
                  2,044
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,572
                  2,382
                  3,454
               
               
                  3200
                  Obligated balance, end of year
                  2,382
                  3,454
                  2,044
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,640
                  3,750
                  3,850
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,574
                  2,362
                  2,426
               
               
                  4011
                  Outlays from discretionary balances
                  1,238
                  2,012
                  1,362
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,812
                  4,374
                  3,788
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  4,500
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  2,804
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  1,472
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  2,804
                  1,472
               
               
                  4180
                  Budget authority, net (total)
                  4,640
                  8,250
                  3,850
               
               
                  4190
                  Outlays, net (total)
                  3,812
                  7,178
                  5,260
               
               
                  
                     
                  
               
            
         
      
      
         LIHEAP provides federally funded assistance to low-income households via State, territory, and tribal governments for the
            purpose of managing costs associated with home energy bills and energy crises, as well as weatherization and minor energy-related
            home repairs. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  2
                  2
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  4,638
                  8,247
                  3,847
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,641
                  8,250
                  3,850
               
               
                  
                     
                  
               
            
         
      
         REFUGEE AND ENTRANT ASSISTANCE
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality
            Act and section 501 of the Refugee Education Assistance Act of 1980, and for carrying out section 462 of the Homeland Security
            Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the Trafficking
            Victims Protection Act of 2000 ("TVPA"), and the Torture Victims Relief Act of 1998,  $4,404,000,000, of which  $4,308,467,000 shall remain available through September 30,  2024 for carrying out such sections 414, 501, 462, and 235 and $30,000,000 shall remain available until expended for the purposes authorized in section 227 of this title: Provided, That amounts available under this heading to carry out the TVPA shall also be available for research and evaluation with
            respect to activities under such Act: Provided further, That the limitation in section  204 of this Act regarding transfers increasing any appropriation shall apply to transfers to appropriations under this heading
            by substituting "15 percent" for "3 percent": Provided further, That the contribution of funds requirement under section 235(c)(6)(C)(iii) of the William Wilberforce Trafficking Victims
            Protection Reauthorization Act of 2008 shall not apply to funds made available under this heading.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Refugee Support Services (RSS) and Transitional & Medical Services (TAMS)
                  540
                  561
                  1,055
               
               
                  0002
                  Assistance for treatment of torture victims
                  16
                  17
                  27
               
               
                  0003
                  Unaccompanied Children
                  2,106
                  1,303
                  3,283
               
               
                  0005
                  Trafficking Victims program
                  28
                  29
                  39
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  2,690
                  1,910
                  4,404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,690
                  1,910
                  4,404
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,097
                  1,417
                  1,417
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  102
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,199
                  1,417
                  1,417
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Base Appropriation
                  1,908
                  1,910
                  4,404
               
               
                  1900
                  Budget authority (total)
                  1,908
                  1,910
                  4,404
               
               
                  1930
                  Total budgetary resources available
                  4,107
                  3,327
                  5,821
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,417
                  1,417
                  1,417
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,191
                  2,602
                  678
               
               
                  3010
                  New obligations, unexpired accounts
                  2,690
                  1,910
                  4,404
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  5
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,149
                  â3,834
                  â3,044
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â102
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,602
                  678
                  2,038
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â180
                  â7
                  â7
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  173
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â7
                  â7
                  â7
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,011
                  2,595
                  671
               
               
                  3200
                  Obligated balance, end of year
                  2,595
                  671
                  2,031
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,908
                  1,910
                  4,404
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  280
                  668
                  1,982
               
               
                  4011
                  Outlays from discretionary balances
                  1,869
                  3,166
                  1,062
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,149
                  3,834
                  3,044
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â173
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â173
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  173
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  173
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  1,908
                  1,910
                  4,404
               
               
                  4080
                  Outlays, net (discretionary)
                  1,976
                  3,834
                  3,044
               
               
                  4180
                  Budget authority, net (total)
                  1,908
                  1,910
                  4,404
               
               
                  4190
                  Outlays, net (total)
                  1,976
                  3,834
                  3,044
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
            programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
            for refugee benefits. The account also includes funding for the care and placement of unaccompanied children, and for the
            rehabilitation of victims of torture and human trafficking. The appropriations request should be $4,404,947,000.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  15
                  15
                  15
               
               
                  11.7
                  Military personnel
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  17
                  17
               
               
                  12.1
                  Civilian personnel benefits
                  5
                  5
                  5
               
               
                  12.2
                  Military personnel benefits
                  2
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  7
                  7
                  7
               
               
                  25.1
                  Advisory and assistance services
                  16
                  16
                  16
               
               
                  25.2
                  Other services from non-Federal sources
                  621
                  621
                  621
               
               
                  25.3
                  Other goods and services from Federal sources
                  123
                  123
                  123
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,898
                  1,119
                  3,613
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,690
                  1,910
                  4,404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,690
                  1,910
                  4,404
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  143
                  143
                  143
               
               
                  1101
                  Direct military average strength employment
                  17
                  17
                  17
               
               
                  
                     
                  
               
            
         
      
         PROMOTING SAFE AND STABLE FAMILIESFor carrying out, except as otherwise provided, section 436 of the Social Security Act,  $345,000,000 and, for carrying out, except as otherwise provided, section 437 of such Act,  $106,000,000: Provided, That of the funds available to carry out section 437,  $60,000,000 shall be allocated consistent with subsections (b) through (d) of such section: Provided further, That of the funds available to carry out section 437, to assist in meeting the requirements described in section 471(e)(4)(C),
             $30,000,000 shall be for grants to each State, territory, and Indian tribe operating title IV-E plans for developing, enhancing, or evaluating
            kinship navigator programs, as described in section 427(a)(1) of such Act and  $9,000,000, in addition to funds otherwise appropriated in section 476 for such purposes, shall be for the Family First Clearinghouse and to support evaluation and technical assistance relating to the evaluation of child and family services: Provided further, That, of the funds available to carry out section 437, $7,000,000 shall be for competitive grants to regional
               partnerships as described in section 437(f), and shall be in addition to any other funds appropriated for such purposes: Provided further, That section 437(b)(1) shall be applied to amounts in the previous proviso by substituting "5 percent" for "3.3 percent",
            and notwithstanding section 436(b)(1), such reserved amounts may be used for identifying, establishing, and disseminating
            practices to meet the criteria specified in section 471(e)(4)(C): Provided further, That the reservation in section 437(b)(2) and the limitations in section 437(d) shall not apply to funds specified in the
            second proviso: Provided further, That the minimum grant award for kinship navigator programs in the case of States and territories shall be $200,000, and,
            in the case of tribes, shall be $25,000.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  383
                  468
                  376
               
               
                  0002
                  Research, training and technical assistance
                  8
                  10
                  10
               
               
                  0003
                  State court improvement activities
                  30
                  31
                  31
               
               
                  0004
                  Family Connection Grants
                  
                  1
                  2
               
               
                  0005
                  Personal Responsibility Education (PREP)
                  71
                  71
                  73
               
               
                  0006
                  Sexual Risk Abstinence Education (SRAE)
                  67
                  69
                  70
               
               
                  0007
                  Family Rec. & Reunification
                  1
                  
                  3
               
               
                  0008
                  Family First Transition Act
                  500
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,060
                  650
                  565
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  53
                  57
                  50
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  57
                  57
                  50
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  93
                  83
                  106
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  995
                  580
                  495
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â20
                  â20
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  975
                  560
                  475
               
               
                  1900
                  Budget authority (total)
                  1,068
                  643
                  581
               
               
                  1930
                  Total budgetary resources available
                  1,125
                  700
                  631
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â8
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  57
                  50
                  66
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  739
                  1,234
                  1,080
               
               
                  3010
                  New obligations, unexpired accounts
                  1,060
                  650
                  565
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â548
                  â804
                  â689
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,234
                  1,080
                  956
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  739
                  1,234
                  1,080
               
               
                  3200
                  Obligated balance, end of year
                  1,234
                  1,080
                  956
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  93
                  83
                  106
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  18
                  20
                  25
               
               
                  4011
                  Outlays from discretionary balances
                  68
                  66
                  63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  86
                  86
                  88
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  975
                  560
                  475
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  103
                  95
                  73
               
               
                  4101
                  Outlays from mandatory balances
                  359
                  623
                  528
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  462
                  718
                  601
               
               
                  4180
                  Budget authority, net (total)
                  1,068
                  643
                  581
               
               
                  4190
                  Outlays, net (total)
                  548
                  804
                  689
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds for a broad range of child welfare services, including family preservation and support services
            and grants to increase the well-being of and improve the permanency outcomes for children affected by substance abuse, through
            Promoting Safe and Stable Families.  It also includes the Sexual Risk Avoidance Education program and the Personal Responsibility
            Education Program (PREP).  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  3
                  2
               
               
                  25.1
                  Advisory and assistance services
                  21
                  24
                  21
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  5
                  6
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,029
                  617
                  535
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,060
                  650
                  565
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  15
                  22
                  23
               
               
                  
                     
                  
               
            
         
      
         Child Care for American Families
         Child Care for American Families
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1513â4â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program
                  
                  
                  6,720
               
               
                  0002
                  Infrastructure
                  
                  
                  25,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct program activities, subtotal
                  
                  
                  31,720
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 92.0)
                  
                  
                  31,720
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  6,720
               
               
                  1200
                  Appropriation
                  
                  
                  5,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  11,720
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  11,720
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â20,000
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  31,720
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â9,220
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  22,500
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  22,500
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  11,720
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  9,220
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  11,720
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  9,220
               
               
                  
                     
                  
               
            
         
      
      
         The Budget provides access to affordable, high-quality child care on a sliding scale for low-income and middle-class families
            for children 0â5 years old.
         
      
         Child Care Entitlement to StatesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Mandatory child care
                  1,177
                  1,177
                  1,177
               
               
                  0002
                  Matching child care
                  1,698
                  2,164
                  2,164
               
               
                  0003
                  Child Care Training and technical assistance
                  15
                  17
                  17
               
               
                  0004
                  Child care tribal grants
                  58
                  100
                  100
               
               
                  0005
                  Child Care Research
                  15
                  17
                  17
               
               
                  0006
                  Child Care Territory Grants
                  
                  75
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,963
                  3,550
                  3,550
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  46
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,917
                  3,550
                  3,550
               
               
                  1930
                  Total budgetary resources available
                  2,963
                  3,550
                  3,550
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,267
                  1,171
                  1,534
               
               
                  3010
                  New obligations, unexpired accounts
                  2,963
                  3,550
                  3,550
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,983
                  â3,187
                  â3,447
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â80
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,171
                  1,534
                  1,637
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,267
                  1,171
                  1,534
               
               
                  3200
                  Obligated balance, end of year
                  1,171
                  1,534
                  1,637
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,917
                  3,550
                  3,550
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,967
                  2,414
                  2,414
               
               
                  4101
                  Outlays from mandatory balances
                  1,016
                  773
                  1,033
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,983
                  3,187
                  3,447
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â4
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  2,917
                  3,550
                  3,550
               
               
                  4170
                  Outlays, net (mandatory)
                  2,979
                  3,187
                  3,447
               
               
                  4180
                  Budget authority, net (total)
                  2,917
                  3,550
                  3,550
               
               
                  4190
                  Outlays, net (total)
                  2,979
                  3,187
                  3,447
               
               
                  
                     
                  
               
            
         
      
      
         This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
            and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the American Rescue Plan Act of 2021 (P.L. 117â002).
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  15
                  15
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,946
                  3,533
                  3,533
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,963
                  3,550
                  3,550
               
               
                  
                     
                  
               
            
         
      
         Universal Preschool
         Universal Preschool
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1507â4â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Universal Preschool Grants to States
                  
                  
                  1,007
               
               
                  0002
                  Head Start Educator Fund
                  
                  
                  2,510
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  3,517
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  1,007
               
               
                  1200
                  Appropriation
                  
                  
                  2,510
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  3,517
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  3,517
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  3,517
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â1,306
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  2,211
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  2,211
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  3,517
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  1,306
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  3,517
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  1,306
               
               
                  
                     
                  
               
            
         
      
      
         The Budget provides high-quality preschool to all 3- and 4-year old children and ensures all employees, including Head Start
            staff, earn at least $15 per hour and pay parity for those with similar qualifications to elementary educators.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1507â4â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  4
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  38
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  3,475
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  3,517
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1507â4â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  30
               
               
                  
                     
                  
               
            
         
      
         PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANTFor carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"),  $7,377,000,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That technical assistance under section 658I(a)(3) of such Act may be provided directly, or through the use of contracts,
            grants, cooperative agreements, or interagency agreements: Provided further, That all funds made available to carry out section 418 of the Social Security Act (42 U.S.C. 618), including funds appropriated
            for that purpose in such section 418 or any other provision of law, shall be subject to the reservation of funds authority
            in paragraphs (4) and (5) of section 658O(a) of the CCDBG Act: Provided further, That in addition to the amounts required to be reserved by the Secretary under section 658O(a)(2)(A) of such Act, $177,330,000
            shall be for Indian tribes and tribal organizations.
      (Department of Health and Human Services Appropriations Act, 2021.)
       
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Child Care Block Grant Payments to States
                  5,796
                  5,881
                  7,340
               
               
                  0002
                  Child Care Block Grant Payments to States [Disaster supplemental]
                  29
                  1
                  
               
               
                  0003
                  Child Care Block Grant Payments to States [CARES supplemental]
                  3,491
                  9
                  
               
               
                  0004
                  Child Care Research and Evaluation Fund
                  29
                  30
                  37
               
               
                  0005
                  Child Care Block Grant Payments to States [CRRSA]
                  
                  9,985
                  
               
               
                  0006
                  Child Care Block Grant Payments to States (ARP)
                  
                  14,990
                  
               
               
                  0007
                  Child Care Stabilization Fund [ARP]
                  
                  23,975
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  9,345
                  54,871
                  7,377
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  30
                  10
                  50
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  9,326
                  15,911
                  7,377
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  39,000
                  
               
               
                  1900
                  Budget authority (total)
                  9,326
                  54,911
                  7,377
               
               
                  1930
                  Total budgetary resources available
                  9,356
                  54,921
                  7,427
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  10
                  50
                  50
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,115
                  6,407
                  42,969
               
               
                  3010
                  New obligations, unexpired accounts
                  9,345
                  54,871
                  7,377
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â7,033
                  â18,309
                  â26,363
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,407
                  42,969
                  23,983
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4,115
                  6,407
                  42,969
               
               
                  3200
                  Obligated balance, end of year
                  6,407
                  42,969
                  23,983
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  9,326
                  15,911
                  7,377
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,100
                  5,564
                  2,951
               
               
                  4011
                  Outlays from discretionary balances
                  2,933
                  3,775
                  6,252
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  7,033
                  9,339
                  9,203
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  39,000
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  8,970
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  17,160
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  8,970
                  17,160
               
               
                  4180
                  Budget authority, net (total)
                  9,326
                  54,911
                  7,377
               
               
                  4190
                  Outlays, net (total)
                  7,033
                  18,309
                  26,363
               
               
                  
                     
                  
               
            
         
      
      
         This program provides grants to States for child care subsidies for low-income working families and activities to improve
            child care quality.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  2
                  3
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  48
                  48
                  64
               
               
                  25.3
                  Other goods and services from Federal sources
                  6
                  7
                  5
               
               
                  41.0
                  Grants, subsidies, and contributions
                  9,288
                  54,813
                  7,304
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  9,345
                  54,871
                  7,377
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  16
                  17
                  24
               
               
                  
                     
                  
               
            
         
      
         SOCIAL SERVICES BLOCK GRANTFor making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph
            for a State to carry out State programs pursuant to title XX-A of such Act shall be 10 percent.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  1,600
                  1,603
                  1,603
               
               
                  0002
                  Health Profession Opportunity Grants
                  82
                  4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,682
                  1,607
                  1,603
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  30
                  30
                  30
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,785
                  1,704
                  1,700
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â100
                  â97
                  â97
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,685
                  1,607
                  1,603
               
               
                  1930
                  Total budgetary resources available
                  1,715
                  1,637
                  1,633
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  30
                  30
                  30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  567
                  500
                  524
               
               
                  3010
                  New obligations, unexpired accounts
                  1,682
                  1,607
                  1,603
               
               
                  3020
                  Outlays (gross)
                  â1,727
                  â1,583
                  â1,640
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  500
                  524
                  487
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  567
                  500
                  524
               
               
                  3200
                  Obligated balance, end of year
                  500
                  524
                  487
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,685
                  1,607
                  1,603
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,276
                  1,179
                  1,257
               
               
                  4101
                  Outlays from mandatory balances
                  451
                  404
                  383
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,727
                  1,583
                  1,640
               
               
                  4180
                  Budget authority, net (total)
                  1,685
                  1,607
                  1,603
               
               
                  4190
                  Outlays, net (total)
                  1,727
                  1,583
                  1,640
               
               
                  
                     
                  
               
            
         
      
      
         The Social Services Block Grant (SSBG) account includes funding for SSBG and the Health Profession Opportunity Grants (HPOG)
            programs.  SSBG funds a broad array of social services for children and adults.  The account also provides funding for the
            HPOG demonstration to provide education and training to Temporary Assistance for Needy Families recipients and other low-income
            individuals for health care occupations that pay well and are expected to either experience labor shortages or be in high
            demand.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  11
                  4
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,669
                  1,601
                  1,603
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,682
                  1,607
                  1,603
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  7
                  7
                  
               
               
                  
                     
                  
               
            
         
      
         CHILDREN AND FAMILIES SERVICES PROGRAMSFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Every Student
            Succeeds Act, the Child Abuse Prevention and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services
            Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act
            of 1978 (adoption opportunities), part B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social
            Security Act, and the Community Services Block Grant Act ("CSBG Act"); and for necessary administrative expenses to carry
            out titles I, IV, V, X, XI, XIV, XVI, and XX-A of the Social Security Act, the Act of July 5, 1960, the Low-Income Home Energy
            Assistance Act of 1981, the Child Care and Development Block Grant Act of 1990,  and section 2204 of the American Rescue Plan Act of 2021, $14,902,760,000, of which $75,000,000, to remain available through September 30,  2023, shall be for grants to States for adoption and legal guardianship incentive payments, as defined by section 473A of the
            Social Security Act and may be made for adoptions and legal guardianships completed before September 30,  2022: Provided, That  $11,932,095,000 shall be for making payments under the Head Start Act, including for Early Head Start-Child Care Partnerships, and, of which,
            notwithstanding section 640 of such Act:
      (1)  $234,000,000 shall be available for a cost of living adjustment, and with respect to any continuing appropriations act, funding available
            for a cost of living adjustment shall not be construed as an authority or condition under this Act;
      (2) $25,000,000 shall be available for allocation by the Secretary to supplement activities described in paragraphs (7)(B)
            and (9) of section 641(c) of the Head Start Act under the Designation Renewal System, established under the authority of sections
            641(c)(7), 645A(b)(12), and 645A(d) of such Act, and such funds shall not be included in the calculation of "base grant" in
            subsequent fiscal years, as such term is used in section 640(a)(7)(A) of such Act; 
      (3)  $950,000,000, in addition to funds otherwise available for such purposes under section 640 of the Head Start Act, shall be
               available through September 30, 2023, for awards to eligible entities for Head Start and Early Head Start programs and to
               entities defined as eligible under section 645A(d) of such Act for high quality infant and toddler care through Early Head
               Start - Child Care Partnerships, and for training and technical assistance for such activities: Provided further, That of
               the funds made available in this subparagraph, up to $21,000,000 shall be available to the Secretary for the administrative
               costs of carrying out this subparagraph: Provided further, That, of the funds made available in this subparagraph, $650,000,000
               shall be prioritized for Early Head Start - Child Care Partnerships and for training and technical assistance for such activities:
               Provided further, That the Secretary shall ensure that areas of greatest need are prioritized for funding made available in
               this subparagraph; 
      (4) $4,000,000 shall be available for the purposes of maintaining the Tribal Colleges and Universities Head Start Partnership
            Program consistent with section 648(g) of such Act; and
      (5) $21,000,000 shall be available to supplement funding otherwise available for research, evaluation, and Federal administrative
            costs:
      Provided further, That the Secretary may reduce the reservation of funds under section 640(a)(2)(C) of such Act in lieu of reducing the reservation
            of funds under sections 640(a)(2)(B), 640(a)(2)(D), and 640(a)(2)(E) of such Act: Provided further, That  $450,000,000 shall be available until December 31,  2022 for carrying out sections 9212 and 9213 of the Every Student Succeeds Act: Provided further, That up to 3 percent of the funds in the preceding proviso shall be available for technical assistance and evaluation related
            to grants awarded under such section 9212: Provided further, That  $786,106,000 shall be for making payments under the CSBG Act: Provided further, That  $32,206,000 shall be for section 680 of the CSBG Act, of which not less than  $21,606,000 shall be for section 680(a)(2) and not less than  $10,600,000 shall be for section 680(a)(3)(B) of such Act: Provided further, That, notwithstanding section 675C(a)(3) of the CSBG Act, to the extent Community Services Block Grant funds are distributed
            as grant funds by a State to an eligible entity as provided under such Act, and have not been expended by such entity, they
            shall remain with such entity for carryover into the next fiscal year for expenditure by such entity consistent with program
            purposes: Provided further, That the Secretary shall establish procedures regarding the disposition of intangible assets and program income that permit
            such assets acquired with, and program income derived from, grant funds authorized under section 680 of the CSBG Act to become
            the sole property of such grantees after a period of not more than 12 years after the end of the grant period for any activity
            consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That intangible assets in the form of loans, equity investments and other debt instruments, and program income may be used
            by grantees for any eligible purpose consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That these procedures shall apply to such grant funds made available after November 29, 1999: Provided further, That funds appropriated for section 680(a)(2) of the CSBG Act shall be available for financing construction and rehabilitation
            and loans or investments in private business enterprises owned by community development corporations: Provided further, That  $463,450,000 shall be for carrying out section 303(a) of the Family Violence Prevention and Services Act, of which $7,000,000 shall be
            allocated notwithstanding section 303(a)(2) of such Act for carrying out section 309 of such Act, and of which $6,750,000 shall be for necessary administrative expenses to carry out such Act and section 2204 of the American
               Rescue Plan Act of 2021, in addition to amounts otherwise available for such purposes: Provided further, That the percentages specified in section 112(a)(2) of the Child Abuse Prevention and Treatment Act shall not apply to funds
            appropriated under this heading: Provided further, That  $4,000,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national
            case management contract and Federal costs of administering the system: Provided further, That up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States
            to support data collection for a study of the system's effectiveness.
      (Department of Health and Human Services Appropriations Act, 2021.)
       
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Head Start
                  11,529
                  12,096
                  11,932
               
               
                  0102
                  Preschool Development Grants
                  270
                  521
                  450
               
               
                  0103
                  Runaway and homeless youth (basic centers)
                  87
                  64
                  68
               
               
                  0104
                  Transitional living
                  51
                  53
                  56
               
               
                  0106
                  Education grants to reduce sexual abuse of runaway youth
                  19
                  20
                  21
               
               
                  0109
                  Child abuse State grants
                  90
                  190
                  120
               
               
                  0110
                  Child abuse discretionary activities
                  35
                  35
                  35
               
               
                  0111
                  Community-based child abuse prevention
                  56
                  308
                  80
               
               
                  0112
                  Child welfare services
                  319
                  269
                  275
               
               
                  0113
                  Child welfare training, research, or demonstration projects
                  18
                  19
                  121
               
               
                  0114
                  Adoption opportunities
                  42
                  44
                  46
               
               
                  0116
                  Adoption and Legal Guardianship Incentives
                  75
                  75
                  75
               
               
                  0117
                  Independent living education and training vouchers
                  46
                  43
                  48
               
               
                  0124
                  Native American programs
                  56
                  77
                  60
               
               
                  0125
                  Social services and income maintenance research
                  7
                  7
                  9
               
               
                  0128
                  ACF Federal administration
                  206
                  208
                  227
               
               
                  0131
                  Disaster human services case management
                  2
                  2
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Direct program activities, subtotal
                  12,908
                  14,031
                  13,627
               
               
                  0301
                  Community services block grant
                  1,701
                  745
                  754
               
               
                  0303
                  Rural community facilities
                  10
                  10
                  11
               
               
                  0304
                  Community economic development
                  20
                  20
                  22
               
               
                  0305
                  Low Income Household Drinking Water & Wastewater Emergency Assistance
                  
                  1,138
                  
               
               
                  0308
                  Domestic violence hotline
                  14
                  13
                  26
               
               
                  0309
                  Family violence prevention and services
                  219
                  432
                  463
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0391
                  Direct program activities, subtotal
                  1,964
                  2,358
                  1,276
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total, direct program
                  14,872
                  16,389
                  14,903
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  14,872
                  16,389
                  14,903
               
               
                  0801
                  Children and Families Services Programs (Reimbursable)
                  12
                  35
                  35
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  12
                  35
                  35
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  14,884
                  16,424
                  14,938
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  932
                  821
                  681
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  3
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  943
                  821
                  681
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  14,751
                  13,929
                  14,903
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  2,320
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1
                  23
                  23
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  2
                  23
                  23
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2
                  12
                  11
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  9
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  11
                  12
                  12
               
               
                  1900
                  Budget authority (total)
                  14,764
                  16,284
                  14,938
               
               
                  1930
                  Total budgetary resources available
                  15,707
                  17,105
                  15,619
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  821
                  681
                  681
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  9,739
                  12,204
                  14,716
               
               
                  3010
                  New obligations, unexpired accounts
                  14,884
                  16,424
                  14,938
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  8
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â12,267
                  â13,912
                  â15,125
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â152
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12,204
                  14,716
                  14,529
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â19
                  â23
                  â23
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  â1
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â23
                  â23
                  â24
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  9,720
                  12,181
                  14,693
               
               
                  3200
                  Obligated balance, end of year
                  12,181
                  14,693
                  14,505
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  14,753
                  13,952
                  14,926
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,621
                  4,263
                  4,880
               
               
                  4011
                  Outlays from discretionary balances
                  7,644
                  9,637
                  9,653
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  12,265
                  13,900
                  14,533
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â6
                  â23
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â6
                  â23
                  â23
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  14,751
                  13,929
                  14,903
               
               
                  4080
                  Outlays, net (discretionary)
                  12,259
                  13,877
                  14,510
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  11
                  2,332
                  12
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  12
                  12
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  580
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2
                  12
                  592
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â2
                  â12
                  â12
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  â1
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  2,320
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  
                  580
               
               
                  4180
                  Budget authority, net (total)
                  14,751
                  16,249
                  14,903
               
               
                  4190
                  Outlays, net (total)
                  12,259
                  13,877
                  15,090
               
               
                  
                     
                  
               
            
         
      
      
         The request totals $14.9 billion, including $11.9 billion for Head Start.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  113
                  116
                  130
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  120
                  123
                  137
               
               
                  12.1
                  Civilian personnel benefits
                  40
                  47
                  45
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  11
                  17
                  17
               
               
                  23.2
                  Rental payments to others
                  1
                  
                  
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  176
                  177
                  201
               
               
                  25.2
                  Other services from non-Federal sources
                  19
                  15
                  20
               
               
                  25.3
                  Other goods and services from Federal sources
                  147
                  140
                  137
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  2
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  14,348
                  15,865
                  14,341
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  14,872
                  16,389
                  14,903
               
               
                  99.0
                  Reimbursable obligations
                  12
                  35
                  35
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  14,884
                  16,424
                  14,938
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,014
                  1,054
                  1,065
               
               
                  1101
                  Direct military average strength employment
                  4
                  6
                  6
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical AssistanceProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Training and technical assistance
                  12
                  18
                  12
               
               
                  0002
                  Federal parent locator service
                  27
                  24
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  39
                  42
                  35
               
               
                  0801
                  Federal Parent Locator Service reimbursable
                  26
                  33
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  26
                  33
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  65
                  75
                  68
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  11
                  7
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  12
                  7
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  37
                  37
                  37
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  35
                  35
                  35
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  25
                  33
                  33
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  1
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  25
                  33
                  33
               
               
                  1900
                  Budget authority (total)
                  60
                  68
                  68
               
               
                  1930
                  Total budgetary resources available
                  72
                  75
                  68
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  23
                  19
                  32
               
               
                  3010
                  New obligations, unexpired accounts
                  65
                  75
                  68
               
               
                  3020
                  Outlays (gross)
                  â68
                  â62
                  â65
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  19
                  32
                  35
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  17
                  13
                  26
               
               
                  3200
                  Obligated balance, end of year
                  13
                  26
                  29
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  60
                  68
                  68
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  45
                  47
                  45
               
               
                  4101
                  Outlays from mandatory balances
                  23
                  15
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  68
                  62
                  65
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â8
                  â10
                  â10
               
               
                  4123
                  Non-Federal sources
                  â17
                  â23
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â25
                  â33
                  â33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  35
                  35
                  35
               
               
                  4170
                  Outlays, net (mandatory)
                  43
                  29
                  32
               
               
                  4180
                  Budget authority, net (total)
                  35
                  35
                  35
               
               
                  4190
                  Outlays, net (total)
                  43
                  29
                  32
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funding for research and technical assistance activities established by the Personal Responsibility
            and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  7
                  9
                  10
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  
                  
               
               
                  23.1
                  Rental payments to GSA
                  1
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  8
                  7
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  10
                  7
               
               
                  25.7
                  Operation and maintenance of equipment
                  9
                  9
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  42
                  35
               
               
                  99.0
                  Reimbursable obligations
                  26
                  33
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  65
                  75
                  68
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  57
                  71
                  71
               
               
                  
                     
                  
               
            
         
      
         PAYMENTS FOR FOSTER CARE AND PERMANENCYFor carrying out, except as otherwise provided, title IV-E of the Social Security Act,   $6,963,000,000.
      For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
             2023, $3,200,000,000.
      For carrying out, after May 31 of the current fiscal year, except as otherwise provided, section 474 of title IV-E of the
            Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal
            year, such sums as may be necessary.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  5,354
                  5,796
                  5,821
               
               
                  0002
                  Independent living
                  143
                  543
                  143
               
               
                  0004
                  Adoption assistance
                  3,385
                  3,802
                  3,739
               
               
                  0005
                  Guardianship
                  219
                  271
                  254
               
               
                  0006
                  Technical Assistance and Implementation Services for Tribal Programs
                  3
                  3
                  3
               
               
                  0007
                  Prevention Services Technical Assistance
                  4
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  9,108
                  10,416
                  9,961
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  6,308
                  7,416
                  6,967
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  â1
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  6,307
                  7,415
                  6,965
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  2,800
                  3,000
                  3,000
               
               
                  1900
                  Budget authority (total)
                  9,107
                  10,415
                  9,965
               
               
                  1930
                  Total budgetary resources available
                  9,110
                  10,416
                  9,965
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,409
                  1,619
                  1,271
               
               
                  3010
                  New obligations, unexpired accounts
                  9,108
                  10,416
                  9,961
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  139
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â8,836
                  â10,764
                  â10,241
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â201
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,619
                  1,271
                  991
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,409
                  1,619
                  1,271
               
               
                  3200
                  Obligated balance, end of year
                  1,619
                  1,271
                  991
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  9,107
                  10,415
                  9,965
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7,933
                  9,337
                  8,927
               
               
                  4101
                  Outlays from mandatory balances
                  903
                  1,427
                  1,314
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8,836
                  10,764
                  10,241
               
               
                  4180
                  Budget authority, net (total)
                  9,107
                  10,415
                  9,965
               
               
                  4190
                  Outlays, net (total)
                  8,836
                  10,764
                  10,241
               
               
                  
                     
                  
               
            
         
      
      
         This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, Foster Care Prevention
            Services, and the Chafee Program for Successful Transition to Adulthood, as well as technical assistance and implementation
            services for tribal programs.
         
         Foster CareâThe proposed level will support eligible low-income children who must be placed outside the home. An average of 191,900 children
            per month are estimated to be served in FY 2022.
         
         Adoption AssistanceâThe proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
            An average of 522,000 children per month are estimated to be served in FY 2022.
         
         Guardianship Assistance ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 45,800 children per month are estimated to be served in FY 2022.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  32
                  34
                  36
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  9,073
                  10,379
                  9,922
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  9,108
                  10,416
                  9,961
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Administration for Community LivingFederal Funds
         AGING AND DISABILITY SERVICES PROGRAMS
         (INCLUDING TRANSFER OF FUNDS)For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), the RAISE Family Caregivers
            Act, the Supporting Grandparents Raising Grandchildren Act, titles III and XXIX of the PHS Act, sections 1252 and 1253 of
            the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, title XX-B of the Social Security
            Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and 5 of subtitle D of title II of the Help
            America Vote Act of 2002, the Assistive Technology Act of 1998, titles II and VII (and section 14 with respect to such titles)
            of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals
            with disabilities,  $2,953,665,000, together with  $55,242,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund
            to carry out section 4360 of the Omnibus Budget Reconciliation Act of 1990: Provided, That, in addition to amounts provided herein, $17,106,000 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 amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease
            prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based
            and effective: Provided further, That, of amounts made available under this heading to carry out section 321 of the OAA, up to one percent
               shall be available for grants to develop and implement evidence-based practices to enhance home and community-based supportive
               services: Provided further, That of amounts made available under this heading to carry out sections 311, 331, and 336 of the OAA, up to one percent
            of such amounts shall be available for developing and implementing evidence-based practices for enhancing senior nutrition,
            including medically-tailored meals:  Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of
            the OAA may be transferred to the Secretary of Agriculture in accordance with such section: Provided further, That, of the amount made available under this heading, up to $8,000,000 shall be available for the Secretary
               to make and evalute competitive grants to centers for independent living that have received grants under part C of chapter
               1 of title VII of the Rehabilitation Act of 1973, to develop evidence-based interventions to increase employment of individuals
               with disabilities: Provided further, That none of the funds made available under this heading may be used by an eligible system (as defined in section 102 of
            the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action
            in a Federal or State court on behalf of an individual or group of individuals with a developmental disability (as defined
            in section 102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A))
            that is attributable to a mental impairment (or a combination of mental and physical impairments), that has as the requested
            remedy the closure of State operated intermediate care facilities for people with intellectual or developmental disabilities,
            unless reasonable public notice of the action has been provided to such individuals (or, in the case of mental incapacitation,
            the legal guardians who have been specifically awarded authority by the courts to make healthcare and residential decisions
            on behalf of such individuals) who are affected by such action, within 90 days of instituting such legal action, which informs
            such individuals (or such legal guardians) of their legal rights and how to exercise such rights consistent with current Federal
            Rules of Civil Procedure: Provided further, That the limitations in the immediately preceding proviso shall not apply in the case of an individual who is neither competent
            to consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who are a ward of the State or
            subject to public guardianship.
      (Department of Health and Human Services Appropriations Act, 2021.)
       
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Aging Services Programs
                  2,730
                  3,500
                  2,538
               
               
                  0102
                  ACL Program Administration
                  41
                  41
                  47
               
               
                  0103
                  Integrated Aging and Disability Services Programs
                  96
                  50
                  78
               
               
                  0104
                  Disability Services Programs
                  411
                  329
                  369
               
               
                  0105
                  National Institute on Disability, Independent Living & Rehab Research
                  112
                  113
                  119
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  3,390
                  4,033
                  3,151
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,390
                  4,033
                  3,151
               
               
                  0801
                  ACL Reimbursable Programs
                  97
                  111
                  110
               
               
                  0802
                  PHS Evaluation: Disability Reimbursable (Collected)
                  
                  
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  97
                  111
                  127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  3,487
                  4,144
                  3,278
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  19
                  206
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6
                  19
                  206
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,376
                  2,482
                  2,954
               
               
                  1120
                  Appropriations transferred to other accts [012â3507]
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,375
                  2,481
                  2,954
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  1,720
                  
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â0116]
                  28
                  28
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  28
                  1,748
                  28
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2
                  11
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  71
                  56
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  73
                  67
                  75
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  35
                  35
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  25
                  35
                  35
               
               
                  1900
                  Budget authority (total)
                  3,501
                  4,331
                  3,092
               
               
                  1930
                  Total budgetary resources available
                  3,507
                  4,350
                  3,298
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  19
                  206
                  20
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,517
                  2,534
                  3,423
               
               
                  3010
                  New obligations, unexpired accounts
                  3,487
                  4,144
                  3,278
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,457
                  â3,255
                  â5,115
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,534
                  3,423
                  1,586
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â129
                  â188
                  â244
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â96
                  â56
                  â75
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â188
                  â244
                  â319
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,388
                  2,346
                  3,179
               
               
                  3200
                  Obligated balance, end of year
                  2,346
                  3,179
                  1,267
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,448
                  2,548
                  3,029
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,325
                  1,526
                  1,817
               
               
                  4011
                  Outlays from discretionary balances
                  1,085
                  1,236
                  2,021
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,410
                  2,762
                  3,838
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â38
                  â67
                  â75
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â71
                  â56
                  â75
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  36
                  56
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â35
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,375
                  2,481
                  2,954
               
               
                  4080
                  Outlays, net (discretionary)
                  2,372
                  2,695
                  3,763
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  53
                  1,783
                  63
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  444
                  7
               
               
                  4101
                  Outlays from mandatory balances
                  46
                  49
                  1,270
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  47
                  493
                  1,277
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1
                  â35
                  â35
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â25
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â24
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  28
                  1,748
                  28
               
               
                  4170
                  Outlays, net (mandatory)
                  46
                  458
                  1,242
               
               
                  4180
                  Budget authority, net (total)
                  3,403
                  4,229
                  2,982
               
               
                  4190
                  Outlays, net (total)
                  2,418
                  3,153
                  5,005
               
               
                  
                     
                  
               
            
         
      
      
         This account funds formula and discretionary grants that provide home and community-based services and supports to assist
            older adults and people of all ages with disabilities to live independently and to fully participate in their communities.
            ACL works with states, localities, tribal organizations, nonprofit organizations, businesses and families, and through networks
            of aging and disability organizations, to provide these services and supports which include nutrition, supportive, caregiver,
            independent living, and protection and advocacy services.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  22
                  22
                  24
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  7
                  8
               
               
                  23.1
                  Rental payments to GSA
                  4
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  46
                  41
                  47
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,310
                  3,960
                  3,069
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,390
                  4,033
                  3,151
               
               
                  99.0
                  Reimbursable obligations
                  97
                  111
                  127
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  3,487
                  4,144
                  3,278
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  177
                  175
                  198
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  12
                  12
                  15
               
               
                  
                     
                  
               
            
         
      
         Departmental ManagementFederal Funds
         GENERAL DEPARTMENTAL MANAGEMENTFor necessary expenses, not otherwise provided, for general departmental management, including hire of six passenger motor
            vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico Border Health
            Commission Act, and  health or human services research and evaluation activities, including such activities that are similar to activities carried
               out by other components of the Department, $576,981,000, together with  $84,328,000 from the amounts available under section 241 of the PHS Act : Provided, That of this amount, $55,400,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $101,000,000 shall be for making competitive contracts and grants to
            public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy and for the
            Federal costs associated with administering and evaluating such contracts and grants, of which not more than 10 percent of
            the available funds shall be for training and technical assistance, evaluation, outreach, and additional program support activities,
            and of the remaining amount 75 percent shall be for replicating programs that have been proven effective through rigorous
            evaluation to reduce teenage pregnancy, behavioral risk factors underlying teenage pregnancy, or other associated risk factors,
            and 25 percent shall be available for research and demonstration grants to develop, replicate, refine, and test additional
            models and innovative strategies for preventing teenage pregnancy: Provided further, That of the amounts provided under this heading from amounts available under section 241 of the PHS Act, $6,800,000 shall
            be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches: Provided further, That of the funds made available under this heading, $35,000,000 shall be for making competitive grants which exclusively
            implement education in sexual risk avoidance (defined as voluntarily refraining from non-marital sexual activity): Provided further, That funding for such competitive grants for sexual risk avoidance shall use medically accurate information referenced to
            peer-reviewed publications by educational, scientific, governmental, or health organizations; implement an evidence-based
            approach integrating research findings with practical implementation that aligns with the needs and desired outcomes for the
            intended audience; and teach the benefits associated with self-regulation, success sequencing for poverty prevention, healthy
            relationships, goal setting, and resisting sexual coercion, dating violence, and other youth risk behaviors such as underage
            drinking or illicit drug use without normalizing teen sexual activity: Provided further, That no more than 10 percent of the funding for such competitive grants for sexual risk avoidance shall be available for
            technical assistance and administrative costs of such programs: Provided further, That funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through
            grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4): Provided further, That of the funds made available under this heading, $5,000,000 shall be for carrying out prize competitions sponsored by
            the Office of the Secretary to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases (as authorized
            by section 24 of the Stevenson-Wydler Technology Innovation Act of 1980 (15 U.S.C. 3719)).
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  GDM Direct
                  480
                  486
                  577
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct, subtotal
                  480
                  486
                  577
               
               
                  0802
                  GDM Reimbursable (collected)
                  173
                  172
                  178
               
               
                  0803
                  PHS Evaluation Reimbursable (Collected)
                  65
                  65
                  84
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  238
                  237
                  262
               
               
                  0811
                  HCFAC Mandatory (R)
                  8
                  10
                  10
               
               
                  0812
                  PTAC Mandatory (R)
                  5
                  5
                  5
               
               
                  0813
                  CDC/ASPA PSA Mandatory (R)
                  280
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0819
                  Reimbursable program activities, subtotal
                  293
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  531
                  252
                  277
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,011
                  738
                  854
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  12
                  39
                  39
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation [GDM Direct]
                  480
                  486
                  577
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  97
                  237
                  262
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  147
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  244
                  237
                  262
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  264
                  15
                  15
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  53
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  317
                  15
                  15
               
               
                  1900
                  Budget authority (total)
                  1,041
                  738
                  854
               
               
                  1930
                  Total budgetary resources available
                  1,053
                  777
                  893
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  39
                  39
                  39
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  526
                  564
                  536
               
               
                  3010
                  New obligations, unexpired accounts
                  1,011
                  738
                  854
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â955
                  â766
                  â790
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â28
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  564
                  536
                  600
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â248
                  â280
                  â280
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â200
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  168
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â280
                  â280
                  â280
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  278
                  284
                  256
               
               
                  3200
                  Obligated balance, end of year
                  284
                  256
                  320
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  724
                  723
                  839
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  362
                  344
                  398
               
               
                  4011
                  Outlays from discretionary balances
                  318
                  383
                  377
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  680
                  727
                  775
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â258
                  â237
                  â262
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â258
                  â237
                  â262
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â147
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  161
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  480
                  486
                  577
               
               
                  4080
                  Outlays, net (discretionary)
                  422
                  490
                  513
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  317
                  15
                  15
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  271
                  15
                  15
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  24
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  275
                  39
                  15
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  â265
                  â15
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â53
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â52
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  10
                  24
                  
               
               
                  4180
                  Budget authority, net (total)
                  480
                  486
                  577
               
               
                  4190
                  Outlays, net (total)
                  432
                  514
                  513
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
            for 2022. The actual allocation is determined annually.
         
         General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
            to HHS components and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
            activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
            promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
            Prevention and Public Health Fund.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  90
                  90
                  91
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  3
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  1
               
               
                  11.7
                  Military personnel
                  2
                  2
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  98
                  98
                  98
               
               
                  12.1
                  Civilian personnel benefits
                  31
                  31
                  31
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  4
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  21
                  21
                  21
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  1
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  21
                  21
                  17
               
               
                  25.2
                  Other services from non-Federal sources
                  26
                  32
                  34
               
               
                  25.3
                  Other goods and services from Federal sources
                  124
                  124
                  138
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  5
                  9
               
               
                  25.7
                  Operation and maintenance of equipment
                  3
                  3
                  3
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  77
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  141
                  141
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  480
                  486
                  577
               
               
                  99.0
                  Reimbursable obligations
                  531
                  252
                  277
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,011
                  738
                  854
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  758
                  799
                  883
               
               
                  1101
                  Direct military average strength employment
                  31
                  38
                  39
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  517
                  552
                  588
               
               
                  2101
                  Reimbursable military average strength employment
                  15
                  11
                  11
               
               
                  
                     
                  
               
            
         
      
         Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         State Response to the Opioid Abuse Crisis, Cures Act
         The 21st Century Cures Act authorized in 2017 and 2018 grants to states, the District of Columbia, and territories to develop
            and provide opioid abuse prevention, treatment, and recovery support services.
         
      
         OFFICE FOR CIVIL RIGHTSFor expenses necessary for the Office for Civil Rights,  $47,931,000.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office for Civil Rights (Direct)
                  39
                  39
                  48
               
               
                  0801
                  Office for Civil Rights (Reimbursable)
                  12
                  27
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  51
                  66
                  68
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  52
                  61
                  44
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  39
                  39
                  48
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  21
                  10
                  10
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  1
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  21
                  10
                  10
               
               
                  1900
                  Budget authority (total)
                  60
                  49
                  58
               
               
                  1930
                  Total budgetary resources available
                  112
                  110
                  102
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  61
                  44
                  34
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  15
                  18
                  35
               
               
                  3010
                  New obligations, unexpired accounts
                  51
                  66
                  68
               
               
                  3020
                  Outlays (gross)
                  â48
                  â49
                  â59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  18
                  35
                  44
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  15
                  18
                  35
               
               
                  3200
                  Obligated balance, end of year
                  18
                  35
                  44
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  39
                  39
                  48
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  33
                  31
                  38
               
               
                  4011
                  Outlays from discretionary balances
                  6
                  2
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  39
                  33
                  46
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  21
                  10
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1
                  1
               
               
                  4101
                  Outlays from mandatory balances
                  9
                  15
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  9
                  16
                  13
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â21
                  â10
                  â10
               
               
                  4180
                  Budget authority, net (total)
                  39
                  39
                  48
               
               
                  4190
                  Outlays, net (total)
                  27
                  39
                  49
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         The Office for Civil Rights funds activities that carry out the Department's civil rights, nondiscrimination, health information
            privacy, and security compliance programs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  17
                  17
                  23
               
               
                  11.3
                  Other than full-time permanent
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  18
                  24
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  6
                  8
               
               
                  21.0
                  Travel and transportation of persons
                  
                  
                  1
               
               
                  23.1
                  Rental payments to GSA
                  4
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  3
                  2
                  3
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  8
                  7
               
               
                  31.0
                  Equipment
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  39
                  48
               
               
                  99.0
                  Reimbursable obligations
                  12
                  27
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  51
                  66
                  68
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  135
                  140
                  179
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  6
                  49
                  49
               
               
                  
                     
                  
               
            
         
      
         OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY From amounts made available pursuant to section 241 of the PHS Act, $86,614,000 shall be for expenses necessary for the Office of the National Coordinator for Health Information Technology, including for grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health information technology (IT)
                  60
                  62
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  60
                  62
                  
               
               
                  0801
                  Office of the National Coordinator for Health IT (ONC): Reimbursable
                  6
                  6
                  6
               
               
                  0802
                  ONC Reimbursable program activity: PHS Evaluation
                  
                  
                  87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  6
                  6
                  93
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  66
                  68
                  93
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  11
                  10
                  22
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  62
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1
                  18
                  102
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  5
                  18
                  102
               
               
                  1900
                  Budget authority (total)
                  65
                  80
                  102
               
               
                  1930
                  Total budgetary resources available
                  76
                  90
                  124
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  10
                  22
                  31
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  54
                  54
                  31
               
               
                  3010
                  New obligations, unexpired accounts
                  66
                  68
                  93
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â64
                  â91
                  â101
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  54
                  31
                  23
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â10
                  â9
                  â9
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â4
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â9
                  â9
                  â9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  44
                  45
                  22
               
               
                  3200
                  Obligated balance, end of year
                  45
                  22
                  14
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  65
                  80
                  102
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  39
                  68
                  87
               
               
                  4011
                  Outlays from discretionary balances
                  25
                  23
                  14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  64
                  91
                  101
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â6
                  â18
                  â102
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â6
                  â18
                  â102
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â4
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  60
                  62
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  58
                  73
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  60
                  62
                  
               
               
                  4190
                  Outlays, net (total)
                  58
                  73
                  â1
               
               
                  
                     
                  
               
            
         
      
      
         This program supports coordination, leadership, and development of Federal health information technology activities and Federal
            initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation
            with participants in the health sector. The Office of the National Coordinator for Health Information Technology was authorized
            in title XXX of the PHS Act as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L.
            111â5, Title XIII) and the 21st Century Cures Act (P.L. 114â255), for the purpose of addressing strategic planning, coordination,
            and the analysis of key technical, economic and other issues related to the public and private adoption of health information
            technology.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  19
                  20
                  
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  21
                  22
                  
               
               
                  12.1
                  Civilian personnel benefits
                  7
                  7
                  
               
               
                  23.1
                  Rental payments to GSA
                  2
                  2
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  13
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  10
                  11
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  7
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  59
                  62
                  
               
               
                  99.0
                  Reimbursable obligations
                  6
                  6
                  93
               
               
                  99.5
                  Adjustment for rounding
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  66
                  68
                  93
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  155
                  177
                  177
               
               
                  1101
                  Direct military average strength employment
                  2
                  
                  
               
               
                  
                     
                  
               
            
         
      
         MEDICARE HEARINGS AND APPEALSFor expenses necessary for Medicare hearings and appeals in the Office of the Secretary,  $196,000,000 shall remain available until September 30,  2023, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
            Insurance Trust Fund.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare Hearings and Appeals (Direct)
                  201
                  192
                  196
               
               
                  0002
                  Proposed User Fees
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  201
                  192
                  198
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  201
                  192
                  198
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  56
                  49
                  49
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  58
                  49
                  49
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  221
                  192
                  198
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â29
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  192
                  192
                  198
               
               
                  1900
                  Budget authority (total)
                  192
                  192
                  198
               
               
                  1930
                  Total budgetary resources available
                  250
                  241
                  247
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  49
                  49
                  49
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  58
                  45
                  2
               
               
                  3010
                  New obligations, unexpired accounts
                  201
                  192
                  198
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â211
                  â235
                  â198
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  45
                  2
                  2
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â156
                  â91
                  â91
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  29
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  36
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â91
                  â91
                  â91
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â98
                  â46
                  â89
               
               
                  3200
                  Obligated balance, end of year
                  â46
                  â89
                  â89
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  192
                  192
                  198
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  116
                  192
                  198
               
               
                  4011
                  Outlays from discretionary balances
                  95
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  211
                  192
                  198
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â253
                  â192
                  â198
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  29
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  61
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â42
                  
                  
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  43
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â42
                  43
                  
               
               
                  
                     
                  
               
            
         
      
      
         This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare
            Prescription Drug, Improvement, and Modernization Act of 2003, and the Medicare appeals related operations of the Departmental
            Appeals Board (DAB). OMHA provides an independent and impartial forum for the adjudication of claims brought by or on behalf
            of Medicare beneficiaries related to their benefits and care. The Departmental Appeals Board for Medicare provides final HHS
            administrative review of claims for Medicare entitlement, payment, and coverage.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  111
                  104
                  113
               
               
                  11.5
                  Other personnel compensation
                  
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  111
                  106
                  115
               
               
                  12.1
                  Civilian personnel benefits
                  39
                  37
                  36
               
               
                  23.1
                  Rental payments to GSA
                  9
                  11
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  8
                  7
                  8
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  11
                  16
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  13
                  11
                  10
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  1
                  
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  32.0
                  Land and structures
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  201
                  192
                  198
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  201
                  192
                  198
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  1,245
                  1,267
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,232
                  
                  
               
               
                  
                     
                  
               
            
         
      
         PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUNDFor expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical,
            and cybersecurity threats to civilian populations, and for other public health emergencies,  $1,513,116,000, of which  $823,380,000 shall remain available through September 30,  2023, for expenses necessary to support advanced research and development pursuant to section 319L of the PHS Act and other administrative
            expenses of the Biomedical Advanced Research and Development Authority: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures shall be in addition to
            any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in
            the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act: Provided further, That $5,000,000 of the amounts made available to support emergency operations shall remain available through September 30,
             2024.
      For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act), $770,000,000,
            to remain available until expended.
      For expenses necessary to carry out section 319F-2(a) of the PHS Act,  $905,000,000, to remain available until expended.
      For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic,  $335,000,000; of which  $300,000,000 shall be available until expended, for activities including the development and purchase of vaccine, antivirals, necessary
            medical supplies, diagnostics, and other surveillance tools: Provided, That notwithstanding section 496(b) of the PHS Act, funds may be used for the construction or renovation of privately owned
            facilities for the production of pandemic influenza vaccines and other biologics, if the Secretary finds such construction
            or renovation necessary to secure sufficient supplies of such vaccines or biologics.
      (Department of Health and Human Services Appropriations Act, 2021.)
         
      
       
      (Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Public Health and Social Services Emergency Fund
                  145,052
                  120,510
                  3,523
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct program activities, subtotal
                  145,052
                  120,510
                  3,523
               
               
                  0801
                  Reimbursable program (FEMA)
                  154
                  160
                  140
               
               
                  0802
                  Reimbursable program activity (OPP)
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  156
                  162
                  142
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  145,208
                  120,672
                  3,665
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  693
                  86,559
                  86,555
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  680
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0343]
                  â2
                  â4
                  â4
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  6
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0956]
                  2
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â9915]
                  32
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  30
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  762
                  86,555
                  86,551
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  234,962
                  51,190
                  3,523
               
               
                  1120
                  Appropriations transferred to other acct [075â0350]
                  â975
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â12
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â9915]
                  â1,806
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0943]
                  â1,000
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0600]
                  â22
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [070â0540]
                  â107
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [070â0530]
                  â182
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0343]
                  â1
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0390]
                  
                  â790
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  230,857
                  50,400
                  3,523
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  70,110
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  15
                  162
                  162
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  141
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  156
                  162
                  162
               
               
                  1900
                  Budget authority (total)
                  231,013
                  120,672
                  3,685
               
               
                  1930
                  Total budgetary resources available
                  231,775
                  207,227
                  90,236
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â8
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  86,559
                  86,555
                  86,571
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,967
                  38,868
                  69,452
               
               
                  3010
                  New obligations, unexpired accounts
                  145,208
                  120,672
                  3,665
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  16
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â111,238
                  â90,088
                  â67,520
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â30
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â55
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  38,868
                  69,452
                  5,597
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â203
                  â272
                  â272
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â141
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  72
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â272
                  â272
                  â272
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4,764
                  38,596
                  69,180
               
               
                  3200
                  Obligated balance, end of year
                  38,596
                  69,180
                  5,325
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  231,013
                  50,562
                  3,685
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  108,816
                  17,282
                  861
               
               
                  4011
                  Outlays from discretionary balances
                  2,422
                  48,268
                  42,121
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  111,238
                  65,550
                  42,982
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â80
                  â162
                  â162
               
               
                  4033
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â81
                  â162
                  â162
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â141
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  65
                  
                  
               
               
                  4053
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  230,857
                  50,400
                  3,523
               
               
                  4080
                  Outlays, net (discretionary)
                  111,157
                  65,388
                  42,820
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  70,110
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  24,538
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  24,538
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  24,538
                  24,538
               
               
                  4180
                  Budget authority, net (total)
                  230,857
                  120,510
                  3,523
               
               
                  4190
                  Outlays, net (total)
                  111,157
                  89,926
                  67,358
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare
            for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding
            for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized by the Pandemic and All-Hazards
            Preparedness and Advancing Innovation Act of 2019. Funds will be used for hospital preparedness and other emergency preparedness
            activities including the National Disaster Medical System and National Biodefense Strategy implementation. The PHSSEF continues
            to support the advanced development, procurement, and stockpiling of biodefense and pandemic influenza countermeasures.
         
         The PHSSEF also supports the HHS Cybersecurity program, National Security and Strategic Information programs, the U.S. Public
            Health Service Commissioned Corps, and the Medical Reserve Corps.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  103
                  139
                  150
               
               
                  11.3
                  Other than full-time permanent
                  24
                  
                  
               
               
                  11.5
                  Other personnel compensation
                  30
                  
                  
               
               
                  11.7
                  Military personnel
                  15
                  11
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  172
                  150
                  175
               
               
                  12.1
                  Civilian personnel benefits
                  43
                  38
                  42
               
               
                  12.2
                  Military personnel benefits
                  2
                  5
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  40
                  12
                  10
               
               
                  22.0
                  Transportation of things
                  220
                  7
                  9
               
               
                  23.1
                  Rental payments to GSA
                  7
                  6
                  8
               
               
                  23.2
                  Rental payments to others
                  10
                  11
                  12
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  18
                  3
                  4
               
               
                  25.1
                  Advisory and assistance services
                  6,701
                  5,161
                  1,652
               
               
                  25.2
                  Other services from non-Federal sources
                  102,068
                  13,150
                  183
               
               
                  25.3
                  Other goods and services from Federal sources
                  15,912
                  4,104
                  103
               
               
                  25.4
                  Operation and maintenance of facilities
                  24
                  25
                  5
               
               
                  25.5
                  Research and development contracts
                  696
                  29,735
                  75
               
               
                  25.7
                  Operation and maintenance of equipment
                  64
                  15
                  40
               
               
                  26.0
                  Supplies and materials
                  6,400
                  4,000
                  811
               
               
                  31.0
                  Equipment
                  62
                  18
                  32
               
               
                  32.0
                  Land and structures
                  182
                  35
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  12,430
                  64,035
                  350
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  145,052
                  120,510
                  3,523
               
               
                  99.0
                  Reimbursable obligations
                  156
                  162
                  142
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  145,208
                  120,672
                  3,665
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,078
                  969
                  1,214
               
               
                  1101
                  Direct military average strength employment
                  105
                  77
                  174
               
               
                  
                     
                  
               
            
         
      
         Defense Production Act Medical Supplies EnhancementProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0150â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  10,000
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  10,000
                  
               
               
                  1930
                  Total budgetary resources available
                  
                  10,000
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  7,300
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  10,000
                  
               
               
                  3020
                  Outlays (gross)
                  
                  â2,700
                  â5,800
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  7,300
                  1,500
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  7,300
               
               
                  3200
                  Obligated balance, end of year
                  
                  7,300
                  1,500
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  10,000
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  2,700
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  5,800
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  2,700
                  5,800
               
               
                  4180
                  Budget authority, net (total)
                  
                  10,000
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  2,700
                  5,800
               
               
                  
                     
                  
               
            
         
      
      
          Defense Production Act Medical Supplies Enhancement includes funds appropriated by the American Rescue Plan Act of 2021 to
            carry out titles I, III, and VII of the Defense Production Act to enhance the emergency medical supply of materials necessary
            to respond to public health emergencies and disasters. Funds will be used for the purchase, production and distribution of
            medical supplies, such as testing and personal protective equipment, and equipment, including durable medical equipment, related
            to combating the COVID-19 pandemic. After September 30, 2022, funds may be used for any other activity necessary to meet critical
            public health needs of the United States, with respect to any pathogen that the President has determined has the potential
            for creating a public health emergency.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0150â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  3
                  
               
               
                  12.1
                  Civilian personnel benefits
                  
                  1
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  4,000
                  
               
               
                  26.0
                  Supplies and materials
                  
                  5,996
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  10,000
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0150â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  25
                  
               
               
                  
                     
                  
               
            
         
      
         Prepare Americans for Future Pandemics
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9003â4â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  6,000
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.5)
                  
                  
                  6,000
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  6,000
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  6,000
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  6,000
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â1,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  4,380
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  4,380
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  6,000
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  1,620
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  6,000
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  1,620
               
               
                  
                     
                  
               
            
         
      
      
         Prepare Americans for Future Pandemics includes $30 billion over four years to create U.S. jobs and prevent the severe job
            losses caused by pandemics through major new investments in medical countermeasures manufacturing; research and development;
            and related biopreparedness and biosecurity. The United States will build on the momentum from the American Rescue Plan, bolster
            scientific leadership, create jobs, markedly decrease the time from discovering a new threat to putting shots in arms, and
            prevent future biological catastrophes. Funds will be administered by the Departments of Health, Defense, and Energy.  
         
      
         Invest in Maternal Health
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9005â4â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  600
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.6)
                  
                  
                  600
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  600
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  600
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  600
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  576
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  576
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  600
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  24
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  600
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  24
               
               
                  
                     
                  
               
            
         
      
      
         The Budget includes a request for $3 billion over five years to invest in maternal health. This proposal will help reduce
            the maternal mortality rate and end race-based disparities in maternal mortality. 
         
      
         Public Health Resilience
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9054â4â1â927
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  360
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 92.0)
                  
                  
                  360
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  1,500
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  1,500
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  1,140
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  360
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â360
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  1,500
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  360
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  1,500
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  360
               
               
                  
                     
                  
               
            
         
      
      
          The Budget proposes $1.5 billion for public health resilience. These investments will increase the resilience of hospitals
            and critical infrastructure, fund health emergency preparedness cooperative agreements, and build resilience against climate
            effects.
         
      
         Transfers from the Patient-Centered Outcomes Research Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  AHRQ
                  34
                  99
                  109
               
               
                  0002
                  Office of the Secretary
                  21
                  25
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  55
                  124
                  136
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  195
                  262
                  261
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  199
                  262
                  261
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  118
                  123
                  136
               
               
                  1930
                  Total budgetary resources available
                  317
                  385
                  397
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  262
                  261
                  261
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  116
                  101
                  73
               
               
                  3010
                  New obligations, unexpired accounts
                  55
                  124
                  136
               
               
                  3020
                  Outlays (gross)
                  â66
                  â152
                  â148
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  101
                  73
                  61
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  116
                  101
                  73
               
               
                  3200
                  Obligated balance, end of year
                  101
                  73
                  61
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  118
                  123
                  136
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4
                  4
               
               
                  4101
                  Outlays from mandatory balances
                  66
                  148
                  144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  66
                  152
                  148
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â118
                  â123
                  â136
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â52
                  29
                  12
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
            20 percent of the funds appropriated or credited to the PCORTF was transferred each year to the Department of Health and Human
            Services (HHS). In FY 2020, PCORTF was extended through FY 2029. As authorized in section 937 of the Public Health Service
            Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded
            comparative clinical effectiveness research and coordinate Federal health programs to build research and data capacity for
            comparative clinical effectiveness research. Transferred funds were distributed to the Secretary of HHS and the Agency for
            Healthcare Research and Quality to carry out these activities.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  40
                  99
                  109
               
               
                  41.0
                  Grants, subsidies, and contributions
                  15
                  25
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  55
                  124
                  136
               
               
                  
                     
                  
               
            
         
      
         Nonrecurring Expenses FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Nonrecurring Expenses Fund Projects
                  243
                  780
                  507
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,024
                  1,191
                  636
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  743
                  600
                  600
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,784
                  1,791
                  1,236
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â350
                  â375
                  â500
               
               
                  1930
                  Total budgetary resources available
                  1,434
                  1,416
                  736
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,191
                  636
                  229
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  793
                  729
                  779
               
               
                  3010
                  New obligations, unexpired accounts
                  243
                  780
                  507
               
               
                  3020
                  Outlays (gross)
                  â290
                  â730
                  â469
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  729
                  779
                  817
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  793
                  729
                  779
               
               
                  3200
                  Obligated balance, end of year
                  729
                  779
                  817
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  â350
                  â375
                  â500
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â101
                  â135
               
               
                  4011
                  Outlays from discretionary balances
                  290
                  831
                  604
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  290
                  730
                  469
               
               
                  4180
                  Budget authority, net (total)
                  â350
                  â375
                  â500
               
               
                  4190
                  Outlays, net (total)
                  290
                  730
                  469
               
               
                  
                     
                  
               
            
         
      
      
         The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
            accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
            technology infrastructure.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  23.1
                  Rental payments to GSA
                  5
                  5
                  5
               
               
                  25.1
                  Advisory and assistance services
                  6
                  6
                  6
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  12
                  12
               
               
                  25.3
                  Other goods and services from Federal sources
                  3
                  2
                  2
               
               
                  25.7
                  Operation and maintenance of equipment
                  17
                  17
                  17
               
               
                  31.0
                  Equipment
                  19
                  19
                  19
               
               
                  32.0
                  Land and structures
                  179
                  719
                  446
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  241
                  780
                  507
               
               
                  99.5
                  Adjustment for rounding
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  243
                  780
                  507
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Health Insurance Reform Implementation FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0119â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  4
                  4
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4
                  4
                  4
               
               
                  1930
                  Total budgetary resources available
                  4
                  4
                  4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4
                  4
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  16
                  13
                  11
               
               
                  3020
                  Outlays (gross)
                  â1
                  â2
                  â2
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  13
                  11
                  9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  16
                  13
                  11
               
               
                  3200
                  Obligated balance, end of year
                  13
                  11
                  9
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  1
                  2
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
      
         Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
         No Surprises Implementation FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  300
                  200
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  200
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  500
                  
               
               
                  1930
                  Total budgetary resources available
                  
                  500
                  200
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  200
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  50
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  300
                  200
               
               
                  3020
                  Outlays (gross)
                  
                  â250
                  â225
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  50
                  25
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  50
               
               
                  3200
                  Obligated balance, end of year
                  
                  50
                  25
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  500
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  250
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  225
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  250
                  225
               
               
                  4180
                  Budget authority, net (total)
                  
                  500
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  250
                  225
               
               
                  
                     
                  
               
            
         
      
      
         Section 118 of the No Surprises Act (P.L. 116â260) appropriated $500,000,000 to the No Surprises Implementation Fund within
            the Department of Health and Human Services. The Fund shall be used for implementation expenses necessary to carry out the
            requirements of the No Surprises Act and Title II Transparency provisions for the Department of Health and Human Services,
            the Department of Labor, and the Department of the Treasury.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  5
                  10
               
               
                  12.1
                  Civilian personnel benefits
                  
                  1
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  
                  2
                  1
               
               
                  22.0
                  Transportation of things
                  
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  264
                  171
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  5
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  12
                  6
               
               
                  25.4
                  Operation and maintenance of facilities
                  
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  4
                  2
               
               
                  26.0
                  Supplies and materials
                  
                  1
                  1
               
               
                  31.0
                  Equipment
                  
                  2
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  300
                  200
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  38
                  75
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  6
                  6
                  6
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  950
                  950
                  1,000
               
               
                  1220
                  Appropriations transferred to other accts [075â0142]
                  â28
                  â28
                  â28
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â854
                  â856
                  â903
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  â12
                  â12
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â56
                  â54
                  â57
               
               
                  1930
                  Total budgetary resources available
                  6
                  6
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6
                  6
                  6
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Prevention and Public Health Fund supports prevention and public health activities. In FY 2022, $943 million is available
            to support a range of public health efforts intended to prevent disease and reduce health care costs. The Secretary has authority
            to transfer to accounts within HHS.
         
      
         Pregnancy Assistance FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  27
                  6
                  
               
               
                  3020
                  Outlays (gross)
                  â20
                  â6
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  27
                  6
                  
               
               
                  3200
                  Obligated balance, end of year
                  6
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  20
                  6
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  20
                  6
                  
               
               
                  
                     
                  
               
            
         
      
      
         This appropriation funds competitive grants to States to assist pregnant and parenting teens and women. Annual funding for
            this program expired at the end of FY 2019. The Budget does request an extension of this program.
         
      
         Section 241 Evaluation Transactions AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â3902â0â1â552
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Section 241 Evaluation Transactions Account (Reimbursable)
                  533
                  541
                  590
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  533
                  541
                  590
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.3)
                  533
                  541
                  590
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  46
                  541
                  590
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  487
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  533
                  541
                  590
               
               
                  1930
                  Total budgetary resources available
                  533
                  541
                  590
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  789
                  936
                  177
               
               
                  3010
                  New obligations, unexpired accounts
                  533
                  541
                  590
               
               
                  3020
                  Outlays (gross)
                  â377
                  â1,300
                  â642
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  936
                  177
                  125
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â788
                  â937
                  â937
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â487
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  338
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â937
                  â937
                  â937
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  â1
                  â760
               
               
                  3200
                  Obligated balance, end of year
                  â1
                  â760
                  â812
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  533
                  541
                  590
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  46
                  541
                  590
               
               
                  4011
                  Outlays from discretionary balances
                  331
                  759
                  52
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  377
                  1,300
                  642
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â376
                  â541
                  â590
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â376
                  â541
                  â590
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â487
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  330
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â157
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  1
                  759
                  52
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  759
                  52
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health Service (PHS) Act Evaluation Transactions account supports the execution of section 241 of the PHS Act.
      
         Program Support CenterFederal Funds
         RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERSFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
            under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
            personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Retirement payments
                  511
                  529
                  550
               
               
                  0002
                  Survivors' benefits
                  32
                  32
                  33
               
               
                  0003
                  Medical care
                  100
                  96
                  90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  643
                  657
                  673
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  643
                  657
                  673
               
               
                  1930
                  Total budgetary resources available
                  643
                  657
                  673
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  94
                  92
                  32
               
               
                  3010
                  New obligations, unexpired accounts
                  643
                  657
                  673
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  15
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â642
                  â717
                  â672
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  92
                  32
                  33
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  94
                  92
                  32
               
               
                  3200
                  Obligated balance, end of year
                  92
                  32
                  33
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  643
                  657
                  673
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  579
                  624
                  639
               
               
                  4101
                  Outlays from mandatory balances
                  63
                  93
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  642
                  717
                  672
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  643
                  657
                  673
               
               
                  4170
                  Outlays, net (mandatory)
                  640
                  717
                  672
               
               
                  4180
                  Budget authority, net (total)
                  643
                  657
                  673
               
               
                  4190
                  Outlays, net (total)
                  640
                  717
                  672
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2020 
                     2021
                     2022
                  
                  
                     
                        
                     
                  
                  
                     Active Duty:
                     
                     
                     
                  
                  
                     HHS
                     4503 
                     4525
                     4694
                  
                  
                     DOJ, BOP
                     681
                     654
                     700
                  
                  
                     Homeland Security
                     495 
                     523
                     550
                  
                  
                     EPA
                     51
                     50 
                      50
                  
                  
                     All Other
                     317 
                     332 
                      366
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Active Duty*
                     6047 
                     6084
                     6360
                  
                  
                     
                     
                     
                     
                  
                  
                     Retirees & Survivors:
                     
                     
                     
                  
                  
                     Retirees
                     6,300 
                     6,380 
                     6,500
                  
                  
                     Retiree family members and survivors
                     1,100 
                     1,120
                     1,100
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Retirement Pay
                     7,400 
                     7,500 
                     7,600
                  
                  
                     Total Beneficiaries (active duty, retirees, survivors)
                     13,813 
                     13,801 
                     13,900
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
            medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned
            Corps.
         
         *The total active duty levels reflect base FTEs plus the supplementals.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  13.0
                  Benefits for former personnel
                  543
                  561
                  583
               
               
                  25.6
                  Medical care
                  100
                  96
                  90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  643
                  657
                  673
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0170â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  29
                  31
                  35
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 12.2)
                  29
                  31
                  35
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  29
                  31
                  35
               
               
                  1900
                  Budget authority (total)
                  29
                  31
                  35
               
               
                  1930
                  Total budgetary resources available
                  29
                  31
                  35
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  29
                  31
                  35
               
               
                  3020
                  Outlays (gross)
                  â29
                  â31
                  â35
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  29
                  31
                  35
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  29
                  31
                  35
               
               
                  4180
                  Budget authority, net (total)
                  29
                  31
                  35
               
               
                  4190
                  Outlays, net (total)
                  29
                  31
                  35
               
               
                  
                     
                  
               
            
         
      
      
         The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
            Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
            appropriation of the annual accrual payment into this fund (P.L. No. 108â375, section 725).
         
      
         General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
         Debt Collection FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  8
                  11
                  12
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  4
                  8
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  11
                  15
                  10
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  12
                  15
                  10
               
               
                  1930
                  Total budgetary resources available
                  12
                  19
                  18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4
                  8
                  6
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  5
                  8
               
               
                  3010
                  New obligations, unexpired accounts
                  8
                  11
                  12
               
               
                  3020
                  Outlays (gross)
                  â3
                  â8
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5
                  8
                  3
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â1
                  â1
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1
                  â1
                  â1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  4
                  7
               
               
                  3200
                  Obligated balance, end of year
                  4
                  7
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  12
                  15
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  3
                  
                  1
               
               
                  4011
                  Outlays from discretionary balances
                  
                  8
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3
                  8
                  17
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â11
                  â15
                  â10
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â8
                  â7
                  7
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â8
                  â7
                  7
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Reimbursable obligations: Personnel compensation: Full-time permanent
                  2
                  2
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  2
                  2
                  3
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  5
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  8
                  11
                  12
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  13
                  25
                  25
               
               
                  
                     
                  
               
            
         
      
         Health Activities FundsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9913â0â1â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         HHS Service and Supply FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Program Support Center
                  465
                  865
                  573
               
               
                  0802
                  OS activities
                  536
                  661
                  728
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,001
                  1,526
                  1,301
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  215
                  198
                  248
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  40
                  250
                  250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  255
                  448
                  498
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,069
                  1,326
                  1,948
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â125
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  944
                  1,326
                  1,948
               
               
                  1930
                  Total budgetary resources available
                  1,199
                  1,774
                  2,446
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  198
                  248
                  1,145
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,013
                  788
                  911
               
               
                  3010
                  New obligations, unexpired accounts
                  1,001
                  1,526
                  1,301
               
               
                  3020
                  Outlays (gross)
                  â1,186
                  â1,153
                  â1,598
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â40
                  â250
                  â250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  788
                  911
                  364
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â531
                  â406
                  â406
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  125
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â406
                  â406
                  â406
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  482
                  382
                  505
               
               
                  3200
                  Obligated balance, end of year
                  382
                  505
                  â42
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  944
                  1,326
                  1,948
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  676
                  669
                  980
               
               
                  4011
                  Outlays from discretionary balances
                  510
                  484
                  618
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,186
                  1,153
                  1,598
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â1,067
                  â1,326
                  â1,948
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,069
                  â1,326
                  â1,948
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  125
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  117
                  â173
                  â350
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  117
                  â173
                  â350
               
               
                  
                     
                  
               
            
         
      
      
         The HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department
            and other Federal agencies. The Program Support Center includes activities, such as personnel and payroll support, information
            technology, financial management operations, and administrative services, including acquisitions management, building and
            property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational
            Health Service. The Office of the Secretary activities include the Service and Supply Fund Manager's Office, departmental
            contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
            acquisition reform, small business consolidation, grants tracking, the physical security component of the Department's implementation
            of Homeland Security Presidential Directive 12, and commercial services management.
         
         Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the
            agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section
            in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either
            through an allocation account or by directly citing that agency's appropriation.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  111
                  178
                  183
               
               
                  11.3
                  Other than full-time permanent
                  3
                  5
                  7
               
               
                  11.5
                  Other personnel compensation
                  4
                  6
                  6
               
               
                  11.7
                  Military personnel
                  6
                  6
                  6
               
               
                  11.8
                  Special personal services payments
                  11
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  135
                  210
                  217
               
               
                  12.1
                  Civilian personnel benefits
                  37
                  44
                  50
               
               
                  12.2
                  Military personnel benefits
                  1
                  4
                  6
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  5
                  4
                  6
               
               
                  23.1
                  Rental payments to GSA
                  18
                  19
                  21
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  61
                  60
                  60
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  79
                  69
                  69
               
               
                  25.2
                  Other services from non-Federal sources
                  374
                  765
                  612
               
               
                  25.3
                  Other goods and services from Federal sources
                  126
                  166
                  93
               
               
                  25.4
                  Operation and maintenance of facilities
                  10
                  15
                  15
               
               
                  25.6
                  Medical care
                  13
                  12
                  12
               
               
                  25.7
                  Operation and maintenance of equipment
                  68
                  65
                  65
               
               
                  26.0
                  Supplies and materials
                  40
                  58
                  40
               
               
                  31.0
                  Equipment
                  30
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,001
                  1,526
                  1,301
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  923
                  1,304
                  1,324
               
               
                  2101
                  Reimbursable military average strength employment
                  40
                  71
                  71
               
               
                  3101
                  Allocation account military average strength employment
                  1,465
                  1,509
                  1,616
               
               
                  
                     
                  
               
            
         
      
      Trust Funds
         Retirement Pay and Survivor Benefits Payments to Commissioned Corps Officers
         Miscellaneous Trust FundsSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  2
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Contributions, Indian Health Facilities
                  7
                  3
                  3
               
               
                  1130
                  Contributions, N.I.H., Unconditional Gift Fund
                  2
                  3
                  3
               
               
                  1130
                  Centers for Disease Control, Gifts and Donations
                  23
                  26
                  26
               
               
                  1130
                  Contributions, N.I.H., Conditional Gift Fund
                  36
                  40
                  40
               
               
                  1130
                  Contributions to the Indian Health Service Gift Fund
                  
                  1
                  1
               
               
                  1140
                  Interest, Miscellaneous Trust Funds
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  69
                  74
                  74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  69
                  74
                  74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  69
                  74
                  76
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Miscellaneous Trust Funds
                  â69
                  â72
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  2
                  4
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Gifts
                  58
                  62
                  62
               
               
                  0003
                  Contributions, Indian Health Facilities
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  64
                  68
                  68
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  173
                  185
                  197
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  7
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  180
                  193
                  205
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  69
                  72
                  72
               
               
                  1930
                  Total budgetary resources available
                  249
                  265
                  277
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  185
                  197
                  209
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  109
                  97
                  72
               
               
                  3010
                  New obligations, unexpired accounts
                  64
                  68
                  68
               
               
                  3020
                  Outlays (gross)
                  â69
                  â85
                  â88
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â7
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  97
                  72
                  44
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  109
                  97
                  72
               
               
                  3200
                  Obligated balance, end of year
                  97
                  72
                  44
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  69
                  72
                  72
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  15
                  26
                  26
               
               
                  4101
                  Outlays from mandatory balances
                  54
                  59
                  62
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  69
                  85
                  88
               
               
                  4180
                  Budget authority, net (total)
                  69
                  72
                  72
               
               
                  4190
                  Outlays, net (total)
                  69
                  85
                  88
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  35
                  31
                  30
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  31
                  30
                  30
               
               
                  
                     
                  
               
            
         
      
      
         Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction,
            improvement, extension, and provision of sanitation facilities.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  4
                  4
                  4
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.8
                  Special personal services payments
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  9
                  9
                  9
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  7
                  5
                  5
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  5
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  8
                  8
                  8
               
               
                  25.5
                  Research and development contracts
                  2
                  2
                  2
               
               
                  25.6
                  Medical care
                  2
                  2
                  2
               
               
                  25.8
                  Subsistence and support of persons
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  6
                  6
                  6
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  19
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  64
                  68
                  68
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  52
                  52
                  52
               
               
                  
                     
                  
               
            
         
      
         Office of the Inspector GeneralFederal Funds
         OFFICE OF INSPECTOR GENERALFor expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations,
            in carrying out the provisions of the Inspector General Act of 1978,  $100,000,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary and investigating
            non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228: Provided further, That, of the amount appropriated under this heading, $5,300,000 shall be available through September 30,
               2023, for activities authorized under section 3022 of the Public Health Service Act (42 U.S.C. 300jj-52) relating to information
               blocking.
      (Department of Health and Human Services Appropriations Act, 2021.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Inspector General (Direct)
                  87
                  90
                  90
               
               
                  0801
                  Office of Inspector General HCFAC Trust Fund
                  223
                  228
                  228
               
               
                  0802
                  Office of Inspector General (Direct Reimbursable)
                  13
                  21
                  21
               
               
                  0803
                  Office of Inspector General HCFAC Discretionary
                  112
                  101
                  99
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  348
                  350
                  348
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  435
                  440
                  438
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  30
                  54
                  39
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  10
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  35
                  54
                  39
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  80
                  84
                  100
               
               
                  1121
                  Appropriations transferred from other acct [075â9911]
                  2
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  5
                  5
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  99
                  89
                  100
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  5
                  5
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  100
                  114
                  111
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  106
                  114
                  111
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  283
                  217
                  222
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â34
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  1
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  249
                  217
                  222
               
               
                  1900
                  Budget authority (total)
                  459
                  425
                  433
               
               
                  1930
                  Total budgetary resources available
                  494
                  479
                  472
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â5
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  54
                  39
                  34
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  102
                  89
                  72
               
               
                  3010
                  New obligations, unexpired accounts
                  435
                  440
                  438
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â443
                  â457
                  â433
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  89
                  72
                  77
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â128
                  â92
                  â92
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  28
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â92
                  â92
                  â92
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â26
                  â3
                  â20
               
               
                  3200
                  Obligated balance, end of year
                  â3
                  â20
                  â15
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  205
                  203
                  211
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  165
                  184
                  192
               
               
                  4011
                  Outlays from discretionary balances
                  31
                  11
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  196
                  195
                  210
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â108
                  â114
                  â111
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â6
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  99
                  89
                  100
               
               
                  4080
                  Outlays, net (discretionary)
                  88
                  81
                  99
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  254
                  222
                  222
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  179
                  203
                  203
               
               
                  4101
                  Outlays from mandatory balances
                  68
                  59
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  247
                  262
                  223
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â271
                  â216
                  â221
               
               
                  4123
                  Non-Federal sources
                  â12
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â283
                  â228
                  â233
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  34
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  
                  11
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  34
                  11
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  5
                  5
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â36
                  34
                  â10
               
               
                  4180
                  Budget authority, net (total)
                  104
                  94
                  100
               
               
                  4190
                  Outlays, net (total)
                  52
                  115
                  89
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
            Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
            1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
            and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
            HHS programs well serve the people that use them. OIG fulfills its mission through a broad range of audits, evaluations, investigations,
            and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health
            Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  40
                  40
                  40
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  42
                  42
                  42
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  16
                  16
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  5
                  6
                  6
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  15
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  4
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  86
                  90
                  90
               
               
                  99.0
                  Reimbursable obligations
                  349
                  350
                  348
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  435
                  440
                  438
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2020 actual
                  2021 est.
                  2022 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,654
                  1,623
                  1,649
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  7
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions
         GENERAL FUND RECEIPT ACCOUNTS(in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2020 actual   
                  2021 est.   
                  2022 est.   
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  142   
                  90   
                  90   
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                     
                  342   
                     
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  967   
                  793   
                  563   
               
               
                  075â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                  279   
                  34   
                  34   
               
               
                  General Fund Offsetting receipts from the public
                  1,388   
                  1,259   
                  687   
               
               
                  
                     
                  
               
               
                  
               
               
                  Intragovernmental payments:
               
               
                  075â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  â27   
                     
                     
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  â27   
                     
                     
               
               
                  
                     
                  
               
            
         
      
      
          
      
         GENERAL PROVISIONSSEC. 201. Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
      when specifically approved by the Secretary.SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural
      mechanism, at a rate in excess of Executive Level II: Provided, That  this section shall not apply to the Head Start program.SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than 2.5 percent,
      of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly, or
      by grants or contracts) and the implementation and effectiveness of programs funded in this title.'
      			
      (TRANSFER OF FUNDS)SEC. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
      which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
      appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.SEC. 205. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act, terminations described in such section may occur
      up to 60 days after the effective date of a contract awarded in fiscal year  2022 under section 338B of such Act, or at any time if the individual who has been awarded such contract has not received funds
      due under the contract.SEC. 206. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. 207. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. 208. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
      Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
      Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
      provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. 209. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.SEC. 210. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year  2022:
      (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
         Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
         that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
         of 1980 and other applicable statutes administered by the Department of State.
      
      (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
         to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
         for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
         functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
         and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
         through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
         foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
         of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
         chronic and environmental diseases, and other health activities abroad.
      
      (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
         benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
         4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
         comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
         percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
         official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
         the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
         Service Act of 1980, to individuals serving in the Foreign Service.
      '
      			
      (TRANSFER OF FUNDS)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (TRANSFER OF FUNDS)SEC. 212. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research" account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. 213. 
      (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director") may use funds authorized under section 402(b)(12)
         of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry out research
         identified pursuant to or research and activities described in such section 402(b)(12).
      
      (b) Peer review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      '
      			
      (TRANSFER OF FUNDS)SEC. 214. Not to exceed  1 percent of funds appropriated by this Act to the offices, institutes, and centers of the National Institutes of Health may be  transferred to and merged with funds appropriated under the heading "National Institutes of Health-Buildings and Facilities":
         Provided, That the use of such transferred funds shall be subject to a centralized prioritization and governance process:
         Provided further, That the Director of the National Institutes of Health shall notify the Committees on Appropriations of
         the House of Representatives and the Senate at least 15 days in advance of any such transfer: Provided further, That this
         transfer authority is in addition to any other transfer authority provided by law.'
      			
      (TRANSFER OF FUNDS)SEC. 215. Of the amounts made available for NIH, 1 percent of the amount made available for National Research Service Awards ("NRSA")
      shall be made available to the Administrator of the Health Resources and Services Administration to make NRSA awards for research
      in primary medical care to individuals affiliated with entities who have received grants or contracts under sections 736,
      739, or 747 of the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of
      the Agency for Healthcare Research and Quality to make NRSA awards for health service research.SEC. 216. 
      (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
         than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
         319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), ifâ
         (1) funds are available and obligatedâ
            (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
            (B) for the estimated costs associated with a necessary termination of the contract; and
         
         (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
            full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
         
      
      (b) A contract entered into under this sectionâ
         (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
         (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
      SEC. 217. Effective during the period beginning on November 1, 2015 and ending January 1, 2023, any provision of law that refers (including
      through cross-reference to another provision of law) to the current recommendations of the United States Preventive Services
      Task Force with respect to breast cancer screening, mammography, and prevention shall be administered by the Secretary involved
      as ifâ
      (1) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to
         breast cancer screening, mammography, and prevention last issued before 2009; and
      
      (2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social
         Security Act (42 U.S.C. 1395x(jj)).
      '
      			
      (TRANSFER OF FUNDS)SEC. 218. The NIH Director may transfer funds for opioid addiction, opioid alternatives, stimulant misuse and addiction, pain management,
      and addiction treatment to other Institutes and Centers of the NIH to be used for the same purpose 15 days after notifying
      the Committees on Appropriations of the House of Representatives and the Senate: Provided, That the transfer authority provided in the previous proviso is in addition to any other transfer authority provided by
      law.SEC. 219. Funds appropriated in this Act that are available for salaries and expenses of employees of the Department of Health and Human
      Services shall also be available to pay travel and related expenses of such an employee or of a member of his or her family,
      when such employee is assigned to duty, in the United States or in a U.S. territory, during a period and in a location that
      are the subject of a determination of a public health emergency under section 319 of the Public Health Service Act and such
      travel is necessary to obtain medical care for an illness, injury, or medical condition that cannot be adequately addressed
      in that location at that time. For purposes of this section, the term "U.S. territory" means Guam, the Commonwealth of Puerto
      Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, or the Trust Territory of the Pacific Islands.SEC. 220. The Department of Health and Human Services may accept donations from the private sector, nongovernmental organizations, and
      other groups independent of the Federal Government for the care of unaccompanied alien children (as defined in section 462(g)(2)
      of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in the care of the Office of Refugee Resettlement of the Administration
      for Children and Families, including monetary donations, medical goods, and services, which may include early childhood developmental screenings, school supplies, toys, clothing, and any other
      items and services intended to promote the wellbeing of such children.SEC. 221. None of the funds made available in this Act under the heading "Department of Health and Human ServicesâAdministration for
      Children and FamiliesâRefugee and Entrant Assistance" may be obligated to a grantee or contractor to house unaccompanied alien
      children (as such term is defined in section 462(g)(2) of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in any facility
      that is not State-licensed for the care of unaccompanied alien children, except in the case that the Secretary determines
      that housing unaccompanied alien children in such a facility is necessary on a temporary basis due to an influx of such children
      or an emergency, provided thatâ
      (1) the terms of the grant or contract for the operations of any such facility that remains in operation for more than six consecutive
         months shall require compliance withâ
         (A) the same requirements as licensed placements, as listed in Exhibit 1 of the Flores Settlement Agreement that the Secretary
            determines are applicable to non-State licensed facilities; and
         
         (B) staffing ratios of one (1) on-duty Youth Care Worker for every eight (8) children or youth during waking hours, one (1) on-duty
            Youth Care Worker for every sixteen (16) children or youth during sleeping hours, and clinician ratios to children (including
            mental health providers) as required in grantee cooperative agreements;
         
      
      (2) the Secretary may grant a 60-day waiver for a contractor's or grantee's non-compliance with paragraph (1) if the Secretary
         certifies and provides a report to Congress on the contractor's or grantee's good-faith efforts and progress towards compliance;
      
      (3) not more than four consecutive waivers under paragraph (2) may be granted to a contractor or grantee with respect to a specific
         facility;
      
      (4) ORR shall ensure full adherence to the monitoring requirements set forth in section 5.5 of its Policies and Procedures Guide
         as of May 15, 2019;
      
      (5) for any such unlicensed facility in operation for more than three consecutive months, ORR shall conduct a minimum of one comprehensive
         monitoring visit during the first three months of operation, with quarterly monitoring visits thereafter; and
      
      (6) not later than 60 days after the date of enactment of this Act, ORR shall brief the Committees on Appropriations of the House
         of Representatives and the Senate outlining the requirements of ORR for influx facilities including any requirement listed
         in paragraph (1)(A) that the Secretary has determined are not applicable to non-State licensed facilities.
      SEC. 222. In addition to the existing Congressional notification for formal site assessments of potential influx facilities, the Secretary
      shall notify the Committees on Appropriations of the House of Representatives and the Senate at least 15 days before operationalizing
      an unlicensed facility, and shall (1) specify whether the facility is hard-sided or soft-sided, and (2) provide analysis that
      indicates that, in the absence of the influx facility, the likely outcome is that unaccompanied alien children will remain
      in the custody of the Department of Homeland Security for longer than 72 hours or that unaccompanied alien children will be
      otherwise placed in danger. Within 60 days of bringing such a facility online, and monthly thereafter, the Secretary shall
      provide to the Committees on Appropriations of the House of Representatives and the Senate a report detailing the total number
      of children in care at the facility, the average length of stay and average length of care of children at the facility, and,
      for any child that has been at the facility for more than 60 days, their length of stay and reason for delay in release.SEC. 223. None of the funds made available in this Act may be used to prevent a United States Senator or Member of the House of Representatives
      from entering, for the purpose of conducting oversight, any facility in the United States used for the purpose of maintaining
      custody of, or otherwise housing, unaccompanied alien children (as defined in section 462(g)(2) of the Homeland Security Act
      of 2002 (6 U.S.C. 279(g)(2))), provided that such Senator or Member has coordinated the oversight visit with the Office of
      Refugee Resettlement not less than two business days in advance to ensure that such visit would not interfere with the operations
      (including child welfare and child safety operations) of such facility.SEC. 224. Funds appropriated in this Act that are available for salaries and expenses of employees of the Centers for Disease Control
      and Prevention shall also be available for the primary and secondary schooling of eligible dependents of personnel stationed
      in a U.S. territory as defined in section 229 of this Act at costs not in excess of those paid for or reimbursed by the Department
      of Defense.'
      			
      (CANCELLATION)
      SEC. 225. Of the unobligated balances in the "Nonrecurring Expenses Fund" established in section 223 of division G of Public Law 110â161,
       $500,000,000 are hereby   permanently cancelled not later than September 30, 2021.SEC. 226.   For purposes of any transfer to appropriations under the heading "Department of Health and Human ServicesâOffice of the SecretaryâPublic
         Health and Social Services Emergency Fund", section 204 of this Act shall be applied by substituting "10 percent" for "3 percent". SEC. 227.  The Secretary of Health and Human Services (Secretary) is authorized to provide, from funds made available in this title for
         such purposes, mental health and other supportive services, including through grants, contracts, or cooperative agreements,
         for children, parents, and legal guardians who were separated at the United States-Mexico border between January 20, 2017,
         and January 20, 2021, in connection with the Zero-Tolerance Policy (as discussed in the Attorney General's memorandum of April
         6, 2018, entitled "Zero-Tolerance for Offenses Under 8 U.S.C. 1325(a)") and any other United States Government practice, policy,
         program, or initiative that resulted in the separation of children who arrived at the United States-Mexico border with their
         parents or legal guardians during such period. The Secretary may identify the individuals eligible to receive such mental
         health and other supportive services under this section through reference to the identified members of the classes, and their
         minor children, in the class-action lawsuits Ms. J.P. v. Barr and Ms. L. v. ICE. SEC. 228.   For fiscal year 2022, the notification requirements described in sections 1804(a) and 1851(d) of the Social Security Act
         may be fulfilled by the Secretary in a manner similar to that described in paragraphs (1) and (2) of section 1806(c) of such
         Act. SEC. 229.    (a)  IN GENERAL. Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
            the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
            within the Department or of another agency under whichâ (1)  the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
               or cooperative agreement on behalf of the ordering agency or unit;  
         (2)  the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
               and  
         (3)   the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
               and for the service of executing or managing the grant or cooperative agreement. 
      
      (b)  CONDITIONS. The conditions for making an agreement described in subsection (a) are thatâ (1)  amounts are available;  
         (2)  the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
                
         (3)  the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.  
      
      (c)  PAYMENT. Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
            agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
            any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
            request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
            shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
            and the actual cost of the services provided.  
      (d)  LIMITATIONS ON FUNDS. A condition or limitation applicable to amounts for grants or cooperative agreements of the ordering
            agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement.
             
      (e)  OBLIGATION OF APPROPRIATIONS. An agreement made under this section obligates an appropriation of the ordering agency or unit.
            The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
            before the end of the period of availability of the appropriation, inâ (1)  awarding the grant or cooperative agreement; or  
         (2)  providing the agreed-to services.  
      
      (f)  NO EFFECT ON OTHER LAWS. This section does not affect other laws concerning reimbursable agreements. SEC. 230.    (a)  IN GENERAL. A State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
            of Health and Human Services, Administration for Community Living, Aging and Disability Services Programs" to carry out programs
            under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
            the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
            or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
            limitations on such transfers under the OAA or such heading.  
      (b)  NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL. A State or tribal organization which elects to make a transfer under
            subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
            of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
            the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
            the Secretary determines that such transfer is not consistent with the objectives of the OAA.  
      (c)  RULES OF CONSTRUCTION. No transfer of grant funds by a State or tribal organization under this section shall be construedâ (1)  as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
               by the Secretary; or  
         (2)  to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
               funds. 
      SEC. 231.   The unobligated balances of amounts appropriated or transferred to the Centers for Disease Control and Prevention under the
         heading "Buildings and Facilities" in title II of division H of the Consolidated Appropriations Act, 2018 (Public Law 115â141)
         for a biosafety level 4 laboratory shall also be available for the acquisition of real property, equipment, construction,
         demolition, renovation of facilities, and installation expenses, including moving expenses, related to such laboratory: Provided,
         That no later than September 30, 2022, the remaining unobligated balances of such funds are hereby permanently cancelled,
         and an amount of additional new budget authority equivalent to the amount cancelled is hereby appropriated, to remain available
         until expended, for the same purposes as provided in this section, in addition to any other amounts available for such purposes. SEC. 232.   Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended 
      (a)  in subsection (a)(5)(C)  (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE. A covered entity shall
               permit"; and  
         (2)  by inserting at the end the following:  
         
            "(ii) USE OF SAVINGS. A covered entity shall permit the Secretary to audit, at the Secretary's expense, the records of the
                  entity to determine how net income from purchases under this section are used by the covered entity."
         
         
            "(iii) RECORDS RETENTION. Covered entities shall retain such records and provide such records and reports as deemed necessary
                  by the Secretary for carrying out this subparagraph.". 
         
      
      (b)  by adding at the end the following new subsection:  
      
         "(f) REGULATIONS. The Secretary may promulgate such regulations as the Secretary determines appropriate to carry out the provisions
               of this section.".
      '
      			
      (INCLUDING TRANSFER OF FUNDS)SEC. 233.    (a)  The Secretary may reserve not more than 0.25 percent from each appropriation made in this Act to the accounts of the Administration
            for Children and Families identified in subsection (b) in order to carry out evaluations of any of the programs or activities
            that are funded under such accounts. Funds reserved under this section may be transferred to the "Children and Families Services
            Programs" account for use by the Assistant Secretary for the Administration for Children and Families and shall remain available
            until expended: Provided, That funds reserved under this section shall not be available for obligation unless the Assistant
            Secretary submits a plan to the Committees on Appropriations of the House of Representatives and the Senate 15 days in advance
            of any such transfer describing the evaluations to be carried out. 
      (b)  The accounts referred to in subsection (a) are: "Low Income Home Energy Assistance", "Refugee and Entrant Assistance", "Payments
            to States for the Child Care and Development Block Grant", and "Children and Families Services Programs". SEC. 234.    (a)  PREMIUM PAY AUTHORITY. If services performed by a Department of Health and Human Services employee during a public health
            emergency declared under section 319 of the Public Health Service Act are determined by the Secretary of Health and Human
            Services to be primarily related to preparation for, prevention of, or response to such public health emergency, any premium
            pay that is provided for such services shall be exempted from the aggregate of basic pay and premium pay calculated under
            section 5547(a) of title 5, United States Code, and any other provision of law limiting the aggregate amount of premium pay
            payable on a biweekly or calendar year basis.  
      (b)  OVERTIME AUTHORITY. Any overtime that is provided for such services described in subsection (a) shall be exempted from any
            annual limit on the amount of overtime payable in a calendar or fiscal year.  
      (c)  APPLICABILITY OF AGGREGATE LIMITATION ON PAY. In determining, for purposes of section 5307 of title 5, United States Code,
            whether an employee's total pay exceeds the annual rate payable under such section, the Secretary of Health and Human Services
            shall not include pay exempted under this section.  
      (d)  LIMITATION OF PAY AUTHORITY. Pay exempted from otherwise applicable limits under subsection (a) shall not cause the aggregate
            pay earned for the calendar year in which the exempted pay is earned to exceed the rate of basic pay payable for a position
            at level II of the Executive Schedule under section 5313 of title 5, United States Code.  
      (e)  DANGER PAY FOR SERVICE IN PUBLIC HEALTH EMERGENCIES. The Secretary of Health and Human Services may grant a danger pay allowance
            under section 5928 of title 5, United States Code, without regard to the conditions of the first sentence of such section,
            for work that is performed by a Department of Health and Human Services employee during a public health emergency declared
            under section 319 of the Public Health Service Act that the Secretary determines is primarily related to preparation for,
            prevention of, or response to such public health emergency and is performed under conditions that threaten physical harm or
            imminent danger to the health or well-being of the employee. 
      (f)  EFFECTIVE DATE. This section shall take effect as if enacted on September 30, 2020. SEC. 235.   Section 2813 of the Public Health Service Act (42 U.S.C. 300hh-15) is amendedâ (1)  by redesignating subsection (i) as subsection (j); and  
      (2)  by inserting after subsection (h) the following new subsection:  
      
         "(i) TORT CLAIMS AND WORK INJURY COMPENSATION COVERAGE FOR CORPS VOLUNTEERS.â
         
            "(1) IN GENERAL. If under section 223 and regulations pursuant to such section, and through an agreement entered into in accordance
                  with such regulations, the Secretary accepts, from an individual in the Corps, services for a specified period that are volunteer
                  and without compensation other than reasonable reimbursement or allowance for expenses actually incurred, such individual
                  shall, during such period, have the coverages described in paragraphs (2) and (3). 
         
         
            "(2) FEDERAL TORT CLAIMS ACT COVERAGE. Such individual shall, while performing such services during such periodâ
            
               "(A) be deemed to be an employee of the Department of Health and Human Services, for purposes of claims under sections 1346(b)
                     and 2672 of title 28, United States Code, for money damages for personal injury, including death, resulting from performance
                     of functions under such agreement; and 
            
            
               "(B) be deemed to be an employee of the Public Health Service performing medical, surgical, dental, or related functions,
                     for purposes of having the remedy provided by such sections of title 28 be exclusive of any other civil action or proceeding
                     by reason of the same subject matter against such individual or against the estate of such individual.
            
         
         
            "(3) COMPENSATION FOR WORK INJURIES. Such individual shall, while performing such services during such period, be deemed to
                  be an employee of the Department of Health and Human Services, and an injury sustained by such an individual shall be deemed
                  'in the performance of duty', for purposes of chapter 81 of title 5, United States Code, pertaining to compensation for work
                  injuries.".
         
      SEC. 236.   Notwithstanding any other provision of law, the Secretary of Health and Human Services may use $7,981,000 of the amounts
         appropriated under the heading "Department of Health and Human ServicesâOffice of the SecretaryâGeneral Departmental Management"
         to supplement funds otherwise available to the Secretary for the hire and purchase of electric vehicles and electric vehicle
         charging stations, and to cover other costs related to electrifying the motor vehicle fleet within HHS: Provided, That electric
         chargers installed in a parking area with such funds shall be deemed personal property under the control and custody of the
         component of the Department of Health and Human Services managing such parking area.  SEC. 237.   Section 402A(d) of the Public Health Service Act (42 U.S.C. 282a(d)) is amendedâ  (1) in the first sentence by striking "under subsection (a)" and inserting "to carry out this title"; and
      (2) in the second sentence by striking "account under subsection (a)(1)".SEC. 238.  The Secretary of Health and Human Services may waive penalties and administrative requirements in title XXVI of the Public
         Health Service Act for awards under such title from amounts provided under the heading "Department of Health and Human ServicesâHealth
         Resources and Services Administration" in this or any other appropriations Act for this fiscal year, including amounts made
         available to such heading by transfer. (Department of Health and Human Services Appropriations Act, 2021.)
         GENERAL PROVISIONS(Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)
         GENERAL PROVISIONS(Coronavirus Response and Relief Supplemental Appropriations Act, 2021.)