Appendix - Department of Health and Human Services

For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; in addition to amounts appropriated to the FDA Innovation Account, for carrying out the activities described in section 1002(b)(4) of the 21st Century Cures Act (Public Law 114–255); for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $6,250,157,000: Provided, That of the amount provided under this heading, $1,141,861,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this account and remain available until expended; $241,431,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; $527,848,000 shall be derived from human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account and remain available until expended; $43,116,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall be credited to this account and remain available until expended; $33,836,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account and remain available until expended; $23,137,000 shall be derived from generic new animal drug user fees authorized by 21 U.S.C. 379j-21, and shall be credited to this account and remain available until expended; $712,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees, medical device user fees, human generic drug user fees, biosimilar biological product user fees, animal drug user fees, and generic new animal drug user fees that exceed the respective fiscal year 2021 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device, human generic drug, biosimilar biological product, animal drug, and generic new animal drug assessments for fiscal year 2021, including any such fees collected prior to fiscal year 2021 but credited for fiscal year 2021, shall be subject to the fiscal year 2021 limitations: Provided further, That the Secretary may accept payment during fiscal year 2021 of user fees specified under this heading and authorized for fiscal year 2022, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2022 for which the Secretary accepts payment in fiscal year 2021 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: Provided further, That of the total amount appropriated: (1) $1,182,625,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs, of which no less than $15,000,000 shall be used for inspections of foreign seafood manufacturers and field examinations of imported seafood; (2) $2,120,173,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs; (3) $457,889,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $284,566,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $657,633,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $76,994,000 shall be for the National Center for Toxicological Research; (7) $680,812,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) $210,485,000 shall be for Rent and Related activities, of which $55,892,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) $235,348,000 shall be for payments to the General Services Administration for rent; and (10) $343,632,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Food Policy and Response, the Office of Operations, the Office of the Chief Scientist, and central services for these offices: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner: Provided further, That any transfer of funds pursuant to section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd(n)) shall only be from amounts made available under this heading for other activities: Provided further, That of the amounts that are made available under this heading for "other activities", and that are not derived from user fees, $1,500,000 shall be transferred to and merged with the appropriation for "Department of Health and Human Services—Office of Inspector General" for oversight of the programs and operations of the Food and Drug Administration and shall be in addition to funds otherwise made available for oversight of the Food and Drug Administration: Provided further, That funds may be transferred from one specified activity to another with the prior notification to the Committees on Appropriations of both Houses of Congress.

In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381, priority review user fees authorized by 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, and voluntary qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C. 379j-62, prescription drug wholesale distributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C. 384d(c)(8), medical countermeasure priority review voucher user fees authorized by 21 U.S.C. 360bbb-4a, and fees relating to over-the-counter monograph drugs authorized by 21 U.S.C. 379j-72 shall be credited to this account, to remain available until expended.

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

For plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided, $30,788,000, to remain available until expended.

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


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

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

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

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

5099	Balance, end of year		1	2


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation. FDA also has responsibility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public health and to reduce tobacco use by minors. FDA advances public health by helping to advance innovations that make medicines more effective, safe, and affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by ensuring the security of the food supply and by fostering the development of medical products and countermeasures to respond to deliberate and naturally emerging public health threats. The FY 2022 Budget includes $6.2 billion in total resources for FDA. The Budget invests in priority activities such as data modernization and enhanced technologies, food safety efforts such as infant and maternal health and nutrition, shortages and supply chain, capacity building, and infrastructure.


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

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

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

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

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


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

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

In addition, contingent upon the enactment of authorizing legislation establishing fees under 21 U.S.C. 387s with respect to products deemed under 21 U.S.C. 387a(b) but not specified in 21 U.S.C. 387s(b)(2)(B), the Secretary shall assess and collect such fees, which shall be credited to this account and remain available until expended, in addition to amounts otherwise derived from fees authorized under 21 U.S.C. 387s.


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

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

0899	Total reimbursable obligations			100

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

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

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

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

The Budget includes a legislative proposal to increase the user fee collected in support of the tobacco program by $100 million and adds electronic nicotine delivery system manufacturers and importers as entities subject to the user fees.


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

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

99.0	Reimbursable obligations			100

99.9	Total new obligations, unexpired accounts			100


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

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

0900	Total new obligations, unexpired accounts	632	619	619

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

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

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

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

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

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


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

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

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

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

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

99.0	Reimbursable obligations	632	295	295

99.9	Total new obligations, unexpired accounts	632	619	619


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

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


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

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

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

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

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

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

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

For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition to amounts available for such purposes under the heading "Salaries and Expenses", $50,000,000, to remain available until expended: Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act, are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the Commissioner of Food and Drugs to the appropriation for "Department of Health and Human Services Food and Drug Administration Salaries and Expenses" solely for the purposes provided in such Act: Provided further, That upon a determination by the Commissioner that funds transferred pursuant to the previous proviso are not necessary for the purposes provided, such amounts may be transferred back to the account: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.

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


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

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

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

5099	Balance, end of year


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

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

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

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

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

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

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

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

The 21st Century Cures Act was enacted into law on December 13, 2016. The Act includes authorities FDA can use to help modernize drug, biological product, and device product development and review and to create greater efficiencies and predictability in product development and review.


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

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

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

99.9	Total new obligations, unexpired accounts	65


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

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


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

	Obligations by program activity:
0801	Revolving Fund for Certification and Other Services (Reimbursable)	9	10	11

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3	2	2
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	10	11
1802	Offsetting collections (previously unavailable)	1	1	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1	–1	–1

1850	Spending auth from offsetting collections, mand (total)	8	10	11
1900	Budget authority (total)	8	10	11
1930	Total budgetary resources available	11	12	13
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2	2	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4	5
3010	New obligations, unexpired accounts	9	10	11
3020	Outlays (gross)	–8	–15	–11

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

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

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

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

FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs, medical devices, and cosmetics. These services are financed wholly by fees paid by the industries affected.


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

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

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

99.9	Total new obligations, unexpired accounts	9	10	11


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

2001	Reimbursable civilian full-time equivalent employment	34	37	37

Federal Funds

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect to primary health care and the Native Hawaiian Health Care Act of 1988, $1,733,772,000: Provided, That no more than $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $120,000,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of section 224 of the PHS Act, and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative claims made under such law.

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $1,380,384,000: Provided, That sections 751(j)(2) and 762(k) of the PHS Act and the proportional funding amounts in paragraphs (1) through (4) of section 756(f) of the PHS Act shall not apply to funds made available under this heading: Provided further, That for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as the "Secretary") may hereafter waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act: Provided further, That fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of 1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the programs authorized by such sections and shall remain available until expended for the National Practitioner Data Bank: Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under such section and subpart: Provided further, That $180,000,000 shall remain available until expended for the purposes of providing primary health services, assigning National Health Service Corps ("NHSC") members to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS Act, and making payments under the NHSC Loan Repayment Program under section 338B of such Act: Provided further, That for purposes of the previous proviso, section 331(a)(3)(D) of the PHS Act shall be applied as if the term "primary health services" includes clinical substance use disorder treatment services, including those provided by masters level, licensed substance use disorder treatment counselors.

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

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health and title V of the Social Security Act, $1,100,084,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $220,116,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and $10,276,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,554,781,000, of which $2,010,881,000 shall remain available to the Secretary through September 30, 2024, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act; and of which $190,000,000, to remain available until expended, shall be available to the Secretary for carrying out a program of grants and contracts under title XXVI or section 311(c) of such Act focused on ending the nationwide HIV/AIDS epidemic, with any grants issued under such section 311(c) administered in conjunction with title XXVI of the PHS Act, including the limitation on administrative expenses.

For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, $136,093,000, of which $122,000 shall be available until expended for facilities renovations and other facilities-related expenses of the National Hansen's Disease Program.

For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act, $400,209,000, of which $57,509,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program: Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, $20,942,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and up to $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) available for the purchase and implementation of telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, $12,500,000 shall be available for State Offices of Rural Health: Provided further, That $12,700,000 shall remain available through September 30, 2024, to support the Rural Residency Development Program.

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $340,000,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office.

For program support in the Health Resources and Services Administration, $167,971,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Care Systems", and "Rural Health".


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

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

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

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

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

0899	Total reimbursable obligations	67	63	63

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

233999	Total subsidy budget authority		1	2

Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training, maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.

HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL), Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans, the program's revolving account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If the program's revolving account has excess funds that will not be used to provide new loans, these excess funds are returned to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects Academic Year 2019–2020 data reported in the Annual Operating Report.


Program	Account Balance


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

Total	1,003,418,895


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

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

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

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

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


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

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


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

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

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

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

The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203 and serves as a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account. Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected in the Vaccine Injury Compensation Program trust fund account.

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


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

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

0900	Total new obligations, unexpired accounts	2	6	9

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

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

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

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

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

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

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

The Covered Countermeasure Process Fund is established pursuant to the Public Health Service (PHS) Act, as amended by Division C of Public Law 109–148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108–20).


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

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

99.0	Direct obligations	1	6	9
99.5	Adjustment for rounding	1

99.9	Total new obligations, unexpired accounts	2	6	9


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

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


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

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

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

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

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

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

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

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

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

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


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

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

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

99.9	Total new obligations, unexpired accounts	400	450	478


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

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


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

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	1	1
1930	Total budgetary resources available	1	1	1
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1
4180	Budget authority, net (total)
4190	Outlays, net (total)


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

	Position with respect to appropriations act limitation on commitments:
2111	Guaranteed loan commitments from current-year authority
2121	Limitation available from carry-forward	888	886	846
2143	Uncommitted limitation carried forward	–886	–846	–774

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

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

2290	Outstanding, end of year	27	56	118

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

Public Law 104–299, Public Law 104–208, and Public Law 115–141 authorize Health Resources and Services Administration (HRSA) to guarantee up to $1 billion in private loans to health centers for the costs of developing and operating managed care networks or plans and for the construction, renovation, and modernization of medical facilities. The program account for this activity is displayed in the Health Resources and Services account (75–0350) as a line in the program and financing schedule.


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

	ASSETS:
1101	Federal assets: Fund balances with Treasury	1	1

1999	Total assets	1	1
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	1	1
	NET POSITION:
3300	Cumulative results of operations

4999	Total liabilities and net position	1	1


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

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	5	5	5

1290	Outstanding, end of year	5	5	5

Titles VI and XVI of the PHS Act established a loan and loan guarantee fund for medical facilities with a maximum amount allowable for the Government's liability. Direct loans were made available for public facilities and guaranteed loans for private, nonprofit facilities. Funds under this authority were established in the amount of $50 million for use in fulfilling guarantees in the event of default, $30 million as a revolving fund for direct loans, and an amount for interest subsidy payments on guaranteed loans.


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

	ASSETS:
1601	Direct loans, gross	5	5

1999	Total assets	5	5
	LIABILITIES:
2201	Non-Federal liabilities: Accounts payable	5	5
	NET POSITION:
3100	Unexpended appropriations
3300	Cumulative results of operations

3999	Total net position

4999	Total liabilities and net position	5	5

Trust Funds

For payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $16,200,000 shall be available from the Trust Fund to the Secretary.


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

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

1199	Total current law receipts	393	385	401

1999	Total receipts	393	385	401

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

2199	Total current law appropriations	–250	–349	–365

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

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


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

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

0191	Direct program activities, subtotal	32	38	48

0900	Total new obligations, unexpired accounts	250	349	365

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

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

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

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

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

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

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

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

The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203 and serves as a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims for vaccine-related injury or death occurring after October 1, 1988.


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

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

99.9	Total new obligations, unexpired accounts	250	349	365


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

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

Federal Funds

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education Assistance Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, $5,678,336,000 to remain available until September 30, 2023, except as otherwise provided herein; and, in addition, $6,152,680,000, which shall become available on October 1, 2022 and remain available through September 30, 2024, except as otherwise provided herein; together with payments received during each fiscal year pursuant to sections 231(b) and 233 of the Public Health Service Act (42 U.S.C. 238(b) and 238b), for services furnished by the Indian Health Service: Provided, That funds made available to tribes and tribal organizations through contracts, grant agreements, or any other agreements or compacts authorized by the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be obligated at the time of the grant or contract award and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That $2,500,000 shall be available for each of fiscal years 2022 and 2023 for grants or contracts with public or private institutions to provide alcohol or drug treatment services to Indians, including alcohol detoxification services: Provided further, That of the total amount of funds provided, $2,409,883,000 shall remain available until expended for Purchased/Referred Care, of which $1,218,059,000 shall be from funds that become available on October 1, 2022: Provided further, That of the total amount specified in the preceding proviso for Purchased/Referred Care, $106,000,000 shall be for the Indian Catastrophic Health Emergency Fund, of which $53,000,000 shall be from funds that become available on October 1, 2022: Provided further, That for each of fiscal years 2022 and 2023, up to $66,000,000 shall remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health Care Improvement Act: Provided further, That of the total amount of funds provided, $116,000,000, including $58,000,000 from funds that become available on October 1, 2022, shall be for costs related to or resulting from accreditation emergencies, including supplementing activities funded under the heading "Indian Health Facilities," of which up to $4,000,000 for each of fiscal years 2022 and 2023 may be used to supplement amounts otherwise available for Purchased/Referred Care: Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited in the Fund authorized by section 108A of that Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of that Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of that Act (25 U.S.C. 1613a and 1616a): Provided further, That the amounts made available within this account for the Substance Abuse and Suicide Prevention Program, for Opioid Prevention, Treatment and Recovery Services, for the Domestic Violence Prevention Program, for the Zero Suicide Initiative, for the housing subsidy authority for civilian employees, for Aftercare Pilot Programs at Youth Regional Treatment Centers, for transformation and modernization costs of the Indian Health Service Electronic Health Record system, for national quality and oversight activities, for improving collections from public and private insurance at Indian Health Service and tribally operated facilities, for an initiative to treat or reduce the transmission of HIV and HCV, for a maternal health initiative, for the Telebehaviorial Health Center of Excellence, for Alzheimer's activities, for Village Built Clinics, and for accreditation emergencies shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act that are available for two fiscal years may be used in their second year of availability for annual contracts that fall within 2 fiscal years, provided the total obligation is recorded in such second year of availability: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act (25 U.S.C. 1613) shall remain available until expended for the purpose of achieving compliance with the applicable conditions and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, and from tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.): Provided further, That of the total amount of funds provided, $637,138,000, including $319,832,000 from the amounts that become available on October 1, 2022, is for the Indian Health Care Improvement Fund and may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account.

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4060	Additional offsets against budget authority only (total)	5

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

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

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


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

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

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

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

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


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

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

For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education Assistance Act agreements with the Indian Health Service for fiscal year 2022, such sums as may be necessary; and, in addition, for fiscal year 2023, such sums as may be necessary, which shall become available on October 1, 2022 and shall remain available through September 30, 2023: Provided, That notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer to another budget account: Provided further, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements for the current fiscal year shall be applied to contract support costs due for such agreements for subsequent fiscal years.

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


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

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

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

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

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

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

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

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

The Contract Support Costs account provides for the reasonable and allowable costs for direct program expenses for the operation of, and any additional administrative or other expense related to, the overhead incurred by tribes and tribal organizations who operate health programs through self-determination contracts and compacts. An estimated $1.1 billion in contract support costs funds will be provided to tribal governments and tribal organizations in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Contract Support Costs account.

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

For payments to tribes and tribal organizations for leases pursuant to section 105(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5324(l)) for fiscal year 2022, such sums as may be necessary; and, in addition, for fiscal year 2023, such sums as may be necessary, which shall become available on October 1, 2022 and shall remain available through September 30, 2023: Provided, That notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer to another budget account.

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


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

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

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

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

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

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

The Payments for Tribal Leases account provides for the reasonable and allowable costs for leases with a Tribe or tribal organization for a building owned or leased by the tribe or tribal organization that is used for administration or delivery of services under the Indian Self-Determination and Education Assistance Act. An estimated $150 million in lease funds will be provided to tribal governments and tribal organizations in fiscal year 2022. The Budget also proposes an advance fiscal year 2023 appropriation for the Payment for Tribal Leases account.

For construction, repair, maintenance, demolition, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health and facilities support activities of the Indian Health Service, $1,500,943,000, to remain available until expended; and, in addition, $1,526,599,000, which shall become available on October 1, 2022, and remain available until expended: Provided, That notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation, or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such facilities will be located: Provided further, That not to exceed $500,000 may be used for each of fiscal years 2022 and 2023 by the Indian Health Service to purchase TRANSAM equipment from the Department of Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development.

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


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

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

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

5099	Balance, end of year


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

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

0100	Total direct program	751	1,369	769

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

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

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

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

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

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

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

3050	Unpaid obligations, end of year	892	1,167	599
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–18	–18	–18

3090	Uncollected pymts, Fed sources, end of year	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	844	874	1,149
3200	Obligated balance, end of year	874	1,149	581

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

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

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

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

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


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

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

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

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

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


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

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

Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C. 5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation, and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences in the field, when authorized under regulations approved by the Secretary of Health and Human Services; uniforms, or allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public Law 93–638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges by the Department of Health and Human Services unless such assessments or charges are identified in the budget justification and provided in this Act, or are notified to the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450 et seq.), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including direct, administrative, and overhead costs associated with the provision of goods, services, or technical assistance: Provided further, That the Indian Health Service may provide to civilian medical personnel serving in hospitals operated by the Indian Health Service housing allowances equivalent to those that would be provided to members of the Commissioned Corps of the United States Public Health Service serving in similar positions at such hospitals: Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations.

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

Federal Funds

For carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $526,580,000.

For carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, $1,420,556,000.

For carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $626,272,000: Provided, That of the amounts made available under this heading, up to $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under Federal or State quarantine law.

For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health promotion, $1,197,714,000: Provided, That funds made available under this heading may be available for making grants under section 1509 of the PHS Act for not less than 21 States, tribes, or tribal organizations: Provided further, That of the funds made available under this heading, $15,000,000 shall be available to continue and expand community specific extension and outreach programs to combat obesity in counties with the highest levels of obesity: Provided further, That the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available under this heading.

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

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

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

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

For carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety and Health Act, with respect to occupational safety and health, $345,300,000.

For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106–554.

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

For carrying out titles II, III, and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, $842,200,000.

For carrying out titles II, III, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support for activities funded in other appropriations included in this Act for the Centers for Disease Control and Prevention, $548,570,000, of which $400,000,000 shall remain available through September 30, 2023, for public health infrastructure and capacity: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading and in all other accounts of the CDC: Provided further, That of the amounts made available under this heading, $35,000,000, to remain available until expended, shall be available to the Director of the CDC for deposit in the Infectious Diseases Rapid Response Reserve Fund established by section 231 of division B of Public Law 115–245: Provided further, That funds appropriated under this heading may be used to support a contract for the operation and maintenance of an aircraft in direct support of activities throughout CDC to ensure the agency is prepared to address public health preparedness emergencies: Provided further, That any amounts made available by this Act to the Centers for Disease Control and Prevention may be used for the salaries and expenses of any CDC employee or fellow responding to an emergency or other urgent public health crisis: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service, or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program and the Respirator Certification Program shall be available through September 30, 2023.


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

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

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

5099	Balance, end of year		1	2


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

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

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

0809	Reimbursable program activities, subtotal	197	653	653

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health, safety, and protection of all Americans. These activities include immunization and respiratory diseases, HIV/AIDS, Hepatitis, STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, public health and scientific services, injury prevention and control, environmental health, global health, programs that reduce the occurrence of birth defects and developmental disabilities, public health preparedness and emergency response, and CDC-wide activities and program support. The FY 2022 Budget includes $400 million for new, dedicated funding to invest in public health infrastructure and capacity, and an additional $183 million to support a range of violence prevention and research activities. The FY 2022 Budget also provides $275 million for CDC to undertake the third year of the Ending the HIV Epidemic in the U.S. initative, and an additional $100 million to continue CDC's Public Health Data Modernization efforts. The FY 2022 Budget provides an additional $100 million for global public health protection activities to protect Americans through partnerships and other activities that support public health capacity improvements in countries at risk for uncontrolled outbreaks of infectious diseases.


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

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

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

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

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


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

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

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

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


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

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

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts	33	30	55


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

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

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

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

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

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

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

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

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

Implemented in fiscal year 2014, CDC's Working Capital Fund has extended availability and serves as the funding mechanism to finance centralized business services support across CDC. Services rendered under the fund are performed at pre-established rates that are used to cover the full cost of operations and future investments. Contributions are collected for services, thereby creating market-like incentives to maximize efficiency and quality.


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

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

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

99.9	Total new obligations, unexpired accounts	655	569	569


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

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


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

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

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

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

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

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

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

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

The FY 2022 Budget provides $35 million for the Infectious Diseases Rapid Response Reserve Fund within the Centers for Disease Control and Prevention. This Fund will provide the ability to respond efficiently and rapidly to emerging infectious disease threats or outbreaks.


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

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

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

99.9	Total new obligations, unexpired accounts	104	10	35


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

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

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) and section 3019 of the Solid Waste Disposal Act, $81,750,000: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA, the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation, biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological profiles pursuant to section 104(i) of CERCLA during fiscal year 2022, and existing profiles may be updated as necessary.

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


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

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

0900	Total new obligations, unexpired accounts	104	93	82

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

99.0	Direct obligations	102	78	82
99.0	Reimbursable obligations	2	15

99.9	Total new obligations, unexpired accounts	104	93	82


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

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


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

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

0900	Total new obligations, unexpired accounts	526	612	712

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

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

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

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

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

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

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

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

HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2021 and 2022 in the Budget reflect estimated Federal obligations for the WTC Health Program.


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

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	4	4	4
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	5	5	5
12.1	Civilian personnel benefits	2	2	2
12.2	Military personnel benefits	1	1	1
25.1	Advisory and assistance services	39	39	39
25.2	Other services from non-Federal sources	105	105	105
25.3	Other goods and services from Federal sources	12	12	12
31.0	Equipment	2	2	2
41.0	Grants, subsidies, and contributions	24	24	24
42.0	Insurance claims and indemnities	336	422	522

99.9	Total new obligations, unexpired accounts	526	612	712


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

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

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $6,539,302,000, of which up to $30,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland.

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, $3,845,681,000.

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

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

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

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

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

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

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

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

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $83,540,000.

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

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

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

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

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

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

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

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

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

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

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

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

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), $96,322,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $474,864,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2023: Provided further, That in fiscal year 2022, the National Library of Medicine may enter into personal services contracts for the provision of services in facilities owned, operated, or constructed under the jurisdiction of the National Institutes of Health (referred to in this title as "NIH").

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $878,957,000: Provided, That up to 10 percent of the amounts made available under this heading shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.

For carrying out the responsibilities of the Office of the Director, NIH, $2,237,259,000: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That all funds credited to the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: Provided further, That $645,939,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That up to $30,000,000 shall be used to carry out section 404I of the PHS Act (42 U.S.C. 283k) with respect to the National Primate Research Centers and Caribbean Primate Research Center: Provided further, That $5,000,000 shall be transferred to and merged with the appropriation for the "Office of Inspector General" for oversight of grant programs and operations of the NIH, including agency efforts to ensure the integrity of its grant application evaluation and selection processes, and shall be in addition to funds otherwise made available for oversight of the NIH: Provided further, That the funds provided in the previous proviso may be transferred from one specified activity to another with 15 days prior notification to the Committees on Appropriations of the House of Representatives and the Senate: Provided further, That the Inspector General shall consult with the Committees on Appropriations of the House of Representatives and the Senate before submitting to the Committees an audit plan for fiscal years 2022 and 2023 no later than 30 days after the date of enactment of this Act: Provided further, That amounts available under this heading are also available to establish, operate, and support the Research Policy Board authorized by section 2034(f) of the 21st Century Cures Act.

In addition to other funds appropriated for the Common Fund established under section 402A(c) of the PHS Act, $12,600,000 is appropriated to the Common Fund for the purpose of carrying out section 402(b)(7)(B)(ii) of the PHS Act (relating to pediatric research), as authorized in the Gabriella Miller Kids First Research Act, of which $3,000,000 shall be derived from the 10-year Pediatric Research Initiative Fund described in section 9008 of title 26, United States Code.

For the study of, construction of, demolition of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, $250,000,000, to remain available through September 30, 2026.

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


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

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

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

5099	Balance, end of year


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This program funds biomedical research and research training. These accounts will continue to be appropriated separately and are displayed in a consolidated format to improve the readability of the presentation. The FY 2022 Budget creates a new Advanced Research Projects Agency for Health within the National Institutes of Health. With an initial focus on cancer and other diseases such as diabetes and Alzheimer's, ARPA-H would drive transformational innovation in health research and speed application and implementation of health breakthroughs.


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

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

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

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

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


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

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


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

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

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

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

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

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

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

For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition to amounts available for such purposes in the appropriations provided to the NIH in this Act, $496,000,000, to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act, are to be derived from amounts transferred under section 1001(b)(2)(A) of such Act, and may be transferred by the Director of the National Institutes of Health to other accounts of the National Institutes of Health solely for the purposes provided in such Act: Provided further, That upon a determination by the Director that funds transferred pursuant to the previous proviso are not necessary for the purposes provided, such amounts may be transferred back to the Account: Provided further, That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.


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

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

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

5099	Balance, end of year


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

	Obligations by program activity:
0001	CURES obligations	153	172	150

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

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

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

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

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

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

The 21st Century Cures Act was enacted into law on December 13, 2016. The 21st Century Cures Act authorizes $4.8 billion over 10 years for four NIH Innovation Projects and includes amendments to the Public Health Service Act to advance Precision Medicine and other high-priority NIH activities. Amounts appropriated into the NIH Innovation Account are either transferred to the individual institutes and centers or obligated directly in the NIH Innovation Account.


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

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

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

99.9	Total new obligations, unexpired accounts	153	172	150


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

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


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

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

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

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

5099	Balance, end of year	17	4	1


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

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	13	13	3
1120	Appropriations transferred to other accts [075–9915]	–13	–13	–3
4180	Budget authority, net (total)
4190	Outlays, net (total)

This special fund was created by the Gabriella Miller Kids First Research Act, enacted on April 3, 2014. This fund receives transfers from the Presidential Election Campaign Fund, which are then appropriated to the NIH Common Fund to support pediatric research.

Federal Funds

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, $2,903,489,000: Provided further, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, $21,039,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for mental health activities and to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1920(b) activities shall not exceed 5 percent of the amounts appropriated for subpart I of part B of title XIX: Provided further, That of the funds made available under this heading for subpart I of part B of title XIX of the PHS Act, $75,000,000 shall be available to support evidence-based crisis systems: Provided further, That up to 10 percent of the amounts made available to carry out the Children's Mental Health Services program may be used to carry out demonstration grants or contracts for early interventions with persons not more than 25 years of age at clinical high risk of developing a first episode of psychosis: Provided further, That section 520E(b)(2) of the PHS Act shall not apply to funds appropriated in this Act for fiscal year 2022: Provided further, That $375,000,000 shall be available until September 30, 2024 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading, $21,420,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 note).

For carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with respect to substance abuse treatment and prevention, and the SUPPORT for Patients and Communities Act, $6,327,743,000: Provided, That $2,250,000,000 shall be for State Opioid Response Grants for carrying out activities pertaining to opioids and stimulants undertaken by the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x-21 et seq.): Provided further, That of such amount $75,000,000 shall be made available to Indian Tribes or tribal organizations: Provided further, That 15 percent of the remaining amount shall be for the States with the highest mortality rate related to opioid use disorders: Provided further, That of the amounts provided for State Opioid Response Grants not more than 2 percent shall be available for Federal administrative expenses, training, technical assistance, and evaluation: Provided further, That of the amount not reserved by the previous three provisos, the Secretary shall make allocations to States, territories, and the District of Columbia according to a formula using national survey results that the Secretary determines are the most objective and reliable measure of drug use and drug-related deaths: Provided further, That prevention and treatment activities funded through such grants may include education, treatment (including the provision of medication), behavioral health services for individuals in treatment programs, referral to treatment services, recovery support, and medical screening associated with such treatment: Provided further, That each State, as well as the District of Columbia, shall receive not less than $4,000,000: Provided further, That in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000 to supplement funds otherwise available for substance abuse treatment activities to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX; and (2) $2,000,000 to evaluate substance abuse treatment programs: Provided further, That each State that receives funds appropriated under this heading in this Act for carrying out subpart II of part B of title XIX of the PHS Act shall expend not less than 10 percent of such funds for recovery support services: Provided further, That none of the funds provided for section 1921 of the PHS Act or State Opioid Response Grants shall be subject to section 241 of such Act.

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

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, $138,945,000: Provided, That in addition to amounts provided herein, $31,428,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities: Provided further, That, in addition, fees may be collected for the costs of publications, data, data tabulations, and data analysis completed under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes: Provided further, That amounts made available in this Act for carrying out section 501(o) of the PHS Act shall remain available through September 30, 2023: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health", "Substance Abuse Treatment", and "Substance Abuse Prevention".


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

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

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

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

0899	Total reimbursable obligations	441	403	403

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective substance misuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance abuse or mental illness. SAMHSA builds partnerships with States, communities, tribal organizations, and private not-for-profit organizations to enhance health and reduce the adverse impact of substance misuse and mental illness on America's communities.


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

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

11.9	Total personnel compensation	54	55	56
12.1	Civilian personnel benefits	15	16	16
12.2	Military personnel benefits	1	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	5	5	5
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	35	36	37
25.2	Other services from non-Federal sources	70	94	92
25.3	Other goods and services from Federal sources	21	33	34
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	6,090	9,884	9,352

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

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


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

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

Federal Funds

For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, $353,000,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2022: Provided further, That, in addition to amounts provided herein, $27,000,000 shall be available to this appropriation, for the purposes under this heading, from amounts provided pursuant to section 241 of the PHS Act: Provided further, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall remain available until September 30, 2023.


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

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

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

0899	Total reimbursable obligations	27	27	54

0900	Total new obligations, unexpired accounts	365	365	407

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

99.9	Total new obligations, unexpired accounts	365	365	407


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

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

Federal Funds

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

In addition, for carrying out such titles after May 31, 2022, for the last quarter of fiscal year 2022 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary, to remain available until expended.

In addition, for carrying out such titles for the first quarter of fiscal year 2023, $165,722,018,000, to remain available until expended.

Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter.


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

	Obligations by program activity:
0001	Medicaid Vendor Payments	490,831	538,883	536,237
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)	–473,685	–522,294	–519,024
3040	Recoveries of prior year unpaid obligations, unexpired	–21,623	–45,850	–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	–853	–1,083	–1,083
3070	Change in uncollected pymts, Fed sources, unexpired	–230

3090	Uncollected pymts, Fed sources, end of year	–1,083	–1,083	–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	–1,062	–1,167	–1,314
4123	Non-Federal sources	–14,155

4130	Offsets against gross budget authority and outlays (total)	–15,217	–1,167	–1,314
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–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


		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			–23
	Outlays			–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.


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


Identification code 075–0512–2–1–551		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments			–23

0799	Total direct obligations			–23

0900	Total new obligations, unexpired accounts (object class 41.0)			–23

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–23
1900	Budget authority (total)			–23
1930	Total budgetary resources available			–23

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–23
3020	Outlays (gross)			23

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–23
	Outlays, gross:
4100	Outlays from new mandatory authority			–23
4180	Budget authority, net (total)			–23
4190	Outlays, net (total)			–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.


Identification code 075–0512–4–1–551		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)			–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


Identification code 075–0516–0–1–551		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	–5	–5	–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)	–332	–307	–364
3040	Recoveries of prior year unpaid obligations, unexpired	–6	–232
3041	Recoveries of prior year unpaid obligations, expired	–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. 106–170), the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152), the Protecting Access to Medicare Act of 2014 (P.L. 113–93), and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10). The account also includes funding for grant programs enacted in the HEALTHY KIDS Act (P.L. 115–120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123), the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115–271), the Medicaid Extenders Act of 2019 (P.L. 116–3), the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116–16), the Sustaining Excellence in Medicaid Act of 2019 (P.L. 116–39), the Continuing Appropriations Act, 2020, the Health Extenders Act of 2019 (P.L. 116–59), the Further Consolidated Appropriation Act, 2020 (P.L. 116–94), the Consolidated Appropriations Act, 2021 (P.L. 116–260), and the American Rescue Plan Act of 2021 (P.L. 117–2).


Identification code 075–0516–0–1–551		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


Identification code 075–0516–0–1–551		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

For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, $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.


Identification code 075–0580–0–1–571		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 (HCFAC—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	–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)	–394,754	–486,092	–454,720
3041	Recoveries of prior year unpaid obligations, expired	–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	–3,102
4123	Non-Federal sources	–3,129

4130	Offsets against gross budget authority and outlays (total)	–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.


Identification code 075–0580–0–1–571		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


Identification code 075–0519–0–1–571		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	–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)	–642	–841	–631
3041	Recoveries of prior year unpaid obligations, expired	–168

3050	Unpaid obligations, end of year	1,105	1,105	1,105
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,799	–2,006	–2,480
3070	Change in uncollected pymts, Fed sources, unexpired	–825	–474	–457
3071	Change in uncollected pymts, Fed sources, expired	618

3090	Uncollected pymts, Fed sources, end of year	–2,006	–2,480	–2,937
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–912	–901	–1,375
3200	Obligated balance, end of year	–901	–1,375	–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	–653	–641	–631
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–825	–474	–457
4142	Offsetting collections credited to expired accounts	367	474	457

4150	Additional offsets against budget authority only (total)	–458

4160	Budget authority, net (mandatory)		200
4170	Outlays, net (mandatory)	–11	200
4180	Budget authority, net (total)		200
4190	Outlays, net (total)	–11	200

Part B of title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982 (P.L. 97–248), provides the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO Program was established to improve budgetary operations.


Identification code 075–0519–0–1–571		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


Identification code 075–0519–0–1–571		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

For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for Medicare & Medicaid Services, not to exceed $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.


Identification code 075–0511–0–1–550		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	–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	–130
1802	Offsetting collections (previously unavailable)	120	98	89
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–103	–94	–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	–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	–74
3010	New obligations, unexpired accounts	6,016	6,811	6,567
3011	Obligations ("upward adjustments"), expired accounts	10
3020	Outlays (gross)	–5,640	–6,776	–6,895
3040	Recoveries of prior year unpaid obligations, unexpired	–125
3041	Recoveries of prior year unpaid obligations, expired	–235

3050	Unpaid obligations, end of year	4,717	4,752	4,424
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–6,881	–4,810	–4,810
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	1,874
3070	Change in uncollected pymts, Fed sources, unexpired	–2,076
3071	Change in uncollected pymts, Fed sources, expired	2,273

3090	Uncollected pymts, Fed sources, end of year	–4,810	–4,810	–4,810
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–316	–93	–58
3200	Obligated balance, end of year	–93	–58	–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	–3,849	–3,975	–4,316
4033	Non-Federal sources	–29	–25	–27

4040	Offsets against gross budget authority and outlays (total)	–3,878	–4,000	–4,343
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2,206
4052	Offsetting collections credited to expired accounts	2,059

4060	Additional offsets against budget authority only (total)	–147

4070	Budget authority, net (discretionary)	200
4080	Outlays, net (discretionary)	–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	–315	–82	–63
4123	Non-Federal sources	–1,821	–2,355	–2,433

4130	Offsets against gross budget authority and outlays (total)	–2,136	–2,437	–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	–37
4170	Outlays, net (mandatory)	–350	254	–19
4180	Budget authority, net (total)	220	544	–37
4190	Outlays, net (total)	–374	339	56

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	286	224	220
5091	Expiring unavailable balance: Offsetting collections	–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.


Identification code 075–0511–0–1–550		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


Identification code 075–0511–0–1–550		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


Identification code 075–0515–0–1–551		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 [075–5551]	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			–5,299
	Appropriations, mandatory:
1200	Appropriation	23,700	24,800	25,900
1221	Appropriations transferred from other acct [075–5551]		1
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–3,170	–1,000
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–15
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–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	–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)	–16,880	–17,220	–17,142
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–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			–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. 105–33) established the Children's Health Insurance Program (CHIP) under title XXI of the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and territories, and support for child health quality and outreach activities. CHIPRA also created a contingency fund in a separate account to assist States who project spending above their available allocated CHIP funds. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended CHIP funding through fiscal year 2015 and 2017, respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123) extended CHIP funding through fiscal year 2023 and 2027, respectively.


Identification code 075–0522–0–1–551		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	–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)	–792	–1,066	–1,105
3040	Recoveries of prior year unpaid obligations, unexpired	–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).


Identification code 075–0522–0–1–551		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


Identification code 075–0522–0–1–551		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


Identification code 075–5551–0–2–551		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	–173	–14	–6
2103	Child Enrollment Contingency Fund	–5,609	–6,093	–14,000
2135	Child Enrollment Contingency Fund			19,002
2135	Child Enrollment Contingency Fund	5,609	11,006

2199	Total current law appropriations	–173	4,899	4,996

2999	Total appropriations	–173	4,899	4,996
4030	Child Enrollment Contingency Fund	484	2,994
5098	Rounding adjustment	–1

5099	Balance, end of year	6,093	14,000	19,002


Identification code 075–5551–0–2–551		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 [075–0515]	–4,037	–1
1035	Unobligated balance precluded from obligation (limitation on obligations)(special and trust)	–484	–2,994

1050	Unobligated balance (total)	1	1,918	1,978
	Budget authority:
	Appropriations, discretionary:
1135	Appropriations precluded from obligation (special or trust)			–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 [075–0515]		–1
1235	Appropriations precluded from obligation (special or trust)	–5,609	–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)	–2	–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			–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. 111–3) established the Child Enrollment Contingency Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended the Contingency Fund through fiscal years 2015 and 2017, respectively. The HEALTHY KIDS Act (P.L. 115–120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115–123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.

The Fund receives an appropriation equal to 20 percent of the CHIP national allotment appropriation under section 2104(a) of the Social Security Act. The Contingency Fund is invested in interest bearing securities of the United States, and the income derived from these investments constitutes a part of the fund.


Identification code 075–0508–0–1–551		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)	–18	–23	–5
3040	Recoveries of prior year unpaid obligations, unexpired	–4

3050	Unpaid obligations, end of year	14	1	1
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–145	–59	–59
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	143
3070	Change in uncollected pymts, Fed sources, unexpired	–57

3090	Uncollected pymts, Fed sources, end of year	–59	–59	–59
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	14	–45	–58
3200	Obligated balance, end of year	–45	–58	–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	–18	–10	–5
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–57
4170	Outlays, net (mandatory)		13
4180	Budget authority, net (total)
4190	Outlays, net (total)		13


Identification code 075–0112–0–1–551		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)	–7	–5	–5
3040	Recoveries of prior year unpaid obligations, unexpired	–3	–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. 111–148) added section 2794 to the Public Health Service Act and provided that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through 2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other insurance reform activities consistent with section 2794(c)(2)(B).


Identification code 075–0113–0–1–551		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)	–53	–55	–54
3040	Recoveries of prior year unpaid obligations, unexpired	–3	–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. 111–148). The PCIP program ended in fiscal year 2014, and outlays in subsequent fiscal years reflect program close out and claims run out costs, as well as allowable administrative costs in the current year.


Identification code 075–0114–0–1–551		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	–6	–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. 111–148) authorized and appropriated $5 billion for the Early Retiree Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan sponsors.


Identification code 075–0115–0–1–551		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)		–15	–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. 111–148) 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. 117–2) 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.


Identification code 075–0126–0–1–551		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		–556	–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)		–9,191	–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.


Identification code 075–5733–0–2–551		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	–5,892	–5,898	–6,324
2103	Risk Adjustment Program Payments	–371	–348	–336
2132	Risk Adjustment Program Payments	348	336	360

2199	Total current law appropriations	–5,915	–5,910	–6,300

2999	Total appropriations	–5,915	–5,910	–6,300

5099	Balance, end of year	348	336	360


Identification code 075–5733–0–2–551		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	–348	–336	–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)	–5,874	–6,856	–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. 111–148) established a permanent risk adjustment program for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which they are calculated.


Identification code 075–5735–0–2–551		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	–2

5099	Balance, end of year


Identification code 075–5735–0–2–551		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)		–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. 111–148) established a transitional three-year reinsurance program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015, and 2016. The Centers for Medicare & Medicaid Services assessed contributing entities a per enrollee fee to fund the reinsurance program and made payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold, up to a reinsurance cap. Reinsurance collections and payments were made in the year following the plan year for which they were applicable. Reinsurance collections ended in FY 2019 and outlays in subsequent fiscal years reflect remaining payments, refunds, and allowable administrative activities.


Identification code 075–0524–0–1–551		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)	–1	–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 075–0524–0–1–551		2020 actual	2021 est.	2022 est.

	Direct loan reestimates:
135001	Startup Loans		–10
135002	Solvency Loans		–36

135999	Total direct loan reestimates		–46

The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L. 112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148).


Identification code 075–0118–0–1–551		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)	–2	–2	–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 075–0118–0–1–551		2020 actual	2021 est.	2022 est.

	Direct loan reestimates:
135002	Startup Loans		–77
135003	Solvency Loans	2	–219

135999	Total direct loan reestimates	2	–296

Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group markets in the States. The Secretary awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.


Identification code 075–0118–0–1–551		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


Identification code 075–4418–0–3–551		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	–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		–107	–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)	–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	–2
4123	Non-Federal sources	–9	–107	–460

4130	Offsets against gross budget authority and outlays (total)	–11	–107	–460

4160	Budget authority, net (mandatory)		193	–457
4170	Outlays, net (mandatory)	–8	–107	–460
4180	Budget authority, net (total)		193	–457
4190	Outlays, net (total)	–8	–107	–460


Identification code 075–4418–0–3–551		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			–481

1290	Outstanding, end of year	1,893	1,893	1,412


Identification code 075–4418–0–3–551		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 (-)	–1,778	–1,778

1499	Net present value of assets related to direct loans	140	140

1999	Total assets	408	408
	LIABILITIES:
2103	Federal liabilities: Debt	408	408
	NET POSITION:
3300	Cumulative results of operations

4999	Total liabilities and net position	408	408


Identification code 075–4482–0–3–551		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	–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		–38	–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)	–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		–38	–116
4180	Budget authority, net (total)	1	11	–114
4190	Outlays, net (total)	2	–38	–116


Identification code 075–4482–0–3–551		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			–122

1290	Outstanding, end of year	480	480	358


Identification code 075–4482–0–3–551		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 (-)	–429	–429

1499	Net present value of assets related to direct loans	56	56

1999	Total assets	66	66
	LIABILITIES:
	Federal liabilities:
2103	Debt	65	65
2104	Resources payable to Treasury
2207	Non-Federal liabilities: Other

2999	Total liabilities	65	65
	NET POSITION:
3300	Cumulative results of operations	1	1

4999	Total liabilities and net position	66	66

Trust Funds


Identification code 075–8005–0–7–571		2020 actual	2021 est.	2022 est.

0100	Balance, start of year	156,175	95,439	74,534
0198	Reconciliation adjustment	–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	–2,607	–2,802	–3,074
2101	Federal Hospital Insurance Trust Fund	–340,483	–330,888	–361,386
2101	Health Care Fraud and Abuse Control Account	–1,406	–1,393	–2,399
2101	Health Care Fraud and Abuse Control Account	–786	–807	–873
2103	Federal Hospital Insurance Trust Fund	–64,534	–20,928	–3,474
2103	Federal Hospital Insurance Trust Fund	–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	–405,863	–356,793	–365,963
	Proposed:
2201	Health Care Fraud and Abuse Control Account			1,127

2999	Total appropriations	–405,863	–356,793	–364,836
3098	Federal Hospital Insurance Trust Fund	–44
5098	Reconciliation adjustment	56

5099	Balance, end of year	95,439	74,534	120,725


Identification code 075–8005–0–7–571		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)	–4,006	–25	–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	–626
3010	New obligations, unexpired accounts	404,393	354,535	362,728
3020	Outlays (gross)	–407,742	–354,550	–362,747
3040	Recoveries of prior year unpaid obligations, unexpired	–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	–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.


Identification code 075–8005–0–7–571		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]	–407,742	–354,550	–362,747
2100	Health Care Fraud and Abuse Control Account [Budget Acct]	–2,052	–2,200	–2,186

2199	Outgo under current law	–409,794	–356,750	–364,933
	Proposed:
2200	Health Care Fraud and Abuse Control Account			1,127

2299	Outgo under proposed legislation			1,127

2999	Total cash outgo (-)	–409,794	–356,750	–363,806
	Surplus or deficit:
3110	Excluding interest	–69,854	–23,239	44,818
3120	Interest	5,321	2,377	2,403

3199	Subtotal, surplus or deficit	–64,533	–20,862	47,221

3999	Total change in fund balance	–64,533	–20,862	47,221
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	626	–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


Identification code 075–8005–0–7–571		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


Identification code 075–8005–0–7–571		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	1	1	1

In 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.


Identification code 075–8393–0–7–571		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		–22	–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	–29		–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	–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)	–2,052	–2,200	–2,186
3040	Recoveries of prior year unpaid obligations, unexpired	–48
3041	Recoveries of prior year unpaid obligations, expired	–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	–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


		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			–1,127
	Outlays			–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. 104–191) established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services (HHS), the Department of Justice, and other agencies.

The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Concpets chapter in the Analytical Perspectives volume.


Identification code 075–8393–0–7–571		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)		–22	–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


Identification code 075–8393–0–7–571		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


Identification code 075–8393–2–7–571		2020 actual	2021 est.	2022 est.

	Obligations by program activity:
0005	Undistributed Savings, SSA Medicare CDRs			–41
0006	Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment			–1,086

0091	Total Mandatory			–1,127

0900	Total new obligations, unexpired accounts			–1,127

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–1,127
1900	Budget authority (total)			–1,127
1930	Total budgetary resources available			–1,127

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–1,127
3020	Outlays (gross)			1,127

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,127
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,127
4180	Budget authority, net (total)			–1,127
4190	Outlays, net (total)			–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.


Identification code 075–8393–2–7–571		2020 actual	2021 est.	2022 est.

	Direct obligations:
92.0	Undistributed (SSA CDR Medicare Savings)			–41
92.0	Undistributed (Medicare impact attributable to HCFAC Cap/Allocation Adjustment)			–1,086

99.9	Total new obligations, unexpired accounts			–1,127


Identification code 075–8004–0–7–571		2020 actual	2021 est.	2022 est.

0100	Balance, start of year	67,661	52,946	138,883
0198	Reconciliation adjustment	–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	–3,031	–3,265	–3,640
2101	Federal Supplementary Medical Insurance Trust Fund	–401,726	–501,085	–464,377
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–860	–881	–881
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–88,884	–98,523	–115,825
2103	Federal Supplementary Medical Insurance Trust Fund	–111
2103	Federal Supplementary Medical Insurance Trust Fund	–18,784	–8	–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	–509,091	–513,920	–576,073

2999	Total appropriations	–509,091	–513,920	–576,073
3098	Federal Supplementary Medical Insurance Trust Fund	–113
3098	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	30

5099	Balance, end of year	52,946	138,883	146,895


Identification code 075–8004–0–7–571		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	–4,305	–8	–7,383
1235	Appropriations precluded from obligation (special or trust)		–89,834	–8,517
1236	Appropriations applied to repay debt	–1,998	–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	–982
3010	New obligations, unexpired accounts	418,480	413,286	455,933
3020	Outlays (gross)	–420,010	–414,217	–459,530
3040	Recoveries of prior year unpaid obligations, unexpired	–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	–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	–3,152	–1,154
5081	Outstanding debt, EOY	–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.


Identification code 075–8004–0–7–571		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]	–420,010	–414,217	–459,530
2100	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]	–89,650	–98,897	–116,575

2199	Outgo under current law	–509,660	–513,114	–576,105

2999	Total cash outgo (-)	–509,660	–513,114	–576,105
	Surplus or deficit:
3110	Excluding interest	–17,359	88,013	3,006
3120	Interest	2,214	2,389	4,974

3199	Subtotal, surplus or deficit	–15,145	90,402	7,980
3298	Reconciliation adjustment	1

3299	Total adjustments	1

3999	Total change in fund balance	–15,144	90,402	7,980
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	1,432	–7,694	–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


Identification code 075–8004–0–7–571		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


Identification code 075–8004–0–7–571		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	4	6	2


Identification code 075–8308–0–7–571		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	–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			–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	–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)	–89,650	–98,897	–116,575
3040	Recoveries of prior year unpaid obligations, unexpired	–30

3050	Unpaid obligations, end of year	14,229	14,737	14,735
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2,789	–6,448	–2,789
3070	Change in uncollected pymts, Fed sources, unexpired	–3,659	3,659

3090	Uncollected pymts, Fed sources, end of year	–6,448	–2,789	–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:		–3,659
4123	Non-Federal sources	–4

4130	Offsets against gross budget authority and outlays (total)	–4	–3,659
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–3,659	3,659
4143	Recoveries of prior year paid obligations, unexpired accounts	4

4150	Additional offsets against budget authority only (total)	–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.


Identification code 075–8308–0–7–571		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


Identification code 075–8308–0–7–571		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	4	4	4

Federal Funds


Identification code 075–1552–0–1–609		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	–1	–1	–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	–19	–15	–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)	–16,554	–16,670	–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. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171). TANF's authorization was most recently extended in the Consolidated Appropriations Act, 2021 (P. L. 116–260).


Identification code 075–1552–0–1–609		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


Identification code 075–1552–0–1–609		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	88	102	108


Identification code 075–1522–0–1–609		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)	–628	–608	–608
3041	Recoveries of prior year unpaid obligations, expired	–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. 116–260).

For carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, $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.


Identification code 075–1501–0–1–609		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	–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			–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)	–4,424	–4,390	–4,157
3040	Recoveries of prior year unpaid obligations, unexpired	–388	–400	–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		–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.


Identification code 075–1501–0–1–609		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

For 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 116–94 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.


Identification code 075–1502–0–1–609		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)	–3,812	–7,178	–5,260
3041	Recoveries of prior year unpaid obligations, expired	–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.


Identification code 075–1502–0–1–609		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

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.


Identification code 075–1503–0–1–609		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)	–2,149	–3,834	–3,044
3040	Recoveries of prior year unpaid obligations, unexpired	–102
3041	Recoveries of prior year unpaid obligations, expired	–33

3050	Unpaid obligations, end of year	2,602	678	2,038
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–180	–7	–7
3071	Change in uncollected pymts, Fed sources, expired	173

3090	Uncollected pymts, Fed sources, end of year	–7	–7	–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	–173

4040	Offsets against gross budget authority and outlays (total)	–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.


Identification code 075–1503–0–1–609		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


Identification code 075–1503–0–1–609		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

For carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out, except as otherwise provided, section 437 of such Act, $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.


Identification code 075–1512–0–1–506		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	–20	–20	–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	–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)	–548	–804	–689
3040	Recoveries of prior year unpaid obligations, unexpired	–4
3041	Recoveries of prior year unpaid obligations, expired	–14

3050	Unpaid obligations, end of year	1,234	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).


Identification code 075–1512–0–1–506		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


Identification code 075–1512–0–1–506		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	15	22	23


Identification code 075–1513–4–1–609		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			–20,000

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			31,720
3020	Outlays (gross)			–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 0–5 years old.


Identification code 075–1550–0–1–609		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)	–2,983	–3,187	–3,447
3041	Recoveries of prior year unpaid obligations, expired	–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	–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. 104–193), as amended by the American Rescue Plan Act of 2021 (P.L. 117–002).


Identification code 075–1550–0–1–609		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


Identification code 075–1507–4–1–506		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)			–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.


Identification code 075–1507–4–1–506		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


Identification code 075–1507–4–1–506		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment			30

For 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.


Identification code 075–1515–0–1–609		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	–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)	–7,033	–18,309	–26,363
3041	Recoveries of prior year unpaid obligations, expired	–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.


Identification code 075–1515–0–1–609		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


Identification code 075–1515–0–1–609		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	16	17	24

For 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.


Identification code 075–1534–0–1–506		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	–100	–97	–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	–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)	–1,727	–1,583	–1,640
3041	Recoveries of prior year unpaid obligations, expired	–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.


Identification code 075–1534–0–1–506		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


Identification code 075–1534–0–1–506		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	7	7

For 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.


Identification code 075–1536–0–1–506		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	–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)	–12,267	–13,912	–15,125
3040	Recoveries of prior year unpaid obligations, unexpired	–8
3041	Recoveries of prior year unpaid obligations, expired	–152

3050	Unpaid obligations, end of year	12,204	14,716	14,529
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–19	–23	–23
3070	Change in uncollected pymts, Fed sources, unexpired	–10		–1
3071	Change in uncollected pymts, Fed sources, expired	6

3090	Uncollected pymts, Fed sources, end of year	–23	–23	–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	–6	–23	–23

4040	Offsets against gross budget authority and outlays (total)	–6	–23	–23
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–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	–2	–12	–12
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–9		–1
4142	Offsetting collections credited to expired accounts			1

4150	Additional offsets against budget authority only (total)	–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


Identification code 075–1536–0–1–506		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


Identification code 075–1536–0–1–506		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


Identification code 075–1553–0–1–609		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	–2	–2	–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	–1	–1	–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)	–68	–62	–65
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	19	32	35
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–6	–6	–6

3090	Uncollected pymts, Fed sources, end of year	–6	–6	–6
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	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	–8	–10	–10
4123	Non-Federal sources	–17	–23	–23

4130	Offsets against gross budget authority and outlays (total)	–25	–33	–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. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).


Identification code 075–1553–0–1–609		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


Identification code 075–1553–0–1–609		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	57	71	71

For 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.


Identification code 075–1545–0–1–609		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	–1	–1	–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	–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)	–8,836	–10,764	–10,241
3041	Recoveries of prior year unpaid obligations, expired	–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 Care—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 Assistance—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 Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been in foster care. An average of 45,800 children per month are estimated to be served in FY 2022.


Identification code 075–1545–0–1–609		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


Identification code 075–1545–0–1–609		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	3	3	3

Federal 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.


Identification code 075–0142–0–1–506		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 [012–3507]	–1	–1

1160	Appropriation, discretionary (total)	3,375	2,481	2,954
	Appropriations, mandatory:
1200	Appropriation		1,720
1221	PPHF Appropriations transferred from other accounts [075–0116]	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	–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)	–2,457	–3,255	–5,115
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–15

3050	Unpaid obligations, end of year	2,534	3,423	1,586
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–129	–188	–244
3070	Change in uncollected pymts, Fed sources, unexpired	–96	–56	–75
3071	Change in uncollected pymts, Fed sources, expired	37

3090	Uncollected pymts, Fed sources, end of year	–188	–244	–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	–38	–67	–75
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–71	–56	–75
4052	Offsetting collections credited to expired accounts	36	56	75

4060	Additional offsets against budget authority only (total)	–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	–1	–35	–35
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–25
4142	Offsetting collections credited to expired accounts	1

4150	Additional offsets against budget authority only (total)	–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.


Identification code 075–0142–0–1–506		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


Identification code 075–0142–0–1–506		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

Federal Funds

For necessary expenses, not otherwise provided, for general departmental management, including hire of six passenger motor vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico Border Health Commission Act, and 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)).


Identification code 075–9912–0–1–551		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	–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)	–955	–766	–790
3041	Recoveries of prior year unpaid obligations, expired	–28

3050	Unpaid obligations, end of year	564	536	600
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–248	–280	–280
3070	Change in uncollected pymts, Fed sources, unexpired	–200
3071	Change in uncollected pymts, Fed sources, expired	168

3090	Uncollected pymts, Fed sources, end of year	–280	–280	–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:	–258	–237	–262

4040	Offsets against gross budget authority and outlays (total)	–258	–237	–262
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–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:	–265	–15	–15
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–53
4142	Offsetting collections credited to expired accounts	1

4150	Additional offsets against budget authority only (total)	–52
4170	Outlays, net (mandatory)	10	24
4180	Budget authority, net (total)	480	486	577
4190	Outlays, net (total)	432	514	513

Note.—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.


Identification code 075–9912–0–1–551		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


Identification code 075–9912–0–1–551		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

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


Identification code 075–0135–0–1–751		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	–1	–1	–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)	–48	–49	–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	–21	–10	–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.


Identification code 075–0135–0–1–751		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


Identification code 075–0135–0–1–751		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

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.


Identification code 075–0130–0–1–551		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)	–64	–91	–101
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	54	31	23
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–10	–9	–9
3070	Change in uncollected pymts, Fed sources, unexpired	–4
3071	Change in uncollected pymts, Fed sources, expired	5

3090	Uncollected pymts, Fed sources, end of year	–9	–9	–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:	–6	–18	–102

4040	Offsets against gross budget authority and outlays (total)	–6	–18	–102
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–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	–1
4180	Budget authority, net (total)	60	62
4190	Outlays, net (total)	58	73	–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. 111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255), for the purpose of addressing strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private adoption of health information technology.


Identification code 075–0130–0–1–551		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


Identification code 075–0130–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	155	177	177
1101	Direct military average strength employment	2

For 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.


Identification code 075–0139–0–1–551		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	–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)	–211	–235	–198
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	45	2	2
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–156	–91	–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	–91	–91	–91
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–98	–46	–89
3200	Obligated balance, end of year	–46	–89	–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	–253	–192	–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)	–42
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		43
4180	Budget authority, net (total)
4190	Outlays, net (total)	–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.


Identification code 075–0139–0–1–551		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


Identification code 075–0139–0–1–551		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

For expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical, and cybersecurity threats to civilian populations, and for other public health emergencies, $1,513,116,000, 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.


Identification code 075–0140–0–1–551		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 [075–0343]	–2	–4	–4
1011	Unobligated balance transfer from other acct [075–0943]	6
1011	Unobligated balance transfer from other acct [075–0956]	2
1011	Unobligated balance transfer from other acct [075–9915]	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 [075–0350]	–975
1120	Appropriations transferred to other acct [075–0128]	–12
1120	Appropriations transferred to other acct [075–9915]	–1,806
1120	Appropriations transferred to other acct [075–0943]	–1,000
1120	Appropriations transferred to other acct [075–0600]	–22
1120	Appropriations transferred to other acct [070–0540]	–107
1120	Appropriations transferred to other acct [070–0530]	–182
1120	Appropriations transferred to other acct [075–0343]	–1
1120	Appropriations transferred to other acct [075–0390]		–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	–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)	–111,238	–90,088	–67,520
3040	Recoveries of prior year unpaid obligations, unexpired	–30
3041	Recoveries of prior year unpaid obligations, expired	–55

3050	Unpaid obligations, end of year	38,868	69,452	5,597
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–203	–272	–272
3070	Change in uncollected pymts, Fed sources, unexpired	–141
3071	Change in uncollected pymts, Fed sources, expired	72

3090	Uncollected pymts, Fed sources, end of year	–272	–272	–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	–80	–162	–162
4033	Non-Federal sources:	–1

4040	Offsets against gross budget authority and outlays (total)	–81	–162	–162
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–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)	–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.


Identification code 075–0140–0–1–551		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


Identification code 075–0140–0–1–551		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


Identification code 075–0150–0–1–551		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)		–2,700	–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.


Identification code 075–0150–0–1–551		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


Identification code 075–0150–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment		25


Identification code 075–9003–4–1–551		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)			–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.


Identification code 075–9005–4–1–551		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)			–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.


Identification code 075–9054–4–1–927		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)			–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.


Identification code 075–0145–0–1–552		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)	–66	–152	–148
3040	Recoveries of prior year unpaid obligations, unexpired	–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	–118	–123	–136
4180	Budget authority, net (total)
4190	Outlays, net (total)	–52	29	12

Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of 20 percent of the funds appropriated or credited to the PCORTF was transferred each year to the Department of Health and Human Services (HHS). In FY 2020, PCORTF was extended through FY 2029. As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research. Transferred funds were distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out these activities.


Identification code 075–0145–0–1–552		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


Identification code 075–0125–0–1–551		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	–350	–375	–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)	–290	–730	–469
3040	Recoveries of prior year unpaid obligations, unexpired	–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	–350	–375	–500
	Outlays, gross:
4010	Outlays from new discretionary authority		–101	–135
4011	Outlays from discretionary balances	290	831	604

4020	Outlays, gross (total)	290	730	469
4180	Budget authority, net (total)	–350	–375	–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.


Identification code 075–0125–0–1–551		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


Identification code 075–0125–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	3	3	3


Identification code 075–0119–0–1–551		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)	–1	–2	–2
3040	Recoveries of prior year unpaid obligations, unexpired	–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. 111–152) appropriated $1,000,000,000 to the Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.


Identification code 075–0127–0–1–551		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)		–250	–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. 116–260) 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.


Identification code 075–0127–0–1–551		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


Identification code 075–0127–0–1–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment		38	75


Identification code 075–0116–0–1–551		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 [075–0142]	–28	–28	–28
1220	Appropriations transferred to other accts [075–0943]	–854	–856	–903
1220	Appropriations transferred to other accts [075–1362]	–12	–12	–12
1230	Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]	–56	–54	–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.


Identification code 075–0117–0–1–551		2020 actual	2021 est.	2022 est.

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	27	6
3020	Outlays (gross)	–20	–6
3041	Recoveries of prior year unpaid obligations, expired	–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.


Identification code 075–3902–0–1–552		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)	–377	–1,300	–642
3041	Recoveries of prior year unpaid obligations, expired	–9

3050	Unpaid obligations, end of year	936	177	125
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–788	–937	–937
3070	Change in uncollected pymts, Fed sources, unexpired	–487
3071	Change in uncollected pymts, Fed sources, expired	338

3090	Uncollected pymts, Fed sources, end of year	–937	–937	–937
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	–1	–760
3200	Obligated balance, end of year	–1	–760	–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	–376	–541	–590

4040	Offsets against gross budget authority and outlays (total)	–376	–541	–590
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–487
4052	Offsetting collections credited to expired accounts	330

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

Federal Funds

For retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.


Identification code 075–0379–0–1–551		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)	–642	–717	–672
3041	Recoveries of prior year unpaid obligations, expired	–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	–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:


	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.


Identification code 075–0379–0–1–551		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


Identification code 075–0170–0–1–551		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)	–29	–31	–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. 108–375, section 725).


Identification code 075–5745–0–2–551		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)	–3	–8	–17

3050	Unpaid obligations, end of year	5	8	3
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1		–1	–1
3070	Change in uncollected pymts, Fed sources, unexpired	–1

3090	Uncollected pymts, Fed sources, end of year	–1	–1	–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	–11	–15	–10
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–1
4080	Outlays, net (discretionary)	–8	–7	7
4180	Budget authority, net (total)
4190	Outlays, net (total)	–8	–7	7


Identification code 075–5745–0–2–551		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


Identification code 075–5745–0–2–551		2020 actual	2021 est.	2022 est.

2001	Reimbursable civilian full-time equivalent employment	13	25	25


Identification code 075–9913–0–1–551		2020 actual	2021 est.	2022 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	1	1
1930	Total budgetary resources available	1	1	1
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–9941–0–4–551		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	–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)	–1,186	–1,153	–1,598
3040	Recoveries of prior year unpaid obligations, unexpired	–40	–250	–250

3050	Unpaid obligations, end of year	788	911	364
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–531	–406	–406
3070	Change in uncollected pymts, Fed sources, unexpired	125

3090	Uncollected pymts, Fed sources, end of year	–406	–406	–406
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	482	382	505
3200	Obligated balance, end of year	382	505	–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	–1,067	–1,326	–1,948
4033	Non-Federal sources	–2

4040	Offsets against gross budget authority and outlays (total)	–1,069	–1,326	–1,948
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	125
4080	Outlays, net (discretionary)	117	–173	–350
4180	Budget authority, net (total)
4190	Outlays, net (total)	117	–173	–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.


Identification code 075–9941–0–4–551		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


Identification code 075–9941–0–4–551		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


Identification code 075–9971–0–7–551		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	–69	–72	–72

5099	Balance, end of year		2	4


Identification code 075–9971–0–7–551		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)	–69	–85	–88
3040	Recoveries of prior year unpaid obligations, unexpired	–7	–8	–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.


Identification code 075–9971–0–7–551		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


Identification code 075–9971–0–7–551		2020 actual	2021 est.	2022 est.

1001	Direct civilian full-time equivalent employment	52	52	52

Federal Funds

For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations, in carrying out the provisions of the Inspector General Act of 1978, $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.


Identification code 075–0128–0–1–551		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 [075–9911]	2
1121	Appropriations transferred from other acct [075–9915]	5	5
1121	Appropriations transferred from other acct [075–0140]	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	–34
1802	Offsetting collections (previously unavailable)	1	1	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–1	–1	–1

1850	Spending auth from offsetting collections, mand (total)	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	–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)	–443	–457	–433
3040	Recoveries of prior year unpaid obligations, unexpired	–5
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	89	72	77
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–128	–92	–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	–92	–92	–92
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–26	–3	–20
3200	Obligated balance, end of year	–3	–20	–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	–108	–114	–111
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–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	–271	–216	–221
4123	Non-Federal sources	–12	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–283	–228	–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)	–36	34	–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.


Identification code 075–0128–0–1–551		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


Identification code 075–0128–0–1–551		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


		2020 actual	2021 est.	2022 est.

Offsetting receipts from the public:
075–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	142	90	90
075–267403	Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies		342
075–310700	Federal Share of Child Support Collections	967	793	563
075–322000	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:
075–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	–27

General Fund Intragovernmental payments		–27

(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.

(a) Authority.—Notwithstanding any other provision of law, the Director of NIH ("Director") may use funds authorized under section 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry out research identified pursuant to or research and activities described in such section 402(b)(12).

(b) Peer review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS Act.

(a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section 319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), if—

(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.

(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.

(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)).

(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 with—

(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.

(a) IN GENERAL. Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit within the Department or of another agency under which—

(1) the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant or cooperative agreement on behalf of the ordering agency or unit;

(2) the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit; and

(3) the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement and for the service of executing or managing the grant or cooperative agreement.

(b) CONDITIONS. The conditions for making an agreement described in subsection (a) are that—

(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, in—

(f) NO EFFECT ON OTHER LAWS. This section does not affect other laws concerning reimbursable agreements.

(a) IN GENERAL. A State or tribal organization which receives grant funds attributable to appropriations under the heading "Department of Health and Human Services, Administration for Community Living, Aging and Disability Services Programs" to carry out programs under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable limitations on such transfers under the OAA or such heading.

(b) NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL. A State or tribal organization which elects to make a transfer under subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless the Secretary determines that such transfer is not consistent with the objectives of the OAA.

(c) RULES OF CONSTRUCTION. No transfer of grant funds by a State or tribal organization under this section shall be construed—

(1) as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight by the Secretary; or

(2) to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such funds.

(1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE. A covered entity shall permit"; and

"(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.".

"(f) REGULATIONS. The Secretary may promulgate such regulations as the Secretary determines appropriate to carry out the provisions of this section.".

(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".

(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.

"(i) TORT CLAIMS AND WORK INJURY COMPENSATION COVERAGE FOR CORPS VOLUNTEERS.—

"(1) IN GENERAL. If under section 223 and regulations pursuant to such section, and through an agreement entered into in accordance with such regulations, the Secretary accepts, from an individual in the Corps, services for a specified period that are volunteer and without compensation other than reasonable reimbursement or allowance for expenses actually incurred, such individual shall, during such period, have the coverages described in paragraphs (2) and (3).

"(2) FEDERAL TORT CLAIMS ACT COVERAGE. Such individual shall, while performing such services during such period—

"(A) be deemed to be an employee of the Department of Health and Human Services, for purposes of claims under sections 1346(b) and 2672 of title 28, United States Code, for money damages for personal injury, including death, resulting from 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.".

(1) in the first sentence by striking "under subsection (a)" and inserting "to carry out this title"; and

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

(INCLUDING TRANSFERS OF FUNDS)

BUILDINGS AND FACILITIES

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

FDA Working Capital Fund

Payment to the FDA Innovation Account, CURES Act

FDA INNOVATION ACCOUNT, CURES ACT

(INCLUDING TRANSFER OF FUNDS)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

PRIMARY HEALTH CARE

HEALTH WORKFORCE

MATERNAL AND CHILD HEALTH

RYAN WHITE HIV/AIDS PROGRAM

HEALTH CARE SYSTEMS

RURAL HEALTH

FAMILY PLANNING

PROGRAM MANAGEMENT

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Health Center Guaranteed Loan Financing Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Indian Health Service

Federal Funds

Indian Health Services

CONTRACT SUPPORT COSTS

Contract Support Costs

(Legislative proposal, not subject to PAYGO)

PAYMENTS FOR TRIBAL LEASES

Payments for Tribal Leases

(Legislative proposal, not subject to PAYGO)

INDIAN HEALTH FACILITIES

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

Centers for Disease Control and Prevention

Federal Funds

IMMUNIZATION AND RESPIRATORY DISEASES

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

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

PUBLIC HEALTH SCIENTIFIC SERVICES

ENVIRONMENTAL HEALTH

INJURY PREVENTION AND CONTROL

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

GLOBAL HEALTH

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

(INCLUDING TRANSFER OF FUNDS)

CDC-wide Activities and Program Support

(Legislative proposal, subject to PAYGO)

BUILDINGS AND FACILITIES

(INCLUDING TRANSFER OF FUNDS)

CDC Working Capital Fund

Infectious Diseases Rapid Response Reserve Fund

TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

NATIONAL CANCER INSTITUTE

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

NATIONAL EYE INSTITUTE

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE ON AGING