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; $4,416,025,000: Provided, That of the amount provided under this heading, $32,238,000 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; $29,459,000 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 animal drug user fees and generic new animal drug user fees that exceed the respective fiscal year 2023 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug and generic new animal drug assessments for fiscal year 2023, including any such fees collected prior to fiscal year 2023 but credited for fiscal year 2023, shall be subject to the fiscal year 2023 limitations: Provided further, That the Secretary may accept payment during fiscal year 2023 of user fees specified under this heading and authorized for fiscal year 2024, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2024 for which the Secretary accepts payment in fiscal year 2023 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 under this heading, $20,000,000 shall be available until September 30, 2025, for the Oncology Center of Excellence to develop and review research, advance regulatory policy, support clinical review of submissions to the Food and Drug Administration related to medical products intended to diagnose or treat cancer, and conduct education and outreach partnerships, in addition to any other amounts available for such purposes: 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.

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.

Note.—A full-year 2022 appropriation for this account was not enacted at the time the Budget was prepared; therefore, the Budget assumes this account is operating under the Continuing Appropriations Act, 2022 (Division A of Public Law 117–43, as amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.


Identification code 075–9911–0–1–554		2021 actual	2022 est.	2023 est.

0100	Balance, start of year			1
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, FDA	2	3	3

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

5099	Balance, end of year		1	2


Identification code 075–9911–0–1–554		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Foods	1,099	1,099	1,220
0002	Human Drugs	689	689	790
0003	Devices and Radiological Health	408	408	466
0004	National Center for Toxicological Research	67	67	79
0005	FDA Other Activities (FDA Headquaters)	193	194	228
0006	FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)	144	130	156
0007	FDA GSA Rental Payments	153	168	166
0008	FDA Buildings and Facilities	11	13	31
0009	Cooperative Research and Development (CRADA)	2	2	2
0010	Animal Drugs and Food	192	192	242
0011	Biologics	254	254	275
0012	Food and Drug Safety (no-year)	1
0015	CURES Activities		50	50
0017	Opioids - IMF	2
0018	FDA HCFAC Wedge Fund	6
0019	Coronavirus Emergency Funding Supplemental	209
0020	FDA User Fees (Non General Fund)	2,847	2,870	864
0022	Seafood Safety Studies-GP Sec. 765	1
0023	Cancer Moonshot			20

0799	Total direct obligations	6,278	6,136	4,589
0802	FDA Reimbursable program (Federal sources)	32	32	35

0899	Total reimbursable obligations	32	32	35

0900	Total new obligations, unexpired accounts	6,310	6,168	4,624

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,131	1,486	1,453
1001	Discretionary unobligated balance brought fwd, Oct 1	1,122
1021	Recoveries of prior year unpaid obligations	111
1033	Recoveries of prior year paid obligations	1

1070	Unobligated balance (total)	1,243	1,486	1,453
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,271	3,215	3,673
1120	Appropriations transferred to other accts [075–0128]	–2	–2	–2
1121	Appropriations transferred from other acct [075–5629]		50	50

1160	Appropriation, discretionary (total)	3,269	3,263	3,721
	Appropriations, mandatory:
1200	Appropriation	500
1201	Appropriation (special or trust fund)	2	2	2

1260	Appropriations, mandatory (total)	502	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,917	2,870	864
1700	Collected		5
1701	Change in uncollected payments, Federal sources	5	–5
1702	Offsetting collections (previously unavailable)	903
1724	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–1,049

1750	Spending auth from offsetting collections, disc (total)	2,776	2,870	864
	Spending authority from offsetting collections, mandatory:
1800	Collected	10
1801	Change in uncollected payments, Federal sources	–3

1850	Spending auth from offsetting collections, mand (total)	7
1900	Budget authority (total)	6,554	6,135	4,587
1930	Total budgetary resources available	7,797	7,621	6,040
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	1,486	1,453	1,416

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3,042	3,099	2,011
3010	New obligations, unexpired accounts	6,310	6,168	4,624
3011	Obligations ("upward adjustments"), expired accounts	182
3020	Outlays (gross)	–6,125	–7,256	–4,493
3040	Recoveries of prior year unpaid obligations, unexpired	–111
3041	Recoveries of prior year unpaid obligations, expired	–199

3050	Unpaid obligations, end of year	3,099	2,011	2,142
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–62	–55	–50
3070	Change in uncollected pymts, Fed sources, unexpired	–2	5
3071	Change in uncollected pymts, Fed sources, expired	9

3090	Uncollected pymts, Fed sources, end of year	–55	–50	–50
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,980	3,044	1,961
3200	Obligated balance, end of year	3,044	1,961	2,092

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,045	6,133	4,585
	Outlays, gross:
4010	Outlays from new discretionary authority	3,707	4,934	3,213
4011	Outlays from discretionary balances	2,391	1,404	1,236

4020	Outlays, gross (total)	6,098	6,338	4,449
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–35	–5
4033	Non-Federal sources:	–2,918	–2,870	–864

4040	Offsets against gross budget authority and outlays (total)	–2,953	–2,875	–864
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–5	5
4052	Offsetting collections credited to expired accounts	35
4053	Recoveries of prior year paid obligations, unexpired accounts	1

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

4070	Budget authority, net (discretionary)	3,123	3,263	3,721
4080	Outlays, net (discretionary)	3,145	3,463	3,585
	Mandatory:
4090	Budget authority, gross	509	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority	25	2	2
4101	Outlays from mandatory balances	2	916	42

4110	Outlays, gross (total)	27	918	44
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:	–9
4123	Non-Federal sources:	–1

4130	Offsets against gross budget authority and outlays (total)	–10
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	3

4160	Budget authority, net (mandatory)	502	2	2
4170	Outlays, net (mandatory)	17	918	44
4180	Budget authority, net (total)	3,625	3,265	3,723
4190	Outlays, net (total)	3,162	4,381	3,629

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	946	1,092	1,092
5092	Unexpired unavailable balance, EOY: Offsetting collections	1,092	1,092	1,092


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	3,625	3,265	3,723
	Outlays	3,162	4,381	3,629
Legislative proposal, subject to PAYGO:
	Budget Authority			1,630
	Outlays			424
Total:
	Budget Authority	3,625	3,265	5,353
	Outlays	3,162	4,381	4,053

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 2023 Budget includes $6.8 billion in total resources for FDA. The Budget invests in priority activities including inspections modernization, critical food safety efforts, medical device cybersecurity, public health employee pay costs, alternative methods to animal testing, and Cancer Moonshot.


Identification code 075–9911–0–1–554		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	1,815	1,849	1,958
11.3	Other than full-time permanent	176	179	188
11.5	Other personnel compensation	134	136	144
11.7	Military personnel	165	168	173
11.8	Special personal services payments	2	2	2

11.9	Total personnel compensation	2,292	2,334	2,465
12.1	Civilian personnel benefits	763	768	812
12.2	Military personnel benefits	20	21	21
21.0	Travel and transportation of persons	45	44	18
22.0	Transportation of things	4	4	5
23.1	Rental payments to GSA	216	237	88
23.3	Communications, utilities, and miscellaneous charges	22	20	24
24.0	Printing and reproduction	2	2	2
25.1	Advisory and assistance services	93	93	40
25.2	Other services from non-Federal sources	964	893	377
25.3	Other goods and services from Federal sources	933	922	391
25.4	Operation and maintenance of facilities	97	94	42
25.5	Research and development contracts	169	116	49
25.7	Operation and maintenance of equipment	77	99	42
26.0	Supplies and materials	74	68	29
31.0	Equipment	26	36	16
32.0	Land and structures	128	70	30
41.0	Grants, subsidies, and contributions	320	314	137
42.0	Insurance claims and indemnities	1	1	1
44.0	Refunds	32

99.0	Direct obligations	6,278	6,136	4,589
99.0	Reimbursable obligations	32	32	35

99.9	Total new obligations, unexpired accounts	6,310	6,168	4,624


Identification code 075–9911–0–1–554		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	16,075	15,692	16,221
1101	Direct military average strength employment	1,097	1,097	1,099
2001	Reimbursable civilian full-time equivalent employment	41	41	41
2101	Reimbursable military average strength employment	3	3	3
3001	Allocation account civilian full-time equivalent employment	34	34	34
3101	Allocation account military average strength employment	2	2	2

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.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities, medical device review activities, biosimilar biological products review activities, and human generic drugs review activities: Provided, That fees of $1,224,132,000 for prescription drug reviews shall be credited to this account and remain available until expended; fees of $248,342,000 for medical device reviews shall be credited to this account and remain available until expended; fees of $550,449,000 for human generic drug reviews shall be credited to this account and remain available until expended; and fees of $40,841,000 for biosimilar biological product reviews 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, biosimilar biological product user fees, and human generic drug user fees that exceed the respective fiscal year 2023 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug reviews, medical device reviews, biosimilar biological products reviews, and human generic drugs reviews for fiscal year 2023 received during fiscal year 2023, including any such fees assessed prior to fiscal year 2023 but credited for fiscal year 2023, shall be subject to the fiscal year 2023 limitations: Provided further, That the Secretary may accept payment during fiscal year 2023 of user fees specified in this paragraph and authorized for fiscal year 2024, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2024 for which the Secretary accepts payment in fiscal year 2023 shall not be included in amounts in this paragraph.


Identification code 075–9911–2–1–554		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	FDA Reimbursable program (User fees)			2,163

0899	Total reimbursable obligations			2,163

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			2,163
1900	Budget authority (total)			2,163
1930	Total budgetary resources available			2,163

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			2,163
3020	Outlays (gross)			–2,163

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			2,163
	Outlays, gross:
4010	Outlays from new discretionary authority			2,163
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources:			–2,163

4040	Offsets against gross budget authority and outlays (total)			–2,163
4180	Budget authority, net (total)
4190	Outlays, net (total)

The FY 2023 Budget proposes additional resources including an estimated $550 million for the human generic drug program, $41 million for biosimilars, $1.2 billion in prescription drug user fees, and $248 million in medical device user fees. In FY 2022, Congress will consider proposed legislation to reauthorize PDUFA, MDUFA, GDUFA, and BsUFA. The Budget proposes legislation that authorizes the collection and spending of these fees subject to appropriations.The Budget also includes a legislative proposal to increase the user fee collected in support of the tobacco program by $100 million and adds electronic nicotine delivery system manufacturers and importers as entities subject to the user fees.


Identification code 075–9911–2–1–554		2021 actual	2022 est.	2023 est.

	Reimbursable obligations:
21.0	Travel and transportation of persons			32
23.1	Rental payments to GSA			151
25.1	Advisory and assistance services			69
25.2	Other services from non-Federal sources			648
25.3	Other goods and services from Federal sources			673
25.4	Operation and maintenance of facilities			71
25.5	Research and development contracts			84
25.7	Operation and maintenance of equipment			72
26.0	Supplies and materials			51
31.0	Equipment			27
32.0	Land and structures			52
41.0	Grants, subsidies, and contributions			233

99.0	Reimbursable obligations			2,163

99.9	Total new obligations, unexpired accounts			2,163


Identification code 075–9911–4–1–554		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0023	Pandemic Prepardness			1,630

0799	Total direct obligations			1,630

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			1,630
1900	Budget authority (total)			1,630
1930	Total budgetary resources available			1,630

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			1,630
3020	Outlays (gross)			–424

3050	Unpaid obligations, end of year			1,206
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			1,206

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			1,630
	Outlays, gross:
4100	Outlays from new mandatory authority			424
4180	Budget authority, net (total)			1,630
4190	Outlays, net (total)			424

The FY 2023 Budget includes FDAs contributions to the HHS Pandemic Preparedness Plan, and reflects the activities and corresponding spending amounts needed for FDA to achieve the Departments preparedness vision. The FY 2023 Budget will expand and modernize FDAs regulatory capacity, IT, laboratory infrastructure, including strengthening the personal protective equipment supply chain by building analytics and creating predictive modeling capabilities. FDA will also focus on clinical evaluation of vaccines and therapeutics that target high-profile viral families and speed development of diagnostics, including expansion of test validation capacity and development of common performance standards. The Budget will also support FDAs work with its international partners to strengthen foreign inspections, harmonize premarket review of vaccines, therapeutics, diagnostics and reducing zoonotic pathogen spillover.


Identification code 075–9911–4–1–554		2021 actual	2022 est.	2023 est.

	Direct obligations:
21.0	Travel and transportation of persons			24
23.1	Rental payments to GSA			114
25.1	Advisory and assistance services			52
25.2	Other services from non-Federal sources			488
25.3	Other goods and services from Federal sources			508
25.4	Operation and maintenance of facilities			54
25.5	Research and development contracts			63
25.7	Operation and maintenance of equipment			54
26.0	Supplies and materials			38
31.0	Equipment			20
32.0	Land and structures			39
41.0	Grants, subsidies, and contributions			176

99.0	Direct obligations			1,630

99.9	Total new obligations, unexpired accounts			1,630


Identification code 075–4613–0–4–554		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity		324	324
0801	Reimbursable program activity	654	295	295

0900	Total new obligations, unexpired accounts	654	619	619

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	32	22	22
1021	Recoveries of prior year unpaid obligations	8

1070	Unobligated balance (total)	40	22	22
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	634	619	619
1701	Change in uncollected payments, Federal sources	2

1750	Spending auth from offsetting collections, disc (total)	636	619	619
1900	Budget authority (total)	636	619	619
1930	Total budgetary resources available	676	641	641
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	22	22	22

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	237	243
3010	New obligations, unexpired accounts	654	619	619
3020	Outlays (gross)	–640	–862	–619
3040	Recoveries of prior year unpaid obligations, unexpired	–8

3050	Unpaid obligations, end of year	243
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1		–2	–2
3070	Change in uncollected pymts, Fed sources, unexpired	–2

3090	Uncollected pymts, Fed sources, end of year	–2	–2	–2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	237	241	–2
3200	Obligated balance, end of year	241	–2	–2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	636	619	619
	Outlays, gross:
4010	Outlays from new discretionary authority	426	619	619
4011	Outlays from discretionary balances	214	243

4020	Outlays, gross (total)	640	862	619
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–634	–619	–619
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2
4080	Outlays, net (discretionary)	6	243
4180	Budget authority, net (total)
4190	Outlays, net (total)	6	243


Identification code 075–4613–0–4–554		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent		74	74
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		78	78
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
42.0	Insurance claims and indemnities		1	1

99.0	Direct obligations		324	324
	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	149	58	58
11.3	Other than full-time permanent	3	1	1
11.5	Other personnel compensation	5	1	1
11.7	Military personnel	2	1	1

11.9	Total personnel compensation	159	61	61
12.1	Civilian personnel benefits	58	20	20
21.0	Travel and transportation of persons	3	1	1
23.3	Communications, utilities, and miscellaneous charges	11	5	5
24.0	Printing and reproduction	2	1	1
25.1	Advisory and assistance services	32	12	12
25.2	Other services from non-Federal sources	126	63	63
25.3	Other goods and services from Federal sources	110	81	81
25.4	Operation and maintenance of facilities	1	2	2
25.7	Operation and maintenance of equipment	128	44	44
26.0	Supplies and materials	6	3	3
31.0	Equipment	9
32.0	Land and structures	9
41.0	Grants, subsidies, and contributions		1	1
43.0	Interest and dividends		1	1

99.0	Reimbursable obligations	654	295	295

99.9	Total new obligations, unexpired accounts	654	619	619


Identification code 075–4613–0–4–554		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1,224	1,224	1,224
1101	Direct military average strength employment	13	13	13


Identification code 075–0148–0–1–554		2021 actual	2022 est.	2023 est.

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

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

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

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

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


Identification code 075–5629–0–2–554		2021 actual	2022 est.	2023 est.

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

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

5099	Balance, end of year


Identification code 075–5629–0–2–554		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	New Obligations for CURES Activities	69

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	48	49	49
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	70	50	50
1120	Appropriations transferred to other acct [075–9911]		–50	–50

1160	Appropriation, discretionary (total)	70
1930	Total budgetary resources available	118	49	49
	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	49	54	3
3010	New obligations, unexpired accounts	69
3020	Outlays (gross)	–64	–51

3050	Unpaid obligations, end of year	54	3	3
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	49	54	3
3200	Obligated balance, end of year	54	3	3

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	70
	Outlays, gross:
4010	Outlays from new discretionary authority	25
4011	Outlays from discretionary balances	39	51

4020	Outlays, gross (total)	64	51
4180	Budget authority, net (total)	70
4190	Outlays, net (total)	64	51

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	14
11.3	Other than full-time permanent	2
11.5	Other personnel compensation	1
11.7	Military personnel	1

11.9	Total personnel compensation	18
12.1	Civilian personnel benefits	6
25.1	Advisory and assistance services	5
25.2	Other services from non-Federal sources	16
25.3	Other goods and services from Federal sources	5
25.5	Research and development contracts	4
25.7	Operation and maintenance of equipment	1
26.0	Supplies and materials	1
41.0	Grants, subsidies, and contributions	13

99.9	Total new obligations, unexpired accounts	69


Identification code 075–5629–0–2–554		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	120
1101	Direct military average strength employment	7


Identification code 075–4309–0–3–554		2021 actual	2022 est.	2023 est.

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

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	1	1
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	11	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	11	11
1900	Budget authority (total)	8	11	11
1930	Total budgetary resources available	10	12	12
	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	5	5	1
3010	New obligations, unexpired accounts	9	11	11
3020	Outlays (gross)	–9	–15	–10

3050	Unpaid obligations, end of year	5	1	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	5	5	1
3200	Obligated balance, end of year	5	1	2

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	11	11
	Outlays, gross:
4100	Outlays from new mandatory authority	6	10	10
4101	Outlays from mandatory balances	3	5

4110	Outlays, gross (total)	9	15	10
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–11	–11
4180	Budget authority, net (total)
4190	Outlays, net (total)	1	4	–1

	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		2021 actual	2022 est.	2023 est.

	Reimbursable obligations:
11.1	Personnel compensation: Full-time permanent	4	6	6
12.1	Civilian personnel benefits	1	1	1
23.1	Rental payments to GSA	1	1	1
25.7	Operation and maintenance of equipment	1	1	1
32.0	Land and structures	2	2	2

99.9	Total new obligations, unexpired accounts	9	11	11


Identification code 075–4309–0–3–554		2021 actual	2022 est.	2023 est.

2001	Reimbursable civilian full-time equivalent employment	41	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, $1,839,022,000: 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, $1,619,884,000: Provided, That section 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 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 section 756(c) of the PHS Act shall apply to paragraphs (1) through (4) of section 756(a) of the PHS Act: Provided further, That $210,000,000 shall remain available until expended for the purposes of providing primary health services, assigning National Health Service Corps ("NHSC") participants 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 within the amount made available in the previous proviso, $15,000,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs (as those terms are defined by the Secretary), notwithstanding the assignment priorities and limitations under section 333(b) of such Act: Provided further, That within the amount made available in the proviso preceding the previous proviso, $25,000,000 shall remain available until expended for the purposes of making loan repayment awards to mental and behavioral health providers, including peer support specialists, in accordance with section 338B of the PHS Act, notwithstanding the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), 333A(a)(1)(B)(ii), and 334 of the PHS Act: Provided further, That for purposes of the previous three provisos, 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 , and services provided by certified peer support specialists: Provided further, That funds made available under this heading may be used to make grants to establish or expand optional community-based nurse practitioner fellowship programs that are accredited or in the accreditation process, with a preference for those in Federally Qualified Health Centers, for practicing postgraduate nurse practitioners in primary care or behavioral health.

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health and title V of the Social Security Act, $1,272,930,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $351,116,000 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, $2,654,781,000, of which $2,010,881,000 shall remain available to the Secretary through September 30, 2025, 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 $290,000,000, 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, $94,009,000, 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, $373,709,000, 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, up to $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 and other efforts to improve health care coordination for rural veterans 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, 2025, 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, $400,000,000: 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 carrying out title III of the Public Health Service Act and for cross-cutting activities and program support for activities funded in other appropriations included in this Act for the Health Resources and Services Administration, $230,709,000, of which $44,500,000 shall be for expenses necessary for the Office for the Advancement of Telehealth, including grants, contracts, and cooperative agreements for the advancement of telehealth activities: 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 Systems", and "Rural Health".


Identification code 075–0350–0–1–550		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0005	Primary Health Care (Health Centers, Free Clinics)	1,640	1,684	1,839
0010	Primary Health Care (Mandatory)	11,395	4,013	3,905
0015	Health Workforce	1,317	1,240	1,620
0020	Health Workforce (Mandatory)	920	1,129	412
0025	Maternal and Child Health	972	1,000	1,273
0030	Maternal and Child Health (Mandatory)	21	22	6
0035	Ryan White HIV/AIDS	2,441	2,428	2,655
0040	Health Systems	127	94	94
0045	Rural Health	339	326	374
0050	Family Planning	286	286	400
0051	Family Planning (Mandatory)	2	48
0055	HRSA Program Management	155	155	169
0056	FQHCs/Rural Health Clinics (Support Act)	6	2
0057	340B Drug Pricing Program/Office of Pharmacy Affairs		10	17
0058	Telehealth		34	44

0091	Direct program activities, subtotal	19,621	12,471	12,808

0300	Total direct programs	19,621	12,471	12,808
	Credit program obligations:
0702	Loan guarantee subsidy	1	2	2

0799	Total direct obligations	19,622	12,473	12,810
0801	Health Resources and Services (Reimbursable)	108	101	101

0899	Total reimbursable obligations	108	101	101

0900	Total new obligations, unexpired accounts	19,730	12,574	12,911

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	443	1,746	766
1001	Discretionary unobligated balance brought fwd, Oct 1	256	215
1010	Unobligated balance transfer to other accts [015–5606]	–5	–5	–5
1021	Recoveries of prior year unpaid obligations	59

1070	Unobligated balance (total)	497	1,741	761
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	7,207	7,207	8,485
1120	Appropriations transferred to other acct [075–1503]	–22

1160	Appropriation, discretionary (total)	7,185	7,207	8,485
	Appropriations, mandatory:
1200	Appropriation	4,451	4,443	4,443
1200	Appropriation [American Rescue Plan]	9,280
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–120	–120

1260	Appropriations, mandatory (total)	13,731	4,323	4,323
	Spending authority from offsetting collections, discretionary:
1700	Collected	22	39	39
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	32	39	39
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	32	30	30
1802	Offsetting collections (previously unavailable)	5	2	2
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–2	–2	–2

1850	Spending auth from offsetting collections, mand (total)	35	30	30
1900	Budget authority (total)	20,983	11,599	12,877
1930	Total budgetary resources available	21,480	13,340	13,638
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–4
1941	Unexpired unobligated balance, end of year	1,746	766	727

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	10,501	16,456	11,590
3010	New obligations, unexpired accounts	19,730	12,574	12,911
3011	Obligations ("upward adjustments"), expired accounts	24
3020	Outlays (gross)	–13,665	–17,440	–15,110
3040	Recoveries of prior year unpaid obligations, unexpired	–59
3041	Recoveries of prior year unpaid obligations, expired	–75

3050	Unpaid obligations, end of year	16,456	11,590	9,391
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–17	–18	–18
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	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10,484	16,438	11,572
3200	Obligated balance, end of year	16,438	11,572	9,373

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	7,217	7,246	8,524
	Outlays, gross:
4010	Outlays from new discretionary authority	2,173	2,368	2,772
4011	Outlays from discretionary balances	5,342	5,509	5,567

4020	Outlays, gross (total)	7,515	7,877	8,339
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–11	–10	–10
4033	Non-Federal sources	–36	–29	–29

4040	Offsets against gross budget authority and outlays (total)	–47	–39	–39
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	25

4060	Additional offsets against budget authority only (total)	15

4070	Budget authority, net (discretionary)	7,185	7,207	8,485
4080	Outlays, net (discretionary)	7,468	7,838	8,300
	Mandatory:
4090	Budget authority, gross	13,766	4,353	4,353
	Outlays, gross:
4100	Outlays from new mandatory authority	2,546	1,856	1,856
4101	Outlays from mandatory balances	3,604	7,707	4,915

4110	Outlays, gross (total)	6,150	9,563	6,771
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–32	–30	–30
4180	Budget authority, net (total)	20,919	11,530	12,808
4190	Outlays, net (total)	13,586	17,371	15,041

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	5	2	2
5092	Unexpired unavailable balance, EOY: Offsetting collections	2	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		2021 actual	2022 est.	2023 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels	27	72	72

215999	Total loan guarantee levels	27	72	72
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.78	2.93	2.89

232999	Weighted average subsidy rate	2.78	2.93	2.89
	Guaranteed loan subsidy budget authority:
233001	Health centers: Facilities renovation loan guarantee levels	1	2	2

233999	Total subsidy budget authority	1	2	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 2020–2021 data reported in the FY 2021 Annual Operating Report.


Program	Account Balance


HPSL	437,467,092
NSL	193,842,531
PCL	155,862,233
LDS	215,701,393

Total	1,002,873,249


Identification code 075–0350–0–1–550		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	234	240	293
11.3	Other than full-time permanent	6	6	6
11.5	Other personnel compensation	7	8	8
11.7	Military personnel	27	27	28

11.9	Total personnel compensation	274	281	335
12.1	Civilian personnel benefits	85	88	105
12.2	Military personnel benefits	3	3	3
13.0	Benefits for former personnel	2	2	2
23.1	Rental payments to GSA	25	25	25
23.3	Communications, utilities, and miscellaneous charges	6	4	4
25.1	Advisory and assistance services	27	27	31
25.2	Other services from non-Federal sources	337	306	302
25.3	Other goods and services from Federal sources	536	328	308
25.4	Operation and maintenance of facilities	1	1	1
25.6	Medical care	3	3	2
25.7	Operation and maintenance of equipment	4	4	4
26.0	Supplies and materials	1	1	1
31.0	Equipment	13	13	13
41.0	Grants, subsidies, and contributions	18,232	11,279	11,565
42.0	Insurance claims and indemnities	73	108	108

99.0	Direct obligations	19,622	12,473	12,809
99.0	Reimbursable obligations	108	101	102

99.9	Total new obligations, unexpired accounts	19,730	12,574	12,911


Identification code 075–0350–0–1–550		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	2,022	2,022	2,561
1101	Direct military average strength employment	170	170	171
2001	Reimbursable civilian full-time equivalent employment	56	56	56
2101	Reimbursable military average strength employment	3	3	3


Identification code 075–0320–0–1–551		2021 actual	2022 est.	2023 est.

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

1070	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, $15,000,000, to remain available until expended.


Identification code 075–0343–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Claims		5	6
0103	Admin Expense	3	4	9

0900	Total new obligations, unexpired accounts	3	9	15

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	2
1011	Unobligated balance transfer from other acct [075–0140]	4	7

1070	Unobligated balance (total)	5	9
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			15
1930	Total budgetary resources available	5	9	15
	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	2	9
3010	New obligations, unexpired accounts	3	9	15
3020	Outlays (gross)	–2	–2	–11

3050	Unpaid obligations, end of year	2	9	13
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	2	9
3200	Obligated balance, end of year	2	9	13

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			15
	Outlays, gross:
4010	Outlays from new discretionary authority			11
4011	Outlays from discretionary balances	2	2

4020	Outlays, gross (total)	2	2	11
4180	Budget authority, net (total)			15
4190	Outlays, net (total)	2	2	11

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			4
25.2	Other services from non-Federal sources	2	2
42.0	Insurance claims and indemnities		6	11

99.0	Direct obligations	2	8	15
99.5	Adjustment for rounding	1	1

99.9	Total new obligations, unexpired accounts	3	9	15


Identification code 075–0343–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	2	2	36
1101	Direct military average strength employment	2	2	6


Identification code 075–0321–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	441	504

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	24	127
1021	Recoveries of prior year unpaid obligations	17

1070	Unobligated balance (total)	41	127
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	400	400
1200	Appropriation [American Rescue Plan]	150
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–23	–23

1260	Appropriations, mandatory (total)	527	377
1930	Total budgetary resources available	568	504
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	127

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	747	801	859
3010	New obligations, unexpired accounts	441	504
3020	Outlays (gross)	–370	–446	–450
3040	Recoveries of prior year unpaid obligations, unexpired	–17

3050	Unpaid obligations, end of year	801	859	409
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	747	801	859
3200	Obligated balance, end of year	801	859	409

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	527	377
	Outlays, gross:
4100	Outlays from new mandatory authority	11	9
4101	Outlays from mandatory balances	359	437	450

4110	Outlays, gross (total)	370	446	450
4180	Budget authority, net (total)	527	377
4190	Outlays, net (total)	370	446	450


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	527	377
	Outlays	370	446	450
Legislative proposal, subject to PAYGO:
	Budget Authority			467
	Outlays			19
Total:
	Budget Authority	527	377	467
	Outlays	370	446	469

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		2021 actual	2022 est.	2023 est.

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

11.9	Total personnel compensation	5	5
12.1	Civilian personnel benefits	2	2
25.1	Advisory and assistance services	30	30
41.0	Grants, subsidies, and contributions	404	467

99.9	Total new obligations, unexpired accounts	441	504


Identification code 075–0321–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	38	38
1101	Direct military average strength employment	3	3


Identification code 075–0321–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs			467

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			467
1930	Total budgetary resources available			467

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			467
3020	Outlays (gross)			–19

3050	Unpaid obligations, end of year			448
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			448

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			467
	Outlays, gross:
4100	Outlays from new mandatory authority			19
4180	Budget authority, net (total)			467
4190	Outlays, net (total)			19

The Budget extends for five years and increases funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program.


Identification code 075–0321–4–1–551		2021 actual	2022 est.	2023 est.

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

11.9	Total personnel compensation			5
12.1	Civilian personnel benefits			2
25.1	Advisory and assistance services			30
41.0	Grants, subsidies, and contributions			430

99.9	Total new obligations, unexpired accounts			467


Identification code 075–0321–4–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment			52
1101	Direct military average strength employment			3


Identification code 075–4442–0–3–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	2	2
	Financing authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	1
1930	Total budgetary resources available	2	2	2
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2	2	2

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	1
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4122	Interest on uninvested funds	–1
4180	Budget authority, net (total)
4190	Outlays, net (total)	–1


Identification code 075–4442–0–3–551		2021 actual	2022 est.	2023 est.

	Position with respect to appropriations act limitation on commitments:
2111	Guaranteed loan commitments from current-year authority
2121	Limitation available from carry-forward	886	859	787
2143	Uncommitted limitation carried forward	–859	–787	–715

2150	Total guaranteed loan commitments	27	72	72
2199	Guaranteed amount of guaranteed loan commitments	21	58	58

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	27	51	112
2231	Disbursements of new guaranteed loans	27	72	72
2251	Repayments and prepayments	–3	–10	–10
	Adjustments:
2263	Terminations for default that result in claim payments		–1
2264	Other adjustments, net

2290	Outstanding, end of year	51	112	174

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	39	87	137

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		2020 actual	2021 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		2021 actual	2022 est.	2023 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		2020 actual	2021 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 $26,200,000 shall be available from the Trust Fund to the Secretary.


Identification code 075–8175–0–7–551		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	3,965	4,060	4,202
	Receipts:
	Current law:
1110	Deposits, Vaccine Injury Compensation Trust Fund	313	329	326
1140	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	59	102	117

1199	Total current law receipts	372	431	443

1999	Total receipts	372	431	443

2000	Total: Balances and receipts	4,337	4,491	4,645
	Appropriations:
	Current law:
2101	Vaccine Injury Compensation Program Trust Fund	–38	–38	–68
2101	Vaccine Injury Compensation Program Trust Fund	–334	–251	–256
2135	Vaccine Injury Compensation Program Trust Fund	85

2199	Total current law appropriations	–287	–289	–324

2999	Total appropriations	–287	–289	–324
4030	Vaccine Injury Compensation Program Trust Fund	10

5099	Balance, end of year	4,060	4,202	4,321


Identification code 075–8175–0–7–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	249	251	256
0103	Claims processing (Claims Court)	10	10	10
0104	Claims processing (HRSA)	11	11	26
0105	Claims processing (Dept. of Justice)	17	17	32

0191	Direct program activities, subtotal	38	38	68

0900	Total new obligations, unexpired accounts	287	289	324

	Budgetary resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	2
1033	Recoveries of prior year paid obligations	8
1035	Unobligated balance of appropriations withdrawn	–10
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	38	38	68
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	334	251	256
1235	Appropriations precluded from obligation (special or trust)	–85

1260	Appropriations, mandatory (total)	249	251	256
1900	Budget authority (total)	287	289	324
1930	Total budgetary resources available	287	289	324

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	18	20	1
3010	New obligations, unexpired accounts	287	289	324
3020	Outlays (gross)	–283	–308	–324
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	20	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	18	20	1
3200	Obligated balance, end of year	20	1	1

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	38	38	68
	Outlays, gross:
4010	Outlays from new discretionary authority	28	38	68
4011	Outlays from discretionary balances	9	9

4020	Outlays, gross (total)	37	47	68
	Mandatory:
4090	Budget authority, gross	249	251	256
	Outlays, gross:
4100	Outlays from new mandatory authority	246	251	256
4101	Outlays from mandatory balances		10

4110	Outlays, gross (total)	246	261	256
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	8

4160	Budget authority, net (mandatory)	249	251	256
4170	Outlays, net (mandatory)	238	261	256
4180	Budget authority, net (total)	287	289	324
4190	Outlays, net (total)	275	308	324

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	3,967	4,054	4,234
5001	Total investments, EOY: Federal securities: Par value	4,054	4,234	4,421

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	4
12.1	Civilian personnel benefits	1	1	1
25.3	Other goods and services from Federal sources	7	7	7
42.0	Insurance claims and indemnities	277	279	312

99.9	Total new obligations, unexpired accounts	287	289	324


Identification code 075–8175–0–7–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	14	14	26
1101	Direct military average strength employment	5	5	6

Federal Funds


Identification code 075–0390–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Clinical services	7,826	6,225	6,225
0002	Preventive health	326	235	235
0003	Urban health	57	76	76
0004	Indian health professions	60	80	80
0005	Tribal management	1	1	1
0006	Direct operations	153	54	54
0007	Self-governance	6	6	6
0009	Diabetes funds	137	150	150

0799	Total direct obligations	8,566	6,827	6,827
0801	Indian Health Services (Reimbursable)	1,893	1,860	1,860

0900	Total new obligations, unexpired accounts	10,459	8,687	8,687

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2,109	4,753	2,126
1001	Discretionary unobligated balance brought fwd, Oct 1	2,064
1021	Recoveries of prior year unpaid obligations	285

1070	Unobligated balance (total)	2,394	4,753	2,126
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	4,301	4,346	6,262
1121	Appropriations transferred from other acct [075–0943]	210
1121	Appropriations transferred from other acct [075–0140]	790

1160	Appropriation, discretionary (total)	5,301	4,346	6,262
	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	–3

1260	Appropriations, mandatory (total)	5,644	147	147
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,884	1,567	1,868
1701	Change in uncollected payments, Federal sources	7

1750	Spending auth from offsetting collections, disc (total)	1,891	1,567	1,868
1900	Budget authority (total)	12,836	6,060	8,277
1930	Total budgetary resources available	15,230	10,813	10,403
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–18
1941	Unexpired unobligated balance, end of year	4,753	2,126	1,716

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,384	1,758	1,299
3010	New obligations, unexpired accounts	10,459	8,687	8,687
3011	Obligations ("upward adjustments"), expired accounts	21
3020	Outlays (gross)	–9,812	–9,146	–8,179
3040	Recoveries of prior year unpaid obligations, unexpired	–285
3041	Recoveries of prior year unpaid obligations, expired	–9

3050	Unpaid obligations, end of year	1,758	1,299	1,807
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–106	–113	–113
3070	Change in uncollected pymts, Fed sources, unexpired	–7

3090	Uncollected pymts, Fed sources, end of year	–113	–113	–113
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,278	1,645	1,186
3200	Obligated balance, end of year	1,645	1,186	1,694

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	7,192	5,913	8,130
	Outlays, gross:
4010	Outlays from new discretionary authority	5,086	5,478	7,504
4011	Outlays from discretionary balances	1,521	774	522

4020	Outlays, gross (total)	6,607	6,252	8,026
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–259	–299	–436
4033	Non-Federal sources	–1,627	–1,268	–1,432

4040	Offsets against gross budget authority and outlays (total)	–1,886	–1,567	–1,868
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7
4052	Offsetting collections credited to expired accounts	2

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

4070	Budget authority, net (discretionary)	5,301	4,346	6,262
4080	Outlays, net (discretionary)	4,721	4,685	6,158
	Mandatory:
4090	Budget authority, gross	5,644	147	147
	Outlays, gross:
4100	Outlays from new mandatory authority	3,103	141	141
4101	Outlays from mandatory balances	102	2,753	12

4110	Outlays, gross (total)	3,205	2,894	153
4180	Budget authority, net (total)	10,945	4,493	6,409
4190	Outlays, net (total)	7,926	7,579	6,311

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


Identification code 075–0390–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	422	336	336
11.3	Other than full-time permanent	18	14	14
11.5	Other personnel compensation	97	77	77
11.7	Military personnel	63	50	50

11.9	Total personnel compensation	600	477	477
12.1	Civilian personnel benefits	181	144	144
12.2	Military personnel benefits	13	10	10
13.0	Benefits for former personnel	13	10	10
21.0	Travel and transportation of persons	5	4	4
21.0	Patient travel	59	47	47
22.0	Transportation of things	11	9	9
23.1	Rental payments to GSA	29	23	23
23.2	Rental payments to others	16	13	13
23.3	Communications, utilities, and miscellaneous charges	31	25	25
25.1	Advisory and assistance services	9	7	7
25.2	Other services from non-Federal sources	311	248	248
25.3	Other goods and services from Federal sources	194	155	155
25.4	Operation and maintenance of facilities	4	3	3
25.6	Medical care	790	634	634
25.8	Subsistence and support of persons	115	92	92
26.0	Supplies and materials	180	143	143
31.0	Equipment	44	35	35
32.0	Land and structures	24	19	19
41.0	Grants, subsidies, and contributions	5,936	4,728	4,728
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	8,566	6,827	6,827
99.0	Reimbursable obligations	1,893	1,860	1,860

99.9	Total new obligations, unexpired accounts	10,459	8,687	8,687


Identification code 075–0390–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	6,797	6,761	6,900
1101	Direct military average strength employment	732	721	736
2001	Reimbursable civilian full-time equivalent employment	6,146	6,114	6,239
2101	Reimbursable military average strength employment	661	651	665


Identification code 075–0390–2–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–6,262
	Appropriations, mandatory:
1200	Appropriation			6,262

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–6,262
	Outlays, gross:
4010	Outlays from new discretionary authority			–5,636
	Mandatory:
4090	Budget authority, gross			6,262
	Outlays, gross:
4100	Outlays from new mandatory authority			5,636
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–0344–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Contract Support Costs	1,182	1,142	1,142

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,182	1,142	1,142
1900	Budget authority (total)	1,182	1,142	1,142
1930	Total budgetary resources available	1,182	1,142	1,142

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	130	321
3010	New obligations, unexpired accounts	1,182	1,142	1,142
3011	Obligations ("upward adjustments"), expired accounts	79
3020	Outlays (gross)	–1,033	–1,463	–1,142
3041	Recoveries of prior year unpaid obligations, expired	–37

3050	Unpaid obligations, end of year	321
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	130	321
3200	Obligated balance, end of year	321

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,182	1,142	1,142
	Outlays, gross:
4010	Outlays from new discretionary authority	956	1,142	1,142
4011	Outlays from discretionary balances	77	321

4020	Outlays, gross (total)	1,033	1,463	1,142
4180	Budget authority, net (total)	1,182	1,142	1,142
4190	Outlays, net (total)	1,033	1,463	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. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


Identification code 075–0344–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	266	251	257
41.0	Grants, subsidies, and contributions	916	891	885

99.9	Total new obligations, unexpired accounts	1,182	1,142	1,142


Identification code 075–0344–2–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–1,142
	Appropriations, mandatory:
1200	Appropriation			1,142

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–1,142
	Outlays, gross:
4010	Outlays from new discretionary authority			–1,142
	Mandatory:
4090	Budget authority, gross			1,142
	Outlays, gross:
4100	Outlays from new mandatory authority			1,142
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–0200–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Payments for Tribal Leases	123	150	150

0900	Total new obligations, unexpired accounts (object class 41.0)	123	150	150

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		16	16
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	139	150	150
1930	Total budgetary resources available	139	166	166
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	16	16	16

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		13
3010	New obligations, unexpired accounts	123	150	150
3020	Outlays (gross)	–110	–163	–150

3050	Unpaid obligations, end of year	13
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		13
3200	Obligated balance, end of year	13

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	139	150	150
	Outlays, gross:
4010	Outlays from new discretionary authority	110	150	150
4011	Outlays from discretionary balances		13

4020	Outlays, gross (total)	110	163	150
4180	Budget authority, net (total)	139	150	150
4190	Outlays, net (total)	110	163	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. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


Identification code 075–0200–2–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–150
	Appropriations, mandatory:
1200	Appropriation			150

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–150
	Outlays, gross:
4010	Outlays from new discretionary authority			–150
	Mandatory:
4090	Budget authority, gross			150
	Outlays, gross:
4100	Outlays from new mandatory authority			150
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 075–0391–0–1–551		2021 actual	2022 est.	2023 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Rent and Charges for Quarters, Indian Health Service	10	9	9

2000	Total: Balances and receipts	10	9	9
	Appropriations:
	Current law:
2101	Indian Health Facilities	–10	–9	–9

5099	Balance, end of year


Identification code 075–0391–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Maintenance	190	168	168
0002	Sanitation Facilities Construction	219	193	193
0003	Facilities and environmental health	293	259	259
0004	Equipment	27	24	24
0005	Health Care Facilities Construction	142	125	125

0100	Total direct program	871	769	769

0799	Total direct obligations	871	769	769
0801	Indian Health Facilities (Reimbursable)	105	57	57

0900	Total new obligations, unexpired accounts	976	826	826

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	944	1,620	2,481
1001	Discretionary unobligated balance brought fwd, Oct 1	931
1021	Recoveries of prior year unpaid obligations	32

1070	Unobligated balance (total)	976	1,620	2,481
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	918	1,619	1,567
	Advance appropriations, discretionary:
1170	Advance appropriation			696
	Appropriations, mandatory:
1200	Appropriation (American Rescue Plan)	600
1201	Appropriation (special or trust fund)	10	9	9

1260	Appropriations, mandatory (total)	610	9	9
	Spending authority from offsetting collections, discretionary:
1700	Collected	92	59	59
1900	Budget authority (total)	1,620	1,687	2,331
1930	Total budgetary resources available	2,596	3,307	4,812
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,620	2,481	3,986

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	892	947	908
3010	New obligations, unexpired accounts	976	826	826
3020	Outlays (gross)	–889	–865	–1,705
3040	Recoveries of prior year unpaid obligations, unexpired	–32

3050	Unpaid obligations, end of year	947	908	29
	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	874	929	890
3200	Obligated balance, end of year	929	890	11

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,010	1,678	2,322
	Outlays, gross:
4010	Outlays from new discretionary authority	349	684	807
4011	Outlays from discretionary balances	352	88	805

4020	Outlays, gross (total)	701	772	1,612
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–92	–59	–59

4040	Offsets against gross budget authority and outlays (total)	–92	–59	–59
	Mandatory:
4090	Budget authority, gross	610	9	9
	Outlays, gross:
4100	Outlays from new mandatory authority	183	9	9
4101	Outlays from mandatory balances	5	84	84

4110	Outlays, gross (total)	188	93	93
4180	Budget authority, net (total)	1,528	1,628	2,272
4190	Outlays, net (total)	797	806	1,646

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


Identification code 075–0391–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	56	49	49
11.3	Other than full-time permanent	3	3	3
11.5	Other personnel compensation	4	4	4
11.7	Military personnel	28	25	25

11.9	Total personnel compensation	91	81	81
12.1	Civilian personnel benefits	22	19	19
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	4	4	4
23.3	Communications, utilities, and miscellaneous charges	13	11	11
25.1	Advisory and assistance services	3	3	3
25.2	Other services from non-Federal sources	178	157	157
25.3	Other goods and services from Federal sources	2	2	2
25.4	Operation and maintenance of facilities	144	127	127
25.7	Operation and maintenance of equipment	89	78	78
25.8	Subsistence and support of persons	2	2	2
26.0	Supplies and materials	7	6	6
31.0	Equipment	64	57	57
32.0	Land and structures	29	25	25
41.0	Grants, subsidies, and contributions	215	189	189

99.0	Direct obligations	871	769	769
99.0	Reimbursable obligations	105	57	57

99.9	Total new obligations, unexpired accounts	976	826	826


Identification code 075–0391–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	960	955	975
1101	Direct military average strength employment	203	200	204
2001	Reimbursable civilian full-time equivalent employment	46	46	47


Identification code 075–0391–2–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–1,567
	Appropriations, mandatory:
1200	Appropriation			1,567

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–1,567
	Outlays, gross:
4010	Outlays from new discretionary authority			–470
	Mandatory:
4090	Budget authority, gross			1,567
	Outlays, gross:
4100	Outlays from new mandatory authority			470
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Budget proposes to shift the four IHS accounts from discretionary to mandatory. After FY 2023, IHS funding would grow to keep pace with healthcare costs and population growth and gradually close longstanding service and facility shortfalls. The net score forgoes discretionary funding for mandatory to provide IHS stable and predictable funding.

Federal Funds

To carry out titles II, III, IV, VII, XI, XV, XVII, XIX, XXI, XXIII, XXVI, and XXVIII of the Public Health Service Act (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, sections 20, 21, and 22 of the Occupational Safety and Health Act, titles II and IV of the Immigration and Nationality Act, section 501 of the Refugee Education Assistance Act, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, $9,620,961,000; of which $128,421,000 shall remain available through September 30, 2024 for international HIV/AIDS; $353,200,000 shall remain available through September 30, 2025 for global public health protection; $600,000,000 shall remain available through September 30, 2024 for public health infrastructure and capacity; and $50,000,000 shall remain available through September 30, 2024 for forecasting epidemics and outbreak analytics: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries: Provided further, 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: Provided further, That funds made available under this heading may be available for making grants under section 1509 of the PHS Act for not less than 21 States, tribes, or tribal organizations: Provided further, That 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: Provided further, 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 of the amounts appropriated under this heading, $55,000,000 shall remain available until September 30, 2027, for costs related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities: Provided further, That funds made available in this or any prior Act that 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 for buildings and facilities to support the replacement of the mine safety research facility: Provided further, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading: 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 to support 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, 2024: Provided further, That in addition to amounts provided herein, $7,000,000 for lead poisoning prevention and $143,540,000 for health statistics shall be made available from amounts available under section 241 of the PHS Act.

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.


Identification code 075–0943–0–1–999		2021 actual	2022 est.	2023 est.

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

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

5099	Balance, end of year		1	2


Identification code 075–0943–0–1–999		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (0958)	167	168
0002	CDC-Wide Activities and Program Support (0943)	15,286	274	9,621
0004	Chronic Disease Prevention and Health Promotion (0948)	1,296	1,277
0005	Emerging and Zoonotic Infectious Diseases (0949)	644	648
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)	53	50
0007	Environmental Health (0947)	222	223
0008	Global Health (0955)	604	592
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)	1,309	1,314
0013	Immunization and Respiratory Diseases (0951)	815	821
0015	Injury Prevention and Control (0952)	680	683
0016	Occupational Safety and Health (0953)	344	345
0019	Public Health Preparedness and Response (0956)	840	842
0020	Public Health Scientific Services (0959)	590	592
0021	Cooperative Research and Development Agreements (CRADA) (5146)	1
0022	Ebola (Emergency pursuant to 2011 BCA)	1
0024	CDC-Wide Activities and Program Support (User and Other Similar Fees)	127

0799	Total direct obligations	22,979	7,829	9,621
0802	CDC-Wide Activities and Program Support (Reimbursable)	252	653	668

0809	Reimbursable program activities, subtotal	252	653	668

0900	Total new obligations, unexpired accounts	23,231	8,482	10,289

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,158	7,711	7,274
1001	Discretionary unobligated balance brought fwd, Oct 1	3,066
1010	Unobligated balance transfer to other accts [075–0140]	–544
1021	Recoveries of prior year unpaid obligations	77

1070	Unobligated balance (total)	2,691	7,711	7,274
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	15,683	6,965	9,621
1120	Appropriations transferred to other acct [075–0390]	–210
1120	Appropriations transferred to other acct [075–1503]	–21
1120	Appropriations transferred to other acct [075–0945]	–10	–10	–35
1121	Appropriations transferred from other acct [075–0116]		856

1160	Appropriation, discretionary (total)	15,442	7,811	9,586
	Appropriations, mandatory:
1200	Appropriation (075–0954 - EEOICPA)	55	55	55
1200	Appropriation (075–0943 American Rescue Plan)	11,520
1201	Appropriation (075–5146 CRADA)	2	1	1
1221	Appropriations transferred from other acct PPHF [075–0116]	856		903
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–5	–5	–4

1260	Appropriations, mandatory (total)	12,428	51	955
	Spending authority from offsetting collections, discretionary:
1700	Collected	291	181	185
1701	Change in uncollected payments, Federal sources	92

1750	Spending auth from offsetting collections, disc (total)	383	181	185
	Spending authority from offsetting collections, mandatory:
1800	Collected	4	2	2
1900	Budget authority (total)	28,257	8,045	10,728
1930	Total budgetary resources available	30,948	15,756	18,002
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	7,711	7,274	7,713

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	10,155	21,997	15,164
3010	New obligations, unexpired accounts	23,231	8,482	10,289
3011	Obligations ("upward adjustments"), expired accounts	35
3020	Outlays (gross)	–11,153	–15,315	–12,298
3040	Recoveries of prior year unpaid obligations, unexpired	–77
3041	Recoveries of prior year unpaid obligations, expired	–194

3050	Unpaid obligations, end of year	21,997	15,164	13,155
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–130	–144	–144
3070	Change in uncollected pymts, Fed sources, unexpired	–92
3071	Change in uncollected pymts, Fed sources, expired	78

3090	Uncollected pymts, Fed sources, end of year	–144	–144	–144
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10,025	21,853	15,020
3200	Obligated balance, end of year	21,853	15,020	13,011

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	15,825	7,992	9,771
	Outlays, gross:
4010	Outlays from new discretionary authority	3,630	2,135	2,600
4011	Outlays from discretionary balances	6,157	7,581	7,430

4020	Outlays, gross (total)	9,787	9,716	10,030
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–359	–181	–185
4033	Non-Federal sources	–12

4040	Offsets against gross budget authority and outlays (total)	–371	–181	–185
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–92
4052	Offsetting collections credited to expired accounts	80

4060	Additional offsets against budget authority only (total)	–12

4070	Budget authority, net (discretionary)	15,442	7,811	9,586
4080	Outlays, net (discretionary)	9,416	9,535	9,845
	Mandatory:
4090	Budget authority, gross	12,432	53	957
	Outlays, gross:
4100	Outlays from new mandatory authority	617	41	223
4101	Outlays from mandatory balances	749	5,558	2,045

4110	Outlays, gross (total)	1,366	5,599	2,268
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–4	–2	–2
4180	Budget authority, net (total)	27,870	7,862	10,541
4190	Outlays, net (total)	10,778	15,132	12,111


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	27,870	7,862	10,541
	Outlays	10,778	15,132	12,111
Legislative proposal, subject to PAYGO:
	Budget Authority			30,088
	Outlays			8,432
Total:
	Budget Authority	27,870	7,862	40,629
	Outlays	10,778	15,132	20,543

The Centers for Disease Control and Prevention (CDC) works to protect the health and safety of all Americans. The agency has played a key role in protecting Americans from recent health emergencies including COVID-19, opioid overdose, Zika, and HIN1. Key programs of the CDC include immunization and respiratory diseases; HIV/AIDS, viral hepatitis, STD, 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 cross-cutting CDC-wide activities and program support, including public health infrastructure. The FY 2023 Budget continues to increase foundational investments in core public health capacities that are essential prepare for and response to public health emergencies and to the effective and efficient functioning of public health system. These include a request for $600 million for dedicated funding to invest in public health infrastructure and capacity, and $50 million to support the Center for Forecasting and Outbreak Analytics, which will sustain efforts begun in FY 2021 with COVID-19 emergency supplemental appropriations. The FY 2023 Budget also provides $310 million for CDC to undertake the fourth year of the Ending the HIV Epidemic in the U.S. initiative, and $200 million to continue CDC's Public Health Data Modernization efforts. The FY 2023 Budget provides $353 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. In addition, the FY 2023 Budget includes several policy proposals to allow CDC to more efficiently respond to public health emergencies, including a proposal to modernize CDC's budget structure by consolidating the existing 13 Treasury accounts, including "Buildings and Facilities", into a single "CDC-Wide Activities and Program Support" account. Nearly all existing budget lines are maintained within the proposed single account structure.


Identification code 075–0943–0–1–999		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	851	887	1,110
11.3	Other than full-time permanent	138	103	135
11.5	Other personnel compensation	70	47	64
11.6	Military personnel - basic allowance for housing	1	1	1
11.7	Military personnel	93	89	118
11.8	Special personal services payments	4	3	4

11.9	Total personnel compensation	1,157	1,130	1,432
12.1	Civilian personnel benefits	371	347	469
12.2	Military personnel benefits	29	30	38
21.0	Travel and transportation of persons	20	11	14
22.0	Transportation of things	9	7	11
23.1	Rental payments to GSA	4	6	6
23.3	Communications, utilities, and miscellaneous charges	4	5	5
24.0	Printing and reproduction	2	3	3
25.1	Advisory and assistance services	2,517	755	1,090
25.2	Other services from non-Federal sources	79	83	90
25.3	Other goods and services from Federal sources	5,374	1,062	1,117
25.4	Operation and maintenance of facilities	16	17	31
25.5	Research and development contracts	30	32	34
25.6	Medical care	5	5	6
25.7	Operation and maintenance of equipment	54	30	46
26.0	Supplies and materials	128	37	74
31.0	Equipment	82	59	76
32.0	Land and structures	1	2	26
41.0	Grants, subsidies, and contributions	13,097	4,208	5,053

99.0	Direct obligations	22,979	7,829	9,621
99.0	Reimbursable obligations	252	653	668

99.9	Total new obligations, unexpired accounts	23,231	8,482	10,289


Identification code 075–0943–0–1–999		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	9,241	10,953	10,412
1101	Direct military average strength employment	743	774	741
2001	Reimbursable civilian full-time equivalent employment	286	251	252
2101	Reimbursable military average strength employment	27	27	26


Identification code 075–0943–4–1–999		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	CDC-Wide Activities and Program Support (0943)			30,088

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			30,088
1900	Budget authority (total)			30,088
1930	Total budgetary resources available			30,088

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			30,088
3020	Outlays (gross)			–8,432

3050	Unpaid obligations, end of year			21,656
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			21,656

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			30,088
	Outlays, gross:
4100	Outlays from new mandatory authority			8,432
4180	Budget authority, net (total)			30,088
4190	Outlays, net (total)			8,432

The FY 2023 Budget for CDC establishes a new Vaccines for Adults (VFA) program, which will provide uninsured adults with access to all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost. As a complement to the successful Vaccines for Children (VFC) program, the VFA program will reduce disparities in vaccine coverage and promote infrastructure for broad access to routine and outbreak vaccines. The FY 2023 Budget also includes mandatory funding for significant investments in pandemic preparedness and biodefense across HHS, including CDC. These investments will allow CDC to transform medical defenses, ensure situational awareness, strengthen public health systems and build core capabilities.


Identification code 075–0943–4–1–999		2021 actual	2022 est.	2023 est.

	Direct obligations:
21.0	Travel and transportation of persons			32
22.0	Transportation of things			1
23.3	Communications, utilities, and miscellaneous charges			1
25.1	Advisory and assistance services			5,443
25.2	Other services from non-Federal sources			40
25.3	Other goods and services from Federal sources			745
25.4	Operation and maintenance of facilities			9
25.5	Research and development contracts			15
25.6	Medical care			2
25.7	Operation and maintenance of equipment			66
26.0	Supplies and materials			2,023
31.0	Equipment			82
41.0	Grants, subsidies, and contributions			21,629

99.9	Total new obligations, unexpired accounts			30,088


Identification code 075–0960–0–1–551		2021 actual	2022 est.	2023 est.

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

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	376	377	377
1021	Recoveries of prior year unpaid obligations	1

1070	Unobligated balance (total)	377	377	377
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	30	30
1930	Total budgetary resources available	407	407	377
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	377	377	377

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	59	33	33
3010	New obligations, unexpired accounts	30	30
3020	Outlays (gross)	–55	–30	–29
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	33	33	4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	59	33	33
3200	Obligated balance, end of year	33	33	4

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	30	30
	Outlays, gross:
4010	Outlays from new discretionary authority	1	12
4011	Outlays from discretionary balances	54	18	29

4020	Outlays, gross (total)	55	30	29
4180	Budget authority, net (total)	30	30
4190	Outlays, net (total)	55	30	29

Buildings and Facilities funds support renovations to existing buildings, as well as repair and improvements (e.g., laboratory ventilation upgrades, structural repairs, roof replacements, and electrical and mechanical repairs) necessary to restore, maintain, and improve CDC's assets. The FY 2023 Budget includes several policy proposals to allow CDC to more efficiently respond to public health emergencies, including a proposal to modernize CDC's budget structure by consolidating the existing 13 Treasury accounts, including "Buildings and Facilities", into a single "CDC-Wide Activities and Program Support" account.


Identification code 075–0960–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.1	Advisory and assistance services	1	2
25.4	Operation and maintenance of facilities	6	10
31.0	Equipment	1
32.0	Land and structures	22	18

99.9	Total new obligations, unexpired accounts	30	30


Identification code 075–4553–0–4–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	CDC Working Capital Fund (Reimbursable)	735	671	671

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	125	232	232
1021	Recoveries of prior year unpaid obligations	19

1070	Unobligated balance (total)	144	232	232
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	823	671	671
1900	Budget authority (total)	823	671	671
1930	Total budgetary resources available	967	903	903
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	232	232	232

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	239	292	217
3010	New obligations, unexpired accounts	735	671	671
3020	Outlays (gross)	–663	–746	–671
3040	Recoveries of prior year unpaid obligations, unexpired	–19

3050	Unpaid obligations, end of year	292	217	217
	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	237	290	215
3200	Obligated balance, end of year	290	215	215

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	823	671	671
	Outlays, gross:
4010	Outlays from new discretionary authority	464	443	443
4011	Outlays from discretionary balances	199	303	228

4020	Outlays, gross (total)	663	746	671
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–823	–671	–671
4180	Budget authority, net (total)
4190	Outlays, net (total)	–160	75

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		2021 actual	2022 est.	2023 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	163	149	150
11.3	Other than full-time permanent	6	5	5
11.5	Other personnel compensation	6	5	5
11.7	Military personnel	4	4	3

11.9	Total personnel compensation	179	163	163
12.1	Civilian personnel benefits	64	58	59
12.2	Military personnel benefits	1	1	1
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	34	31	31
23.3	Communications, utilities, and miscellaneous charges	23	21	21
25.1	Advisory and assistance services	114	104	106
25.2	Other services from non-Federal sources	49	45	44
25.3	Other goods and services from Federal sources	119	109	109
25.4	Operation and maintenance of facilities	79	72	73
25.7	Operation and maintenance of equipment	57	52	50
31.0	Equipment	12	11	10
32.0	Land and structures	3	3	3

99.9	Total new obligations, unexpired accounts	735	671	671


Identification code 075–4553–0–4–551		2021 actual	2022 est.	2023 est.

2001	Reimbursable civilian full-time equivalent employment	1,604	1,620	1,635
2101	Reimbursable military average strength employment	25	27	27


Identification code 075–0945–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity	18	10	35

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	601	594	594
1021	Recoveries of prior year unpaid obligations	1

1070	Unobligated balance (total)	602	594	594
	Budget authority:
	Appropriations, discretionary:
1121	Appropriations transferred from other acct [075–0943]	10	10	35
1930	Total budgetary resources available	612	604	629
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	594	594	594

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	37	26	5
3010	New obligations, unexpired accounts	18	10	35
3020	Outlays (gross)	–28	–31	–26
3040	Recoveries of prior year unpaid obligations, unexpired	–1

3050	Unpaid obligations, end of year	26	5	14
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	37	26	5
3200	Obligated balance, end of year	26	5	14

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	10	10	35
	Outlays, gross:
4010	Outlays from new discretionary authority		6	22
4011	Outlays from discretionary balances	28	25	4

4020	Outlays, gross (total)	28	31	26
4180	Budget authority, net (total)	10	10	35
4190	Outlays, net (total)	28	31	26

The FY 2023 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		2021 actual	2022 est.	2023 est.

	Direct obligations:
21.0	Travel and transportation of persons	1	2	2
25.1	Advisory and assistance services	3		19
25.3	Other goods and services from Federal sources	2	5	11
26.0	Supplies and materials	1	1	1
31.0	Equipment	1	2	2
41.0	Grants, subsidies, and contributions	10

99.9	Total new obligations, unexpired accounts	18	10	35

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, $85,020,000: 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 2023, and existing profiles may be updated as necessary.


Identification code 075–0944–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Agency for Toxic Substances and Disease Registry, Toxic Substance (Direct)	96	78	85
0801	Agency for Toxic Substances and Disease Registry, Toxic Substance (Reimbursable)	7	14	14

0900	Total new obligations, unexpired accounts	103	92	99

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	33	29	18
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	78	78	85
1121	Appropriations transferred from other acct [097–0100]	15

1160	Appropriation, discretionary (total)	93	78	85
	Spending authority from offsetting collections, discretionary:
1700	Collected	5	3
1701	Change in uncollected payments, Federal sources	2

1750	Spending auth from offsetting collections, disc (total)	7	3
1900	Budget authority (total)	100	81	85
1930	Total budgetary resources available	133	110	103
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	29	18	4

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	78	81	53
3010	New obligations, unexpired accounts	103	92	99
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–97	–120	–79
3041	Recoveries of prior year unpaid obligations, expired	–5

3050	Unpaid obligations, end of year	81	53	73
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–7	–6	–6
3070	Change in uncollected pymts, Fed sources, unexpired	–2
3071	Change in uncollected pymts, Fed sources, expired	3

3090	Uncollected pymts, Fed sources, end of year	–6	–6	–6
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	71	75	47
3200	Obligated balance, end of year	75	47	67

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	100	81	85
	Outlays, gross:
4010	Outlays from new discretionary authority	51	53	55
4011	Outlays from discretionary balances	43	67	24

4020	Outlays, gross (total)	94	120	79
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–8	–3

4040	Offsets against gross budget authority and outlays (total)	–8	–3
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2
4052	Offsetting collections credited to expired accounts	3

4060	Additional offsets against budget authority only (total)	1

4070	Budget authority, net (discretionary)	93	78	85
4080	Outlays, net (discretionary)	86	117	79
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3
4180	Budget authority, net (total)	93	78	85
4190	Outlays, net (total)	89	117	79


Identification code 075–0944–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	23	22	21
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	29	28	27
12.1	Civilian personnel benefits	9	7	8
25.1	Advisory and assistance services	12	3	11
25.2	Other services from non-Federal sources	3	1	2
25.3	Other goods and services from Federal sources	13	12	12
25.7	Operation and maintenance of equipment	1
31.0	Equipment	3	2	2
41.0	Grants, subsidies, and contributions	26	25	23

99.0	Direct obligations	96	78	85
99.0	Reimbursable obligations	7	14	14

99.9	Total new obligations, unexpired accounts	103	92	99


Identification code 075–0944–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	198	194	194
1101	Direct military average strength employment	30	30	30
2001	Reimbursable civilian full-time equivalent employment	1	2	2
2101	Reimbursable military average strength employment	1	1	1


Identification code 075–0946–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	World Trade Center Health Program—Federal Share (CDC/NIOSH)	506	577	710
0002	World Trade Center Health Program—NYC	56	64	79

0900	Total new obligations, unexpired accounts	562	641	789

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	928	973	908
1021	Recoveries of prior year unpaid obligations	5
1033	Recoveries of prior year paid obligations	45

1070	Unobligated balance (total)	978	973	908
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	457	518	535
1200	Appropriation (WTC—NYC DHSS—CDC)	51	58	59

1260	Appropriations, mandatory (total)	508	576	594
	Spending authority from offsetting collections, mandatory:
1800	Collected	49
1900	Budget authority (total)	557	576	594
1930	Total budgetary resources available	1,535	1,549	1,502
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	973	908	713

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	255	239	439
3010	New obligations, unexpired accounts	562	641	789
3020	Outlays (gross)	–573	–441	–520
3040	Recoveries of prior year unpaid obligations, unexpired	–5

3050	Unpaid obligations, end of year	239	439	708
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	255	239	439
3200	Obligated balance, end of year	239	439	708

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	557	576	594
	Outlays, gross:
4100	Outlays from new mandatory authority		265	273
4101	Outlays from mandatory balances	573	176	247

4110	Outlays, gross (total)	573	441	520
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–94
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	45

4160	Budget authority, net (mandatory)	508	576	594
4170	Outlays, net (mandatory)	479	441	520
4180	Budget authority, net (total)	508	576	594
4190	Outlays, net (total)	479	441	520

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 2022 and 2023 in the Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 075–0946–0–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	5	5	8
11.3	Other than full-time permanent	1	1	1
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	7	7	10
12.1	Civilian personnel benefits	2	2	3
25.1	Advisory and assistance services	25	50	39
25.3	Other goods and services from Federal sources	14	17	21
25.4	Operation and maintenance of facilities		1
25.6	Medical care	114	137	170
31.0	Equipment	2	2	2
41.0	Grants, subsidies, and contributions	16	30	24
42.0	Insurance claims and indemnities	382	395	520

99.9	Total new obligations, unexpired accounts	562	641	789


Identification code 075–0946–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	52	52	62
1101	Direct military average strength employment	7	7	7

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $6,497,851,000, 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, $3,822,961,000.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $513,191,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $2,206,080,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $2,543,043,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $6,268,313,000.

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $3,097,557,000, of which $1,271,505,000 shall be from funds available under section 241 of the PHS Act: Provided, That not less than $410,644,000 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, $1,674,941,000.

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $853,355,000.

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $932,056,000.

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, $83,035,000.

For carrying out section 301 and title IV of the PHS Act with respect to aging, $4,011,413,000.

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $676,254,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $508,704,000.

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $198,670,000.

For carrying out section 301 and title IV of the PHS Act with respect to alcohol misuse, alcohol use disorder, and other alcohol-associated disorders, $566,725,000.

For carrying out section 301 and title IV of the PHS Act with respect to drugs and addiction, $1,843,326,000.

For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,985,828,000.

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $629,154,000.

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $419,493,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $183,368,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $659,817,000.

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), $95,801,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $471,998,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2024: Provided further, That in fiscal year 2023, 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, $873,654,000: Provided, That up to $90,000,000 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network: Provided further, That at least $599,349,000 is provided to the Clinical and Translational Sciences Awards program.

For carrying out the responsibilities of the Office of the Director, NIH, $2,302,065,000: 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 2023 and 2024 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 from the 10-year Pediatric Research Initiative Fund described in section 9008 of title 26, United States Code, for the purpose of carrying out section 402(b)(7)(B)(ii) of the PHS Act (relating to pediatric research), as authorized in the Gabriella Miller Kids First Research Act.

For the study of, construction of, demolition of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, $300,000,000, to remain available through September 30, 2027.

For carrying out section 301 and title IV of the PHS Act with respect to advanced research projects for health, $5,000,000,000, to remain available through September 30, 2025.


Identification code 075–9915–0–1–552		2021 actual	2022 est.	2023 est.

0100	Balance, start of year
	Receipts:
	Current law:
1130	Cooperative Research and Development Agreements, NIH	54	82	82

2000	Total: Balances and receipts	54	82	82
	Appropriations:
	Current law:
2101	National Institutes of Health	–54	–82	–82

5099	Balance, end of year


Identification code 075–9915–0–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	6,670	6,748	6,714
0002	National Heart, Lung, and Blood Institute (0872)	3,673	3,696	3,823
0003	National Institute of Dental and Craniofacial Research (0873)	483	485	513
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	2,125	2,132	2,206
0005	National Institute of Neurological Disorders and Stroke (0886)	2,491	2,534	2,768
0006	National Institute of Allergy and Infectious Diseases (0885)	6,421	6,599	6,268
0007	National Institute of General Medical Sciences (0851)	1,715	1,720	1,826
0008	National Institute of Child Health and Human Development (0844)	1,588	1,590	1,675
0009	National Eye Institute (0887)	833	836	853
0010	National Institute of Environmental Health Sciences (0862)	896	898	1,015
0011	National Institute on Aging (0843)	3,888	3,899	4,012
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	632	634	676
0013	National Institute on Deafness and Other Communication Disorder (0890)	497	498	509
0014	National Institute of Mental Health (0892)	2,100	2,106	2,211
0015	National Institute on Drug Abuse (0893)	1,476	1,480	1,843
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	553	555	567
0017	National Institute of Nursing Research (0889)	174	175	199
0018	National Human Genome Research Institute (0891)	614	616	629
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	523	429	419
0021	National Center for Complementary and Integrative Health (0896)	154	154	183
0022	National Institute on Minority Health and Health Disparities (0897)	389	391	660
0023	John E. Fogarty International Center (0819)	84	84	96
0024	National Library of Medicine (0807)	463	465	472
0025	NIH Office of the Director (0846)	2,695	2,479	2,310
0026	NIH Buildings and facilities (0838)	180	200	300
0027	NIH Cooperative Research and Development Agreements	47	82	82
0028	National Center for Advancing Translational Sciences (0875)	866	858	874
0029	Advanced Research Projects Agency for Health			5,000
0031	Type 1 Diabetes	104	433	141

0799	Total direct obligations	42,334	42,776	48,844
0801	NIH Reimbursable - Other	5,229	5,400	5,555
0802	NIH Royalties	100	96	96

0809	Reimbursable program activities, subtotal	5,329	5,496	5,651

0899	Total reimbursable obligations	5,329	5,496	5,651

0900	Total new obligations, unexpired accounts	47,663	48,272	54,495

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,304	2,131	975
1001	Discretionary unobligated balance brought fwd, Oct 1	2,948
1010	Unobligated balance transfer to other accts [075–0140]	–773
1021	Recoveries of prior year unpaid obligations	193
1033	Recoveries of prior year paid obligations	4

1070	Unobligated balance (total)	2,728	2,131	975
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	42,352	41,103	47,947
1120	Appropriations transferred to other acct [075–1503]	–1,186
1120	Appropriations transferred to other acct [075–0128]	–5	–5	–5
1121	Appropriations transferred from other acct [075–5628]	295	295	666
1121	Appropriations transferred from other acct [075–5736]	13	4	13

1160	Appropriation, discretionary (total)	41,469	41,397	48,621
	Appropriations, mandatory:
1200	Appropriation	150	150	150
1201	Appropriation (special or trust fund)	54	82	82
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–9	–9

1260	Appropriations, mandatory (total)	204	223	223
	Spending authority from offsetting collections, discretionary:
1700	Collected	4,996	5,496	5,651
1701	Change in uncollected payments, Federal sources	401

1750	Spending auth from offsetting collections, disc (total)	5,397	5,496	5,651
	Spending authority from offsetting collections, mandatory:
1800	Collected	2
1900	Budget authority (total)	47,072	47,116	54,495
1930	Total budgetary resources available	49,800	49,247	55,470
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	2,131	975	975

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	46,468	49,673	51,475
3010	New obligations, unexpired accounts	47,663	48,272	54,495
3011	Obligations ("upward adjustments"), expired accounts	478
3020	Outlays (gross)	–43,880	–46,470	–47,826
3040	Recoveries of prior year unpaid obligations, unexpired	–193
3041	Recoveries of prior year unpaid obligations, expired	–863

3050	Unpaid obligations, end of year	49,673	51,475	58,144
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–969	–796	–796
3070	Change in uncollected pymts, Fed sources, unexpired	–401
3071	Change in uncollected pymts, Fed sources, expired	574

3090	Uncollected pymts, Fed sources, end of year	–796	–796	–796
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	45,499	48,877	50,679
3200	Obligated balance, end of year	48,877	50,679	57,348

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	46,866	46,893	54,272
	Outlays, gross:
4010	Outlays from new discretionary authority	13,060	11,919	12,801
4011	Outlays from discretionary balances	30,664	34,373	34,795

4020	Outlays, gross (total)	43,724	46,292	47,596
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–5,359	–5,496	–5,651
4033	Non-Federal sources	–223

4040	Offsets against gross budget authority and outlays (total)	–5,582	–5,496	–5,651
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–401
4052	Offsetting collections credited to expired accounts	582
4053	Recoveries of prior year paid obligations, unexpired accounts	4

4060	Additional offsets against budget authority only (total)	185

4070	Budget authority, net (discretionary)	41,469	41,397	48,621
4080	Outlays, net (discretionary)	38,142	40,796	41,945
	Mandatory:
4090	Budget authority, gross	206	223	223
	Outlays, gross:
4100	Outlays from new mandatory authority	13	25	25
4101	Outlays from mandatory balances	143	153	205

4110	Outlays, gross (total)	156	178	230
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–2
4180	Budget authority, net (total)	41,673	41,620	48,844
4190	Outlays, net (total)	38,296	40,974	42,175


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	41,673	41,620	48,844
	Outlays	38,296	40,974	42,175
Legislative proposal, subject to PAYGO:
	Budget Authority			12,050
	Outlays			362
Total:
	Budget Authority	41,673	41,620	60,894
	Outlays	38,296	40,974	42,537

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 2023 Budget continues to fund a new Advanced Research Projects Agency for Health within the National Institutes of Health, as first proposed in the FY 2022 Budget. 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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	1,144	1,222	1,313
11.3	Other than full-time permanent	587	616	651
11.5	Other personnel compensation	71	75	78
11.7	Military personnel	13	14	15
11.8	Special personal services payments	221	229	239

11.9	Total personnel compensation	2,036	2,156	2,296
12.1	Civilian personnel benefits	656	726	772
12.2	Military personnel benefits	11	12	13
21.0	Travel and transportation of persons	8	10	11
22.0	Transportation of things	8	9	8
23.1	Rental payments to GSA	31	32	30
23.3	Communications, utilities, and miscellaneous charges	12	12	12
25.1	Advisory and assistance services	1,425	1,407	1,445
25.2	Other services from non-Federal sources	1,880	1,560	1,586
25.3	Other goods and services from Federal sources	3,024	3,082	3,140
25.4	Operation and maintenance of facilities	49	235	46
25.5	Research and development contracts	1,695	1,659	1,652
25.6	Medical care	43	45	44
25.7	Operation and maintenance of equipment	176	176	181
26.0	Supplies and materials	273	295	267
31.0	Equipment	176	239	235
32.0	Land and structures	160	149	218
41.0	Grants, subsidies, and contributions	30,671	30,972	36,888

99.0	Direct obligations	42,334	42,776	48,844
99.0	Reimbursable obligations	5,329	5,496	5,651

99.9	Total new obligations, unexpired accounts	47,663	48,272	54,495


Identification code 075–9915–0–1–552		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	13,617	14,669	15,181
1101	Direct military average strength employment	132	134	136
2001	Reimbursable civilian full-time equivalent employment	4,574	4,782	4,895
2101	Reimbursable military average strength employment	85	90	90


Identification code 075–9915–4–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Prepare for pandemic and biological threats			12,050

0900	Total new obligations, unexpired accounts (object class 25.5)			12,050

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			12,050
1930	Total budgetary resources available			12,050

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			12,050
3020	Outlays (gross)			–362

3050	Unpaid obligations, end of year			11,688
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			11,688

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			12,050
	Outlays, gross:
4100	Outlays from new mandatory authority			362
4180	Budget authority, net (total)			12,050
4190	Outlays, net (total)			362

The 2023 Budget includes mandatory funding to support research and development of vaccines, diagnostics, and therapeutics against high priority viral families, biosafety and biosecurity, and expanded laboratory capacity and clinical trial infrastructure as part of investments across HHS to ensure national readiness for potential future pandemic threats.


Identification code 075–0147–0–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Payment to NIH Innovation (object class 94.0)	404	496	1,085

0900	Total new obligations, unexpired accounts (object class 94.0)	404	496	1,085

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	404	496	1,085
1930	Total budgetary resources available	404	496	1,085

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	404	496	1,085
3020	Outlays (gross)	–404	–496	–1,085

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	404	496	1,085
	Outlays, gross:
4100	Outlays from new mandatory authority	404	496	1,085
4180	Budget authority, net (total)	404	496	1,085
4190	Outlays, net (total)	404	496	1,085

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, $1,085,000,000, 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		2021 actual	2022 est.	2023 est.

0100	Balance, start of year			92
	Receipts:
	Current law:
1140	General Fund Payment, NIH Innovation, CURES Act	404	496	1,085

2000	Total: Balances and receipts	404	496	1,177
	Appropriations:
	Current law:
2101	NIH Innovation, Cures Act	–404	–404	–1,085

5099	Balance, end of year		92	92


Identification code 075–5628–0–2–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	CURES obligations	96	185	419

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	63	76
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	404	404	1,085
1120	Appropriations transferred to other acct [075–9915]	–295	–295	–666

1160	Appropriation, discretionary (total)	109	109	419
1930	Total budgetary resources available	172	185	419
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	76

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	246	174	219
3010	New obligations, unexpired accounts	96	185	419
3020	Outlays (gross)	–168	–140	–203

3050	Unpaid obligations, end of year	174	219	435
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	246	174	219
3200	Obligated balance, end of year	174	219	435

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	109	109	419
	Outlays, gross:
4010	Outlays from new discretionary authority		19	76
4011	Outlays from discretionary balances	168	121	127

4020	Outlays, gross (total)	168	140	203
4180	Budget authority, net (total)	109	109	419
4190	Outlays, net (total)	168	140	203

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.1	Advisory and assistance services	2	2
25.3	Other goods and services from Federal sources	6	4	7
25.5	Research and development contracts			15
41.0	Grants, subsidies, and contributions	88	179	397

99.9	Total new obligations, unexpired accounts	96	185	419


Identification code 075–5736–0–2–552		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	17	4
	Receipts:
	Current law:
1140	Transfers from Presidential Election Campaign Fund			21

2000	Total: Balances and receipts	17	4	21
	Appropriations:
	Current law:
2101	10-Year Pediatric Research Initiative Fund	–13	–4	–13

5099	Balance, end of year	4		8


Identification code 075–5736–0–2–552		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	13	4	13
1120	Appropriations transferred to other accts [075–9915]	–13	–4	–13
4180	Budget authority, net (total)
4190	Outlays, net (total)

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

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, $4,182,687,000: 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, not less than 10 percent shall be used 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 2023: Provided further, That $552,500,000 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). Provided further, That notwithstanding sections 1911(b) and 1912 of the PHS Act, amounts made available under this heading for subpart I of part B of title XIX of such Act shall also be available to support evidence-based programs that address early intervention and prevention of mental disorders among at-risk children and adults: Provided further, That States shall expend at least 10 percent of the amount each receives for carrying out section 1911 of the PHS Act to support evidence-based programs that address early intervention and prevention of mental disorders for at-risk youth and adults: Provided further, That notwithstanding section 1912 of the PHS Act, the plan described in such section and section 1911(b) of the PHS Act shall also include the evidence-based programs described in the previous proviso pursuant to plan criteria established by the Secretary.

For carrying out titles III and V of the PHS Act with respect to substance use treatment and title XIX of such Act with respect to substance use treatment and prevention, and the SUPPORT for Patients and Communities Act, $5,493,243,000: Provided, That $2,000,000,000 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 use 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 use 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 use treatment programs: Provided further, That for purposes of calculating the HIV set-aside under subpart II of part B of title XIX, the rate of cases of HIV shall be used instead of the rate of cases of AIDS: 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 use prevention, $311,912,000.

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance Use Services", and "Substance Use Prevention Services" 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 Use and Mental Health Services Administration, $149,645,000: 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 use 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 Use Services", and "Substance Use Prevention Services".


Identification code 075–1362–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0006	Mental Health	3,274	1,870	4,183
0007	Substance Use Services	5,190	3,774	5,493
0008	Substance Use Prevention	208	208	312
0009	Health Surveillance and Program Support	4,384	129	150
0011	SAMHSA Prevention Fund	12	12	12

0100	Total, direct program	13,068	5,993	10,150

0799	Total direct obligations	13,068	5,993	10,150
0802	SAMHSA Reimbursables	189	269	269
0810	SAMHSA Reimbursable: PHS Evaluation	129	134	134

0899	Total reimbursable obligations	318	403	403

0900	Total new obligations, unexpired accounts	13,386	6,396	10,553

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6	655	630
1021	Recoveries of prior year unpaid obligations	59

1070	Unobligated balance (total)	65	655	630
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	10,120	5,948	10,137
1120	Appropriations transferred to other acct [075–1503]	–18
1121	Appropriations transferred from other acct [075–0116]		12

1160	Appropriation, discretionary (total)	10,102	5,960	10,137
	Appropriations, mandatory:
1200	Appropriation [COVID]	3,560
1221	Appropriations transferred from the Prevention and Public Health Fund [075–0116]	12		12

1260	Appropriations, mandatory (total)	3,572		12
	Spending authority from offsetting collections, discretionary:
1700	Collected	36	411	177
1701	Change in uncollected payments, Federal sources	283

1750	Spending auth from offsetting collections, disc (total)	319	411	177
1900	Budget authority (total)	13,993	6,371	10,326
1930	Total budgetary resources available	14,058	7,026	10,956
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–17
1941	Unexpired unobligated balance, end of year	655	630	403

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	8,568	15,527	13,262
3010	New obligations, unexpired accounts	13,386	6,396	10,553
3011	Obligations ("upward adjustments"), expired accounts	29
3020	Outlays (gross)	–6,087	–8,661	–10,509
3040	Recoveries of prior year unpaid obligations, unexpired	–59
3041	Recoveries of prior year unpaid obligations, expired	–310

3050	Unpaid obligations, end of year	15,527	13,262	13,306
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–449	–556	–556
3070	Change in uncollected pymts, Fed sources, unexpired	–283
3071	Change in uncollected pymts, Fed sources, expired	176

3090	Uncollected pymts, Fed sources, end of year	–556	–556	–556
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8,119	14,971	12,706
3200	Obligated balance, end of year	14,971	12,706	12,750

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	10,421	6,371	10,314
	Outlays, gross:
4010	Outlays from new discretionary authority	1,165	1,956	3,186
4011	Outlays from discretionary balances	4,906	5,979	6,606

4020	Outlays, gross (total)	6,071	7,935	9,792
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–169	–409	–175
4033	Non-Federal sources	–8	–2	–2

4040	Offsets against gross budget authority and outlays (total)	–177	–411	–177
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–283
4052	Offsetting collections credited to expired accounts	141

4060	Additional offsets against budget authority only (total)	–142

4070	Budget authority, net (discretionary)	10,102	5,960	10,137
4080	Outlays, net (discretionary)	5,894	7,524	9,615
	Mandatory:
4090	Budget authority, gross	3,572		12
	Outlays, gross:
4100	Outlays from new mandatory authority	4		4
4101	Outlays from mandatory balances	12	726	713

4110	Outlays, gross (total)	16	726	717
4180	Budget authority, net (total)	13,674	5,960	10,149
4190	Outlays, net (total)	5,910	8,250	10,332


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	13,674	5,960	10,149
	Outlays	5,910	8,250	10,332
Legislative proposal, subject to PAYGO:
	Budget Authority			413
	Outlays			124
Total:
	Budget Authority	13,674	5,960	10,562
	Outlays	5,910	8,250	10,456

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 use disorders 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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	48	48	50
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	4	4

11.9	Total personnel compensation	54	55	57
12.1	Civilian personnel benefits	15	16	17
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	5	5	7
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	36	37	38
25.2	Other services from non-Federal sources	84	94	193
25.3	Other goods and services from Federal sources	24	25	33
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	12,843	5,754	9,798

99.0	Direct obligations	13,068	5,993	10,150
99.0	Reimbursable obligations	318	403	403

99.9	Total new obligations, unexpired accounts	13,386	6,396	10,553


Identification code 075–1362–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	400	462	568
1101	Direct military average strength employment	29	30	31
2001	Reimbursable civilian full-time equivalent employment	40	148	117
2101	Reimbursable military average strength employment	3	10	9


Identification code 075–1362–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0006	Mental Health			413

0100	Total, direct program			413

0900	Total new obligations, unexpired accounts (object class 41.0)			413

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation [CHMC]			413
1930	Total budgetary resources available			413

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			413
3020	Outlays (gross)			–124

3050	Unpaid obligations, end of year			289
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			289

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			413
	Outlays, gross:
4100	Outlays from new mandatory authority			124
4180	Budget authority, net (total)			413
4190	Outlays, net (total)			124

The Community Mental Health Centers will expand access and improve the quality of services available to people with serious mental illness (SMI) and serious emotional disorders (SED).

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, $376,091,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2023: Provided further, That, in addition to amounts provided herein, $39,800,000 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, 2024.


Identification code 075–1700–0–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Research on Health Costs, Quality and Outcomes	193	195	229
0002	Medical Expenditure Panel Survey	72	72	72
0003	AHRQ Program Support	71	71	75

0799	Total direct obligations	336	338	376
0803	Research on Health Costs, Quality and Outcomes (Reimbursable)	21	31	60
0805	AHRQ Program Support (Reimbursable)		2	1

0899	Total reimbursable obligations	21	33	61

0900	Total new obligations, unexpired accounts	357	371	437

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	15	17	2
1001	Discretionary unobligated balance brought fwd, Oct 1	6
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	338	338	376
1120	Appropriations transferred to other acct [075–1503]	–1

1160	Appropriation, discretionary (total)	337	338	376
	Spending authority from offsetting collections, discretionary:
1700	Collected	1	1	1
1701	Change in uncollected payments, Federal sources	13	17	60

1750	Spending auth from offsetting collections, disc (total)	14	18	61
	Spending authority from offsetting collections, mandatory:
1800	Collected	8
1900	Budget authority (total)	359	356	437
1930	Total budgetary resources available	374	373	439
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	17	2	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	339	335	353
3010	New obligations, unexpired accounts	357	371	437
3020	Outlays (gross)	–355	–353	–419
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	335	353	371
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–28	–24	–25
3070	Change in uncollected pymts, Fed sources, unexpired	–13	–17	–60
3071	Change in uncollected pymts, Fed sources, expired	17	16	16

3090	Uncollected pymts, Fed sources, end of year	–24	–25	–69
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	311	311	328
3200	Obligated balance, end of year	311	328	302

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	351	356	437
	Outlays, gross:
4010	Outlays from new discretionary authority	136	136	193
4011	Outlays from discretionary balances	213	217	226

4020	Outlays, gross (total)	349	353	419
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–18	–17	–60
4030	Federal sources		–1	–1

4040	Offsets against gross budget authority and outlays (total)	–18	–18	–61
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–13	–17	–60
4052	Offsetting collections credited to expired accounts	17	17	60

4060	Additional offsets against budget authority only (total)	4

4070	Budget authority, net (discretionary)	337	338	376
4080	Outlays, net (discretionary)	331	335	358
	Mandatory:
4090	Budget authority, gross	8
	Outlays, gross:
4101	Outlays from mandatory balances	6
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8
4180	Budget authority, net (total)	337	338	376
4190	Outlays, net (total)	329	335	358

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	33	34	36
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	1	1	2
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	39	40	43
12.1	Civilian personnel benefits	13	13	14
23.1	Rental payments to GSA	3	3	3
25.2	Other services from non-Federal sources	9	9	9
25.3	Other goods and services from Federal sources	23	23	18
25.5	Research and development contracts	132	132	124
41.0	Grants, subsidies, and contributions	117	118	165

99.0	Direct obligations	336	338	376
99.0	Reimbursable obligations	21	33	61

99.9	Total new obligations, unexpired accounts	357	371	437


Identification code 075–1700–0–1–552		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	257	257	264
1101	Direct military average strength employment	5	5	5
2001	Reimbursable civilian full-time equivalent employment	2	2	2
3001	Allocation account civilian full-time equivalent employment	6	6	24

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $367,357,090,000, to remain available until expended.

In addition, for carrying out such titles after May 31, 2023, for the last quarter of fiscal year 2023 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 2024, $197,580,474,000, 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments	531,284	584,922	555,251
0002	State and local administration	24,509	22,954	23,649
0003	Vaccines for Children	3,806	5,555	5,609

0799	Total direct obligations	559,599	613,431	584,509

0900	Total new obligations, unexpired accounts (object class 41.0)	559,599	613,431	584,509

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	311	418
1021	Recoveries of prior year unpaid obligations	27,081	52,757	49,991
1033	Recoveries of prior year paid obligations	11,781

1070	Unobligated balance (total)	39,173	53,175	49,991
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	379,581	409,923	367,357
	Advance appropriations, mandatory:
1270	Advance appropriation	139,903	148,732	165,722
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,126	1,601	1,439
1801	Change in uncollected payments, Federal sources	234

1850	Spending auth from offsetting collections, mand (total)	1,360	1,601	1,439
1900	Budget authority (total)	520,844	560,256	534,518
1930	Total budgetary resources available	560,017	613,431	584,509
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	418

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	72,293	71,316	68,551
3010	New obligations, unexpired accounts	559,599	613,431	584,509
3020	Outlays (gross)	–533,495	–563,439	–537,216
3040	Recoveries of prior year unpaid obligations, unexpired	–27,081	–52,757	–49,991

3050	Unpaid obligations, end of year	71,316	68,551	65,853
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,084	–1,318	–1,318
3070	Change in uncollected pymts, Fed sources, unexpired	–234

3090	Uncollected pymts, Fed sources, end of year	–1,318	–1,318	–1,318
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	71,209	69,998	67,233
3200	Obligated balance, end of year	69,998	67,233	64,535

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	520,844	560,256	534,518
	Outlays, gross:
4100	Outlays from new mandatory authority	504,507	545,879	534,518
4101	Outlays from mandatory balances	28,988	17,560	2,698

4110	Outlays, gross (total)	533,495	563,439	537,216
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,126	–1,601	–1,439
4123	Non-Federal sources	–11,781

4130	Offsets against gross budget authority and outlays (total)	–12,907	–1,601	–1,439
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–234
4143	Recoveries of prior year paid obligations, unexpired accounts	11,781

4150	Additional offsets against budget authority only (total)	11,547

4160	Budget authority, net (mandatory)	519,484	558,655	533,079
4170	Outlays, net (mandatory)	520,588	561,838	535,777
4180	Budget authority, net (total)	519,484	558,655	533,079
4190	Outlays, net (total)	520,588	561,838	535,777


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	519,484	558,655	533,079
	Outlays	520,588	561,838	535,777
Legislative proposal, not subject to PAYGO:
	Budget Authority			–18
	Outlays			–18
Legislative proposal, subject to PAYGO:
	Budget Authority			134
	Outlays			134
Total:
	Budget Authority	519,484	558,655	533,195
	Outlays	520,588	561,838	535,893

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	2021	2022	2023

Vaccine Purchase	3,570	5,292	5,267
Vaccine Stockpile	10	11	99
Ordering, Distribution, and Operations	226	252	242

Total Obligations	3,806	5,555	5,608


Identification code 075–0512–2–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments			–18

0799	Total direct obligations			–18

0900	Total new obligations, unexpired accounts (object class 41.0)			–18

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–18
1900	Budget authority (total)			–18
1930	Total budgetary resources available			–18

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–18
3020	Outlays (gross)			18

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–18
	Outlays, gross:
4100	Outlays from new mandatory authority			–18
4180	Budget authority, net (total)			–18
4190	Outlays, net (total)			–18

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicaid Vendor Payments			134

0799	Total direct obligations			134

0900	Total new obligations, unexpired accounts (object class 41.0)			134

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			134
1900	Budget authority (total)			134
1930	Total budgetary resources available			134

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			134
3020	Outlays (gross)			–134

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			134
	Outlays, gross:
4100	Outlays from new mandatory authority			134
4180	Budget authority, net (total)			134
4190	Outlays, net (total)			134


Identification code 075–0516–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0012	Medicaid integrity program	76	107	115
0018	Money follows the person (MFP) demonstration	414	765	819
0019	MFP evaluations and technical support	2	2	2
0023	Grants to improve outreach and enrollment	20	52	9
0028	Demo to increase substance use provider under the Medicaid Program	1	1
0029	Community-based mobile crisis intervention services	15

0799	Total direct obligations	528	927	945

0900	Total new obligations, unexpired accounts	528	927	945

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	798	788	665
1012	Unobligated balance transfers between expired and unexpired accounts	268	292
1021	Recoveries of prior year unpaid obligations	16

1070	Unobligated balance (total)	1,082	1,080	665
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	531	543	547
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–5	–31	–32

1260	Appropriations, mandatory (total)	526	512	515
1900	Budget authority (total)	526	512	515
1930	Total budgetary resources available	1,608	1,592	1,180
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–292
1941	Unexpired unobligated balance, end of year	788	665	235

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	418	531	1,094
3010	New obligations, unexpired accounts	528	927	945
3020	Outlays (gross)	–359	–364	–531
3040	Recoveries of prior year unpaid obligations, unexpired	–16
3041	Recoveries of prior year unpaid obligations, expired	–40

3050	Unpaid obligations, end of year	531	1,094	1,508
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	418	531	1,094
3200	Obligated balance, end of year	531	1,094	1,508

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	526	512	515
	Outlays, gross:
4100	Outlays from new mandatory authority	32	42	51
4101	Outlays from mandatory balances	327	322	480

4110	Outlays, gross (total)	359	364	531
4180	Budget authority, net (total)	526	512	515
4190	Outlays, net (total)	359	364	531


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	526	512	515
	Outlays	359	364	531
Legislative proposal, subject to PAYGO:
	Budget Authority			545
	Outlays			545
Total:
	Budget Authority	526	512	1,060
	Outlays	359	364	1,076

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		2021 actual	2022 est.	2023 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent - Medicaid Integrity Program	35	39	39

11.9	Total personnel compensation	35	39	39
12.1	Civilian personnel benefits - Medicaid Integrity Program	9	9	9
41.0	Grants, subsidies, and contributions - Medicaid Integrity Program	32	59	67
41.0	Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations	414	765	819
41.0	Grants, subsidies, and contributions - MFP evaluations and technical support	2	2	2
41.0	Grants, subsidies, and contributions - Grants to improve outreach and enrollment	20	52	9
41.0	Grants, subsidies, and contributions - Demo to increase substance use provider capacity under Medicaid	1	1
41.0	Grants, subsidies, and contributions - Community-based mobile crisis intervention services	15

99.0	Direct obligations	528	927	945

99.9	Total new obligations, unexpired accounts	528	927	945


Identification code 075–0516–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	218	240	240
1101	Direct military average strength employment	6	6	6


Identification code 075–0516–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0027	Demonstration Programs to Improve Mental Health Services			45
0030	Establish performance bonus fund to improve behavioral health in Medicaid			500

0799	Total direct obligations			545

0900	Total new obligations, unexpired accounts			545

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			545
1900	Budget authority (total)			545
1930	Total budgetary resources available			545

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			545
3020	Outlays (gross)			–545

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			545
	Outlays, gross:
4100	Outlays from new mandatory authority			545
4180	Budget authority, net (total)			545
4190	Outlays, net (total)			545

This schedule reflects the Administration's State Grants and Demonstrations proposals.


Identification code 075–0516–4–1–551		2021 actual	2022 est.	2023 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions - Demos to Improve Mental Health			45
41.0	Grants, subsidies, and contributions - Establish performance bonus fund to improve behavioral health in Medicaid			500

99.0	Direct obligations			545

99.9	Total new obligations, unexpired accounts			545

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, $548,130,000,000.

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	335,479	384,646	434,348
0002	Part D benefits (Rx Drug)	96,290	100,969	111,800
0003	Part D Federal administration (Rx Drug)	882	882	600
0004	General Fund Transfers to HI	1,327	1,360	1,376
0006	Federal Bureau of Investigation (HCFAC)	148	153	157
0007	Federal payments from taxation of OASDI benefits (HI)	24,975	32,439	35,072
0008	Criminal fines (HCFAC)	68	34	21
0009	Civil penalties and damages (HCFAC—DOJ and CMS administration)	15	53	54
0010	Asset Forfeiture	135	33	34
0011	State Low Income Determinations	5	5	5

0900	Total new obligations, unexpired accounts	459,324	520,574	583,467

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	439,514	487,862	548,129
1200	Appropriation (indefinite, annual)	13,514
1200	Appropriation (permanent, Taxation of OASDI)	24,975	32,439	35,072
1200	Appropriation (permanent, annual, HCFAC - FBI)	148	153	157
1200	Appropriation (permanent, HCFAC)	218	120	109
1200	Appropriation (definite, annual, CAA Section 101)	3,000

1260	Appropriations, mandatory (total)	481,369	520,574	583,467
1930	Total budgetary resources available	481,369	520,574	583,467
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–22,045

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	16,873	16,385	72,968
3010	New obligations, unexpired accounts	459,324	520,574	583,467
3020	Outlays (gross)	–444,202	–463,991	–506,496
3041	Recoveries of prior year unpaid obligations, expired	–15,610

3050	Unpaid obligations, end of year	16,385	72,968	149,939
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	16,873	16,385	72,968
3200	Obligated balance, end of year	16,385	72,968	149,939

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	481,369	520,574	583,467
	Outlays, gross:
4100	Outlays from new mandatory authority	443,922	447,606	478,338
4101	Outlays from mandatory balances	280	16,385	28,158

4110	Outlays, gross (total)	444,202	463,991	506,496
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–22
4123	Non-Federal sources	–4,507

4130	Offsets against gross budget authority and outlays (total)	–4,529
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	4,529

4160	Budget authority, net (mandatory)	481,369	520,574	583,467
4170	Outlays, net (mandatory)	439,673	463,991	506,496
4180	Budget authority, net (total)	481,369	520,574	583,467
4190	Outlays, net (total)	439,673	463,991	506,496

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	361,506	519,214	582,091
42.0	Insurance claims and indemnities (HI Uninsured Federal)	95	82	52
94.0	Financial transfers (Federal admin)	97,723	1,278	1,324

99.9	Total new obligations, unexpired accounts	459,324	520,574	583,467


Identification code 075–0519–0–1–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	QIO Clinical Quality Improvement		144	90
0003	QIO Support Contracts	422	453	475
0004	QIO Administration	69	75	76
0005	American Rescue Plan Act - SNF Infection Control Support		200

0900	Total new obligations, unexpired accounts	491	872	641

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		200
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	200
	Spending authority from offsetting collections, mandatory:
1800	Collected	172	311	174
1801	Change in uncollected payments, Federal sources	469	361	467

1850	Spending auth from offsetting collections, mand (total)	641	672	641
1900	Budget authority (total)	841	672	641
1930	Total budgetary resources available	841	872	641
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–150
1941	Unexpired unobligated balance, end of year	200

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,105	928	928
3010	New obligations, unexpired accounts	491	872	641
3011	Obligations ("upward adjustments"), expired accounts	69
3020	Outlays (gross)	–645	–872	–641
3041	Recoveries of prior year unpaid obligations, expired	–92

3050	Unpaid obligations, end of year	928	928	928
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2,005	–1,887	–2,248
3070	Change in uncollected pymts, Fed sources, unexpired	–469	–361	–467
3071	Change in uncollected pymts, Fed sources, expired	587

3090	Uncollected pymts, Fed sources, end of year	–1,887	–2,248	–2,715
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–900	–959	–1,320
3200	Obligated balance, end of year	–959	–1,320	–1,787

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	841	672	641
	Outlays, gross:
4100	Outlays from new mandatory authority	176	203	247
4101	Outlays from mandatory balances	469	669	394

4110	Outlays, gross (total)	645	872	641
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–642	–672	–641
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–469	–361	–467
4142	Offsetting collections credited to expired accounts	470	361	467

4150	Additional offsets against budget authority only (total)	1

4160	Budget authority, net (mandatory)	200
4170	Outlays, net (mandatory)	3	200
4180	Budget authority, net (total)	200
4190	Outlays, net (total)	3	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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	33	39	39
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	35	41	41
12.1	Civilian personnel benefits	12	12	12
23.1	Rental payments to GSA	4	4	4
25.2	Other services from non-Federal sources	418	762	562
25.3	Other goods and services from Federal sources	13	33	13
25.4	Operation and maintenance of facilities	9	20	9

99.9	Total new obligations, unexpired accounts	491	872	641


Identification code 075–0519–0–1–571		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	264	253	262
1101	Direct military average strength employment	6	6	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 $4,346,985,000, 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 2023 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, $494,261,000 shall remain available until September 30, 2024, and shall be available for the Survey and Certification Program.


Identification code 075–0511–0–1–550		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Program operations	2,772	2,785	2,957
0002	Federal administration	769	773	896
0003	State survey and certification	426	397	494
0004	Research, demonstrations, and evaluation projects	20	20
0007	ARRA Medicare/Medicaid HIT	19	22	19
0009	Other Mandatory Program Activity	106	101	88

0100	Total direct program	4,112	4,098	4,454

0799	Total direct obligations	4,112	4,098	4,454
0801	Clinical laboratory improvement amendments	72	78	78
0802	Sale of data	27	20	20
0803	Coordination of benefits	43	38	40
0804	Medicare advantage/Prescription drug plan	96	96	109
0805	Provider enrollment	27	73	74
0806	Recovery audit contractors	133	204	204
0808	Marketplace User Fees	1,729	1,879	1,723
0810	Risk Adjustment Administrative Expenses	47	53	51
0813	Other reimbursable program activity	37	56	59

0899	Total reimbursable obligations	2,211	2,497	2,358

0900	Total new obligations, unexpired accounts	6,323	6,595	6,812

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,214	4,639	4,690
1001	Discretionary unobligated balance brought fwd, Oct 1	182
1020	Adjustment of unobligated bal brought forward, Oct 1	651
1021	Recoveries of prior year unpaid obligations	67

1070	Unobligated balance (total)	3,932	4,639	4,690
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (General Fund Total)	503	3	3
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,768	4,055	4,428
1701	Change in uncollected payments, Federal sources	2,279
1710	Spending authority from offsetting collections transferred to other accounts [075–1503]	–12

1750	Spending auth from offsetting collections, disc (total)	4,035	4,055	4,428
	Spending authority from offsetting collections, mandatory:
1800	Collected	2,584	2,620	2,465
1801	Change in uncollected payments, Federal sources	–45
1802	Offsetting collections (previously unavailable)	95	96	99
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced	–97	–128	–146

1850	Spending auth from offsetting collections, mand (total)	2,537	2,588	2,418
1900	Budget authority (total)	7,075	6,646	6,849
1930	Total budgetary resources available	11,007	11,285	11,539
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–45
1941	Unexpired unobligated balance, end of year	4,639	4,690	4,727

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,717	4,893	4,408
3010	New obligations, unexpired accounts	6,323	6,595	6,812
3011	Obligations ("upward adjustments"), expired accounts	31
3020	Outlays (gross)	–5,927	–7,080	–6,820
3040	Recoveries of prior year unpaid obligations, unexpired	–67
3041	Recoveries of prior year unpaid obligations, expired	–184

3050	Unpaid obligations, end of year	4,893	4,408	4,400
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–4,810	–5,465	–5,465
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	–651
3070	Change in uncollected pymts, Fed sources, unexpired	–2,234
3071	Change in uncollected pymts, Fed sources, expired	2,230

3090	Uncollected pymts, Fed sources, end of year	–5,465	–5,465	–5,465
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–744	–572	–1,057
3200	Obligated balance, end of year	–572	–1,057	–1,065

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,035	4,055	4,428
	Outlays, gross:
4010	Outlays from new discretionary authority	1,663	2,068	2,255
4011	Outlays from discretionary balances	2,186	2,198	2,065

4020	Outlays, gross (total)	3,849	4,266	4,320
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,738	–3,975	–4,346
4033	Non-Federal sources	–38	–80	–82

4040	Offsets against gross budget authority and outlays (total)	–3,776	–4,055	–4,428
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2,279
4052	Offsetting collections credited to expired accounts	2,008

4060	Additional offsets against budget authority only (total)	–271

4070	Budget authority, net (discretionary)	–12
4080	Outlays, net (discretionary)	73	211	–108
	Mandatory:
4090	Budget authority, gross	3,040	2,591	2,421
	Outlays, gross:
4100	Outlays from new mandatory authority	24	1,270	1,174
4101	Outlays from mandatory balances	2,054	1,544	1,326

4110	Outlays, gross (total)	2,078	2,814	2,500
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–738	–63	–68
4123	Non-Federal sources	–1,850	–2,557	–2,397

4130	Offsets against gross budget authority and outlays (total)	–2,588	–2,620	–2,465
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	45
4142	Offsetting collections credited to expired accounts	4

4150	Additional offsets against budget authority only (total)	49

4160	Budget authority, net (mandatory)	501	–29	–44
4170	Outlays, net (mandatory)	–510	194	35
4180	Budget authority, net (total)	489	–29	–44
4190	Outlays, net (total)	–437	405	–73

	Memorandum (non-add) entries:
5090	Unexpired unavailable balance, SOY: Offsetting collections	224	219	251
5091	Expiring unavailable balance: Offsetting collections	–7
5092	Unexpired unavailable balance, EOY: Offsetting collections	219	251	298
5093	Expired unavailable balance, SOY: Offsetting collections	115	122	122
5095	Expired unavailable balance, EOY: Offsetting collections	115	122	122


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	489	–29	–44
	Outlays	–437	405	–73
Legislative proposal, subject to PAYGO:
	Budget Authority			300
	Outlays			50
Total:
	Budget Authority	489	–29	256
	Outlays	–437	405	–23

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	409	408	443
11.3	Other than full-time permanent	11	11	12
11.5	Other personnel compensation	9	9	10
11.7	Military personnel	14	14	15

11.9	Total personnel compensation	443	442	480
12.1	Civilian personnel benefits	186	185	202
12.2	Military personnel benefits	8	8	9
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	4	4	4
23.3	Communications, utilities, and miscellaneous charges	8	8	9
24.0	Printing and reproduction	56	56	61
25.2	Other services from non-Federal sources	2,831	2,820	3,065
25.3	Other goods and services from Federal sources	145	145	157
25.6	Medical care	393	392	426
25.7	Operation and maintenance of equipment	21	21	23
41.0	Grants, subsidies, and contributions	16	16	17

99.0	Direct obligations	4,112	4,098	4,454
99.0	Reimbursable obligations	2,211	2,497	2,358

99.9	Total new obligations, unexpired accounts	6,323	6,595	6,812


Identification code 075–0511–0–1–550		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	4,075	4,106	4,394
1001	Direct civilian full-time equivalent employment	56	35	26
1101	Direct military average strength employment	130	130	125
2001	Reimbursable civilian full-time equivalent employment	460	555	576
2101	Reimbursable military average strength employment	21	21	21


Identification code 075–0511–4–1–550		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Program operations			300

0100	Total direct program			300

0799	Total direct obligations			300

0900	Total new obligations, unexpired accounts (object class 25.2)			300

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (General Fund Total)			300
1900	Budget authority (total)			300
1930	Total budgetary resources available			300

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			300
3020	Outlays (gross)			–50

3050	Unpaid obligations, end of year			250
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			250

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			300
	Outlays, gross:
4100	Outlays from new mandatory authority			50
4180	Budget authority, net (total)			300
4190	Outlays, net (total)			50

This display includes resources to implement HHS's legislative proposals in the FY 2023 Budget.


Identification code 075–0515–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Grants to states and US territories	18,144	19,218	18,686
0002	CHIP Redistribution Funds	1
0003	Child health quality	7	12	16

0900	Total new obligations, unexpired accounts (object class 41.0)	18,152	19,230	18,702

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12,251	10,328	10,998
1011	Unobligated balance transfer from other acct [075–5551]	1
1033	Recoveries of prior year paid obligations	84

1070	Unobligated balance (total)	12,336	10,328	10,998
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced		–2,000
1134	Appropriations precluded from obligation		–4,000	–12,315

1160	Appropriation, discretionary (total)		–6,000	–12,315
	Appropriations, mandatory:
1200	Appropriation	24,800	25,900	25,900
1202	Appropriation (previously unavailable)			4,000
1230	75-X-0515 - Appropriations and/or unobligated balance of appropriations permanently reduced	–2,000
1230	75–21–0515 - Appropriations and/or unobligated balance of appropriations permanently reduced	–1,000

1260	Appropriations, mandatory (total)	21,800	25,900	29,900
1900	Budget authority (total)	21,800	19,900	17,585
1930	Total budgetary resources available	34,136	30,228	28,583
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–5,656
1941	Unexpired unobligated balance, end of year	10,328	10,998	9,881

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,809	8,729	11,346
3010	New obligations, unexpired accounts	18,152	19,230	18,702
3020	Outlays (gross)	–16,177	–16,613	–16,168
3041	Recoveries of prior year unpaid obligations, expired	–55

3050	Unpaid obligations, end of year	8,729	11,346	13,880
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,809	8,729	11,346
3200	Obligated balance, end of year	8,729	11,346	13,880

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–6,000	–12,315
	Mandatory:
4090	Budget authority, gross	21,800	25,900	29,900
	Outlays, gross:
4100	Outlays from new mandatory authority	9,671	7,892	4,417
4101	Outlays from mandatory balances	6,506	8,721	11,751

4110	Outlays, gross (total)	16,177	16,613	16,168
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources:	–84
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	84

4160	Budget authority, net (mandatory)	21,800	25,900	29,900
4170	Outlays, net (mandatory)	16,093	16,613	16,168
4180	Budget authority, net (total)	21,800	19,900	17,585
4190	Outlays, net (total)	16,093	16,613	16,168


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	21,800	19,900	17,585
	Outlays	16,093	16,613	16,168
Legislative proposal, subject to PAYGO:
	Outlays			–230
Total:
	Budget Authority	21,800	19,900	17,585
	Outlays	16,093	16,613	15,938

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 075–0515–4–1–551		2021 actual	2022 est.	2023 est.

	Change in obligated balance:
	Unpaid obligations:
3020	Outlays (gross)			230

3050	Unpaid obligations, end of year			230
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			230

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances			–230
4180	Budget authority, net (total)
4190	Outlays, net (total)			–230


Identification code 075–0522–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Administration	330	390	379
0002	Innovation Activities	370	376	377

0900	Total new obligations, unexpired accounts	700	766	756

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10,460	9,835	9,069
1021	Recoveries of prior year unpaid obligations	75

1070	Unobligated balance (total)	10,535	9,835	9,069
1930	Total budgetary resources available	10,535	9,835	9,069
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9,835	9,069	8,313

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,028	925	743
3010	New obligations, unexpired accounts	700	766	756
3020	Outlays (gross)	–728	–948	–737
3040	Recoveries of prior year unpaid obligations, unexpired	–75

3050	Unpaid obligations, end of year	925	743	762
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,028	925	743
3200	Obligated balance, end of year	925	743	762

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	728	948	737
4180	Budget authority, net (total)
4190	Outlays, net (total)	728	948	737

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	83	101	103
11.3	Other than full-time permanent	2	3	3
11.5	Other personnel compensation	1	1	2
11.7	Military personnel	2	2	2

11.9	Total personnel compensation	88	107	110
12.1	Civilian personnel benefits	22	26	27
12.2	Military personnel benefits	1	1	1
23.1	Rental payments to GSA	2	3	3
25.2	Other services from non-Federal sources	510	538	522
25.3	Other goods and services from Federal sources	6	7	7
25.4	Operation and maintenance of facilities	2	3	3
41.0	Grants, subsidies, and contributions	69	80	82

99.0	Direct obligations	700	765	755
99.5	Adjustment for rounding		1	1

99.9	Total new obligations, unexpired accounts	700	766	756


Identification code 075–0522–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	507	497	497
1101	Direct military average strength employment	16	16	16


Identification code 075–5551–0–2–551		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	6,093	13,999	14,000
	Receipts:
	Current law:
1140	Interest, Child Enrollment Contingency Fund	14	21	29

2000	Total: Balances and receipts	6,107	14,020	14,029
	Appropriations:
	Current law:
2101	Child Enrollment Contingency Fund	–14	–20	–29
2103	Child Enrollment Contingency Fund	–6,093	–14,000	–14,000
2135	Child Enrollment Contingency Fund		14,000	19,860
2135	Child Enrollment Contingency Fund	9,087

2199	Total current law appropriations	2,980	–20	5,831

2999	Total appropriations	2,980	–20	5,831
4030	Child Enrollment Contingency Fund	4,912

5099	Balance, end of year	13,999	14,000	19,860


Identification code 075–5551–0–2–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,913	1,980	7,180
1010	Unobligated balance transfer to other accts [075–0515]	–1
1035	Unobligated balance precluded from obligation (limitation on obligations)(special and trust)	–4,912

1070	Unobligated balance (total)		1,980	7,180
	Budget authority:
	Appropriations, discretionary:
1135	Appropriations precluded from obligation (special or trust)		–14,000	–19,860
	Appropriations, mandatory:
1200	Appropriation	4,960	5,180	1,980
1201	Appropriation (special or trust fund)	14	20	29
1203	Appropriation (previously unavailable)(special or trust)	6,093	14,000	14,000
1235	Appropriations precluded from obligation (special or trust)	–9,087

1260	Appropriations, mandatory (total)	1,980	19,200	16,009
1900	Budget authority (total)	1,980	5,200	–3,851
1930	Total budgetary resources available	1,980	7,180	3,329
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,980	7,180	3,329

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	309	309	309

3050	Unpaid obligations, end of year	309	309	309
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	309	309	309
3200	Obligated balance, end of year	309	309	309

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–14,000	–19,860
	Mandatory:
4090	Budget authority, gross	1,980	19,200	16,009
4180	Budget authority, net (total)	1,980	5,200	–3,851
4190	Outlays, net (total)

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	Incentive payments to hospitals	53	56	5

0900	Total new obligations, unexpired accounts (object class 42.0)	53	56	5

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	59	1	1
1020	Adjustment of unobligated bal brought forward, Oct 1	–59
1021	Recoveries of prior year unpaid obligations	2

1070	Unobligated balance (total)	2	1	1
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected from the HI Trust Fund	49	56	5
1801	Change in uncollected payments, Federal sources	3

1850	Spending auth from offsetting collections, mand (total)	52	56	5
1930	Total budgetary resources available	54	57	6
	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	14	19	19
3010	New obligations, unexpired accounts	53	56	5
3020	Outlays (gross)	–46	–56	–24
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	19	19
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–59	–3	–3
3061	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	59
3070	Change in uncollected pymts, Fed sources, unexpired	–3

3090	Uncollected pymts, Fed sources, end of year	–3	–3	–3
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	14	16	16
3200	Obligated balance, end of year	16	16	–3

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	52	56	5
	Outlays, gross:
4100	Outlays from new mandatory authority	36	37	5
4101	Outlays from mandatory balances	10	19	19

4110	Outlays, gross (total)	46	56	24
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–49	–56	–5
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–3
4170	Outlays, net (mandatory)	–3		19
4180	Budget authority, net (total)
4190	Outlays, net (total)	–3		19


Identification code 075–0112–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Premium rate review grants	20		11

0900	Total new obligations, unexpired accounts (object class 41.0)	20		11

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	8	10	11
1020	Adjustment of unobligated bal brought forward, Oct 1	17
1021	Recoveries of prior year unpaid obligations	5	1

1070	Unobligated balance (total)	30	11	11
1930	Total budgetary resources available	30	11	11
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	10	11

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	9	21	14
3010	New obligations, unexpired accounts	20		11
3020	Outlays (gross)	–3	–6	–5
3040	Recoveries of prior year unpaid obligations, unexpired	–5	–1

3050	Unpaid obligations, end of year	21	14	20
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	9	21	14
3200	Obligated balance, end of year	21	14	20

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3	6	5
4180	Budget authority, net (total)
4190	Outlays, net (total)	3	6	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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Pre-Existing Condition Insurance Plan Program (Direct)	60
0002	Administration		68	14

0799	Total direct obligations	60	68	14

0900	Total new obligations, unexpired accounts (object class 25.2)	60	68	14

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	141	83	15
1021	Recoveries of prior year unpaid obligations	2

1070	Unobligated balance (total)	143	83	15
1930	Total budgetary resources available	143	83	15
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	83	15	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	71	75	93
3010	New obligations, unexpired accounts	60	68	14
3020	Outlays (gross)	–54	–50	–48
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	75	93	59
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	71	75	93
3200	Obligated balance, end of year	75	93	59

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	54	50	48
4180	Budget authority, net (total)
4190	Outlays, net (total)	54	50	48

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		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	32	32	36
1021	Recoveries of prior year unpaid obligations		4

1070	Unobligated balance (total)	32	36	36
1930	Total budgetary resources available	32	36	36
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	32	36	36

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4	4
3040	Recoveries of prior year unpaid obligations, unexpired		–4

3050	Unpaid obligations, end of year	4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4	4
3200	Obligated balance, end of year	4
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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0002	Administration	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		20	10
3010	New obligations, unexpired accounts	20
3020	Outlays (gross)		–10	–10

3050	Unpaid obligations, end of year	20	10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		20	10
3200	Obligated balance, end of year	20	10

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	20
	Outlays, gross:
4101	Outlays from mandatory balances		10	10
4180	Budget authority, net (total)	20
4190	Outlays, net (total)		10	10

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Cost Sharing Reductions		7,877	5,733
0002	Basic Health Program		1,886	1,669

0900	Total new obligations, unexpired accounts (object class 41.0)		9,763	7,402

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		10,353	7,849
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–590	–447

1260	Appropriations, mandatory (total)		9,763	7,402
1900	Budget authority (total)		9,763	7,402
1930	Total budgetary resources available		9,763	7,402

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		9,763	7,402
3020	Outlays (gross)		–9,763	–7,402

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		9,763	7,402
	Outlays, gross:
4100	Outlays from new mandatory authority		9,763	7,402
4180	Budget authority, net (total)		9,763	7,402
4190	Outlays, net (total)		9,763	7,402


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority		9,763	7,402
	Outlays		9,763	7,402
Legislative proposal, subject to PAYGO:
	Budget Authority			9
	Outlays			9
Total:
	Budget Authority		9,763	7,411
	Outlays		9,763	7,411

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 075–0126–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Cost Sharing Reductions			9

0900	Total new obligations, unexpired accounts (object class 41.0)			9

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			10
1230	Appropriations and/or unobligated balance of appropriations permanently reduced			–1

1260	Appropriations, mandatory (total)			9
1930	Total budgetary resources available			9

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			9
3020	Outlays (gross)			–9

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			9
	Outlays, gross:
4100	Outlays from new mandatory authority			9
4180	Budget authority, net (total)			9
4190	Outlays, net (total)			9

The proposals build on existing consumer protections and improve access to behavioral health services by doing the following: requiring coverage of three behavioral health visits and three primary care visits without cost-sharing; limiting utilization management controls for behavioral health; amending MHPAEA to authorize the Secretaries to regulate behavioral health network adequacy for all plans and issuers; and creating a new standard for parity in behavioral health based on comparative analysis of reimbursement rates.


Identification code 075–5733–0–2–551		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	348	393	360
	Receipts:
	Current law:
1110	Receipts, Risk Adjustment Program	6,887	6,311	6,318

2000	Total: Balances and receipts	7,235	6,704	6,678
	Appropriations:
	Current law:
2101	Risk Adjustment Program Payments	–6,887	–6,311	–6,318
2103	Risk Adjustment Program Payments	–348	–393	–360
2132	Risk Adjustment Program Payments	393	360	360

2199	Total current law appropriations	–6,842	–6,344	–6,318

2999	Total appropriations	–6,842	–6,344	–6,318

5099	Balance, end of year	393	360	360


Identification code 075–5733–0–2–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Risk Adjustment Program Payments (Direct)	6,341	6,344	6,318

0900	Total new obligations, unexpired accounts (object class 41.0)	6,341	6,344	6,318

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	410	911	911
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	6,887	6,311	6,318
1203	Appropriation (previously unavailable)(special or trust)	348	393	360
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–393	–360	–360

1260	Appropriations, mandatory (total)	6,842	6,344	6,318
1930	Total budgetary resources available	7,252	7,255	7,229
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	911	911	911

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3,054	2,420
3010	New obligations, unexpired accounts	6,341	6,344	6,318
3020	Outlays (gross)	–6,975	–8,764	–6,318

3050	Unpaid obligations, end of year	2,420
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3,054	2,420
3200	Obligated balance, end of year	2,420

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	6,842	6,344	6,318
	Outlays, gross:
4100	Outlays from new mandatory authority	3,511	6,344	6,318
4101	Outlays from mandatory balances	3,464	2,420

4110	Outlays, gross (total)	6,975	8,764	6,318
4180	Budget authority, net (total)	6,842	6,344	6,318
4190	Outlays, net (total)	6,975	8,764	6,318

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		2021 actual	2022 est.	2023 est.

0100	Balance, start of year
	Receipts:
	Current law:
1110	Contributions, Transitional Reinsurance Program	1

2000	Total: Balances and receipts	1
	Appropriations:
	Current law:
2101	Transitional Reinsurance Program	–1

5099	Balance, end of year


Identification code 075–5735–0–2–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Transitional reinsurance payments		14

0900	Total new obligations, unexpired accounts (object class 41.0)		14

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7	14
1033	Recoveries of prior year paid obligations	6

1070	Unobligated balance (total)	13	14
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1
1930	Total budgetary resources available	14	14
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	14

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	212	212
3010	New obligations, unexpired accounts		14
3020	Outlays (gross)		–226

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	1
	Outlays, gross:
4101	Outlays from mandatory balances		226
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–6
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	6

4160	Budget authority, net (mandatory)	1
4170	Outlays, net (mandatory)	–6	226
4180	Budget authority, net (total)	1
4190	Outlays, net (total)	–6	226

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy		1

0900	Total new obligations, unexpired accounts (object class 25.2)		1

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		1
1930	Total budgetary resources available		1

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

3050	Unpaid obligations, end of year	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2	1
3200	Obligated balance, end of year	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		1
	Outlays, gross:
4100	Outlays from new mandatory authority		1
4101	Outlays from mandatory balances	1	1

4110	Outlays, gross (total)	1	2
4180	Budget authority, net (total)		1
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		2021 actual	2022 est.	2023 est.

	Direct loan reestimates:
135001	Startup Loans	–10	–6
135002	Solvency Loans	–36	2

135999	Total direct loan reestimates	–46	–4

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
	Credit program obligations:
0705	Reestimates of direct loan subsidy		6
0706	Interest on reestimates of direct loan subsidy		2
0709	Administrative expenses	1

0900	Total new obligations, unexpired accounts (object class 25.2)	1	8

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		8
1900	Budget authority (total)		8
1930	Total budgetary resources available	1	8

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

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

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		8
	Outlays, gross:
4100	Outlays from new mandatory authority		8
4101	Outlays from mandatory balances	1	1

4110	Outlays, gross (total)	1	9
4180	Budget authority, net (total)		8
4190	Outlays, net (total)	1	9

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


Identification code 075–0118–0–1–551		2021 actual	2022 est.	2023 est.

	Direct loan reestimates:
135002	Startup Loans	–77	–30
135003	Solvency Loans	–219	7

135999	Total direct loan reestimates	–296	–23

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 075–4418–0–3–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
	Credit program obligations:
0713	Payment of interest to Treasury	8	8	8
0742	Downward reestimates paid to receipt accounts	249	27
0743	Interest on downward reestimates	47	3

0900	Total new obligations, unexpired accounts	304	38	8

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	24	7	4
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	284	27	3
	Spending authority from offsetting collections, mandatory:
1800	Collected	66	51	6
1825	Spending authority from offsetting collections applied to repay debt	–63	–43

1850	Spending auth from offsetting collections, mand (total)	3	8	6
1900	Budget authority (total)	287	35	9
1930	Total budgetary resources available	311	42	13
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	7	4	5

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			38
3010	New obligations, unexpired accounts	304	38	8
3020	Outlays (gross)	–304

3050	Unpaid obligations, end of year		38	46
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			38
3200	Obligated balance, end of year		38	46

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	287	35	9
	Financing disbursements:
4110	Outlays, gross (total)	304
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources		–7
4122	Interest on uninvested funds		–3	–6
4123	Non-Federal sources	–66	–41

4130	Offsets against gross budget authority and outlays (total)	–66	–51	–6

4160	Budget authority, net (mandatory)	221	–16	3
4170	Outlays, net (mandatory)	238	–51	–6
4180	Budget authority, net (total)	221	–16	3
4190	Outlays, net (total)	238	–51	–6


Identification code 075–4418–0–3–551		2021 actual	2022 est.	2023 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	1,893	1,812	1,771
1251	Repayments: Repayments and prepayments		–41
1263	Write-offs for default: Direct loans	–81		–94

1290	Outstanding, end of year	1,812	1,771	1,677


Identification code 075–4418–0–3–551		2020 actual	2021 actual

	ASSETS:
	Federal assets:
1101	Fund balances with Treasury	9	6
	Investments in U.S. securities:
1106	Receivables, net	259	7
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	1,893	1,812
1402	Interest receivable	25	41
1405	Allowance for subsidy cost (-)	–1,778	–1,467

1499	Net present value of assets related to direct loans	140	386

1999	Total assets	408	399
	LIABILITIES:
2103	Federal liabilities: Debt	408	399
	NET POSITION:
3300	Cumulative results of operations

4999	Total liabilities and net position	408	399


Identification code 075–4482–0–3–551		2021 actual	2022 est.	2023 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	5
0743	Interest on downward reestimates	6	1

0900	Total new obligations, unexpired accounts	48	8	2

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	4	11
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	47	6	2
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	11	112
1825	Spending authority from offsetting collections applied to repay debt	–5	–2	–112

1850	Spending auth from offsetting collections, mand (total)	4	9
1900	Budget authority (total)	51	15	2
1930	Total budgetary resources available	52	19	13
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4	11	11

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			8
3010	New obligations, unexpired accounts	48	8	2
3020	Outlays (gross)	–48

3050	Unpaid obligations, end of year		8	10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			8
3200	Obligated balance, end of year		8	10

	Financing authority and disbursements, net:
	Mandatory:
4090	Budget authority, gross	51	15	2
	Financing disbursements:
4110	Outlays, gross (total)	48
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources		–2
4123	Non-Federal sources	–9	–9	–112

4130	Offsets against gross budget authority and outlays (total)	–9	–11	–112

4160	Budget authority, net (mandatory)	42	4	–110
4170	Outlays, net (mandatory)	39	–11	–112
4180	Budget authority, net (total)	42	4	–110
4190	Outlays, net (total)	39	–11	–112


Identification code 075–4482–0–3–551		2021 actual	2022 est.	2023 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	480	471	347
1251	Repayments: Repayments and prepayments		–6	–12
1263	Write-offs for default: Direct loans	–9	–118	–118

1290	Outstanding, end of year	471	347	217


Identification code 075–4482–0–3–551		2020 actual	2021 actual

	ASSETS:
	Federal assets:
1101	Fund balances with Treasury	5	5
	Investments in U.S. securities:
1106	Receivables, net	5	2
1206	Non-Federal assets: Receivables, net
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross	480	471
1402	Interest receivable	5	9
1405	Allowance for subsidy cost (-)	–429	–378

1499	Net present value of assets related to direct loans	56	102

1999	Total assets	66	109
	LIABILITIES:
	Federal liabilities:
2103	Debt	65	108
2104	Resources payable to Treasury
2207	Non-Federal liabilities: Other

2999	Total liabilities	65	108
	NET POSITION:
3300	Cumulative results of operations	1	1

4999	Total liabilities and net position	66	109


Identification code 075–0521–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Mental Health Parity Enforcement Grants			125

0900	Total new obligations, unexpired accounts (object class 41.0)			125

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			125
1930	Total budgetary resources available			125

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			125
3020	Outlays (gross)			–10

3050	Unpaid obligations, end of year			115
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			115

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			125
	Outlays, gross:
4100	Outlays from new mandatory authority			10
4180	Budget authority, net (total)			125
4190	Outlays, net (total)			10

This proposal provides $125 million in mandatory funding in FY 2023, available for a period of five fiscal years, for grants to states to enforce mental health parity requirements. This proposal would allow any funds from grants that are not expended by the states at the end of the five fiscal years to remain available to the HHS Secretary to make additional mental health parity grants.


Identification code 999–9068–4–1–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity			70

0900	Total new obligations, unexpired accounts (object class 92.0)			70

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

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

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

The Budget proposes investments in Medicare that strengthen mental health services, enhance Medicare beneficiary access to vaccines, and address gaps in physician incentive payments. This reflects the combined policy impacts of these investments and is net of premiums and other offsetting collections.

Trust Funds


Identification code 075–8005–0–7–571		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	95,439	92,022	118,682
0198	Reconciliation adjustment	–44

0199	Balance, start of year	95,395	92,022	118,682
	Receipts:
	Current law:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	273,479	305,903	320,963
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	552	527	536
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	20,787	22,205	21,840
1110	FHI Trust Fund, Civil Penalties and Damages	385	598	629
1130	FHI Trust Fund, Other Proprietary Interest from the Public	1	2	2
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	293	419	461
1130	FHI Trust Fund, Medicare Refunds	27,966	28,016	7,394
1130	Affordable Care Act Medicare Shared Savings Models (HI)	79	48	48
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	4,141	4,742	4,911
1140	FHI Trust Fund, Federal Employer Contributions (FICA)	4,283	4,442	4,603
1140	FHI Trust Fund, Postal Service Employer Contributions (FICA)	597	620	660
1140	FHI Trust Fund, Interest Received by Trust Funds	2,438	2,911	3,313
1140	FHI Trust Fund, Taxation on OASDI Benefits	24,975	32,439	35,072
1140	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	148	153	157
1140	FHI Trust Fund, Transfers from General Fund (criminal Fines)	67	19	21
1140	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	69	53	54
1140	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	135	33	34
1140	FHI Trust Fund, Interest Payments by Railroad Retirement Board	16	10	14
1140	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,298	929	993

1199	Total current law receipts	361,709	404,069	401,705
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–4
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–938

1299	Total proposed receipts			–942

1999	Total receipts	361,709	404,069	400,763

2000	Total: Balances and receipts	457,104	496,091	519,445
	Appropriations:
	Current law:
2101	Federal Hospital Insurance Trust Fund	–2,802	–2,802	–3,056
2101	Federal Hospital Insurance Trust Fund	–356,721	–399,022	–397,259
2101	Health Care Fraud and Abuse Control Account	–807	–807	–899
2101	Health Care Fraud and Abuse Control Account	–1,415	–1,364	–2,322
2103	Federal Hospital Insurance Trust Fund	–4,006	–2,917	–19,045
2103	Health Care Fraud and Abuse Control Account		–51	–54
2132	Federal Hospital Insurance Trust Fund	31	2,917	8,146
2132	Health Care Fraud and Abuse Control Account		23	54
2135	Federal Hospital Insurance Trust Fund	786	26,614

2199	Total current law appropriations	–364,934	–377,409	–414,435
	Proposed:
2201	Health Care Fraud and Abuse Control Account			1,141

2999	Total appropriations	–364,934	–377,409	–413,294
3098	Federal Hospital Insurance Trust Fund	–81
5098	Reconciliation adjustment	–67

5099	Balance, end of year	92,022	118,682	106,151


Identification code 075–8005–0–7–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Benefit payments, HI	382,161	371,741	407,507
0002	HIT Incentive Payments	6	5
0003	Administration, HI	2,924	2,950	3,218
0004	Quality improvement organizations, HI	385	513	489

0799	Total direct obligations	385,476	375,209	411,214

0900	Total new obligations, unexpired accounts	385,476	375,209	411,214

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			1
1021	Recoveries of prior year unpaid obligations	17
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	81
1033	Recoveries of prior year paid obligations	22,666

1070	Unobligated balance (total)	22,764		1
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	2,802	2,802	3,056
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	356,721	399,022	397,259
1203	Appropriation (previously unavailable)(special or trust)	4,006	2,917	19,045
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)	–31	–2,917	–8,146
1235	Appropriations precluded from obligation (special or trust)	–786	–26,614

1260	Appropriations, mandatory (total)	359,910	372,408	408,158
1900	Budget authority (total)	362,712	375,210	411,214
1930	Total budgetary resources available	385,476	375,210	411,215
	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	36,279	41,570	41,429
3001	Adjustments to unpaid obligations, brought forward, Oct 1	183
3010	New obligations, unexpired accounts	385,476	375,209	411,214
3020	Outlays (gross)	–380,351	–375,350	–411,075
3040	Recoveries of prior year unpaid obligations, unexpired	–17

3050	Unpaid obligations, end of year	41,570	41,429	41,568
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	36,462	41,570	41,429
3200	Obligated balance, end of year	41,570	41,429	41,568

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,802	2,802	3,056
	Outlays, gross:
4010	Outlays from new discretionary authority	1,927	1,781	1,877
4011	Outlays from discretionary balances	842	1,142	1,040

4020	Outlays, gross (total)	2,769	2,923	2,917
	Mandatory:
4090	Budget authority, gross	359,910	372,408	408,158
	Outlays, gross:
4100	Outlays from new mandatory authority	323,782	332,730	362,511
4101	Outlays from mandatory balances	53,800	39,697	45,647

4110	Outlays, gross (total)	377,582	372,427	408,158
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–22,666
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	22,666

4160	Budget authority, net (mandatory)	359,910	372,408	408,158
4170	Outlays, net (mandatory)	354,916	372,427	408,158
4180	Budget authority, net (total)	362,712	375,210	411,214
4190	Outlays, net (total)	357,685	375,350	411,075

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	133,735	136,168	161,934
5001	Total investments, EOY: Federal securities: Par value	136,168	161,934	150,548

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		2021 actual	2022 est.	2023 est.

	Unexpended balance, start of year:
0100	Balance, start of year	134,361	136,267	162,551

0999	Total balance, start of year	134,361	136,267	162,551
	Cash income during the year:
	Current law:
	Receipts:
1110	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	273,479	305,903	320,963
1110	FHI Trust Fund, Receipts from Railroad Retirement Board	552	527	536
1110	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	20,787	22,205	21,840
1110	FHI Trust Fund, Civil Penalties and Damages	385	598	629
1130	FHI Trust Fund, Basic Premium, Medicare Advantage	293	419	461
1130	FHI Trust Fund, Medicare Refunds	27,966	28,016	7,394
1130	Affordable Care Act Medicare Shared Savings Models (HI)	79	48	48
1130	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	4,141	4,742	4,911
1130	Federal Hospital Insurance Trust Fund	22,666
1150	FHI Trust Fund, Interest Received by Trust Funds	2,438	2,911	3,313
1150	FHI Trust Fund, Other Proprietary Interest from the Public	1	2	2
1150	FHI Trust Fund, Interest Payments by Railroad Retirement Board	16	10	14
1160	FHI Trust Fund, Federal Employer Contributions (FICA)	4,283	4,442	4,603
1160	FHI Trust Fund, Postal Service Employer Contributions (FICA)	597	620	660
1160	FHI Trust Fund, Taxation on OASDI Benefits	24,975	32,439	35,072
1160	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	148	153	157
1160	FHI Trust Fund, Transfers from General Fund (criminal Fines)	67	19	21
1160	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	69	53	54
1160	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	135	33	34
1160	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	1,298	929	993

1199	Income under present law	384,375	404,069	401,705
	Proposed:
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–938
1210	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–4

1299	Income proposed			–942

1999	Total cash income	384,375	404,069	400,763
	Cash outgo during year:
	Current law:
2100	Federal Hospital Insurance Trust Fund [Budget Acct]	–380,351	–375,350	–411,075
2100	Health Care Fraud and Abuse Control Account [Budget Acct]	–2,119	–2,435	–3,261

2199	Outgo under current law	–382,470	–377,785	–414,336
	Proposed:
2200	Health Care Fraud and Abuse Control Account			1,141

2299	Outgo under proposed legislation			1,141

2999	Total cash outgo (-)	–382,470	–377,785	–413,195
	Surplus or deficit:
3110	Excluding interest	–550	23,361	–15,761
3120	Interest	2,455	2,923	3,329

3199	Subtotal, surplus or deficit	1,905	26,284	–12,432
3298	Reconciliation adjustment	1

3299	Total adjustments	1

3999	Total change in fund balance	1,906	26,284	–12,432
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	99	617	–429
4200	Federal Hospital Insurance Trust Fund	136,168	161,934	150,548

4999	Total balance, end of year	136,267	162,551	150,119


Identification code 075–8005–0–7–571		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	2
41.0	Payment for Quality Improvement Organization (QIO) activities	385	513	489
42.0	Insurance claims and indemnities (benefits)	377,232	371,746	407,507
94.0	Financial transfers	7,857	2,950	3,218

99.9	Total new obligations, unexpired accounts	385,476	375,209	411,214


Identification code 075–8005–0–7–571		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1	1	1

In addition to amounts otherwise available for program integrity and program management, $899,000,000, to remain available through September 30, 2024, 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 $692,174,000 shall be for the Centers for Medicare & Medicaid Services program integrity activities, of which $109,612,000 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 $97,214,000 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 2023 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, $323,000,000 is provided to meet the terms of a concurrent resolution on the budget for health care fraud and abuse control activities, and $576,000,000 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 2023 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicare integrity program	1,036	963	1,002
0002	FBI fraud and abuse control	156	153	157
0003	Other fraud and abuse control	325	323	331
0005	Undistributed Savings, Medicare SSA CDRs		–47	–287
0006	Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment			1,119

0091	Total Mandatory	1,517	1,392	2,322
0101	CMS discretionary	682	616	692
0102	Other discretionary	191	191	207

0191	Total Discretionary	873	807	899

0900	Total new obligations, unexpired accounts	2,390	2,199	3,221

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	557	417	417
1001	Discretionary unobligated balance brought fwd, Oct 1	218
1021	Recoveries of prior year unpaid obligations	36

1070	Unobligated balance (total)	593	417	417
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	807	807	899
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1,415	1,364	2,322
1203	Appropriation (previously unavailable)(special or trust)		51	54
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced		–23	–54

1260	Appropriations, mandatory (total)	1,415	1,392	2,322
1900	Budget authority (total)	2,222	2,199	3,221
1930	Total budgetary resources available	2,815	2,616	3,638
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	417	417	417
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	8
1952	Expired unobligated balance, start of year	69	71	71
1953	Expired unobligated balance, end of year	63	71	71

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,062	2,267	2,031
3010	New obligations, unexpired accounts	2,390	2,199	3,221
3020	Outlays (gross)	–2,119	–2,435	–3,261
3040	Recoveries of prior year unpaid obligations, unexpired	–36
3041	Recoveries of prior year unpaid obligations, expired	–30

3050	Unpaid obligations, end of year	2,267	2,031	1,991
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,062	2,267	2,031
3200	Obligated balance, end of year	2,267	2,031	1,991

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	807	807	899
	Outlays, gross:
4010	Outlays from new discretionary authority	176	322	359
4011	Outlays from discretionary balances	602	530	540

4020	Outlays, gross (total)	778	852	899
	Mandatory:
4090	Budget authority, gross	1,415	1,392	2,322
	Outlays, gross:
4100	Outlays from new mandatory authority	513	661	1,550
4101	Outlays from mandatory balances	828	922	812

4110	Outlays, gross (total)	1,341	1,583	2,362
4180	Budget authority, net (total)	2,222	2,199	3,221
4190	Outlays, net (total)	2,119	2,435	3,261


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	2,222	2,199	3,221
	Outlays	2,119	2,435	3,261
Legislative proposal, not subject to PAYGO:
	Budget Authority			–1,141
	Outlays			–1,141
Total:
	Budget Authority	2,222	2,199	2,080
	Outlays	2,119	2,435	2,120

The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services (HHS), the Department of Justice, and other agencies.

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


Identification code 075–8393–0–7–571		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent (CMS)	64	65	65
11.3	Other Than Full-Time Permanent	1	1	1
11.5	Other Personnel Compensation	1	1	1
11.7	Military Personnel	1	1	1

11.9	Total personnel compensation	67	68	68
12.1	Civilian Personnel Benefits (CMS)	19	19	19
12.2	Military Personnel Benefits	1	1	1
23.1	Rental Payments to GSA	14	14	14
23.3	Communications, Utilities, and Miscellaneous Charges	5	5	5
25.2	Other Services from Non-Federal Sources	1,238	1,157	1,236
25.3	Other Goods and Services from Federal Sources	38	36	38
25.4	Operation and Maintenance of Facilities	5	5	5
25.6	Medical Care (CMS)	309	290	309
92.0	Undistributed (SSA CDR Medicare baseline Savings)		–47	–287
92.0	Undistributed (Medicare baseline impact attributable to HCFAC Cap/Allocation Adjustment)			1,119
94.0	Financial Transfers	694	651	694

99.9	Total new obligations, unexpired accounts	2,390	2,199	3,221


Identification code 075–8393–0–7–571		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	472	522	522
1101	Direct military average strength employment	13	13	13


Identification code 075–8393–2–7–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0005	Undistributed Savings, Medicare SSA CDRs			–22
0006	Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment			–1,119

0091	Total Mandatory			–1,141

0900	Total new obligations, unexpired accounts			–1,141

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–1,141
1900	Budget authority (total)			–1,141
1930	Total budgetary resources available			–1,141

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			–1,141
3020	Outlays (gross)			1,141

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,141
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,141
4180	Budget authority, net (total)			–1,141
4190	Outlays, net (total)			–1,141

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
92.0	Undistributed (SSA CDR Medicare baseline Savings)			–22
92.0	Undistributed (Medicare baseline impact attributable to HCFAC Cap/Allocation Adjustment)			–1,119

99.9	Total new obligations, unexpired accounts			–1,141


Identification code 075–8004–0–7–571		2021 actual	2022 est.	2023 est.

0100	Balance, start of year	52,946	132,486	150,908
0198	Rounding adjustment	1

0199	Balance, start of year	52,947	132,486	150,908
	Receipts:
	Current law:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	2,790	2,660	1,581
1130	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
1130	Gifts, Medicare Prescription Drug Accounts, FSMI		413	567
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	5,604	5,745	5,906
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,859	12,708	13,975
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	399	556	611
1130	Gifts, FSMI Fund		1	1
1130	Medicare Refunds, SMI	16,026	16,076	5,419
1130	Affordable Care Act Medicare Shared Savings Models, SMI	112	45	45
1130	Premiums Collected for the Aged, FSMI Fund	98,508	115,794	130,466
1130	Premiums Collected for the Disabled, FSMI Fund	13,862	14,626	15,544
1140	Federal Contributions, FSMI Fund	330,973	339,627	375,698
1140	Interest Received by Trust Fund, FSMI Fund	2,053	3,138	3,740
1140	Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI		5	5
1140	Interest, Medicare Prescription Drug Account, FSMI	46	50	65
1140	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	882	882	500
1140	Federal Contributions for Benefits, Prescription Drug Account, SMI	81,181	89,850	93,961
1140	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1

1199	Total current law receipts	564,297	602,180	648,088

1999	Total receipts	564,297	602,180	648,088

2000	Total: Balances and receipts	617,244	734,666	798,996
	Appropriations:
	Current law:
2101	Federal Supplementary Medical Insurance Trust Fund	–3,265	–3,301	–4,173
2101	Federal Supplementary Medical Insurance Trust Fund	–461,390	–491,549	–529,785
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–881	–878	–596
2101	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–98,759	–108,362	–113,916
2103	Federal Supplementary Medical Insurance Trust Fund	–4,305	–3,588	–10,187
2132	Federal Supplementary Medical Insurance Trust Fund	11	3,588	10,187
2132	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund		103	382
2135	Federal Supplementary Medical Insurance Trust Fund	85,895	20,229	21,324

2199	Total current law appropriations	–482,694	–583,758	–626,764

2999	Total appropriations	–482,694	–583,758	–626,764
3098	Federal Supplementary Medical Insurance Trust Fund	–145
5098	Reconciliation adjustment	–1,919

5099	Balance, end of year	132,486	150,908	172,232


Identification code 075–8004–0–7–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Benefit payments, SMI	428,627	469,848	506,799
0002	Transfer to Medicaid for payment of SMI premiums	1,360	1,314	1,434
0004	Administration, SMI	3,058	3,301	4,249
0005	Quality Improvement Organizations, SMI	126	159	152

0799	Total direct obligations	433,171	474,622	512,634

0900	Total new obligations, unexpired accounts	433,171	474,622	512,634

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1
1021	Recoveries of prior year unpaid obligations	5
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	145
1033	Recoveries of prior year paid obligations	14,810

1070	Unobligated balance (total)	14,960	1
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	3,265	3,301	4,173
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	461,390	491,549	529,785
1203	Appropriation (previously unavailable)(special or trust)	4,305	3,588	10,187
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced	–11	–3,588	–10,187
1235	Appropriations precluded from obligation (special or trust)	–85,895	–20,229	–21,324
1236	Appropriations applied to repay debt	–10,539

1260	Appropriations, mandatory (total)	369,250	471,320	508,461
	Borrowing authority, mandatory:
1400	Borrowing authority	45,697
1900	Budget authority (total)	418,212	474,621	512,634
1930	Total budgetary resources available	433,172	474,622	512,634
	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	29,334	32,812	32,622
3001	Adjustments to unpaid obligations, brought forward, Oct 1	2,060
3010	New obligations, unexpired accounts	433,171	474,622	512,634
3020	Outlays (gross)	–431,748	–474,812	–512,446
3040	Recoveries of prior year unpaid obligations, unexpired	–5

3050	Unpaid obligations, end of year	32,812	32,622	32,810
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	31,394	32,812	32,622
3200	Obligated balance, end of year	32,812	32,622	32,810

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,265	3,301	4,173
	Outlays, gross:
4010	Outlays from new discretionary authority	1,902	2,160	2,566
4011	Outlays from discretionary balances	1,661	1,291	1,419

4020	Outlays, gross (total)	3,563	3,451	3,985
	Mandatory:
4090	Budget authority, gross	414,947	471,320	508,461
	Outlays, gross:
4100	Outlays from new mandatory authority	386,045	440,774	475,337
4101	Outlays from mandatory balances	42,140	30,587	33,124

4110	Outlays, gross (total)	428,185	471,361	508,461
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–14,810
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	14,810

4160	Budget authority, net (mandatory)	414,947	471,320	508,461
4170	Outlays, net (mandatory)	413,375	471,361	508,461
4180	Budget authority, net (total)	418,212	474,621	512,634
4190	Outlays, net (total)	416,938	474,812	512,446

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	87,477	170,677	156,727
5001	Total investments, EOY: Federal securities: Par value	170,677	156,727	179,051
5080	Outstanding debt, SOY	–1,154	–36,312	–36,312
5081	Outstanding debt, EOY	–36,312	–36,312	–36,312
5082	Borrowing	–45,697

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		2021 actual	2022 est.	2023 est.

	Unexpended balance, start of year:
0100	Balance, start of year	88,909	137,647	157,689

0999	Total balance, start of year	88,909	137,647	157,689
	Cash income during the year:
	Current law:
	Receipts:
1110	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	2,790	2,660	1,581
1130	Gifts, Medicare Prescription Drug Accounts, FSMI		413	567
1130	Premiums Collected for Medicare Prescription Drug Account, FSMI	5,604	5,745	5,906
1130	Payments from States, Medicare Prescription Drug Account, FSMI	11,859	12,708	13,975
1130	Basic Premium, Medicare Advantage, FSMI Trust Fund	399	556	611
1130	Gifts, FSMI Fund		1	1
1130	Medicare Refunds, SMI	16,026	16,076	5,419
1130	Affordable Care Act Medicare Shared Savings Models, SMI	112	45	45
1130	Premiums Collected for the Aged, FSMI Fund	98,508	115,794	130,466
1130	Premiums Collected for the Disabled, FSMI Fund	13,862	14,626	15,544
1130	Federal Supplementary Medical Insurance Trust Fund	14,810
1130	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	2
1150	Interest Received by Trust Fund, FSMI Fund	2,053	3,138	3,740
1150	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
1150	Interest, Medicare Prescription Drug Account, FSMI	46	50	65
1160	Federal Contributions, FSMI Fund	330,973	339,627	375,698
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	882	882	500
1160	Federal Contributions for Benefits, Prescription Drug Account, SMI	81,181	89,850	93,961
1160	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1
1160	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund		1,807

1199	Income under present law	579,109	603,987	648,088

1999	Total cash income	579,109	603,987	648,088
	Cash outgo during year:
	Current law:
2100	Federal Supplementary Medical Insurance Trust Fund [Budget Acct]	–431,748	–474,812	–512,446
2100	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]	–98,621	–109,133	–114,107

2199	Outgo under current law	–530,369	–583,945	–626,553

2999	Total cash outgo (-)	–530,369	–583,945	–626,553
	Surplus or deficit:
3110	Excluding interest	46,640	16,851	17,727
3120	Interest	2,100	3,191	3,808

3199	Subtotal, surplus or deficit	48,740	20,042	21,535
3298	Reconciliation adjustment	–2

3299	Total adjustments	–2

3999	Total change in fund balance	48,738	20,042	21,535
	Unexpended balance, end of year:
4100	Uninvested balance (net), end of year	–33,030	962	173
4200	Federal Supplementary Medical Insurance Trust Fund	170,677	156,727	179,051

4999	Total balance, end of year	137,647	157,689	179,224


Identification code 075–8004–0–7–571		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
41.0	Payment for Quality Improvement Organization (QIO) activity	126	159	152
42.0	Insurance claims and indemnities	426,494	471,161	508,233
94.0	Financial transfers	6,550	3,301	4,248

99.0	Direct obligations	433,171	474,622	512,634

99.9	Total new obligations, unexpired accounts	433,171	474,622	512,634


Identification code 075–8004–0–7–571		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	5	1	1


Identification code 075–8308–0–7–571		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	98,760	108,228	112,793
0002	Administrative Costs	882	882	600

0799	Total direct obligations	99,642	109,110	113,393
0801	Reimbursable program activity	1,807

0900	Total new obligations, unexpired accounts	101,449	109,110	113,393

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			27
1033	Recoveries of prior year paid obligations	2

1070	Unobligated balance (total)	2		27
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust)	881	878	596
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	98,759	108,362	113,916
1232	Appropriations and/or unobligated balance of appropriations temporarily reduced		–103	–382

1260	Appropriations, mandatory (total)	98,759	108,259	113,534
	Spending authority from offsetting collections, mandatory:
1800	Collected		1,807
1801	Change in uncollected payments, Federal sources	1,807	–1,807

1850	Spending auth from offsetting collections, mand (total)	1,807
1900	Budget authority (total)	101,447	109,137	114,130
1930	Total budgetary resources available	101,449	109,137	114,157
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		27	764

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	14,230	17,061	17,038
3001	Adjustments to unpaid obligations, brought forward, Oct 1	3
3010	New obligations, unexpired accounts	101,449	109,110	113,393
3020	Outlays (gross)	–98,621	–109,133	–114,107

3050	Unpaid obligations, end of year	17,061	17,038	16,324
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–6,448	–8,255	–6,448
3070	Change in uncollected pymts, Fed sources, unexpired	–1,807	1,807

3090	Uncollected pymts, Fed sources, end of year	–8,255	–6,448	–6,448
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,785	8,806	10,590
3200	Obligated balance, end of year	8,806	10,590	9,876

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	881	878	596
	Outlays, gross:
4010	Outlays from new discretionary authority	364	520	390
4011	Outlays from discretionary balances	159	351	183

4020	Outlays, gross (total)	523	871	573
	Mandatory:
4090	Budget authority, gross	100,566	108,259	113,534
	Outlays, gross:
4100	Outlays from new mandatory authority	85,220	91,592	100,532
4101	Outlays from mandatory balances	12,878	16,670	13,002

4110	Outlays, gross (total)	98,098	108,262	113,534
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:		–1,807
4123	Non-Federal sources	–2

4130	Offsets against gross budget authority and outlays (total)	–2	–1,807
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1,807	1,807
4143	Recoveries of prior year paid obligations, unexpired accounts	2

4150	Additional offsets against budget authority only (total)	–1,805	1,807

4160	Budget authority, net (mandatory)	98,759	108,259	113,534
4170	Outlays, net (mandatory)	98,096	106,455	113,534
4180	Budget authority, net (total)	99,640	109,137	114,130
4190	Outlays, net (total)	98,619	107,326	114,107

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.2	Other services from non-Federal sources	882	882	600
42.0	Insurance claims and indemnities	98,760	108,228	112,793

99.0	Direct obligations	99,642	109,110	113,393
99.0	Reimbursable obligations	1,807

99.9	Total new obligations, unexpired accounts	101,449	109,110	113,393


Identification code 075–8308–0–7–571		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	4	4	4

Federal Funds


Identification code 075–1552–0–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	State family assistance grant	16,437	16,343	16,343
0002	Territories - family assistance grants	78	78	78
0006	Tribal work programs	4	8	8
0009	Healthy marriage and responsible fatherhood grants	147	149	149
0010	Evaluation Funding and What Works Clearinghouse	43	45	45
0011	Census Bureau Research	10	10	10
0012	Pandemic Emergency Assistance	995	1	1

0900	Total new obligations, unexpired accounts	17,714	16,634	16,634

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		5	94
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	17,739	16,739	16,739
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–1	–1	–1

1260	Appropriations, mandatory (total)	17,738	16,738	16,738
1900	Budget authority (total)	17,738	16,738	16,738
1930	Total budgetary resources available	17,738	16,743	16,832
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–19	–15	–15
1941	Unexpired unobligated balance, end of year	5	94	183

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	9,449	11,776	11,373
3010	New obligations, unexpired accounts	17,714	16,634	16,634
3011	Obligations ("upward adjustments"), expired accounts	2
3020	Outlays (gross)	–15,383	–17,037	–16,517
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	11,776	11,373	11,490
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	9,449	11,776	11,373
3200	Obligated balance, end of year	11,776	11,373	11,490

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	17,738	16,738	16,738
	Outlays, gross:
4100	Outlays from new mandatory authority	10,032	9,813	9,813
4101	Outlays from mandatory balances	5,351	7,224	6,704

4110	Outlays, gross (total)	15,383	17,037	16,517
4180	Budget authority, net (total)	17,738	16,738	16,738
4190	Outlays, net (total)	15,383	17,037	16,517

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 Continuing Appropriations Act of 2022 (P. L. 117–70).


Identification code 075–1552–0–1–609		2021 actual	2022 est.	2023 est.

11.1	Direct obligations: Personnel compensation: Full-time permanent	14	9	9

11.9	Total personnel compensation	14	9	9
12.1	Civilian personnel benefits	1	1	1
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	49	48	48
25.2	Other services from non-Federal sources	24	23	23
25.3	Other goods and services from Federal sources	7	6	6
25.4	Operation and maintenance of facilities	1	1	1
41.0	Grants, subsidies, and contributions	17,617	16,545	16,545

99.9	Total new obligations, unexpired accounts	17,714	16,634	16,634


Identification code 075–1552–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	98	102	102


Identification code 075–1522–0–1–609		2021 actual	2022 est.	2023 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	8	23	25
3010	New obligations, unexpired accounts	608	608	608
3011	Obligations ("upward adjustments"), expired accounts	14
3020	Outlays (gross)	–604	–606	–604
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	23	25	29
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	8	23	25
3200	Obligated balance, end of year	23	25	29

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	608	608	608
	Outlays, gross:
4100	Outlays from new mandatory authority	596	598	596
4101	Outlays from mandatory balances	8	8	8

4110	Outlays, gross (total)	604	606	604
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–14
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	14

4160	Budget authority, net (mandatory)	608	608	608
4170	Outlays, net (mandatory)	590	606	604
4180	Budget authority, net (total)	608	608	608
4190	Outlays, net (total)	590	606	604

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 Contining Appropriations Act of 2022 (P.L. 117–70).

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, $2,883,000,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2024, $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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	State child support administrative costs	3,940	3,691	3,675
0002	Child support incentive payments	600	600	655
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,550	4,301	4,340
0102	Payments to territories	66	53	33
0103	Repatriation	9	11	10

0191	Subtotal, other payments	75	64	43

0799	Total direct obligations	4,625	4,365	4,383
0801	Offset obligations (CSE grants to States)		2

0900	Total new obligations, unexpired accounts	4,625	4,367	4,383

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	111	138
1021	Recoveries of prior year unpaid obligations	809	200	200
1033	Recoveries of prior year paid obligations	25
1037	Unobligated balance of appropriations withdrawn	–540

1070	Unobligated balance (total)	295	311	338
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3,039	2,795	2,883
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–1	–1

1260	Appropriations, mandatory (total)	3,039	2,794	2,882
	Advance appropriations, mandatory:
1270	Advance appropriation	1,400	1,400	1,300
	Spending authority from offsetting collections, mandatory:
1800	Collected	2
1900	Budget authority (total)	4,441	4,194	4,182
1930	Total budgetary resources available	4,736	4,505	4,520
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	111	138	137

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,804	1,435	1,486
3010	New obligations, unexpired accounts	4,625	4,367	4,383
3020	Outlays (gross)	–4,185	–4,116	–4,122
3040	Recoveries of prior year unpaid obligations, unexpired	–809	–200	–200

3050	Unpaid obligations, end of year	1,435	1,486	1,547
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,804	1,435	1,486
3200	Obligated balance, end of year	1,435	1,486	1,547

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,441	4,194	4,182
	Outlays, gross:
4100	Outlays from new mandatory authority	3,761	3,543	3,523
4101	Outlays from mandatory balances	424	573	599

4110	Outlays, gross (total)	4,185	4,116	4,122
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–27
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	25

4160	Budget authority, net (mandatory)	4,439	4,194	4,182
4170	Outlays, net (mandatory)	4,158	4,116	4,122
4180	Budget authority, net (total)	4,439	4,194	4,182
4190	Outlays, net (total)	4,158	4,116	4,122

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.1	Advisory and assistance services		1	1
25.2	Other services from non-Federal sources	6	7	7
41.0	Grants, subsidies, and contributions	4,619	4,359	4,375

99.0	Direct obligations	4,625	4,367	4,383

99.9	Total new obligations, unexpired accounts	4,625	4,367	4,383

For carrying out subsections (b) and (d) of section 2602 of the Low-Income Home Energy Assistance Act of 1981 (42 U.S.C. 8621 et seq.), $3,975,304,000: Provided, That notwithstanding section 2609A(a) of such Act, not more than $20,500,000 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 2023 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 2022 from amounts appropriated in the Department of Health and Human Services Appropriations Act for such fiscal year 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 2022 being ratably reduced: Provided further, That notwithstanding any provision of the Low-Income Home Energy Assistance Act of 1981 (42 U.S.C. 8621 et seq.), of the amounts received by a State, territory, or Tribe under this heading for fiscal year 2023, not more than 2.7% of such amounts may be used for the activities described in section 2912 of the American Rescue Plan Act of 2021 (Public Law 117–2): Provided further, That of the total amount of funds available to a State, territory, or Tribe for the activities described in section 2912 of the American Rescue Plan Act, not more than 15% of such amounts shall be available for administrative expenses.


Identification code 075–1502–0–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	LIHEAP Block Grant	8,214	3,850	4,075

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1
1012	Unobligated balance transfers between expired and unexpired accounts	1

1070	Unobligated balance (total)	2
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,750	3,850	3,975
1120	Appropriations transferred to other acct [075–1503]	–38

1160	Appropriation, discretionary (total)	3,712	3,850	3,975
	Advance appropriations, discretionary:
1170	Advance appropriation			100
	Appropriations, mandatory:
1200	Appropriation	4,500
1900	Budget authority (total)	8,212	3,850	4,075
1930	Total budgetary resources available	8,214	3,850	4,075

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,383	6,145	4,335
3010	New obligations, unexpired accounts	8,214	3,850	4,075
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–4,417	–5,660	–6,317
3041	Recoveries of prior year unpaid obligations, expired	–36

3050	Unpaid obligations, end of year	6,145	4,335	2,093
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,383	6,145	4,335
3200	Obligated balance, end of year	6,145	4,335	2,093

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,712	3,850	4,075
	Outlays, gross:
4010	Outlays from new discretionary authority	2,243	2,462	2,567
4011	Outlays from discretionary balances	1,915	1,626	1,388

4020	Outlays, gross (total)	4,158	4,088	3,955
	Mandatory:
4090	Budget authority, gross	4,500
	Outlays, gross:
4100	Outlays from new mandatory authority	259
4101	Outlays from mandatory balances		1,572	2,362

4110	Outlays, gross (total)	259	1,572	2,362
4180	Budget authority, net (total)	8,212	3,850	4,075
4190	Outlays, net (total)	4,417	5,660	6,317

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			2
25.1	Advisory and assistance services	2	2	7
25.2	Other services from non-Federal sources			3
25.3	Other goods and services from Federal sources	1	1	9
41.0	Grants, subsidies, and contributions	8,211	3,847	4,054

99.9	Total new obligations, unexpired accounts	8,214	3,850	4,075


Identification code 075–1502–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment			11

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, $6,327,843,000, of which $6,261,346,000 shall remain available through September 30, 2025 for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out the TVPA shall also be available for research and evaluation with respect to activities under such Act: Provided further, That 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Refugee Support Services (RSS) and Transitional & Medical Services (TAMS)	561	561	1,360
0002	Assistance for treatment of torture victims	27	17	27
0003	Unaccompanied Children	6,866	6,361	4,901
0005	Trafficking Victims program	40	29	39

0799	Total direct obligations	7,494	6,968	6,327
0801	Reimbursable program activity	56	56	56

0900	Total new obligations, unexpired accounts	7,550	7,024	6,383

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,418	543	3,456
1021	Recoveries of prior year unpaid obligations	445
1033	Recoveries of prior year paid obligations	1

1070	Unobligated balance (total)	1,864	543	3,456
	Budget authority:
	Appropriations, discretionary:
1100	Base Appropriation	1,935	8,954	6,328
1121	Appropriations transferred from other acct [075–1502]	38
1121	Appropriations transferred from other acct [075–9912]	2
1121	Appropriations transferred from other acct [075–1515]	33
1121	Appropriations transferred from other acct [075–0140]	858
1121	Appropriations transferred from other acct [075–1700]	1
1121	Appropriations transferred from other acct [075–0943]	21
1121	Appropriations transferred from other acct [075–0350]	22
1121	Appropriations transferred from other acct [075–1362]	18
1121	Appropriations transferred from other acct [075–9915]	1,186
1121	Appropriations transferred from other acct [075–0142]	7

1160	Appropriation, discretionary (total)	4,121	8,954	6,328
	Spending authority from offsetting collections, discretionary:
1700	Collected	44
1711	Spending authority from offsetting collections transferred from other accounts [075–0511]	12

1750	Spending auth from offsetting collections, disc (total)	56
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,077	983
1801	Change in uncollected payments, Federal sources	983

1850	Spending auth from offsetting collections, mand (total)	2,060	983
1900	Budget authority (total)	6,237	9,937	6,328
1930	Total budgetary resources available	8,101	10,480	9,784
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	543	3,456	3,401

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,603	3,374	2,135
3010	New obligations, unexpired accounts	7,550	7,024	6,383
3011	Obligations ("upward adjustments"), expired accounts	2	151
3020	Outlays (gross)	–6,231	–8,414	–5,545
3040	Recoveries of prior year unpaid obligations, unexpired	–445
3041	Recoveries of prior year unpaid obligations, expired	–105

3050	Unpaid obligations, end of year	3,374	2,135	2,973
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–7	–990	–990
3070	Change in uncollected pymts, Fed sources, unexpired	–983

3090	Uncollected pymts, Fed sources, end of year	–990	–990	–990
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,596	2,384	1,145
3200	Obligated balance, end of year	2,384	1,145	1,983

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,177	8,954	6,328
	Outlays, gross:
4010	Outlays from new discretionary authority	2,590	5,405	2,848
4011	Outlays from discretionary balances	2,383	1,062	2,422

4020	Outlays, gross (total)	4,973	6,467	5,270
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–44
4033	Non-Federal sources	–2

4040	Offsets against gross budget authority and outlays (total)	–46
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	1
4053	Recoveries of prior year paid obligations, unexpired accounts	1

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	4,133	8,954	6,328
4080	Outlays, net (discretionary)	4,927	6,467	5,270
	Mandatory:
4090	Budget authority, gross	2,060	983
	Outlays, gross:
4100	Outlays from new mandatory authority	1,258	442
4101	Outlays from mandatory balances		1,505	275

4110	Outlays, gross (total)	1,258	1,947	275
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,077	–983
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–983
4170	Outlays, net (mandatory)	181	964	275
4180	Budget authority, net (total)	4,133	8,954	6,328
4190	Outlays, net (total)	5,108	7,431	5,545


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	4,133	8,954	6,328
	Outlays	5,108	7,431	5,545
Legislative proposal, subject to PAYGO:
	Budget Authority			1,813
	Outlays			816
Total:
	Budget Authority	4,133	8,954	8,141
	Outlays	5,108	7,431	6,361

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 $6,327,843,000.


Identification code 075–1503–0–1–609		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	20	23	31
11.7	Military personnel	2	2	3

11.9	Total personnel compensation	22	25	34
12.1	Civilian personnel benefits	5	8	11
12.2	Military personnel benefits	1	1	2
23.1	Rental payments to GSA	7	7	7
25.1	Advisory and assistance services	16	16	16
25.2	Other services from non-Federal sources	3,564	3,032	2,378
25.3	Other goods and services from Federal sources	2,533	2,533	2,533
25.4	Operation and maintenance of facilities	1	1	1
41.0	Grants, subsidies, and contributions	1,345	1,345	1,345

99.0	Direct obligations	7,494	6,968	6,327
99.0	Reimbursable obligations	56	56	56

99.9	Total new obligations, unexpired accounts	7,550	7,024	6,383


Identification code 075–1503–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	193	193	259
1101	Direct military average strength employment	21	21	21


Identification code 075–1503–4–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0003	Unaccompanied Children - Contingency Fund			1,547
0004	Unaccompanied Children - Legal Services			266

0900	Total new obligations, unexpired accounts (object class 41.0)			1,813

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			1,813
1900	Budget authority (total)			1,813
1930	Total budgetary resources available			1,813

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			1,813
3020	Outlays (gross)			–816

3050	Unpaid obligations, end of year			997
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			997

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			1,813
	Outlays, gross:
4100	Outlays from new mandatory authority			816
4180	Budget authority, net (total)			1,813
4190	Outlays, net (total)			816

The Budget proposes a mandatory contingency fund authorized in fiscal years 2023 through 2025 that provides additional funding during months of high referrals of unaccompanied children (UC), as well as mandatory funding for scaling-up UC legal representation towards a goal of achieving universal representation.

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Grants to States and Tribes	455	376	376
0002	Research, training and technical assistance	6	10	10
0003	State court improvement activities	30	31	31
0004	Family Connection Grants	1	2	2
0005	Personal Responsibility Education (PREP)	82	73	73
0006	Sexual Risk Abstinence Education (SRAE)	72	70	70
0007	Family Rec. & Reunification	1	3	3
0008	Foster Family Home 1822	2
0009	Family First Transition Act 2021	3

0900	Total new obligations, unexpired accounts	652	565	565

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	56	49	34
1021	Recoveries of prior year unpaid obligations	2
1033	Recoveries of prior year paid obligations	3

1070	Unobligated balance (total)	61	49	34
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	83	83	106
	Appropriations, mandatory:
1200	Appropriation	580	495	495
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–20	–28	–28

1260	Appropriations, mandatory (total)	560	467	467
1900	Budget authority (total)	643	550	573
1930	Total budgetary resources available	704	599	607
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	49	34	42

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,235	1,318	1,111
3010	New obligations, unexpired accounts	652	565	565
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–536	–772	–802
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–32

3050	Unpaid obligations, end of year	1,318	1,111	874
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,235	1,318	1,111
3200	Obligated balance, end of year	1,318	1,111	874

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	83	83	106
	Outlays, gross:
4010	Outlays from new discretionary authority	22	20	25
4011	Outlays from discretionary balances	65	63	73

4020	Outlays, gross (total)	87	83	98
	Mandatory:
4090	Budget authority, gross	560	467	467
	Outlays, gross:
4100	Outlays from new mandatory authority	104	73	65
4101	Outlays from mandatory balances	345	616	639

4110	Outlays, gross (total)	449	689	704
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	3

4160	Budget authority, net (mandatory)	560	467	467
4170	Outlays, net (mandatory)	446	689	704
4180	Budget authority, net (total)	643	550	573
4190	Outlays, net (total)	533	772	802


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	643	550	573
	Outlays	533	772	802
Legislative proposal, subject to PAYGO:
	Budget Authority			300
	Outlays			78
Total:
	Budget Authority	643	550	873
	Outlays	533	772	880

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
25.1	Advisory and assistance services	15	14	14
25.3	Other goods and services from Federal sources	13	15	15
41.0	Grants, subsidies, and contributions	622	534	534

99.9	Total new obligations, unexpired accounts	652	565	565


Identification code 075–1512–0–1–506		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	24	19	20


Identification code 075–1512–4–1–506		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Grants to States and Tribes			220
0003	State court improvement activities			30
0010	Legal Services			50

0900	Total new obligations, unexpired accounts			300

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			300
1930	Total budgetary resources available			300

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			300
3020	Outlays (gross)			–78

3050	Unpaid obligations, end of year			222
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			222

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			300
	Outlays, gross:
4100	Outlays from new mandatory authority			78
4180	Budget authority, net (total)			300
4190	Outlays, net (total)			78

The Budget proposes to increase funding for Promoting Safe and Stable Families by $300 million per year and to create a new set-aside to increase access to legal services for children and families involved in the child welfare system.


Identification code 075–1512–4–1–506		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			2
25.1	Advisory and assistance services			10
25.3	Other goods and services from Federal sources			12
41.0	Grants, subsidies, and contributions			276

99.9	Total new obligations, unexpired accounts			300


Identification code 075–1512–4–1–506		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment			14


Identification code 075–1550–0–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Mandatory child care	1,177	1,177	1,177
0002	Matching child care	2,164	2,164	2,164
0003	Child Care Training and technical assistance	17	17	17
0004	Child care tribal grants	100	100	100
0005	Child Care Research	17	17	17
0006	Child Care Territory Grants	75	75	75

0900	Total new obligations, unexpired accounts	3,550	3,550	3,550

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3,550	3,550	3,550
1930	Total budgetary resources available	3,550	3,550	3,550

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,170	1,517	1,829
3010	New obligations, unexpired accounts	3,550	3,550	3,550
3011	Obligations ("upward adjustments"), expired accounts	3
3020	Outlays (gross)	–3,154	–3,238	–3,415
3041	Recoveries of prior year unpaid obligations, expired	–52

3050	Unpaid obligations, end of year	1,517	1,829	1,964
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,170	1,517	1,829
3200	Obligated balance, end of year	1,517	1,829	1,964

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	3,550	3,550	3,550
	Outlays, gross:
4100	Outlays from new mandatory authority	2,230	2,229	2,229
4101	Outlays from mandatory balances	924	1,009	1,186

4110	Outlays, gross (total)	3,154	3,238	3,415
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	3

4160	Budget authority, net (mandatory)	3,550	3,550	3,550
4170	Outlays, net (mandatory)	3,151	3,238	3,415
4180	Budget authority, net (total)	3,550	3,550	3,550
4190	Outlays, net (total)	3,151	3,238	3,415

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.1	Advisory and assistance services	15	15	15
25.3	Other goods and services from Federal sources	6	6	6
41.0	Grants, subsidies, and contributions	3,529	3,529	3,529

99.9	Total new obligations, unexpired accounts	3,550	3,550	3,550

The Child Care Entitlement to States includes a new allocation of up to of one half of one percent of the program funds for resources to effectively administer the Child Care and Development Fund. Funds can be used for Federal administrative expenses to carry out section 418 of the Social Security Act.

For carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $7,562,000,000 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: Provided further, That of the amounts made available under this heading, the Secretary may reserve up to 0.5 percent for Federal administrative expenses: Provided further, That of the total amount of 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 or any other provision of law, the Secretary may reserve up to 0.5 percent of such funds for Federal administrative expenses to carry out such section.


Identification code 075–1515–0–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Child Care Block Grant Payments to States	5,849	5,881	7,524
0002	Child Care Block Grant Payments to States [Disaster supplemental]	1
0003	Child Care Block Grant Payments to States [CARES supplemental]	8
0004	Child Care Research and Evaluation Fund	30	30	38
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	54,838	5,911	7,562

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10	50	50
1012	Unobligated balance transfers between expired and unexpired accounts	1

1070	Unobligated balance (total)	11	50	50
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	15,911	5,911	7,562
1120	Appropriations transferred to other acct [075–1503]	–33

1160	Appropriation, discretionary (total)	15,878	5,911	7,562
	Appropriations, mandatory:
1200	Appropriation	39,000
1900	Budget authority (total)	54,878	5,911	7,562
1930	Total budgetary resources available	54,889	5,961	7,612
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	50	50	50

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,407	49,106	31,146
3010	New obligations, unexpired accounts	54,838	5,911	7,562
3020	Outlays (gross)	–12,121	–23,871	–24,050
3041	Recoveries of prior year unpaid obligations, expired	–18

3050	Unpaid obligations, end of year	49,106	31,146	14,658
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,407	49,106	31,146
3200	Obligated balance, end of year	49,106	31,146	14,658

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	15,878	5,911	7,562
	Outlays, gross:
4010	Outlays from new discretionary authority	6,169	2,536	3,025
4011	Outlays from discretionary balances	4,451	7,005	6,611

4020	Outlays, gross (total)	10,620	9,541	9,636
	Mandatory:
4090	Budget authority, gross	39,000
	Outlays, gross:
4100	Outlays from new mandatory authority	1,501
4101	Outlays from mandatory balances		14,330	14,414

4110	Outlays, gross (total)	1,501	14,330	14,414
4180	Budget authority, net (total)	54,878	5,911	7,562
4190	Outlays, net (total)	12,121	23,871	24,050

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3	4	11
12.1	Civilian personnel benefits	1	1	4
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.1	Advisory and assistance services	63	53	60
25.3	Other goods and services from Federal sources	10	10	10
41.0	Grants, subsidies, and contributions	54,760	5,842	7,476

99.9	Total new obligations, unexpired accounts	54,838	5,911	7,562


Identification code 075–1515–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	32	33	92

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,603	1,603	1,603
0002	Health Profession Opportunity Grants	3	2

0900	Total new obligations, unexpired accounts	1,606	1,605	1,603

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	30	32	30
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,718	1,700	1,700
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–97	–97	–97

1260	Appropriations, mandatory (total)	1,621	1,603	1,603
1930	Total budgetary resources available	1,651	1,635	1,633
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–13
1941	Unexpired unobligated balance, end of year	32	30	30

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	500	435	404
3010	New obligations, unexpired accounts	1,606	1,605	1,603
3020	Outlays (gross)	–1,655	–1,636	–1,627
3041	Recoveries of prior year unpaid obligations, expired	–16

3050	Unpaid obligations, end of year	435	404	380
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	500	435	404
3200	Obligated balance, end of year	435	404	380

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,621	1,603	1,603
	Outlays, gross:
4100	Outlays from new mandatory authority	1,280	1,253	1,253
4101	Outlays from mandatory balances	375	383	374

4110	Outlays, gross (total)	1,655	1,636	1,627
4180	Budget authority, net (total)	1,621	1,603	1,603
4190	Outlays, net (total)	1,655	1,636	1,627

The Social Services Block Grant (SSBG) account includes funding for SSBG (for a broad array of social services for children and adults.


Identification code 075–1534–0–1–506		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1
25.1	Advisory and assistance services	2	1
41.0	Grants, subsidies, and contributions	1,603	1,603	1,603

99.9	Total new obligations, unexpired accounts	1,606	1,605	1,603


Identification code 075–1534–0–1–506		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	7	6

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, and section 2204 of the American Rescue Plan Act of 2021, $15,311,822,000, of which $75,000,000, to remain available through September 30, 2024, 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, 2023: Provided, That $12,203,454,000 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) $505,359,000 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, 2024, 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, 2023 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 $789,834,000 shall be for making payments under the CSBG Act: Provided further, That $35,615,000 shall be for section 680 of the CSBG Act, of which not less than $23,615,000 shall be for section 680(a)(2) and not less than $12,000,000 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 $491,869,000 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 $8,000,000 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0101	Head Start	12,509	10,748	12,203
0102	Preschool Development Grants	280	517	450
0103	Runaway and homeless youth (basic centers)	60	64	71
0104	Transitional living	57	53	58
0106	Education grants to reduce sexual abuse of runaway youth	20	20	21
0109	Child abuse State grants	190	90	125
0110	Child abuse discretionary activities	35	35	42
0111	Community-based child abuse prevention	309	63	90
0112	Child welfare services	269	269	279
0113	Child welfare training, research, or demonstration projects	19	19	121
0114	Adoption opportunities	44	44	46
0116	Adoption and Legal Guardianship Incentives	52	98	75
0117	Independent living education and training vouchers	48	43	48
0124	Native American programs	76	57	63
0125	Social services and income maintenance research	8	8	69
0128	ACF Federal administration	212	219	234
0131	Disaster human services case management	2	2	8

0191	Direct program activities, subtotal	14,190	12,349	14,003
0301	Community services block grant	832	745	754
0303	Rural community facilities	10	10	12
0304	Community economic development	20	20	24
0305	Low Income Household Drinking Water & Wastewater Emergency Assistance	1,127	10
0308	Domestic violence hotline	13	13	27
0309	Family violence prevention and services	378	438	492

0391	Direct program activities, subtotal	2,380	1,236	1,309

0400	Total, direct program	16,570	13,585	15,312

0799	Total direct obligations	16,570	13,585	15,312
0801	Children and Families Services Programs (Reimbursable)	15	34	34

0809	Reimbursable program activities, subtotal	15	34	34

0900	Total new obligations, unexpired accounts	16,585	13,619	15,346

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	820	540	5
1012	Unobligated balance transfers between expired and unexpired accounts	4
1021	Recoveries of prior year unpaid obligations	65

1070	Unobligated balance (total)	889	540	5
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	13,929	13,049	15,312
	Appropriations, mandatory:
1200	Appropriation	2,320
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	23	23
1701	Change in uncollected payments, Federal sources	1

1750	Spending auth from offsetting collections, disc (total)	4	23	23
	Spending authority from offsetting collections, mandatory:
1800	Collected	3	11	11
1801	Change in uncollected payments, Federal sources	10	1	1

1850	Spending auth from offsetting collections, mand (total)	13	12	12
1900	Budget authority (total)	16,266	13,084	15,347
1930	Total budgetary resources available	17,155	13,624	15,352
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–30
1941	Unexpired unobligated balance, end of year	540	5	6

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	12,204	15,296	14,091
3010	New obligations, unexpired accounts	16,585	13,619	15,346
3011	Obligations ("upward adjustments"), expired accounts	20
3020	Outlays (gross)	–13,219	–14,824	–15,300
3040	Recoveries of prior year unpaid obligations, unexpired	–65
3041	Recoveries of prior year unpaid obligations, expired	–229

3050	Unpaid obligations, end of year	15,296	14,091	14,137
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–23	–26	–27
3070	Change in uncollected pymts, Fed sources, unexpired	–11	–1	–1
3071	Change in uncollected pymts, Fed sources, expired	8

3090	Uncollected pymts, Fed sources, end of year	–26	–27	–28
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	12,181	15,270	14,064
3200	Obligated balance, end of year	15,270	14,064	14,109

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	13,933	13,072	15,335
	Outlays, gross:
4010	Outlays from new discretionary authority	4,532	4,495	5,294
4011	Outlays from discretionary balances	8,622	9,747	9,414

4020	Outlays, gross (total)	13,154	14,242	14,708
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3	–23	–23
4033	Non-Federal sources	–4

4040	Offsets against gross budget authority and outlays (total)	–7	–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	4

4060	Additional offsets against budget authority only (total)	3

4070	Budget authority, net (discretionary)	13,929	13,049	15,312
4080	Outlays, net (discretionary)	13,147	14,219	14,685
	Mandatory:
4090	Budget authority, gross	2,333	12	12
	Outlays, gross:
4100	Outlays from new mandatory authority	61	12	12
4101	Outlays from mandatory balances	4	570	580

4110	Outlays, gross (total)	65	582	592
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–6	–12	–12
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–10	–1	–1
4142	Offsetting collections credited to expired accounts	3	1	1

4150	Additional offsets against budget authority only (total)	–7

4160	Budget authority, net (mandatory)	2,320
4170	Outlays, net (mandatory)	59	570	580
4180	Budget authority, net (total)	16,249	13,049	15,312
4190	Outlays, net (total)	13,206	14,789	15,265

The request totals $15.3 billion, including $12.2 billion for Head Start, and provides assistance to children, families, and communities through partnerships with States and local community agencies.


Identification code 075–1536–0–1–506		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	120	123	121
11.3	Other than full-time permanent	5	5	4
11.5	Other personnel compensation	2	2	2
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	128	131	128
12.1	Civilian personnel benefits	44	43	45
21.0	Travel and transportation of persons			2
23.1	Rental payments to GSA	5	5	10
23.3	Communications, utilities, and miscellaneous charges	1	1	2
25.1	Advisory and assistance services	144	144	305
25.2	Other services from non-Federal sources	13	13	19
25.3	Other goods and services from Federal sources	209	209	85
25.4	Operation and maintenance of facilities	5	5	5
26.0	Supplies and materials			1
31.0	Equipment	3	3	1
41.0	Grants, subsidies, and contributions	16,018	13,031	14,709

99.0	Direct obligations	16,570	13,585	15,312
99.0	Reimbursable obligations	15	34	34

99.9	Total new obligations, unexpired accounts	16,585	13,619	15,346


Identification code 075–1536–0–1–506		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1,071	1,049	1,017
1101	Direct military average strength employment	4	4	4
2001	Reimbursable civilian full-time equivalent employment	9	10	10


Identification code 075–1553–0–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Training and technical assistance	13	12	12
0002	Federal parent locator service	24	23	23

0799	Total direct obligations	37	35	35
0801	Federal Parent Locator Service reimbursable	28	38	38

0899	Total reimbursable obligations	28	38	38

0900	Total new obligations, unexpired accounts	65	73	73

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7	8	10
1021	Recoveries of prior year unpaid obligations	4

1070	Unobligated balance (total)	11	8	10
	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	27	40	40
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)	27	40	40
1900	Budget authority (total)	62	75	75
1930	Total budgetary resources available	73	83	85
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	8	10	12

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	20	10	9
3010	New obligations, unexpired accounts	65	73	73
3020	Outlays (gross)	–71	–74	–73
3040	Recoveries of prior year unpaid obligations, unexpired	–4

3050	Unpaid obligations, end of year	10	9	9
	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	14	4	3
3200	Obligated balance, end of year	4	3	3

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	62	75	75
	Outlays, gross:
4100	Outlays from new mandatory authority	49	59	59
4101	Outlays from mandatory balances	22	15	14

4110	Outlays, gross (total)	71	74	73
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–9	–12	–12
4123	Non-Federal sources	–18	–28	–28

4130	Offsets against gross budget authority and outlays (total)	–27	–40	–40

4160	Budget authority, net (mandatory)	35	35	35
4170	Outlays, net (mandatory)	44	34	33
4180	Budget authority, net (total)	35	35	35
4190	Outlays, net (total)	44	34	33

	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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	9	10	10
12.1	Civilian personnel benefits	3	3	3
23.1	Rental payments to GSA	4	4	4
25.3	Other goods and services from Federal sources	7	4	4
25.7	Operation and maintenance of equipment	14	14	14

99.0	Direct obligations	37	35	35
99.0	Reimbursable obligations	28	38	38

99.9	Total new obligations, unexpired accounts	65	73	73


Identification code 075–1553–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	66	76	82

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, $7,606,000,000.

For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year 2024, $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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Foster care	5,788	6,032	6,189
0002	Independent living	547	143	143
0004	Adoption assistance	3,641	4,046	4,128
0005	Guardianship	249	317	345
0006	Technical Assistance and Implementation Services for Tribal Programs	3	3	3
0007	Prevention Services Technical Assistance	1	1	1

0900	Total new obligations, unexpired accounts	10,229	10,542	10,809

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		99	95
1012	Unobligated balance transfers between expired and unexpired accounts	4
1020	Adjustment of unobligated bal brought forward, Oct 1	654

1070	Unobligated balance (total)	658	99	95
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	7,417	7,541	7,611
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2	–3	–3

1260	Appropriations, mandatory (total)	7,415	7,538	7,608
	Advance appropriations, mandatory:
1270	Advance appropriation	3,000	3,000	3,200
1900	Budget authority (total)	10,415	10,538	10,808
1930	Total budgetary resources available	11,073	10,637	10,903
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–745
1941	Unexpired unobligated balance, end of year	99	95	94

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,618	1,984	1,836
3010	New obligations, unexpired accounts	10,229	10,542	10,809
3011	Obligations ("upward adjustments"), expired accounts	84
3020	Outlays (gross)	–9,713	–10,690	–10,206
3041	Recoveries of prior year unpaid obligations, expired	–234

3050	Unpaid obligations, end of year	1,984	1,836	2,439
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,618	1,984	1,836
3200	Obligated balance, end of year	1,984	1,836	2,439

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	10,415	10,538	10,808
	Outlays, gross:
4100	Outlays from new mandatory authority	8,357	8,913	9,140
4101	Outlays from mandatory balances	1,356	1,777	1,066

4110	Outlays, gross (total)	9,713	10,690	10,206
4180	Budget authority, net (total)	10,415	10,538	10,808
4190	Outlays, net (total)	9,713	10,690	10,206


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	10,415	10,538	10,808
	Outlays	9,713	10,690	10,206
Legislative proposal, subject to PAYGO:
	Budget Authority		161	444
	Outlays		161	444
Total:
	Budget Authority	10,415	10,699	11,252
	Outlays	9,713	10,851	10,650

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 225,600 children per month are estimated to be served in FY 2023.

Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 523,300 children per month are estimated to be served in FY 2023.

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 67,800 children per month are estimated to be served in FY 2023.


Identification code 075–1545–0–1–609		2021 actual	2022 est.	2023 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	34	42	46
25.2	Other services from non-Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	10,192	10,497	10,760

99.9	Total new obligations, unexpired accounts	10,229	10,542	10,809


Identification code 075–1545–0–1–609		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	3	3	3


Identification code 075–1545–4–1–609		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Foster care		161	344
0002	Independent living			100

0900	Total new obligations, unexpired accounts (object class 41.0)		161	444

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		161	444
1900	Budget authority (total)		161	444
1930	Total budgetary resources available		161	444

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts		161	444
3020	Outlays (gross)		–161	–444

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		161	444
	Outlays, gross:
4100	Outlays from new mandatory authority		161	444
4180	Budget authority, net (total)		161	444
4190	Outlays, net (total)		161	444

The Budget proposes to increase reimbursement rates for the Prevention Services and Kinship Navigator programs. The Budget also proposes to increase reimbursement rates in the foster care and guardianship assistance programs for children placed with kin and to reduce reimbursement rates for children placed in most congregate care settings. The Budget proposes to increase Chafee funding by $100 million per year and add flexibilities in the program. Finally, the Budget proposes to amend title IV-E to prohibit states and contractors from discriminating against prospective foster or adoptive parents or children in foster care or being considered for adoption on the basis of their religious beliefs, sexual orientation, gender identity, gender expression, or sex.

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 of 2000, 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, $2,930,491,000, 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, $27,503,000 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, 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 notwithstanding section 206(h) of the OAA, up to one percent of amounts appropriated to carry out programs authorized under title III of such Act shall be available for conducting evaluations: Provided further, That up to five percent of the funds provided for adult protective services grants under section 2042 of title XXof the Social Security Act may be used to make grants to Tribes and Tribal Organizations: Provided further, That up to $1.5 million of funds made available under this heading for aging network support activities under sections 202, 215, and 411 of the OAA and up to $1.5 million of funds made available under this heading for projects of national significance under subtitle E of title I of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 may be merged and used for demonstration grants that benefit both older individuals and individuals with any type of disability: 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0101	Aging Services Programs	3,495	1,872	2,308
0102	ACL Program Administration	41	41	57
0103	Integrated Aging and Disability Services Programs	46	54	68
0104	Disability Services Programs	324	316	380
0105	National Institute on Disability, Independent Living & Rehab Research	113	113	119

0300	Total, direct program	4,019	2,396	2,932

0799	Total direct obligations	4,019	2,396	2,932
0801	ACL Reimbursable Programs	112	109	110
0802	PHS Evaluation: Disability Reimbursable (Collected)			28

0899	Total reimbursable obligations	112	109	138

0900	Total new obligations, unexpired accounts	4,131	2,505	3,070

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	17	220	59
1021	Recoveries of prior year unpaid obligations	1

1070	Unobligated balance (total)	18	220	59
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,481	2,207	2,930
1120	Appropriations transferred to other acct [012–3507]	–1	–1
1120	Appropriations transferred to other acct [075–1503]	–7
1121	Appropriations transferred from other acct [075–0116]		28

1160	Appropriation, discretionary (total)	2,473	2,234	2,930
	Appropriations, mandatory:
1200	Appropriation	1,720
1221	PPHF Appropriations transferred from other accounts [075–0116]	28		28

1260	Appropriations, mandatory (total)	1,748		28
	Spending authority from offsetting collections, discretionary:
1701	Change in uncollected payments, Federal sources	75	75	77
	Spending authority from offsetting collections, mandatory:
1800	Collected		35	35
1801	Change in uncollected payments, Federal sources	38

1850	Spending auth from offsetting collections, mand (total)	38	35	35
1900	Budget authority (total)	4,334	2,344	3,070
1930	Total budgetary resources available	4,352	2,564	3,129
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	220	59	59

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,534	3,979	2,605
3010	New obligations, unexpired accounts	4,131	2,505	3,070
3011	Obligations ("upward adjustments"), expired accounts	3
3020	Outlays (gross)	–2,664	–3,879	–3,778
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–24

3050	Unpaid obligations, end of year	3,979	2,605	1,897
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–187	–297	–372
3070	Change in uncollected pymts, Fed sources, unexpired	–113	–75	–77
3071	Change in uncollected pymts, Fed sources, expired	3

3090	Uncollected pymts, Fed sources, end of year	–297	–372	–449
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,347	3,682	2,233
3200	Obligated balance, end of year	3,682	2,233	1,448

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,548	2,309	3,007
	Outlays, gross:
4010	Outlays from new discretionary authority	878	1,381	1,802
4011	Outlays from discretionary balances	1,729	988	922

4020	Outlays, gross (total)	2,607	2,369	2,724
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–2	–75	–77
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–75	–75	–77
4052	Offsetting collections credited to expired accounts	2	75	77

4060	Additional offsets against budget authority only (total)	–73

4070	Budget authority, net (discretionary)	2,473	2,234	2,930
4080	Outlays, net (discretionary)	2,605	2,294	2,647
	Mandatory:
4090	Budget authority, gross	1,786	35	63
	Outlays, gross:
4100	Outlays from new mandatory authority	12	7	7
4101	Outlays from mandatory balances	45	1,503	1,047

4110	Outlays, gross (total)	57	1,510	1,054
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–35	–35
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–38

4160	Budget authority, net (mandatory)	1,748		28
4170	Outlays, net (mandatory)	57	1,475	1,019
4180	Budget authority, net (total)	4,221	2,234	2,958
4190	Outlays, net (total)	2,662	3,769	3,666

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	23	24	31
12.1	Civilian personnel benefits	8	8	10
23.1	Rental payments to GSA	3	3	3
25.1	Advisory and assistance services	50	52	57
41.0	Grants, subsidies, and contributions	3,935	2,309	2,830

99.0	Direct obligations	4,019	2,396	2,931
99.0	Reimbursable obligations	112	109	139

99.9	Total new obligations, unexpired accounts	4,131	2,505	3,070


Identification code 075–0142–0–1–506		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	171	175	219
2001	Reimbursable civilian full-time equivalent employment	12	12	12

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, $579,839,000, together with $85,228,000 from the amounts available under section 241 of the PHS Act : Provided, That of this amount, $58,400,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $111,000,000 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, $7,700,000 shall be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches: 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	GDM Direct	486	486	580

0100	Direct, subtotal	486	486	580
0802	GDM Reimbursable (collected)	189	189	181
0803	PHS Evaluation Reimbursable (Collected)	65	65	86

0809	Reimbursable program activities, subtotal	254	254	267
0811	OGC HCFAC Mandatory (R)	7	7	10
0812	ASPE PTAC Mandatory (R)	4	4	5
0813	ASPA/CDC/ PSA Mandatory (R)	22	22
0814	ASPE Equity Mandatory (R)	1	1
0816	OASH OCCHE Mandatory (R)	1	1

0819	Reimbursable program activities, subtotal	35	35	15

0899	Total reimbursable obligations	289	289	282

0900	Total new obligations, unexpired accounts	775	775	862

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	39	56	55
1001	Discretionary unobligated balance brought fwd, Oct 1	1
1011	Unobligated balance transfer from other acct [075–0116]	3
1021	Recoveries of prior year unpaid obligations	13

1070	Unobligated balance (total)	55	56	55
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation [GDM Direct]	486	486	580
1120	Appropriations transferred — other accts [075–1503]	–2

1160	Appropriation, discretionary (total)	484	486	580
	Spending authority from offsetting collections, discretionary:
1700	Collected	102	254	267
1701	Change in uncollected payments, Federal sources	156
1711	Spending authority from offsetting collections transferred from other accounts [075–0139]	1

1750	Spending auth from offsetting collections, disc (total)	259	254	267
	Spending authority from offsetting collections, mandatory:
1800	Collected	40	35	15
1801	Change in uncollected payments, Federal sources	–6

1850	Spending auth from offsetting collections, mand (total)	34	35	15
1900	Budget authority (total)	777	775	862
1930	Total budgetary resources available	832	831	917
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1	–1
1941	Unexpired unobligated balance, end of year	56	55	55

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	563	562	518
3010	New obligations, unexpired accounts	775	775	862
3011	Obligations ("upward adjustments"), expired accounts	13
3020	Outlays (gross)	–743	–819	–803
3040	Recoveries of prior year unpaid obligations, unexpired	–13
3041	Recoveries of prior year unpaid obligations, expired	–33

3050	Unpaid obligations, end of year	562	518	577
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–280	–301	–301
3070	Change in uncollected pymts, Fed sources, unexpired	–150
3071	Change in uncollected pymts, Fed sources, expired	129

3090	Uncollected pymts, Fed sources, end of year	–301	–301	–301
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	283	261	217
3200	Obligated balance, end of year	261	217	276

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	743	740	847
	Outlays, gross:
4010	Outlays from new discretionary authority	369	354	402
4011	Outlays from discretionary balances	338	377	386

4020	Outlays, gross (total)	707	731	788
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–227	–254	–267
4033	Non-Federal sources:	–1

4040	Offsets against gross budget authority and outlays (total)	–228	–254	–267
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–156
4052	Offsetting collections credited to expired accounts	126

4060	Additional offsets against budget authority only (total)	–30

4070	Budget authority, net (discretionary)	485	486	580
4080	Outlays, net (discretionary)	479	477	521
	Mandatory:
4090	Budget authority, gross	34	35	15
	Outlays, gross:
4100	Outlays from new mandatory authority	8	35	15
4101	Outlays from mandatory balances	28	53

4110	Outlays, gross (total)	36	88	15
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources:	–40	–35	–15
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	6
4170	Outlays, net (mandatory)	–4	53
4180	Budget authority, net (total)	485	486	580
4190	Outlays, net (total)	475	530	521

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation for 2023. 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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	85	85	108
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	2	2	4

11.9	Total personnel compensation	92	92	117
12.1	Civilian personnel benefits	33	33	44
12.2	Military personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	21	21	22
23.3	Communications, utilities, and miscellaneous charges	2	2	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	41	41	37
25.2	Other services from non-Federal sources	25	25	35
25.3	Other goods and services from Federal sources	126	126	140
25.4	Operation and maintenance of facilities	2	2	11
25.7	Operation and maintenance of equipment	2	2	3
26.0	Supplies and materials	1	1	1
31.0	Equipment	1	1	2
41.0	Grants, subsidies, and contributions	137	137	164

99.0	Direct obligations	486	486	580
99.0	Reimbursable obligations	289	289	282

99.9	Total new obligations, unexpired accounts	775	775	862


Identification code 075–9912–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	751	799	950
1101	Direct military average strength employment	26	38	43
2001	Reimbursable civilian full-time equivalent employment	544	552	591
2101	Reimbursable military average strength employment	6	11	12


Identification code 075–0135–0–1–751		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Office for Civil Rights (Direct)	39	39	60
0801	Office for Civil Rights (Reimbursable)	18	20	21

0900	Total new obligations, unexpired accounts	57	59	81

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	62	53	43
1021	Recoveries of prior year unpaid obligations	2

1070	Unobligated balance (total)	64	53	43
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	39	39	60
	Spending authority from offsetting collections, mandatory:
1800	Collected	7	10	10
1802	Offsetting collections (previously unavailable)		1	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced		–1	–1

1850	Spending auth from offsetting collections, mand (total)	7	10	10
1900	Budget authority (total)	46	49	70
1930	Total budgetary resources available	110	102	113
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	53	43	32

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	18	22	33
3010	New obligations, unexpired accounts	57	59	81
3020	Outlays (gross)	–51	–48	–74
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	22	33	40
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	18	22	33
3200	Obligated balance, end of year	22	33	40

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	39	39	60
	Outlays, gross:
4010	Outlays from new discretionary authority	29	31	48
4011	Outlays from discretionary balances	6	5	12

4020	Outlays, gross (total)	35	36	60
	Mandatory:
4090	Budget authority, gross	7	10	10
	Outlays, gross:
4100	Outlays from new mandatory authority		2	2
4101	Outlays from mandatory balances	16	10	12

4110	Outlays, gross (total)	16	12	14
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–7	–10	–10
4180	Budget authority, net (total)	39	39	60
4190	Outlays, net (total)	44	38	64

	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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	15	17	29
11.3	Other than full-time permanent			1
11.5	Other personnel compensation	1	1	1

11.9	Total personnel compensation	16	18	31
12.1	Civilian personnel benefits	5	6	10
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	2	3	5
25.3	Other goods and services from Federal sources	11	7	8
25.4	Operation and maintenance of facilities		1
31.0	Equipment	1		1

99.0	Direct obligations	39	39	60
99.0	Reimbursable obligations	18	20	21

99.9	Total new obligations, unexpired accounts	57	59	81


Identification code 075–0135–0–1–751		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	126	140	231
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	54	49	49

From amounts made available pursuant to section 241 of the PHS Act, $103,614,000 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Health information technology (IT)	62	62

0799	Total direct obligations	62	62
0801	Office of the National Coordinator for Health IT (ONC): Reimbursable	4	4	4
0802	ONC Reimbursable program activity: PHS Evaluation			104

0899	Total reimbursable obligations	4	4	108

0900	Total new obligations, unexpired accounts	66	66	108

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	11	19	40
1021	Recoveries of prior year unpaid obligations	8

1070	Unobligated balance (total)	19	19	40
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	62	62
	Spending authority from offsetting collections, discretionary:
1700	Collected	1	25	104
1701	Change in uncollected payments, Federal sources	3

1750	Spending auth from offsetting collections, disc (total)	4	25	104
1900	Budget authority (total)	66	87	104
1930	Total budgetary resources available	85	106	144
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	19	40	36

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	54	42	27
3010	New obligations, unexpired accounts	66	66	108
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–69	–81	–74
3040	Recoveries of prior year unpaid obligations, unexpired	–8
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	42	27	61
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–9	–7	–7
3070	Change in uncollected pymts, Fed sources, unexpired	–3
3071	Change in uncollected pymts, Fed sources, expired	5

3090	Uncollected pymts, Fed sources, end of year	–7	–7	–7
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	45	35	20
3200	Obligated balance, end of year	35	20	54

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	66	87	104
	Outlays, gross:
4010	Outlays from new discretionary authority	43	65	57
4011	Outlays from discretionary balances	26	16	17

4020	Outlays, gross (total)	69	81	74
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources:	–6	–25	–104

4040	Offsets against gross budget authority and outlays (total)	–6	–25	–104
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–3
4052	Offsetting collections credited to expired accounts	5

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	62	62
4080	Outlays, net (discretionary)	63	56	–30
4180	Budget authority, net (total)	62	62
4190	Outlays, net (total)	63	56	–30

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	22	22
11.5	Other personnel compensation	2	2

11.9	Total personnel compensation	24	24
12.1	Civilian personnel benefits	8	8
23.1	Rental payments to GSA	2	2
25.2	Other services from non-Federal sources	12	12
25.3	Other goods and services from Federal sources	11	11
41.0	Grants, subsidies, and contributions	6	6

99.0	Direct obligations	63	63
99.0	Reimbursable obligations	4	4	108
99.5	Adjustment for rounding	–1	–1

99.9	Total new obligations, unexpired accounts	66	66	108


Identification code 075–0130–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	180	180	180

For expenses necessary for Medicare hearings and appeals in the Office of the Secretary, $196,000,000 shall remain available until September 30,2024, 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicare Hearings and Appeals (Direct)	208	192	196

0799	Total direct obligations	208	192	196

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	48	40	40
1021	Recoveries of prior year unpaid obligations	5

1070	Unobligated balance (total)	53	40	40
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	187	192	196
1701	Change in uncollected payments, Federal sources	10
1710	Spending authority from offsetting collections transferred to other accounts [075–0120]	–1

1750	Spending auth from offsetting collections, disc (total)	196	192	196
1900	Budget authority (total)	196	192	196
1930	Total budgetary resources available	249	232	236
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	40	40	40

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	45	40	2
3010	New obligations, unexpired accounts	208	192	196
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–203	–230	–196
3040	Recoveries of prior year unpaid obligations, unexpired	–5
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	40	2	2
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–92	–96	–96
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	6

3090	Uncollected pymts, Fed sources, end of year	–96	–96	–96
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–47	–56	–94
3200	Obligated balance, end of year	–56	–94	–94

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	196	192	196
	Outlays, gross:
4010	Outlays from new discretionary authority	131	192	196
4011	Outlays from discretionary balances	72

4020	Outlays, gross (total)	203	192	196
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–187	–192	–196
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10

4060	Additional offsets against budget authority only (total)	–10

4070	Budget authority, net (discretionary)	–1
4080	Outlays, net (discretionary)	16
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		38
4180	Budget authority, net (total)	–1
4190	Outlays, net (total)	16	38

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	117	108	101
11.5	Other personnel compensation		2	2

11.9	Total personnel compensation	117	110	103
12.1	Civilian personnel benefits	41	39	37
23.1	Rental payments to GSA	12	11	10
23.3	Communications, utilities, and miscellaneous charges	8	7	14
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services			2
25.2	Other services from non-Federal sources	17	12	12
25.3	Other goods and services from Federal sources	9	11	15
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	2
26.0	Supplies and materials			1

99.0	Direct obligations	208	192	196

99.9	Total new obligations, unexpired accounts	208	192	196


Identification code 075–0139–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1,228	1,090	1,025

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, $1,687,610,000, of which $828,380,000 shall remain available through September 30, 2024, 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, 2025: Provided further, That $132,801,000 of the amounts made available to support coordination of the development, production, and distribution of vaccines, therapeutics, and other medical countermeasures 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, $975,000,000, to remain available until expended.

For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic, $382,000,000; of which $347,000,000 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	117,764	97,439	3,815

0100	Direct program activities, subtotal	117,764	97,439	3,815
0801	Reimbursable program (FEMA)	135	135	140
0802	Reimbursable program activity (OPP)	3	3	2

0899	Total reimbursable obligations	138	138	142

0900	Total new obligations, unexpired accounts	117,902	97,577	3,957

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	86,561	95,631	1,056
1001	Discretionary unobligated balance brought fwd, Oct 1	86,548
1010	Unobligated balance transfer to other accts [075–0343]	–4	–7
1011	Unobligated balance transfer from other acct [075–0943]	544
1011	Unobligated balance transfer from other acct [075–0846]	581
1011	Unobligated balance transfer from other acct [075–0849]	114
1011	Unobligated balance transfer from other acct [075–0898]	78
1021	Recoveries of prior year unpaid obligations	4,334
1033	Recoveries of prior year paid obligations	1,541

1070	Unobligated balance (total)	93,749	95,624	1,056
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	51,192	2,847	3,815
1120	Appropriations transferred to other acct [075–1503]	–858
1120	Appropriations transferred to other acct [075–0390]	–790

1160	Appropriation, discretionary (total)	49,544	2,847	3,815
	Appropriations, mandatory:
1200	Appropriation	70,110
	Spending authority from offsetting collections, discretionary:
1700	Collected	2	162	165
1701	Change in uncollected payments, Federal sources	135

1750	Spending auth from offsetting collections, disc (total)	137	162	165
1900	Budget authority (total)	119,791	3,009	3,980
1930	Total budgetary resources available	213,540	98,633	5,036
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–7
1941	Unexpired unobligated balance, end of year	95,631	1,056	1,079

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	38,868	80,077	109,794
3010	New obligations, unexpired accounts	117,902	97,577	3,957
3011	Obligations ("upward adjustments"), expired accounts	37
3020	Outlays (gross)	–72,302	–67,860	–21,715
3040	Recoveries of prior year unpaid obligations, unexpired	–4,334
3041	Recoveries of prior year unpaid obligations, expired	–94

3050	Unpaid obligations, end of year	80,077	109,794	92,036
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–272	–332	–332
3070	Change in uncollected pymts, Fed sources, unexpired	–135
3071	Change in uncollected pymts, Fed sources, expired	75

3090	Uncollected pymts, Fed sources, end of year	–332	–332	–332
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	38,596	79,745	109,462
3200	Obligated balance, end of year	79,745	109,462	91,704

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	49,681	3,009	3,980
	Outlays, gross:
4010	Outlays from new discretionary authority	7,917	644	1,028
4011	Outlays from discretionary balances	59,361	41,182	6,665

4020	Outlays, gross (total)	67,278	41,826	7,693
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–98	–162	–165
4033	Non-Federal sources:	–1,551

4040	Offsets against gross budget authority and outlays (total)	–1,649	–162	–165
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–135
4052	Offsetting collections credited to expired accounts	106
4053	Recoveries of prior year paid obligations, unexpired accounts	1,541

4060	Additional offsets against budget authority only (total)	1,512

4070	Budget authority, net (discretionary)	49,544	2,847	3,815
4080	Outlays, net (discretionary)	65,629	41,664	7,528
	Mandatory:
4090	Budget authority, gross	70,110
	Outlays, gross:
4100	Outlays from new mandatory authority	5,022
4101	Outlays from mandatory balances	2	26,034	14,022

4110	Outlays, gross (total)	5,024	26,034	14,022
4180	Budget authority, net (total)	119,654	2,847	3,815
4190	Outlays, net (total)	70,653	67,698	21,550


		2021 actual	2022 est.	2023 est.

Enacted/requested:
	Budget Authority	119,654	2,847	3,815
	Outlays	70,653	67,698	21,550
Legislative proposal, subject to PAYGO:
	Budget Authority			40,019
	Outlays			6,003
Total:
	Budget Authority	119,654	2,847	43,834
	Outlays	70,653	67,698	27,553

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	149	123	183
11.3	Other than full-time permanent	19	16	14
11.5	Other personnel compensation	11	9	1
11.7	Military personnel	18	15	15
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	198	164	214
12.1	Civilian personnel benefits	48	40	55
12.2	Military personnel benefits	6	5	7
21.0	Travel and transportation of persons	9	7	12
22.0	Transportation of things	205	169	7
23.1	Rental payments to GSA	9	7	7
23.2	Rental payments to others	11	9	16
23.3	Communications, utilities, and miscellaneous charges	7	6	4
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	8,119	6,686	263
25.2	Other services from non-Federal sources	35,561	29,513	1,001
25.3	Other goods and services from Federal sources	34,746	28,730	1,020
25.4	Operation and maintenance of facilities	5	4	6
25.5	Research and development contracts	529	437	17
25.6	Medical care	11	9	1
25.7	Operation and maintenance of equipment	99	82	33
26.0	Supplies and materials	1,321	1,092	43
31.0	Equipment	150	124	5
32.0	Land and structures	9	7	1
41.0	Grants, subsidies, and contributions	36,718	30,345	1,100
42.0	Insurance claims and indemnities	1	1	1
43.0	Interest and dividends	1	1	1

99.0	Direct obligations	117,764	97,439	3,815
99.0	Reimbursable obligations	138	138	142

99.9	Total new obligations, unexpired accounts	117,902	97,577	3,957


Identification code 075–0140–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1,102	1,214	1,649
1101	Direct military average strength employment	114	94	197


Identification code 075–0140–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Prepare for pandemic and biological threats			40,019

0100	Direct program activities, subtotal			40,019

0900	Total new obligations, unexpired accounts (object class 25.5)			40,019

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			40,019
1930	Total budgetary resources available			40,019

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			40,019
3020	Outlays (gross)			–6,003

3050	Unpaid obligations, end of year			34,016
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			34,016

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			40,019
	Outlays, gross:
4100	Outlays from new mandatory authority			6,003
4180	Budget authority, net (total)			40,019
4190	Outlays, net (total)			6,003

The 2023 Budget includes mandatory funding for significant investments in pandemic preparedness across HHS, including the Office of the Assistant Secretary for Preparedness and Response. These investments will support advanced development and manufacturing of vaccines, therapeutics, and diagnostics for high priority viral families and scale up manufacturing capacity for medical countermeasures.


Identification code 075–0150–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity	689	5,800	900

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		9,311	3,511
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	10,000
1930	Total budgetary resources available	10,000	9,311	3,511
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9,311	3,511	2,611

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		637	637
3010	New obligations, unexpired accounts	689	5,800	900
3020	Outlays (gross)	–52	–5,800	–500

3050	Unpaid obligations, end of year	637	637	1,037
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		637	637
3200	Obligated balance, end of year	637	637	1,037

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	10,000
	Outlays, gross:
4100	Outlays from new mandatory authority	52
4101	Outlays from mandatory balances		5,800	500

4110	Outlays, gross (total)	52	5,800	500
4180	Budget authority, net (total)	10,000
4190	Outlays, net (total)	52	5,800	500

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.1	Advisory and assistance services	14	118	18
25.2	Other services from non-Federal sources	9	76	11
25.3	Other goods and services from Federal sources	506	4,259	662
32.0	Land and structures	160	1,347	209

99.9	Total new obligations, unexpired accounts	689	5,800	900


Identification code 075–0151–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity			237

0900	Total new obligations, unexpired accounts (object class 25.6)			237

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			237
1930	Total budgetary resources available			237

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			237
3020	Outlays (gross)			–213

3050	Unpaid obligations, end of year			24
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			24

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			237
	Outlays, gross:
4100	Outlays from new mandatory authority			213
4180	Budget authority, net (total)			237
4190	Outlays, net (total)			213

This national program creates a financing delivery system to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wrap-around services through States, IHS and tribal entities, and localities, and establish a network of community providers to reach underserved areas and populations. Together, these investments will help support the National HIV/AIDS Strategy (2022–2025) commitment to a 75 percent reduction in HIV infection by 2025.


Identification code 075–0136–4–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity			750

0900	Total new obligations, unexpired accounts (object class 41.0)			750

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			7,500
1930	Total budgetary resources available			7,500
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			6,750

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts			750
3020	Outlays (gross)			–750

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			7,500
	Outlays, gross:
4100	Outlays from new mandatory authority			750
4180	Budget authority, net (total)			7,500
4190	Outlays, net (total)			750

The fund will support innovative, transformational initiatives to improve system capacity, connect more people to the care they need, and create a continuum of support by promoting wellness and recovery. These programs will prioritize sustainability, integration, leverage existing capacity, and support new models of care, including hub-and-spoke models.


Identification code 075–0145–0–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	AHRQ	63	105	111
0002	Office of the Secretary		26	28

0900	Total new obligations, unexpired accounts	63	131	139

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	261	318	323
1021	Recoveries of prior year unpaid obligations	5

1070	Unobligated balance (total)	266	318	323
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	115	136	144
1930	Total budgetary resources available	381	454	467
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	318	323	328

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	101	91	74
3010	New obligations, unexpired accounts	63	131	139
3020	Outlays (gross)	–68	–148	–133
3040	Recoveries of prior year unpaid obligations, unexpired	–5

3050	Unpaid obligations, end of year	91	74	80
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	101	91	74
3200	Obligated balance, end of year	91	74	80

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	115	136	144
	Outlays, gross:
4100	Outlays from new mandatory authority		4	4
4101	Outlays from mandatory balances	68	144	129

4110	Outlays, gross (total)	68	148	133
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–115	–136	–144
4180	Budget authority, net (total)
4190	Outlays, net (total)	–47	12	–11

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	38	105	111
41.0	Grants, subsidies, and contributions	25	26	28

99.9	Total new obligations, unexpired accounts	63	131	139


Identification code 075–0145–0–1–552		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	4


Identification code 075–0125–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Nonrecurring Expenses Fund Projects	372	1,029	509

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,191	1,458	804
1012	Unobligated balance transfers between expired and unexpired accounts	997	750	750
1021	Recoveries of prior year unpaid obligations	17

1070	Unobligated balance (total)	2,205	2,208	1,554
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced	–375	–375	–500
1930	Total budgetary resources available	1,830	1,833	1,054
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,458	804	545

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	728	785	1,315
3010	New obligations, unexpired accounts	372	1,029	509
3020	Outlays (gross)	–298	–499	–184
3040	Recoveries of prior year unpaid obligations, unexpired	–17

3050	Unpaid obligations, end of year	785	1,315	1,640
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	728	785	1,315
3200	Obligated balance, end of year	785	1,315	1,640

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	–375	–375	–500
	Outlays, gross:
4010	Outlays from new discretionary authority		–101	–135
4011	Outlays from discretionary balances	298	600	319

4020	Outlays, gross (total)	298	499	184
4180	Budget authority, net (total)	–375	–375	–500
4190	Outlays, net (total)	298	499	184

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
23.1	Rental payments to GSA	1	3	1
25.1	Advisory and assistance services	7	19	10
25.2	Other services from non-Federal sources	19	53	26
25.4	Operation and maintenance of facilities	6	17	8
25.7	Operation and maintenance of equipment	18	49	25
32.0	Land and structures	321	888	439

99.0	Direct obligations	372	1,029	509

99.9	Total new obligations, unexpired accounts	372	1,029	509


Identification code 075–0125–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 075–0119–0–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4	6	6
1021	Recoveries of prior year unpaid obligations	2

1070	Unobligated balance (total)	6	6	6
1930	Total budgetary resources available	6	6	6
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6	6	6

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	14	12	10
3020	Outlays (gross)		–2	–2
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	12	10	8
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	14	12	10
3200	Obligated balance, end of year	12	10	8

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		2	2
4180	Budget authority, net (total)
4190	Outlays, net (total)		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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Direct program activity	63	144	138

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		437	293
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	500
1930	Total budgetary resources available	500	437	293
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	437	293	155

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		54	54
3010	New obligations, unexpired accounts	63	144	138
3020	Outlays (gross)	–9	–144	–138

3050	Unpaid obligations, end of year	54	54	54
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		54	54
3200	Obligated balance, end of year	54	54	54

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	500
	Outlays, gross:
4100	Outlays from new mandatory authority	9
4101	Outlays from mandatory balances		144	138

4110	Outlays, gross (total)	9	144	138
4180	Budget authority, net (total)	500
4190	Outlays, net (total)	9	144	138

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	5	11	11
12.1	Civilian personnel benefits	2	5	5
21.0	Travel and transportation of persons	2	5	4
25.1	Advisory and assistance services	1	2	2
25.2	Other services from non-Federal sources	53	121	116

99.9	Total new obligations, unexpired accounts	63	144	138


Identification code 075–0127–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	64	209	209


Identification code 075–0116–0–1–551		2021 actual	2022 est.	2023 est.

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6	3	50
1010	Unobligated balance transfer to other accts [075–0120]	–3

1070	Unobligated balance (total)	3	3	50
	Budget authority:
	Appropriations, discretionary:
1120	Appropriations transferred to other acct [075–0142]		–28
1120	Appropriations transferred to other acct [075–0943]		–856
1120	Appropriations transferred to other acct [075–1362]		–12

1160	Appropriation, discretionary (total)		–896
	Appropriations, mandatory:
1200	Appropriation	950	1,000	1,000
1220	Appropriations transferred to other accts [075–0142]	–28		–28
1220	Appropriations transferred to other accts [075–0943]	–856		–903
1220	Appropriations transferred to other accts [075–1362]	–12		–12
1230	Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]	–54	–57	–57

1260	Appropriations, mandatory (total)		943
1900	Budget authority (total)		47
1930	Total budgetary resources available	3	50	50
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	50	50

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–896
	Mandatory:
4090	Budget authority, gross		943
4180	Budget authority, net (total)		47
4190	Outlays, net (total)

The Prevention and Public Health Fund supports prevention and public health activities. In FY 2023, $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		2021 actual	2022 est.	2023 est.

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6	1
3020	Outlays (gross)	–3	–1
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6	1
3200	Obligated balance, end of year	1

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3	1
4180	Budget authority, net (total)
4190	Outlays, net (total)	3	1

This appropriation funds competitive grants to States to assist pregnant and parenting teens and women. Annual funding for this program expired at the end of FY 2019. The Budget does request an extension of this program.


Identification code 075–3902–0–1–552		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	Section 241 Evaluation Transactions Account (Reimbursable)	541	555	633

0809	Reimbursable program activities, subtotal	541	555	633

0900	Total new obligations, unexpired accounts (object class 25.3)	541	555	633

	Budgetary resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	27	555	633
1701	Change in uncollected payments, Federal sources	514

1750	Spending auth from offsetting collections, disc (total)	541	555	633
1930	Total budgetary resources available	541	555	633

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	936	845	793
3010	New obligations, unexpired accounts	541	555	633
3020	Outlays (gross)	–618	–607	–685
3041	Recoveries of prior year unpaid obligations, expired	–14

3050	Unpaid obligations, end of year	845	793	741
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–936	–844	–844
3070	Change in uncollected pymts, Fed sources, unexpired	–514
3071	Change in uncollected pymts, Fed sources, expired	606

3090	Uncollected pymts, Fed sources, end of year	–844	–844	–844
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		1	–51
3200	Obligated balance, end of year	1	–51	–103

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	541	555	633
	Outlays, gross:
4010	Outlays from new discretionary authority	27	555	633
4011	Outlays from discretionary balances	591	52	52

4020	Outlays, gross (total)	618	607	685
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–618	–555	–633

4040	Offsets against gross budget authority and outlays (total)	–618	–555	–633
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–514
4052	Offsetting collections credited to expired accounts	591

4060	Additional offsets against budget authority only (total)	77
4080	Outlays, net (discretionary)		52	52
4180	Budget authority, net (total)
4190	Outlays, net (total)		52	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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Retirement payments	657	550	573
0002	Survivors' benefits		35	36
0003	Medical care		104	101

0900	Total new obligations, unexpired accounts	657	689	710

	Budgetary resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	657	689	710
1930	Total budgetary resources available	657	689	710

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	91	84	34
3010	New obligations, unexpired accounts	657	689	710
3011	Obligations ("upward adjustments"), expired accounts	12
3020	Outlays (gross)	–659	–739	–708
3041	Recoveries of prior year unpaid obligations, expired	–17

3050	Unpaid obligations, end of year	84	34	36
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	91	84	34
3200	Obligated balance, end of year	84	34	36

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	657	689	710
	Outlays, gross:
4100	Outlays from new mandatory authority	596	655	674
4101	Outlays from mandatory balances	63	84	34

4110	Outlays, gross (total)	659	739	708
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	3

4160	Budget authority, net (mandatory)	657	689	710
4170	Outlays, net (mandatory)	656	739	708
4180	Budget authority, net (total)	657	689	710
4190	Outlays, net (total)	656	739	708

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2021	2022	2023

Active Duty:
HHS	4,394	4,814	4,845
DOJ, BOP	645	613	610
Homeland Security	548	576	563
EPA	47	47	43
All Other	341	345	331

Total Active Duty*	5975	6,395	6,392

Retirees & Survivors:
Retirees	6,380	6,500	6,300
Retiree family members and survivors	1,120	1,100	1,100

Total Retirement Pay	7,500	7,600	7,400
Total Beneficiaries (active duty, retirees, survivors)	13,475	13,995	13,697

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
13.0	Benefits for former personnel	561	585	609
25.6	Medical care	96	104	101

99.9	Total new obligations, unexpired accounts	657	689	710


Identification code 075–0170–0–1–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Medicare eligible accruals	30	36	37

0900	Total new obligations, unexpired accounts (object class 12.2)	30	36	37

	Budgetary resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	30	36	37
1900	Budget authority (total)	30	36	37
1930	Total budgetary resources available	30	36	37

	Change in obligated balance:
	Unpaid obligations:
3010	New obligations, unexpired accounts	30	36	37
3020	Outlays (gross)	–30	–36	–37

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	30	36	37
	Outlays, gross:
4010	Outlays from new discretionary authority	30	36	37
4180	Budget authority, net (total)	30	36	37
4190	Outlays, net (total)	30	36	37

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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	Reimbursable program activity	8	15	10

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4	5
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	10	10	10
1701	Change in uncollected payments, Federal sources	–1

1750	Spending auth from offsetting collections, disc (total)	9	10	10
1930	Total budgetary resources available	13	15	10
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	5	3	9
3010	New obligations, unexpired accounts	8	15	10
3020	Outlays (gross)	–10	–9	–2

3050	Unpaid obligations, end of year	3	9	17
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1
3070	Change in uncollected pymts, Fed sources, unexpired	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4	3	9
3200	Obligated balance, end of year	3	9	17

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	9	10	10
	Outlays, gross:
4010	Outlays from new discretionary authority	6	1	1
4011	Outlays from discretionary balances	4	8	1

4020	Outlays, gross (total)	10	9	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–10	–10	–10
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	1
4080	Outlays, net (discretionary)		–1	–8
4180	Budget authority, net (total)
4190	Outlays, net (total)		–1	–8


Identification code 075–5745–0–2–551		2021 actual	2022 est.	2023 est.

11.1	Reimbursable obligations: Personnel compensation: Full-time permanent	2	2	2

11.9	Total personnel compensation	2	2	2
12.1	Civilian personnel benefits	1	1	1
25.1	Advisory and assistance services	5	12	7

99.9	Total new obligations, unexpired accounts	8	15	10


Identification code 075–5745–0–2–551		2021 actual	2022 est.	2023 est.

2001	Reimbursable civilian full-time equivalent employment	18	25	25


Identification code 075–9913–0–1–551		2021 actual	2022 est.	2023 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0801	Program Support Center	424	573	506
0802	OS activities	636	728	902

0900	Total new obligations, unexpired accounts	1,060	1,301	1,408

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	198	265	1,162
1021	Recoveries of prior year unpaid obligations	117	250	250

1070	Unobligated balance (total)	315	515	1,412
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	956	1,948	1,948
1701	Change in uncollected payments, Federal sources	54

1750	Spending auth from offsetting collections, disc (total)	1,010	1,948	1,948
1930	Total budgetary resources available	1,325	2,463	3,360
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	265	1,162	1,952

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	788	792	546
3010	New obligations, unexpired accounts	1,060	1,301	1,408
3020	Outlays (gross)	–939	–1,297	–1,703
3040	Recoveries of prior year unpaid obligations, unexpired	–117	–250	–250

3050	Unpaid obligations, end of year	792	546	1
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–406	–460	–460
3070	Change in uncollected pymts, Fed sources, unexpired	–54

3090	Uncollected pymts, Fed sources, end of year	–460	–460	–460
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	382	332	86
3200	Obligated balance, end of year	332	86	–459

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,010	1,948	1,948
	Outlays, gross:
4010	Outlays from new discretionary authority	690	981	980
4011	Outlays from discretionary balances	249	316	723

4020	Outlays, gross (total)	939	1,297	1,703
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–954	–1,948	–1,948
4033	Non-Federal sources	–2

4040	Offsets against gross budget authority and outlays (total)	–956	–1,948	–1,948
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–54
4080	Outlays, net (discretionary)	–17	–651	–245
4180	Budget authority, net (total)
4190	Outlays, net (total)	–17	–651	–245

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		2021 actual	2022 est.	2023 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	118	138	177
11.3	Other than full-time permanent	4	5	6
11.5	Other personnel compensation	4	5	6
11.7	Military personnel	7	9	11
11.8	Special personal services payments	14	15

11.9	Total personnel compensation	147	172	200
12.1	Civilian personnel benefits	42	49	61
12.2	Military personnel benefits	1	2	2
21.0	Travel and transportation of persons		4	4
22.0	Transportation of things	2	1	6
23.1	Rental payments to GSA	21	14	22
23.3	Communications, utilities, and miscellaneous charges	24	31	34
24.0	Printing and reproduction	1	3	4
25.1	Advisory and assistance services	19	30	36
25.2	Other services from non-Federal sources	339	554	480
25.3	Other goods and services from Federal sources	175	160	207
25.4	Operation and maintenance of facilities	17	7	12
25.6	Medical care	12	11	15
25.7	Operation and maintenance of equipment	194	179	216
26.0	Supplies and materials	23	25	33
31.0	Equipment	43	59	76

99.9	Total new obligations, unexpired accounts	1,060	1,301	1,408


Identification code 075–9941–0–4–551		2021 actual	2022 est.	2023 est.

2001	Reimbursable civilian full-time equivalent employment	1,020	1,331	1,426
2101	Reimbursable military average strength employment	42	64	64
3101	Allocation account military average strength employment	1,534	1,534	1,504

Trust Funds


Identification code 075–9971–0–7–551		2021 actual	2022 est.	2023 est.

0100	Balance, start of year		1	3
	Receipts:
	Current law:
1130	Contributions, Indian Health Facilities	3	3	3
1130	Contributions, N.I.H., Unconditional Gift Fund	5	3	3
1130	Centers for Disease Control, Gifts and Donations	21	26	26
1130	Contributions, N.I.H., Conditional Gift Fund	44	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	74	74	74

1999	Total receipts	74	74	74

2000	Total: Balances and receipts	74	75	77
	Appropriations:
	Current law:
2101	Miscellaneous Trust Funds	–73	–72	–72

5099	Balance, end of year	1	3	5


Identification code 075–9971–0–7–551		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0002	Gifts	57	62	62
0003	Contributions, Indian Health Facilities	3	6	6

0900	Total new obligations, unexpired accounts	60	68	68

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	185	204	216
1021	Recoveries of prior year unpaid obligations	3	8	8
1033	Recoveries of prior year paid obligations	3

1070	Unobligated balance (total)	191	212	224
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	73	72	72
1930	Total budgetary resources available	264	284	296
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	204	216	228

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	97	88	60
3010	New obligations, unexpired accounts	60	68	68
3020	Outlays (gross)	–66	–88	–84
3040	Recoveries of prior year unpaid obligations, unexpired	–3	–8	–8

3050	Unpaid obligations, end of year	88	60	36
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	97	88	60
3200	Obligated balance, end of year	88	60	36

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	73	72	72
	Outlays, gross:
4100	Outlays from new mandatory authority	12	26	26
4101	Outlays from mandatory balances	54	62	58

4110	Outlays, gross (total)	66	88	84
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4143	Recoveries of prior year paid obligations, unexpired accounts	3

4160	Budget authority, net (mandatory)	73	72	72
4170	Outlays, net (mandatory)	63	88	84
4180	Budget authority, net (total)	73	72	72
4190	Outlays, net (total)	63	88	84

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	31	29	29
5001	Total investments, EOY: Federal securities: Par value	29	29	29

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		2021 actual	2022 est.	2023 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	3	3	3
11.3	Other than full-time permanent	1	1	1
11.8	Special personal services payments	2	2	2

11.9	Total personnel compensation	6	6	6
12.1	Civilian personnel benefits	1	1	1
25.1	Advisory and assistance services	6	7	7
25.2	Other services from non-Federal sources	11	12	12
25.3	Other goods and services from Federal sources	5	6	6
25.5	Research and development contracts	2	2	2
25.6	Medical care	1	1	1
26.0	Supplies and materials	7	8	8
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	20	24	24

99.9	Total new obligations, unexpired accounts	60	68	68


Identification code 075–9971–0–7–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	43	43	43
1101	Direct military average strength employment	2	2	2

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, $106,329,000: 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, 2024, 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		2021 actual	2022 est.	2023 est.

	Obligations by program activity:
0001	Office of Inspector General (Direct)	90	90	90
0801	Office of Inspector General HCFAC Trust Fund	253	228	228
0802	Office of Inspector General (Direct Reimbursable)	23	21	21
0803	Office of Inspector General HCFAC Discretionary	99	101	99

0899	Total reimbursable obligations	375	350	348

0900	Total new obligations, unexpired accounts	465	440	438

	Budgetary resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	53	162	146
1001	Discretionary unobligated balance brought fwd, Oct 1	15
1021	Recoveries of prior year unpaid obligations	6

1070	Unobligated balance (total)	59	162	146
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	80	84	106
1121	Appropriations transferred from other acct [075–9911]	2	2	2
1121	Appropriations transferred from other acct [075–9915]	5	5	5

1160	Appropriation, discretionary (total)	87	91	113
	Advance appropriations, discretionary:
1170	Advance appropriation			4
	Appropriations, mandatory:
1200	Appropriation	10
	Spending authority from offsetting collections, discretionary:
1700	Collected	100	111	111
1701	Change in uncollected payments, Federal sources	14

1750	Spending auth from offsetting collections, disc (total)	114	111	111
	Spending authority from offsetting collections, mandatory:
1800	Collected	219	222	222
1801	Change in uncollected payments, Federal sources	144
1802	Offsetting collections (previously unavailable)		1	1
1823	New and/or unobligated balance of spending authority from offsetting collections temporarily reduced		–1	–1

1850	Spending auth from offsetting collections, mand (total)	363	222	222
1900	Budget authority (total)	574	424	450
1930	Total budgetary resources available	633	586	596
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	162	146	158

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	89	105	72
3010	New obligations, unexpired accounts	465	440	438
3011	Obligations ("upward adjustments"), expired accounts	1
3020	Outlays (gross)	–442	–473	–448
3040	Recoveries of prior year unpaid obligations, unexpired	–6
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	105	72	62
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–93	–243	–243
3070	Change in uncollected pymts, Fed sources, unexpired	–158
3071	Change in uncollected pymts, Fed sources, expired	8

3090	Uncollected pymts, Fed sources, end of year	–243	–243	–243
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–4	–138	–171
3200	Obligated balance, end of year	–138	–171	–181

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	201	202	228
	Outlays, gross:
4010	Outlays from new discretionary authority	170	183	208
4011	Outlays from discretionary balances	33	18	18

4020	Outlays, gross (total)	203	201	226
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–107	–111	–111
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–14
4052	Offsetting collections credited to expired accounts	7

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

4070	Budget authority, net (discretionary)	87	91	117
4080	Outlays, net (discretionary)	96	90	115
	Mandatory:
4090	Budget authority, gross	373	222	222
	Outlays, gross:
4100	Outlays from new mandatory authority	182	202	202
4101	Outlays from mandatory balances	57	70	20

4110	Outlays, gross (total)	239	272	222
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–210	–221	–221
4123	Non-Federal sources	–9	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–219	–233	–233
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–144
4142	Offsetting collections credited to expired accounts		11	11

4150	Additional offsets against budget authority only (total)	–144	11	11

4160	Budget authority, net (mandatory)	10
4170	Outlays, net (mandatory)	20	39	–11
4180	Budget authority, net (total)	97	91	117
4190	Outlays, net (total)	116	129	104

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		2021 actual	2022 est.	2023 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	15
21.0	Travel and transportation of persons	2	2	2
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	6	6	6
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.2	Other services from non-Federal sources	15	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	90	90	89
99.0	Reimbursable obligations	375	350	349

99.9	Total new obligations, unexpired accounts	465	440	438


Identification code 075–0128–0–1–551		2021 actual	2022 est.	2023 est.

1001	Direct civilian full-time equivalent employment	1,624	1,599	1,638
2001	Reimbursable civilian full-time equivalent employment	10	10	10


		2021 actual	2022 est.	2023 est.

Offsetting receipts from the public:
075–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	203	203	203
075–267403	Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies	342	36
075–310700	Federal Share of Child Support Collections	887	699	575
075–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	1,019	34	34
General Fund Offsetting receipts from the public		2,451	972	812


Intragovernmental payments:
075–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	–10

General Fund Intragovernmental payments		–10

(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.

(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 administer and 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 describing the evaluations to be carried out 15 days in advance of any such transfer.

(b) The accounts referred to in subsection (a) are: "Low Income Home Energy Assistance", "Refugee and Entrant Assistance", "Payments to States for the Child Care and Development Block Grant", and "Children and Families Services Programs".

(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, 2021.

"(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

(a) Amounts made available to the Department of Health and Human Services in this or any other Act under the heading "Administration for Children and Families—Refugee and Entrant Assistance" may in this fiscal year and hereafter be used to provide, including through grants, contracts, or cooperative agreements, mental health and other supportive services, including access to legal services, to children, parents, and legal guardians who were separated at the United States-Mexico border between January 20, 2017, and January 20, 2021: Provided, That such services shall also be available to immediate family members of such individuals if such family members are in the United States and in the same household: Provided further, That amounts made available to the Department of Health and Human Services for refugee and entrant assistance activities in any other provision of law may be used to carry out the purposes of this section: Provided further, That the Secretary of Health and Human Services may identify the children, parents, and legal guardians eligible to receive mental health and other supportive services described under this section through reference to the identified members of the classes, and their minor children, in the class-action lawsuits Ms. J.P. v. Barr and Ms. L. v. ICE; Provided further, the Secretary has sole discretion to identify the individuals who will receive services under this section due to their status as immediate family members residing in the same household of class members or class members' minor children, and such identification shall not be subject to judicial review.

(b) Notwithstanding any other provision of law, in this fiscal year and hereafter, individuals identified in subsection (a), including immediate family members of such individuals residing in the same household if such immediate family members are identified by the Secretary in accordance with such subsection, shall be eligible for resettlement assistance, entitlement programs, and other benefits available to refugees admitted under section 207 of the Immigration and Nationality Act (8 U.S.C. 1157) to the same extent, and for the same periods of time, as such refugees.

(a) The Public Health Service Act (42 U.S.C. 201 et seq.), the Controlled Substances Act (21 U.S.C. 801 et seq.), the Comprehensive Smoking Education Act (15 U.S.C. 1331 et seq.), the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198), the Drug Abuse Prevention, Treatment, and Rehabilitation Act (21 U.S.C. 1101 et seq.), the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10101 et seq.), and title 5 of the United States Code are each amended—

(1) by striking "National Institute on Drug Abuse" each place it appears and inserting "National Institute on Drugs and Addiction"; and

(2) by striking "National Advisory Council on Drug Abuse" each place it appears and inserting "National Advisory Council on Drugs and Addiction".

(b) Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—

(1) in section 464H(b)(5), by striking "National Institute of Drug Abuse" and inserting "National Institute on Drugs and Addiction";

(2) in sections 464L, 464M(a), 464O, and 494A, by striking "drug abuse" each place it appears and inserting "drug use";

(3) in section 464L(a), by striking "treatment of drug abusers" and inserting "treatment of drug addiction";

(4) in section 464M(a), by striking "prevention of such abuse" and inserting "prevention of such use";

(A) in the section heading, by striking "DRUG ABUSE RESEARCH CENTERS" and inserting "DRUGS AND ADDICTION RESEARCH CENTERS";

(i) in matter preceding paragraph (1), by striking "National Drug Abuse Research Centers" and inserting "National Drugs and Addiction Research Centers"; and

(ii) in paragraph (1)(C), by striking "treatment of drug abuse" and inserting "treatment of drug addiction"; and

(i) by striking "DRUG ABUSE AND ADDICTION RESEARCH" and inserting "DRUGS AND ADDICTION RESEARCH CENTERS";

(ii) in paragraph (1), by striking "National Drug Abuse Treatment Clinical Trials Network" and inserting "National Drug Addiction Treatment Clinical Trials Network"; and

(iii) in paragraph (2)(H), by striking "reasons that individuals abuse drugs, or refrain from abusing drugs" and inserting "reasons that individuals use drugs or refrain from using drugs"; and

(i) in paragraph (1), by striking "drug abuse treatments" and inserting "drug addiction treatments"; and

(ii) in paragraph (6), by striking "treatment of drug abuse" and inserting "treatment of drug addiction"; and

(i) by striking "disease of drug abuse" and inserting "disease of drug addiction";

(ii) by striking "abused drugs" each place it appears and inserting "addictive drugs"; and

(c) Section 464N of the Public Health Service Act (42 U.S.C. 285o-2), as amended by subsection (b)(5), is further amended by striking "drug abuse" each place it appears and inserting "drug use".

(d) Any reference in any law, regulation, map, document, paper, or other record of the United States to the National Institute on Drug Abuse shall be considered to be a reference to the National Institute on Drugs and Addiction.

(a) The Public Health Service Act (42 U.S.C. 201 et seq.) and the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 (42 U.S.C. 4541 et seq.) are each amended—

(1) by striking "National Institute on Alcohol Abuse and Alcoholism" each place it appears and inserting "National Institute on Alcohol Effects and Alcohol-Associated Disorders"; and

(2) by striking "National Advisory Council on Alcohol Abuse and Alcoholism" each place it appears and inserting "National Advisory Council on Alcohol Effects and Alcohol-Associated Disorders".

(b) Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—

(i) by striking "prevention of alcohol abuse" and inserting "prevention of alcohol misuse"; and

(ii) by striking "treatment of alcoholism" and inserting "treatment of alcohol-associated disorders"; and

(I) in subparagraph (A), by striking "alcohol abuse and domestic violence" and inserting "alcohol misuse and domestic violence";

(II) in subparagraph (D), by striking "abuse of alcohol" and inserting "misuse of alcohol";

(III) by striking subparagraph (E) and inserting "(E) the effect of social pressures, legal requirements regarding the use of alcoholic beverages, the cost of such beverages, and the economic status and education of users of such beverages on the incidence of alcohol misuse, alcohol use disorder, and other alcohol-associated disorders,"; and

(ii) in paragraph (5), by striking "impact of alcohol abuse" and inserting "impact of alcohol misuse";

(2) in sections 464H(b), 464I, and 494A, by striking "alcohol abuse and alcoholism" each place it appears and inserting "alcohol misuse, alcohol use disorder, and other alcohol-associated disorders";

(3) in sections 464H(b) and 464J(a), by striking "alcoholism and alcohol abuse" each place it appears and inserting "alcohol misuse, alcohol use disorder, and other alcohol-associated disorders"; and

(A) by striking "alcoholism and other alcohol problems" each place it appears and inserting "alcohol misuse, alcohol use disorder, and other alcohol-associated disorders";

(B) in the matter preceding paragraph (1), by striking "interdisciplinary research related to alcoholism" and inserting "interdisciplinary research related to alcohol-associated disorders"; and

(C) in paragraph (1)(E), by striking "alcohol problems" each place it appears and inserting "alcohol misuse, alcohol use disorder, and other alcohol-associated disorders".

(c) Any reference in any law, regulation, map, document, paper, or other record of the United States to the National Institute on Alcohol Abuse and Alcoholism shall be considered to be a reference to the National Institute on Alcohol Effects and Alcohol-Associated Disorders.

(1) by striking "Substance Abuse and Mental Health Services Administration" each place it appears and inserting "Substance Use And Mental Health Services Administration";

(2) by striking "Center for Substance Abuse Treatment" each place it appears and inserting "Center for Substance Use Services"; and

(3) by striking "Center for Substance Abuse Prevention" each place it appears and inserting "Center for Substance Use Prevention Services".

(b) Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is amended—

(1) in the title heading, by striking "SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION" and inserting "SUBSTANCE USE AND MENTAL HEALTH SERVICES ADMINISTRATION";

(A) in the section heading, by striking "SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION" and inserting "SUBSTANCE USE AND MENTAL HEALTH SERVICES ADMINISTRATION"; and

(B) in subsection (a), by striking "(hereafter referred to in this title as the Administration)" and inserting "(hereafter referred to in this title as SAMHSA or the Administration)";

(3) in section 507, in the section heading, by striking "CENTER FOR SUBSTANCE ABUSE TREATMENT" and inserting "CENTER FOR SUBSTANCE USE SERVICES";

(4) in section 513(a), in the subsection heading, by striking "CENTER FOR SUBSTANCE ABUSE TREATMENT" and inserting "CENTER FOR SUBSTANCE USE SERVICES"; and

(5) in section 515, in the section heading, by striking "CENTER FOR SUBSTANCE ABUSE PREVENTION" and inserting "CENTER FOR SUBSTANCE USE PREVENTION SERVICES".

(c) Section 1932(b)(3) of the Public Health Service Act (42 U.S.C. 300x-32(b)(3)) is amended in the paragraph heading by striking "CENTER FOR SUBSTANCE ABUSE PREVENTION" and inserting "CENTER FOR SUBSTANCE USE PREVENTION SERVICES".

(d) Section 1935(b)(2) of the Public Health Service Act (42 U.S.C. 300x-35(b)(2)) is amended in the paragraph heading by striking "CENTER FOR SUBSTANCE ABUSE PREVENTION" and inserting "CENTER FOR SUBSTANCE USE PREVENTION SERVICES".

(e) The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et seq.) is amended by striking "Substance Abuse and Mental Health Services Administration" each place it appears and inserting "Substance use And Mental Health Services Administration".

(f) The Social Security Act is amended in sections 1861, 1866F, and 1945 (42 U.S.C. 1395x, 1395cc-6, 1396w-4) by striking "Substance Abuse and Mental Health Services Administration" each place it appears and inserting "Substance use And Mental Health Services Administration".

(g) Section 105(a)(7)(C)(i)(III) of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106(a)(7)(C)(i)(III)) is amended by striking "Substance Abuse and Mental Health Services Administration" and inserting "Substance use And Mental Health Services Administration".

(1) Except as provided in paragraph (2), any reference in any law, regulation, map, document, paper, or other record of the United States to the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment of such Administration, or the Center for Substance Abuse Prevention of such Administration shall be considered to be a reference to the Substance use And Mental Health Services Administration, the Center for Substance Use Services of such Administration, or the Center for Substance Use Prevention Services of such Administration, respectively.

(2) Paragraph (1) shall not be construed to alter or affect section 6001(d) of the 21st Century Cures Act (42 U.S.C. 290aa note), providing that a reference to the Administrator of the Substance Abuse and Mental Health Services Administration shall be construed to be a reference to the Assistant Secretary for Mental Health and Substance Use.

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)

Salaries and Expenses

(Legislative proposal, 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 SYSTEMS

RURAL HEALTH

FAMILY PLANNING

HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Maternal, Infant, and Early Childhood Home Visiting Programs

(Legislative proposal, subject to PAYGO)

Health Center Guaranteed Loan Financing Account

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Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Indian Health Service

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Indian Health Services

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CONTRACT SUPPORT COSTS

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PAYMENTS FOR TRIBAL LEASES

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INDIAN HEALTH FACILITIES

INDIAN HEALTH FACILITIES

(Including Transfers of Funds)

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Funding for Indian Health Services

Funding for Indian Health Services

(Legislative proposal, subject to PAYGO)

Centers for Disease Control and Prevention

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CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

(INCLUDING TRANSFER OF FUNDS)

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

CDC-wide Activities and Program Support

(Legislative proposal, subject to PAYGO)

BUILDINGS AND FACILITIES

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

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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

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES