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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES
         Food and Drug AdministrationFederal Funds
         Salaries and Expenses
         (INCLUDING TRANSFERS OF FUNDS)For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
            of space rental and related costs pursuant to Public Law 92â313 for programs and activities of the Food and Drug Administration
            which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; in addition
            to amounts appropriated to the FDA Innovation Account, for carrying out the activities described in section 1002(b)(4) of
            the 21st Century Cures Act (Public Law 114â255); for miscellaneous and emergency expenses of enforcement activities, authorized
            and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding
            section 521 of Public Law 107â188; $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 ServicesâOffice
            of Inspector General" for oversight of the programs and operations of the Food and Drug Administration and shall be in addition
            to funds otherwise made available for oversight of the Food and Drug Administration: Provided further, That funds may be transferred from one specified activity to another with the prior notification to the Committees on Appropriations
            of both Houses of Congress.
      In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381,
            priority review user fees authorized by 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, and voluntary
            qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C. 379j-62,
            prescription drug wholesale distributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics
            provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C.
            384d(c)(8), medical countermeasure priority review voucher user fees authorized by 21 U.S.C. 360bbb-4a, and fees relating
            to over-the-counter monograph drugs authorized by 21 U.S.C. 379j-72 shall be credited to this account, to remain available
            until expended.
      
         BUILDINGS AND FACILITIESFor plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities
            of or used by the Food and Drug Administration, where not otherwise provided, $30,788,000, to remain available until expended.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  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 [075â0128]
                  â2
                  â2
                  â2
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â5
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  903
                  
                  
               
               
                  1724
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â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
                  â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
                  â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)
                  â6,125
                  â7,256
                  â4,493
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â111
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â199
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,099
                  2,011
                  2,142
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â62
                  â55
                  â50
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  5
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â55
                  â50
                  â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:
                  â35
                  â5
                  
               
               
                  4033
                  Non-Federal sources:
                  â2,918
                  â2,870
                  â864
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â2,953
                  â2,875
                  â864
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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:
                  â9
                  
                  
               
               
                  4123
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses 
         (Legislative proposal, not subject to PAYGO)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.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â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)
                  
                  
                  â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:
                  
                  
                  â2,163
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â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
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â4â1â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)
                  
                  
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â4â1â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
               
               
                  
                     
                  
               
            
         
      
         FDA Working Capital FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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)
                  â640
                  â862
                  â619
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  243
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â2
                  â2
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â2
                  â2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  237
                  241
                  â2
               
               
                  3200
                  Obligated balance, end of year
                  241
                  â2
                  â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
                  â634
                  â619
                  â619
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  6
                  243
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  6
                  243
                  
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â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
               
               
                  
                     
                  
               
            
         
      
         Payment to the FDA Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0148â0â1â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)
                  â70
                  â50
                  â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.
         
      
         FDA INNOVATION ACCOUNT, CURES ACT
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes under the heading "Salaries and Expenses", $50,000,000, to remain available until expended:
            Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act,
            are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the Commissioner
            of Food and Drugs to the appropriation for "Department of Health and Human Services Food and Drug Administration Salaries
            and Expenses" solely for the purposes provided in such Act: Provided further, That upon a determination by the Commissioner that funds transferred pursuant to the previous proviso are not necessary
            for the purposes provided, such amounts may be transferred back to the account: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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
                  â70
                  â50
                  â50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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 [075â9911]
                  
                  â50
                  â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)
                  â64
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  120
                  
                  
               
               
                  1101
                  Direct military average strength employment
                  7
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other ServicesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  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
                  â1
                  â1
                  â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)
                  â9
                  â15
                  â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
                  â8
                  â11
                  â11
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  4
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  41
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services AdministrationFederal Funds
         PRIMARY HEALTH CAREFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
            to primary health care and the Native Hawaiian Health Care Act of 1988, $1,839,022,000: 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.
      
         HEALTH WORKFORCEFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of
            the Social Security Act, and the Health Care Quality Improvement Act of 1986, $1,619,884,000: 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.
      
         MATERNAL AND CHILD HEALTHFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health and title V of the
            Social Security Act, $1,272,930,000: 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.
      
         RYAN WHITE HIV/AIDS PROGRAMFor 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.
      
         HEALTH SYSTEMSFor carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
            Research Act of 2005, $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.
      
         RURAL HEALTHFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
            and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act, $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.
      
         FAMILY PLANNINGFor 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. 
      
         HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORTFor 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".
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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 [015â5606]
                  â5
                  â5
                  â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 [075â1503]
                  â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
                  
                  â120
                  â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
                  â2
                  â2
                  â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
                  â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)
                  â13,665
                  â17,440
                  â15,110
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â59
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  16,456
                  11,590
                  9,391
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â17
                  â18
                  â18
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â18
                  â18
                  â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
                  â11
                  â10
                  â10
               
               
                  4033
                  Non-Federal sources
                  â36
                  â29
                  â29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â47
                  â39
                  â39
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â32
                  â30
                  â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 075â0350â0â1â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 2020â2021 data reported in the FY 2021 Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     437,467,092
                  
                  
                     NSL
                     193,842,531 
                  
                  
                     PCL
                     155,862,233 
                  
                  
                     LDS
                     215,701,393 
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     1,002,873,249
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury CompensationProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0320â0â1â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
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â1
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process Fund For carrying out section 319F-4 of the PHS Act, $15,000,000, to remain available until expended. 
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â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 [075â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)
                  â2
                  â2
                  â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 109â148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
            resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
            has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
            claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting ProgramsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
                  â23
                  â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)
                  â370
                  â446
                  â450
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  38
                  38
                  
               
               
                  1101
                  Direct military average strength employment
                  3
                  3
                  
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â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)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  52
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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
                  â1
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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
                  â859
                  â787
                  â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
                  â3
                  â10
                  â10
               
               
                  
                  Adjustments:
               
               
                  2263
                  Terminations for default that result in claim payments
                  
                  â1
                  
               
               
                  2264
                  Other adjustments, net
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  51
                  112
                  174
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  39
                  87
                  137
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 104â299, Public Law 104â208, and Public Law 115â141 authorize Health Resources and Services Administration (HRSA)
            to guarantee up to $1 billion in private loans to health centers for the costs of developing and operating managed care networks
            or plans and for the construction, renovation, and modernization of medical facilities. The program account for this activity
            is displayed in the Health Resources and Services account (75â0350) as a line in the program and financing schedule.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  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
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan FundStatus of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â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.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â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
         VACCINE INJURY COMPENSATION PROGRAM TRUST FUNDFor payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
            claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
            to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $26,200,000 shall be available from the Trust Fund to the Secretary.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â38
                  â38
                  â68
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â334
                  â251
                  â256
               
               
                  2135
                  Vaccine Injury Compensation Program Trust Fund
                  85
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â287
                  â289
                  â324
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â287
                  â289
                  â324
               
               
                  4030
                  Vaccine Injury Compensation Program Trust Fund
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  4,060
                  4,202
                  4,321
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â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)
                  â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)
                  â283
                  â308
                  â324
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
            for vaccine-related injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health ServiceFederal Funds
         Indian Health ServicesNote.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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 [075â0943]
                  210
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  â3
                  â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
                  â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)
                  â9,812
                  â9,146
                  â8,179
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â285
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,758
                  1,299
                  1,807
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â106
                  â113
                  â113
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â113
                  â113
                  â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
                  â259
                  â299
                  â436
               
               
                  4033
                  Non-Federal sources
                  â1,627
                  â1,268
                  â1,432
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,886
                  â1,567
                  â1,868
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health Services
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â2â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â6,262
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  6,262
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â6,262
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         CONTRACT SUPPORT COSTSNote.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â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)
                  â1,033
                  â1,463
                  â1,142
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Contract Support Costs
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â2â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â1,142
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  1,142
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â1,142
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         PAYMENTS FOR TRIBAL LEASESNote.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0200â0â1â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)
                  â110
                  â163
                  â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. 
         
      
         Payments for Tribal Leases
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0200â2â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â150
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â150
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         INDIAN HEALTH FACILITIESNote.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
         INDIAN HEALTH FACILITIES
         (Including Transfers of Funds) 
      (Infrastructure Investments and Jobs Appropriations Act.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
                  â10
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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)
                  â889
                  â865
                  â1,705
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  947
                  908
                  29
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â18
                  â18
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â18
                  â18
                  â18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â92
                  â59
                  â59
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â92
                  â59
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health Facilities
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â2â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â1,567
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  1,567
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â1,567
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Funding for Indian Health Services
         Funding for Indian Health Services
         (Legislative proposal, subject to PAYGO)
          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. 
         
      
         Centers for Disease Control and PreventionFederal Funds
         CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
         (INCLUDING TRANSFER OF 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 115â245: Provided further, That funds appropriated
            under this heading may be used to support a contract for the operation and maintenance of an aircraft in direct support of
            activities throughout CDC to ensure the agency is prepared to address public health preparedness emergencies: Provided further,
            That any amounts made available by this Act to the Centers for Disease Control and Prevention may be used 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.
      
         ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAMFor necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
            available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of
            division B, title I of Public Law 106â554.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
         
      (Afghanistan Supplemental Appropriations Act, 2022.)
         
      (Additional Afghanistan Supplemental Appropriations Act, 2022.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
                  â2
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  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 [075â0140]
                  â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 [075â0390]
                  â210
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â21
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0945]
                  â10
                  â10
                  â35
               
               
                  1121
                  Appropriations transferred from other acct [075â0116]
                  
                  856
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  15,442
                  7,811
                  9,586
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1200
                  Appropriation (075â0943 American Rescue Plan)
                  11,520
                  
                  
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  2
                  1
                  1
               
               
                  1221
                  Appropriations transferred from other acct PPHF [075â0116]
                  856
                  
                  903
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â5
                  â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
                  â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)
                  â11,153
                  â15,315
                  â12,298
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â77
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â194
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  21,997
                  15,164
                  13,155
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â130
                  â144
                  â144
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â92
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  78
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â144
                  â144
                  â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
                  â359
                  â181
                  â185
               
               
                  4033
                  Non-Federal sources
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â371
                  â181
                  â185
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â92
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  80
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â4
                  â2
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  27,870
                  7,862
                  10,541
               
               
                  4190
                  Outlays, net (total)
                  10,778
                  15,132
                  12,111
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
         CDC-wide Activities and Program Support
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â4â1â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)
                  
                  
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â4â1â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
               
               
                  
                     
                  
               
            
         
      
         BUILDINGS AND FACILITIESNote.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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)
                  â55
                  â30
                  â29
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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)
                  â663
                  â746
                  â671
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  292
                  217
                  217
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â2
                  â2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â823
                  â671
                  â671
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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
               
               
                  
                     
                  
               
            
         
      
         Infectious Diseases Rapid Response Reserve FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â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 [075â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)
                  â28
                  â31
                  â26
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0945â0â1â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
               
               
                  
                     
                  
               
            
         
      
         TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTHFor necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
            in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
            and section 3019 of the Solid Waste Disposal Act, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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 [097â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
                  â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)
                  â97
                  â120
                  â79
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  81
                  53
                  73
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â7
                  â6
                  â6
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â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
                  â8
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â8
                  â3
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  World Trade Center Health ProgramâFederal Share (CDC/NIOSH)
                  506
                  577
                  710
               
               
                  0002
                  World Trade Center Health Programâ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 (WTCâNYC DHSSâ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)
                  â573
                  â441
                  â520
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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. 111â347)
            on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
            Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
            health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
            2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
            Compensation Reauthorization Act of 2015 (P.L. 114â113, Division O, Title III). The amounts included for 2022 and 2023 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â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
               
               
                  
                     
                  
               
            
         
      
         National Institutes of HealthFederal Funds
         NATIONAL CANCER INSTITUTEFor 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 InstituteâFrederick Federally Funded Research and
            Development Center in Frederick, Maryland.
      
         NATIONAL HEART, LUNG, AND BLOOD INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
            and blood products, $3,822,961,000.
      
         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCHFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $513,191,000.
      
         NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $2,206,080,000.
      
         NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKEFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $2,543,043,000.
      
         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $6,268,313,000.
      
         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCESFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $3,097,557,000, 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.
      
         EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENTFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,674,941,000.
      
         NATIONAL EYE INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $853,355,000.
      
         NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCESFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $932,056,000.
      
         NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCESFor necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
            section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and
            section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $83,035,000.
      
         NATIONAL INSTITUTE ON AGINGFor carrying out section 301 and title IV of the PHS Act with respect to aging, $4,011,413,000.
      
         NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASESFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
            $676,254,000.
      
         NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERSFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $508,704,000.
      
         NATIONAL INSTITUTE OF NURSING RESEARCHFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, $198,670,000.
      
         NATIONAL INSTITUTE ON ALCOHOL 
         EFFECTS AND ALCOHOL-ASSOCIATED DISORDERSFor 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.
      
         NATIONAL INSTITUTE ON DRUGS AND ADDICTIONFor carrying out section 301 and title IV of the PHS Act with respect to drugs and addiction, $1,843,326,000.
      
         NATIONAL INSTITUTE OF MENTAL HEALTHFor carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,985,828,000.
      
         NATIONAL HUMAN GENOME RESEARCH INSTITUTEFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, $629,154,000.
      
         NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERINGFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $419,493,000.
      
         NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTHFor carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $183,368,000.
      
         NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIESFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
            $659,817,000.
      
         JOHN E. FOGARTY INTERNATIONAL CENTERFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
            of the PHS Act), $95,801,000.
      
         NATIONAL LIBRARY OF MEDICINEFor 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").
      
         NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCESFor 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.
      
         OFFICE OF THE DIRECTOR
         (INCLUDING TRANSFER OF FUNDS)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.
      
         BUILDINGS AND FACILITIESFor the study of, construction of, demolition of, renovation of, and acquisition of equipment for, facilities of or used by
            NIH, including the acquisition of real property, $300,000,000, to remain available through September 30, 2027.
         Advanced Research Projects Agency for HealthFor carrying out section 301 and title IV of the PHS Act with respect to advanced research projects for health, $5,000,000,000,
            to remain available through September 30, 2025. 
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
                  â54
                  â82
                  â82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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 [075â0140]
                  â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 [075â1503]
                  â1,186
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0128]
                  â5
                  â5
                  â5
               
               
                  1121
                  Appropriations transferred from other acct [075â5628]
                  295
                  295
                  666
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  â9
                  â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
                  â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)
                  â43,880
                  â46,470
                  â47,826
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â193
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â863
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  49,673
                  51,475
                  58,144
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â969
                  â796
                  â796
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â401
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  574
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â796
                  â796
                  â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
                  â5,359
                  â5,496
                  â5,651
               
               
                  4033
                  Non-Federal sources
                  â223
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â5,582
                  â5,496
                  â5,651
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  41,673
                  41,620
                  48,844
               
               
                  4190
                  Outlays, net (total)
                  38,296
                  40,974
                  42,175
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â4â1â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)
                  
                  
                  â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.  
         
      
         Payment to the NIH Innovation Account, CURES ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0147â0â1â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)
                  â404
                  â496
                  â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.
         
      
         NIH INNOVATION ACCOUNT, CURES ACT
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes in the appropriations provided to the NIH in this Act, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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
                  â404
                  â404
                  â1,085
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  92
                  92
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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 [075â9915]
                  â295
                  â295
                  â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)
                  â168
                  â140
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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
               
               
                  
                     
                  
               
            
         
      
         10-Year Pediatric Research Initiative FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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
                  â13
                  â4
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  4
                  
                  8
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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 [075â9915]
                  â13
                  â4
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         This special fund was created by the Gabriella Miller Kids First Research Act, enacted on April 3, 2014. This fund receives
            transfers from the Presidential Election Campaign Fund, which are then appropriated to the NIH Common Fund to support pediatric
            research. 
         
      
         Substance Use And Mental Health Services AdministrationFederal Funds
         MENTAL HEALTHFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
            Individuals with Mental Illness Act, $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 113â93: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading, $21,420,000 shall be to carry out section 224 of the Protecting Access
            to Medicare Act of 2014 (Public Law 113â93; 42 U.S.C. 290aa 22 note). 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.
      
         SUBSTANCE USE SERVICESFor 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.
      
         SUBSTANCE USE  PREVENTION SERVICESFor carrying out titles III and V of the PHS Act with respect to substance use prevention, $311,912,000.
      
         HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor 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".
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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 [075â1503]
                  â18
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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 [075â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
                  â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)
                  â6,087
                  â8,661
                  â10,509
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â59
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â310
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15,527
                  13,262
                  13,306
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â449
                  â556
                  â556
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â283
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  176
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â556
                  â556
                  â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
                  â169
                  â409
                  â175
               
               
                  4033
                  Non-Federal sources
                  â8
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â177
                  â411
                  â177
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â283
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  141
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Substance Use And Mental Health Services Administration
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â4â1â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)
                  
                  
                  â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).
         
      
         Agency for Healthcare Research and QualityFederal Funds
         HEALTHCARE RESEARCH AND QUALITY For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
            Medicare Prescription Drug, Improvement, and Modernization Act of 2003,  $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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 [075â1503]
                  â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)
                  â355
                  â353
                  â419
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  335
                  353
                  371
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â28
                  â24
                  â25
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  â17
                  â60
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  17
                  16
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â24
                  â25
                  â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
                  â18
                  â17
                  â60
               
               
                  4030
                  Federal sources
                  
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â18
                  â18
                  â61
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  â17
                  â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
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Centers for Medicare and Medicaid ServicesFederal Funds
         GRANTS TO STATES FOR MEDICAIDFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â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)
                  â533,495
                  â563,439
                  â537,216
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â27,081
                  â52,757
                  â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
                  â1,084
                  â1,318
                  â1,318
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â234
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,318
                  â1,318
                  â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
                  â1,126
                  â1,601
                  â1,439
               
               
                  4123
                  Non-Federal sources
                  â11,781
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â12,907
                  â1,601
                  â1,439
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â18
               
               
                  
                  Outlays
                  
                  
                  â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.
         
         Vaccines for Children (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     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
                  
                  
                     
                        
                     
                  
               
            
         
      
         Grants to States for Medicaid
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â2â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â18
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â18
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â18
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â18
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â18
               
               
                  3020
                  Outlays (gross)
                  
                  
                  18
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â18
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â18
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â18
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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. 
         
      
         Grants to States for Medicaid
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â4â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
         State Grants and DemonstrationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  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
                  â5
                  â31
                  â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
                  â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)
                  â359
                  â364
                  â531
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â16
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10). The account also includes funding for grant programs
            enacted in the HEALTHY KIDS Act (P.L. 115â120), the Advancing Chronic Care, Extenders, and Social Services Act (P.L. 115â123),
            the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115â271),
            the Medicaid Extenders Act of 2019 (P.L. 116â3), the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116â16),
            the Sustaining Excellence in Medicaid Act of 2019 (P.L. 116â39), the Continuing Appropriations Act, 2020, the Health Extenders
            Act of 2019 (P.L. 116â59), the Further Consolidated Appropriation Act, 2020 (P.L. 116â94), the Consolidated Appropriations
            Act, 2021 (P.L. 116â260), and the American Rescue Plan Act of 2021 (P.L. 117â2). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â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
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â4â1â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)
                  
                  
                  â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.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â4â1â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
               
               
                  
                     
                  
               
            
         
      
         PAYMENTS TO THE HEALTH CARE TRUST FUNDSFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
            under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
            of 1965, section 278(d)(3) of Public Law 97â248, and for administrative expenses incurred pursuant to section 201(g) of the
            Social Security Act, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â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 (HCFACâ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
                  â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)
                  â444,202
                  â463,991
                  â506,496
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â22
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â4,507
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement OrganizationsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â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
                  â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)
                  â645
                  â872
                  â641
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â92
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  928
                  928
                  928
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2,005
                  â1,887
                  â2,248
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â469
                  â361
                  â467
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  587
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,887
                  â2,248
                  â2,715
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â900
                  â959
                  â1,320
               
               
                  3200
                  Obligated balance, end of year
                  â959
                  â1,320
                  â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
                  â642
                  â672
                  â641
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â469
                  â361
                  â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. 97â248), provides
            the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to
            promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure
            that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance
            Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO
            Program was established to improve budgetary operations.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â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
               
               
                  
                     
                  
               
            
         
      
         PROGRAM MANAGEMENTFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
            XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
            Medicare & Medicaid Services, not to exceed $4,346,985,000, 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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â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 [075â1503]
                  â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
                  â45
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  95
                  96
                  99
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â97
                  â128
                  â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
                  â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)
                  â5,927
                  â7,080
                  â6,820
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â67
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â184
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,893
                  4,408
                  4,400
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â4,810
                  â5,465
                  â5,465
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  â651
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,234
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,230
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5,465
                  â5,465
                  â5,465
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â744
                  â572
                  â1,057
               
               
                  3200
                  Obligated balance, end of year
                  â572
                  â1,057
                  â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
                  â3,738
                  â3,975
                  â4,346
               
               
                  4033
                  Non-Federal sources
                  â38
                  â80
                  â82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,776
                  â4,055
                  â4,428
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,279
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,008
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â271
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  â12
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  73
                  211
                  â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
                  â738
                  â63
                  â68
               
               
                  4123
                  Non-Federal sources
                  â1,850
                  â2,557
                  â2,397
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2,588
                  â2,620
                  â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
                  â29
                  â44
               
               
                  4170
                  Outlays, net (mandatory)
                  â510
                  194
                  35
               
               
                  4180
                  Budget authority, net (total)
                  489
                  â29
                  â44
               
               
                  4190
                  Outlays, net (total)
                  â437
                  405
                  â73
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  224
                  219
                  251
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  489
                  â29
                  â44
               
               
                  
                  Outlays
                  â437
                  405
                  â73
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  300
               
               
                  
                  Outlays
                  
                  
                  50
               
               
                  Total:
               
               
                  
                  Budget Authority
                  489
                  â29
                  256
               
               
                  
                  Outlays
                  â437
                  405
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Program Management
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â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)
                  
                  
                  â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.
      
         Children's Health Insurance FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â0â1â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 [075â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
                  
                  â2,000
                  
               
               
                  1134
                  Appropriations precluded from obligation
                  
                  â4,000
                  â12,315
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  â6,000
                  â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
                  â2,000
                  
                  
               
               
                  1230
                  75â21â0515 - Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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
                  â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)
                  â16,177
                  â16,613
                  â16,168
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  â6,000
                  â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:
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â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. 105â33) established the Children's Health Insurance Program (CHIP) under title XXI of
            the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured
            children from low-income families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured
            children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health
            Insurance Program Reauthorization Act of 2009 (P.L. 111â3, CHIPRA) reauthorized the CHIP program and appropriated funding
            for CHIP through fiscal year 2013. CHIPRA made some modifications to the program, including increased funding for States and
            territories, and support for child health quality and outreach activities. CHIPRA also created a contingency fund in a separate
            account to assist States who project spending above their available allocated CHIP funds. The Patient Protection and Affordable
            Care Act of 2010 (P.L. 111â148) and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended CHIP funding
            through fiscal year 2015 and 2017, respectively.  The HEALTHY KIDS Act (P.L. 115â120) and the Advancing Chronic Care, Extenders,
            and Social Services Act (P.L. 115â123) extended CHIP funding through fiscal year 2023 and 2027, respectively.
         
      
         Children's Health Insurance Fund
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â4â1â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
                  
                  
                  â230
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â230
               
               
                  
                     
                  
               
            
         
      
         Center for Medicare and Medicaid InnovationProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â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)
                  â728
                  â948
                  â737
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â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
                  â14
                  â20
                  â29
               
               
                  2103
                  Child Enrollment Contingency Fund
                  â6,093
                  â14,000
                  â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
                  â20
                  5,831
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  2,980
                  â20
                  5,831
               
               
                  4030
                  Child Enrollment Contingency Fund
                  4,912
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  13,999
                  14,000
                  19,860
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â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 [075â0515]
                  â1
                  
                  
               
               
                  1035
                  Unobligated balance precluded from obligation (limitation on obligations)(special and trust)
                  â4,912
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1070
                  Unobligated balance (total)
                  
                  1,980
                  7,180
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1135
                  Appropriations precluded from obligation (special or trust)
                  
                  â14,000
                  â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)
                  â9,087
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,980
                  19,200
                  16,009
               
               
                  1900
                  Budget authority (total)
                  1,980
                  5,200
                  â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
                  
                  â14,000
                  â19,860
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,980
                  19,200
                  16,009
               
               
                  4180
                  Budget authority, net (total)
                  1,980
                  5,200
                  â3,851
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111â3) established the Child Enrollment Contingency
            Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
            it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
            number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) and the Medicare
            Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended the Contingency Fund through fiscal years 2015 and 2017,
            respectively. The HEALTHY KIDS Act (P.L. 115â120) and the Advancing Chronic Care, Extenders, and Social Services Act (P.L.
            115â123) extended the Contingency Fund through FY 2023 and FY 2027, respectively.
         
         The Fund receives an appropriation equal to 20 percent of the CHIP national allotment appropriation under section 2104(a)
            of the Social Security Act. The Contingency Fund is invested in interest bearing securities of the United States, and the
            income derived from these investments constitutes a part of the fund.
         
      
         Medicare Health Information Technology Incentive Payments, Recovery ActProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0508â0â1â551
                  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
                  â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)
                  â46
                  â56
                  â24
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  19
                  19
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â59
                  â3
                  â3
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  59
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â3
                  â3
                  â3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  14
                  16
                  16
               
               
                  3200
                  Obligated balance, end of year
                  16
                  16
                  â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
                  â49
                  â56
                  â5
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â3
                  
                  19
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â3
                  
                  19
               
               
                  
                     
                  
               
            
         
      
         Rate Review GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0112â0â1â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)
                  â3
                  â6
                  â5
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  â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. 111â148) added section 2794 to the Public Health Service Act and provided
            that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
            program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
            2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
            insurance reform activities consistent with section 2794(c)(2)(B).
         
      
         Pre-Existing Condition Insurance Plan ProgramProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  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)
                  â54
                  â50
                  â48
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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.
            111â148). The PCIP program ended in fiscal year 2014, and outlays in subsequent fiscal years reflect program close out and
            claims run out costs, as well as allowable administrative costs in the current year.
         
      
         Early Retiree Reinsurance ProgramProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  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
                  
                  â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. 111â148) authorized and appropriated $5 billion for the Early Retiree
            Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
            sponsors.
         
      
         Affordable Insurance Exchange GrantsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  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)
                  
                  â10
                  â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. 111â148) provided amounts necessary to enable the Secretary
            to award grants to States to implement Health Insurance Exchanges beginning no later than March 23, 2011, and allowed for
            renewal of grants through January 1, 2015. The final round of grants was awarded to States in December 2014. The American
            Rescue Plan Act of 2021 (P.L. 117â2) created a grant program for state-based Marketplaces established under section 1311(b)
            of the Patient Protection and Affordable Care Act. $20 million has been appropriated and is available until September 30,
            2022 to enable state-based Marketplaces to modernize or update any system, program, or technology required to be compliant
            with applicable federal requirements.
         
      
         Cost-sharing ReductionsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â0â1â551
                  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
                  
                  â590
                  â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)
                  
                  â9,763
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
         Cost-sharing Reductions
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â4â1â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
                  
                  
                  â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)
                  
                  
                  â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.
         
      
         Risk Adjustment Program PaymentsSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â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
                  â6,887
                  â6,311
                  â6,318
               
               
                  2103
                  Risk Adjustment Program Payments
                  â348
                  â393
                  â360
               
               
                  2132
                  Risk Adjustment Program Payments
                  393
                  360
                  360
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â6,842
                  â6,344
                  â6,318
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â6,842
                  â6,344
                  â6,318
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  393
                  360
                  360
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â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
                  â393
                  â360
                  â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)
                  â6,975
                  â8,764
                  â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. 111â148) established a permanent risk adjustment program
            for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
            and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
            with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
            a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
            they are calculated.
         
      
         Transitional Reinsurance ProgramSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  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
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â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)
                  
                  â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
                  â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)
                  â6
                  226
                  
               
               
                  4180
                  Budget authority, net (total)
                  1
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â6
                  226
                  
               
               
                  
                     
                  
               
            
         
      
      
         Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111â148) established a transitional three-year reinsurance
            program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015, and 2016.
            The Centers for Medicare & Medicaid Services assessed contributing entities a per enrollee fee to fund the reinsurance program
            and made payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold, up to
            a reinsurance cap. Reinsurance collections and payments were made in the year following the plan year for which they were
            applicable. Reinsurance collections ended in FY 2019 and outlays in subsequent fiscal years reflect remaining payments, refunds,
            and allowable administrative activities. 
         
      
         Consumer Operated and Oriented Plan Program Contingency FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  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)
                  â1
                  â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 075â0524â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135001
                  Startup Loans
                  â10
                  â6
                  
               
               
                  135002
                  Solvency Loans
                  â36
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  â46
                  â4
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
            112â240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
            loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
         Consumer Operated and Oriented Plan Program AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  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)
                  â1
                  â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 075â0118â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  â77
                  â30
                  
               
               
                  135003
                  Solvency  Loans
                  â219
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  â296
                  â23
                  
               
               
                  
                     
                  
               
            
         
      
      
         Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated funding for the
            Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
            insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
            markets in the States. The Secretary awarded loans to qualified nonprofit issuers to fund start-up costs and reserves, which
            enabled qualified issuers to meet state solvency requirements. The Secretary issued the final round of loans in December 2014.
            
         
      
         Consumer Operated and Oriented Plan Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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
                  â63
                  â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)
                  â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
                  
                  â7
                  
               
               
                  4122
                  Interest on uninvested funds
                  
                  â3
                  â6
               
               
                  4123
                  Non-Federal sources
                  â66
                  â41
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â66
                  â51
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  221
                  â16
                  3
               
               
                  4170
                  Outlays, net (mandatory)
                  238
                  â51
                  â6
               
               
                  4180
                  Budget authority, net (total)
                  221
                  â16
                  3
               
               
                  4190
                  Outlays, net (total)
                  238
                  â51
                  â6
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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
                  
                  â41
                  
               
               
                  1263
                  Write-offs for default: Direct loans
                  â81
                  
                  â94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,812
                  1,771
                  1,677
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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 (-)
                  â1,778
                  â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
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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
                  â5
                  â2
                  â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)
                  â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
                  
                  â2
                  
               
               
                  4123
                  Non-Federal sources
                  â9
                  â9
                  â112
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â9
                  â11
                  â112
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  42
                  4
                  â110
               
               
                  4170
                  Outlays, net (mandatory)
                  39
                  â11
                  â112
               
               
                  4180
                  Budget authority, net (total)
                  42
                  4
                  â110
               
               
                  4190
                  Outlays, net (total)
                  39
                  â11
                  â112
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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
                  
                  â6
                  â12
               
               
                  1263
                  Write-offs for default: Direct loans
                  â9
                  â118
                  â118
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  471
                  347
                  217
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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 (-)
                  â429
                  â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
               
               
                  
                     
                  
               
            
         
      
         Mental Health Parity Enforcement Grants
         Mental Health Parity Enforcement Grants
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0521â4â1â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)
                  
                  
                  â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.
         
      
         Medicare Investments
         Medicare Investments
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 999â9068â4â1â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)
                  
                  
                  â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
         Federal Hospital Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  95,439
                  92,022
                  118,682
               
               
                  0198
                  Reconciliation adjustment
                  â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)
                  
                  
                  â4
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â938
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â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
                  â2,802
                  â2,802
                  â3,056
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â356,721
                  â399,022
                  â397,259
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â807
                  â807
                  â899
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,415
                  â1,364
                  â2,322
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â4,006
                  â2,917
                  â19,045
               
               
                  2103
                  Health Care Fraud and Abuse Control Account
                  
                  â51
                  â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
                  â364,934
                  â377,409
                  â414,435
               
               
                  
                  Proposed:
               
               
                  2201
                  Health Care Fraud and Abuse Control Account
                  
                  
                  1,141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â364,934
                  â377,409
                  â413,294
               
               
                  3098
                  Federal Hospital Insurance Trust Fund
                  â81
                  
                  
               
               
                  5098
                  Reconciliation adjustment
                  â67
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  92,022
                  118,682
                  106,151
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â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)
                  â31
                  â2,917
                  â8,146
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  â786
                  â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)
                  â380,351
                  â375,350
                  â411,075
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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.
         
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â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)
                  
                  
                  â938
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â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]
                  â380,351
                  â375,350
                  â411,075
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [Budget Acct]
                  â2,119
                  â2,435
                  â3,261
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â382,470
                  â377,785
                  â414,336
               
               
                  
                  Proposed:
               
               
                  2200
                  Health Care Fraud and Abuse Control Account
                  
                  
                  1,141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  1,141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â382,470
                  â377,785
                  â413,195
               
               
                  
                  Surplus or deficit:
               
               
                  3110
                  Excluding interest
                  â550
                  23,361
                  â15,761
               
               
                  3120
                  Interest
                  2,455
                  2,923
                  3,329
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  1,905
                  26,284
                  â12,432
               
               
                  3298
                  Reconciliation adjustment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  1,906
                  26,284
                  â12,432
               
               
                  
                  Unexpended balance, end of year:
               
               
                  4100
                  Uninvested balance (net), end of year
                  99
                  617
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNTIn addition to amounts otherwise available for program integrity and program management, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â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
                  
                  â47
                  â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
                  
                  â23
                  â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
                  â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)
                  â2,119
                  â2,435
                  â3,261
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â36
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â1,141
               
               
                  
                  Outlays
                  
                  
                  â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. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
            in the Analytical Perspectives volume.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â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)
                  
                  â47
                  â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â2â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0005
                  Undistributed Savings, Medicare SSA CDRs
                  
                  
                  â22
               
               
                  0006
                  Undistributed Medicare and Medicaid baseline impact attributable to HCFAC Cap/Allocation Adjustment
                  
                  
                  â1,119
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  
                  
                  â1,141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,141
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â1,141
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â1,141
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,141
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,141
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,141
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,141
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,141
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,141
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â2â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  92.0
                  Undistributed (SSA CDR Medicare baseline Savings)
                  
                  
                  â22
               
               
                  92.0
                  Undistributed (Medicare baseline impact attributable to HCFAC Cap/Allocation Adjustment)
                  
                  
                  â1,119
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,141
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust FundSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â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
                  â3,265
                  â3,301
                  â4,173
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â461,390
                  â491,549
                  â529,785
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â881
                  â878
                  â596
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â98,759
                  â108,362
                  â113,916
               
               
                  2103
                  Federal Supplementary Medical Insurance Trust Fund
                  â4,305
                  â3,588
                  â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
                  â482,694
                  â583,758
                  â626,764
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â482,694
                  â583,758
                  â626,764
               
               
                  3098
                  Federal Supplementary Medical Insurance Trust Fund
                  â145
                  
                  
               
               
                  5098
                  Reconciliation adjustment
                  â1,919
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  132,486
                  150,908
                  172,232
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â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
                  â11
                  â3,588
                  â10,187
               
               
                  1235
                  Appropriations precluded from obligation (special or trust)
                  â85,895
                  â20,229
                  â21,324
               
               
                  1236
                  Appropriations applied to repay debt
                  â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)
                  â431,748
                  â474,812
                  â512,446
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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
                  â1,154
                  â36,312
                  â36,312
               
               
                  5081
                  Outstanding debt, EOY
                  â36,312
                  â36,312
                  â36,312
               
               
                  5082
                  Borrowing
                  â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.
         
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â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]
                  â431,748
                  â474,812
                  â512,446
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [Budget Acct]
                  â98,621
                  â109,133
                  â114,107
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â530,369
                  â583,945
                  â626,553
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â530,369
                  â583,945
                  â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
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â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
                  
                  â103
                  â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
                  â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)
                  â98,621
                  â109,133
                  â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
                  â6,448
                  â8,255
                  â6,448
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,807
                  1,807
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â8,255
                  â6,448
                  â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:
                  
                  â1,807
                  
               
               
                  4123
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2
                  â1,807
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,807
                  1,807
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Administration for Children and FamiliesFederal Funds
         Temporary Assistance for Needy FamiliesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  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
                  â1
                  â1
                  â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
                  â19
                  â15
                  â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)
                  â15,383
                  â17,037
                  â16,517
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171). TANF's authorization was most recently extended in the Continuing Appropriations Act of 2022 (P.
            L. 117â70).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  98
                  102
                  102
               
               
                  
                     
                  
               
            
         
      
         Contingency FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â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)
                  â604
                  â606
                  â604
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 117â70).  
         
      
         PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT PROGRAMSFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
            of July 5, 1960, $2,883,000,000, 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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â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
                  â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
                  
                  â1
                  â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)
                  â4,185
                  â4,116
                  â4,122
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â809
                  â200
                  â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
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â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
               
               
                  
                     
                  
               
            
         
      
         LOW INCOME HOME ENERGY ASSISTANCEFor 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 117â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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
         LOW INCOME HOME ENERGY ASSISTANCE
      (Infrastructure Investments and Jobs Appropriations Act.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â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 [075â1503]
                  â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)
                  â4,417
                  â5,660
                  â6,317
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  11
               
               
                  
                     
                  
               
            
         
      
         REFUGEE AND ENTRANT ASSISTANCE
         (INCLUDING TRANSFER OF FUNDS)For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality
            Act and section 501 of the Refugee Education Assistance Act of 1980, and for carrying out section 462 of the Homeland Security
            Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the Trafficking
            Victims Protection Act of 2000 ("TVPA"), and the Torture Victims Relief Act of 1998, $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
         Refugee and Entrant Assistance
      (Afghanistan Supplemental Appropriations Act, 2022.)
         Refugee and Entrant Assistance
      (Additional Afghanistan Supplemental Appropriations Act, 2022.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â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 [075â1502]
                  38
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9912]
                  2
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1515]
                  33
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  858
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1700]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  21
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0350]
                  22
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1362]
                  18
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  1,186
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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 [075â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
                  â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)
                  â6,231
                  â8,414
                  â5,545
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â445
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â105
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,374
                  2,135
                  2,973
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â7
                  â990
                  â990
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â983
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â990
                  â990
                  â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
                  â44
                  
                  
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â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
                  â1,077
                  â983
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Refugee and Entrant Assistance
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â4â1â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)
                  
                  
                  â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.  
         
      
         PROMOTING SAFE AND STABLE FAMILIESFor carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out,
            except as otherwise provided, section 437 of such Act, $106,000,000: Provided, That of the funds available to carry out section 437, $60,000,000 shall be allocated consistent with subsections (b) through
            (d) of such section: Provided further, That of the funds available to carry out section 437, to assist in meeting the requirements described in section 471(e)(4)(C),
            $30,000,000 shall be for grants to each State, territory, and Indian tribe operating title IV-E plans for developing, enhancing,
            or evaluating kinship navigator programs, as described in section 427(a)(1) of such Act and $9,000,000, in addition to funds
            otherwise appropriated in section 476 for such purposes, shall be for the Family First Clearinghouse and to support evaluation
            and technical assistance relating to the evaluation of child and family services: Provided further, That, of the funds available
            to carry out section 437, $7,000,000 shall be for competitive grants to regional partnerships as described in section 437(f),
            and shall be in addition to any other funds appropriated for such purposes: Provided further, That section 437(b)(1) shall be applied to amounts in the previous proviso by substituting "5 percent" for "3.3 percent",
            and notwithstanding section 436(b)(1), such reserved amounts may be used for identifying, establishing, and disseminating
            practices to meet the criteria specified in section 471(e)(4)(C): Provided further, That the reservation in section 437(b)(2) and the limitations in section 437(d) shall not apply to funds specified in the
            second proviso: Provided further, That the minimum grant award for kinship navigator programs in the case of States and territories shall be $200,000, and,
            in the case of tribes, shall be $25,000.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â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
                  â20
                  â28
                  â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
                  â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)
                  â536
                  â772
                  â802
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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).  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  24
                  19
                  20
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable Families
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â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)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  14
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to StatesProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â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)
                  â3,154
                  â3,238
                  â3,415
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 104â193), as amended by the American Rescue Plan Act of 2021 (P.L. 117â002).
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  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
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States
         (Legislative proposal, subject to PAYGO)
          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.
         
      
         PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANTFor carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $7,562,000,000 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.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â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 [075â1503]
                  â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
                  â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)
                  â12,121
                  â23,871
                  â24,050
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  32
                  33
                  92
               
               
                  
                     
                  
               
            
         
      
         SOCIAL SERVICES BLOCK GRANTFor making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph
            for a State to carry out State programs pursuant to title XX-A of such Act shall be 10 percent.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â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
                  â97
                  â97
                  â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
                  â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)
                  â1,655
                  â1,636
                  â1,627
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.  
         
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  7
                  6
                  
               
               
                  
                     
                  
               
            
         
      
         CHILDREN AND FAMILIES SERVICES PROGRAMSFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Every Student
            Succeeds Act, the Child Abuse Prevention and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services
            Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act
            of 1978 (adoption opportunities), part B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social
            Security Act, and the Community Services Block Grant Act ("CSBG Act"); and for necessary administrative expenses to carry
            out titles I, IV, V, X, XI, XIV, XVI, and XX-A of the Social Security Act, the Act of July 5, 1960, 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.
      
         Children and Families Services Programs 
      (Afghanistan Supplemental Appropriations Act, 2022.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â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
                  â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)
                  â13,219
                  â14,824
                  â15,300
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â65
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â229
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15,296
                  14,091
                  14,137
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â23
                  â26
                  â27
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â11
                  â1
                  â1
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â26
                  â27
                  â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
                  â3
                  â23
                  â23
               
               
                  4033
                  Non-Federal sources
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â7
                  â23
                  â23
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  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
                  â6
                  â12
                  â12
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  â1
                  â1
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  3
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical AssistanceProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â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
                  â2
                  â2
                  â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
                  â1
                  â1
                  â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)
                  â71
                  â74
                  â73
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10
                  9
                  9
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  â9
                  â12
                  â12
               
               
                  4123
                  Non-Federal sources
                  â18
                  â28
                  â28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â27
                  â40
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  66
                  76
                  82
               
               
                  
                     
                  
               
            
         
      
         PAYMENTS FOR FOSTER CARE AND PERMANENCYFor 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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â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
                  â2
                  â3
                  â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
                  â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)
                  â9,713
                  â10,690
                  â10,206
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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 Careâ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 Assistanceâ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 ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 67,800 children per month are estimated to be served in FY 2023.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and Permanency
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â4â1â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)
                  
                  â161
                  â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.  
         
      
         Administration for Community LivingFederal Funds
         AGING AND DISABILITY SERVICES PROGRAMS
         (INCLUDING TRANSFER OF FUNDS)For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), the RAISE Family Caregivers
            Act, the Supporting Grandparents Raising Grandchildren Act, titles III and XXIX of the PHS Act, sections 1252 and 1253 of
            the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, title XX-B of the Social Security
            Act, the Developmental Disabilities Assistance and Bill of Rights Act 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.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â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 [012â3507]
                  â1
                  â1
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â7
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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 [075â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
                  â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)
                  â2,664
                  â3,879
                  â3,778
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â24
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,979
                  2,605
                  1,897
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â187
                  â297
                  â372
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â113
                  â75
                  â77
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â297
                  â372
                  â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
                  â2
                  â75
                  â77
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â75
                  â75
                  â77
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  75
                  77
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  
                  â35
                  â35
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Departmental ManagementFederal Funds
         GENERAL DEPARTMENTAL MANAGEMENTFor necessary expenses, not otherwise provided, for general departmental management, including hire of six passenger motor
            vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico Border Health
            Commission Act, and health or human services research and evaluation activities, including such activities that are similar
            to activities carried out by other components of the Department, $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)).
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â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 [075â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 â other accts [075â1503]
                  â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 [075â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
                  â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
                  â1
                  â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)
                  â743
                  â819
                  â803
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â13
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  562
                  518
                  577
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â280
                  â301
                  â301
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â150
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â301
                  â301
                  â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:
                  â227
                  â254
                  â267
               
               
                  4033
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â228
                  â254
                  â267
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â156
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  126
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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:
                  â40
                  â35
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  6
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â4
                  53
                  
               
               
                  4180
                  Budget authority, net (total)
                  485
                  486
                  580
               
               
                  4190
                  Outlays, net (total)
                  475
                  530
                  521
               
               
                  
                     
                  
               
            
         
      
      
         Note.â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â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
               
               
                  
                     
                  
               
            
         
      
         OFFICE FOR CIVIL RIGHTSFor expenses necessary for the Office for Civil Rights, $60,250,000.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â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
                  
                  â1
                  â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)
                  â51
                  â48
                  â74
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â7
                  â10
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
         OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY 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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â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)
                  â69
                  â81
                  â74
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  42
                  27
                  61
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â9
                  â7
                  â7
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â7
                  â7
                  â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:
                  â6
                  â25
                  â104
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â6
                  â25
                  â104
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â30
               
               
                  4180
                  Budget authority, net (total)
                  62
                  62
                  
               
               
                  4190
                  Outlays, net (total)
                  63
                  56
                  â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.
            111â5, Title XIII) and the 21st Century Cures Act (P.L. 114â255), for the purpose of addressing strategic planning, coordination,
            and the analysis of key technical, economic and other issues related to the public and private adoption of health information
            technology.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  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
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  66
                  66
                  108
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  180
                  180
                  180
               
               
                  
                     
                  
               
            
         
      
         MEDICARE HEARINGS AND APPEALSFor expenses necessary for Medicare hearings and appeals in the Office of the Secretary, $196,000,000 shall remain available
            until September 30,2024, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal
            Supplementary Medical Insurance Trust Fund.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â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 [075â0120]
                  â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
                  â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)
                  â203
                  â230
                  â196
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  40
                  2
                  2
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â92
                  â96
                  â96
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â96
                  â96
                  â96
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â47
                  â56
                  â94
               
               
                  3200
                  Obligated balance, end of year
                  â56
                  â94
                  â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
                  â187
                  â192
                  â196
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  â1
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  16
                  
                  
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  38
                  
               
               
                  4180
                  Budget authority, net (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,228
                  1,090
                  1,025
               
               
                  
                     
                  
               
            
         
      
         PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUNDFor expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical,
            and cybersecurity threats to civilian populations, and for other public health emergencies, $1,687,610,000, 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.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â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 [075â0343]
                  â4
                  â7
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  544
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0846]
                  581
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0849]
                  114
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â1503]
                  â858
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0390]
                  â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
                  â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)
                  â72,302
                  â67,860
                  â21,715
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4,334
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â94
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  80,077
                  109,794
                  92,036
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â272
                  â332
                  â332
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â135
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â332
                  â332
                  â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
                  â98
                  â162
                  â165
               
               
                  4033
                  Non-Federal sources:
                  â1,551
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,649
                  â162
                  â165
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Public Health and Social Services Emergency Fund
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â4â1â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)
                  
                  
                  â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.
         
      
         Advanced Research Projects Agency for Health
         Defense Production Act Medical Supplies EnhancementProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0150â0â1â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)
                  â52
                  â5,800
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0150â0â1â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
               
               
                  
                     
                  
               
            
         
      
         PrEP for All to End the HIV Epidemic
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0151â4â1â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)
                  
                  
                  â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 (2022â2025) commitment to a 75 percent reduction in HIV infection by 2025.
         
      
         Mental Health Transformation Fund
         Mental Health Transformation Fund
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0136â4â1â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)
                  
                  
                  â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.  
         
      
         Transfers from the Patient-Centered Outcomes Research Trust FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â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)
                  â68
                  â148
                  â133
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â115
                  â136
                  â144
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â47
                  12
                  â11
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
            20 percent of the funds appropriated or credited to the PCORTF was transferred each year to the Department of Health and Human
            Services (HHS). In FY 2020, PCORTF was extended through FY 2029. As authorized in section 937 of the Public Health Service
            Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded
            comparative clinical effectiveness research and coordinate Federal health programs to build research and data capacity for
            comparative clinical effectiveness research. Transferred funds were distributed to the Secretary of HHS and the Agency for
            Healthcare Research and Quality to carry out these activities.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Nonrecurring Expenses FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â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
                  â375
                  â375
                  â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)
                  â298
                  â499
                  â184
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â375
                  â375
                  â500
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â101
                  â135
               
               
                  4011
                  Outlays from discretionary balances
                  298
                  600
                  319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  298
                  499
                  184
               
               
                  4180
                  Budget authority, net (total)
                  â375
                  â375
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Health Insurance Reform Implementation FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0119â0â1â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)
                  
                  â2
                  â2
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
         No Surprises Implementation FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  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)
                  â9
                  â144
                  â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. 116â260) appropriated $500,000,000 to the No Surprises Implementation Fund within
            the Department of Health and Human Services. The Fund shall be used for implementation expenses necessary to carry out the
            requirements of the No Surprises Act and Title II Transparency provisions for the Department of Health and Human Services,
            the Department of Labor, and the Department of the Treasury.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0127â0â1â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  64
                  209
                  209
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â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 [075â0120]
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1070
                  Unobligated balance (total)
                  3
                  3
                  50
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1120
                  Appropriations transferred to other acct [075â0142]
                  
                  â28
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0943]
                  
                  â856
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1362]
                  
                  â12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  â896
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  950
                  1,000
                  1,000
               
               
                  1220
                  Appropriations transferred to other accts [075â0142]
                  â28
                  
                  â28
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â856
                  
                  â903
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  
                  â12
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â54
                  â57
                  â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
                  
                  â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.
         
      
         Pregnancy Assistance FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â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)
                  â3
                  â1
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
         Section 241 Evaluation Transactions AccountProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â3902â0â1â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)
                  â618
                  â607
                  â685
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  845
                  793
                  741
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â936
                  â844
                  â844
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â514
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  606
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â844
                  â844
                  â844
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  1
                  â51
               
               
                  3200
                  Obligated balance, end of year
                  1
                  â51
                  â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
                  â618
                  â555
                  â633
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â618
                  â555
                  â633
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.
      
         Program Support CenterFederal Funds
         RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERSFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
            under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
            personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â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)
                  â659
                  â739
                  â708
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     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.
         
         *The total active duty levels reflect base FTEs plus the supplementals.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â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
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0170â0â1â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)
                  â30
                  â36
                  â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. 108â375, section 725).
         
      
         General Fund Payment for Unfunded Liability, USPHS Commissioned Corps Retirement Pay and Survivor Benefit Costs
         Debt Collection FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â551
                  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
                  â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)
                  â10
                  â9
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3
                  9
                  17
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â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
                  â10
                  â10
                  â10
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  
                  â1
                  â8
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  â1
                  â8
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5745â0â2â551
                  2021 actual
                  2022 est.
                  2023 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  18
                  25
                  25
               
               
                  
                     
                  
               
            
         
      
         Health Activities FundsProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9913â0â1â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)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         HHS Service and Supply FundProgram and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â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)
                  â939
                  â1,297
                  â1,703
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â117
                  â250
                  â250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  792
                  546
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â406
                  â460
                  â460
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â54
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â460
                  â460
                  â460
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  382
                  332
                  86
               
               
                  3200
                  Obligated balance, end of year
                  332
                  86
                  â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
                  â954
                  â1,948
                  â1,948
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â956
                  â1,948
                  â1,948
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â54
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â17
                  â651
                  â245
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â17
                  â651
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â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
         Retirement Pay and Survivor Benefits Payments to Commissioned Corps Officers
         Miscellaneous Trust FundsSpecial and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  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
                  â73
                  â72
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  1
                  3
                  5
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â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)
                  â66
                  â88
                  â84
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  â8
                  â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
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Office of the Inspector GeneralFederal Funds
         OFFICE OF INSPECTOR GENERALFor expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations,
            in carrying out the provisions of the Inspector General Act of 1978,  $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.
      Note.â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 117â43, as
         amended). The amounts included for 2022 reflect the annualized level provided by the continuing resolution.  
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â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 [075â9911]
                  2
                  2
                  2
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  â1
                  â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
                  â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)
                  â442
                  â473
                  â448
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  105
                  72
                  62
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â93
                  â243
                  â243
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â158
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â243
                  â243
                  â243
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â4
                  â138
                  â171
               
               
                  3200
                  Obligated balance, end of year
                  â138
                  â171
                  â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
                  â107
                  â111
                  â111
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â14
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â210
                  â221
                  â221
               
               
                  4123
                  Non-Federal sources
                  â9
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â219
                  â233
                  â233
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â144
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  
                  11
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â144
                  11
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  10
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  20
                  39
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â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
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions
         GENERAL FUND RECEIPT ACCOUNTS(in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2021 actual   
                  2022 est.   
                  2023 est.   
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  203   
                  203   
                  203   
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                  342   
                  36   
                     
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  887   
                  699   
                  575   
               
               
                  075â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:
               
               
                  075â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  â10   
                     
                     
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  â10   
                     
                     
               
               
                  
                     
                  
               
            
         
      
      
          
      
         GENERAL PROVISIONSSEC. 201. Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
      when specifically approved by the Secretary.SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural
      mechanism, at a rate in excess of Executive Level II: Provided, That this section shall not apply to the Head Start program.SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than 2.55 percent,
      of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly, or
      by grants or contracts) and the implementation and effectiveness of programs funded in this title.'
      			
      (TRANSFER OF FUNDS)SEC. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
      which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
      appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.SEC. 205. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act, terminations described in such section may occur
      up to 60 days after the effective date of a contract awarded in fiscal year 2023 under section 338B of such Act, or at any
      time if the individual who has been awarded such contract has not received funds due under the contract.SEC. 206. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. 207. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. 208. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
      Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
      Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
      provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. 209. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.SEC. 210. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year 2023:
      (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
         Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
         that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
         of 1980 and other applicable statutes administered by the Department of State.
      
      (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
         to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
         for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
         functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
         and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
         through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
         foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
         of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
         chronic and environmental diseases, and other health activities abroad.
      
      (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
         benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
         4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
         comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
         percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
         official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
         the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
         Service Act of 1980, to individuals serving in the Foreign Service.
      '
      			
      (TRANSFER OF FUNDS)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (TRANSFER OF FUNDS)SEC. 212. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research" account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. 213. 
      (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director") may use funds authorized under section 402(b)(12)
         of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry out research
         identified pursuant to or research and activities described in such section 402(b)(12).
      
      (b) Peer review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      '
      			
      (TRANSFER OF FUNDS)SEC. 214. Not to exceed 1 percent of funds appropriated by this Act to the offices, institutes, and centers of the National Institutes
      of Health may be transferred to and merged with funds appropriated under the heading "National Institutes of Health-Buildings
      and Facilities": Provided, That the use of such transferred funds shall be subject to a centralized prioritization and governance
      process: Provided further, That the Director of the National Institutes of Health shall notify the Committees on Appropriations
      of the House of Representatives and the Senate at least 15 days in advance of any such transfer: Provided further, That this
      transfer authority is in addition to any other transfer authority provided by law.'
      			
      (TRANSFER OF FUNDS)SEC. 215. Of the amounts made available for NIH, 1 percent of the amount made available for National Research Service Awards ("NRSA")
      shall be made available to the Administrator of the Health Resources and Services Administration to make NRSA awards for research
      in primary medical care to individuals affiliated with entities who have received grants or contracts under sections 736,
      739, or 747 of the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of
      the Agency for Healthcare Research and Quality to make NRSA awards for health service research.SEC. 216. 
      (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
         than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
         319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), ifâ
         (1) funds are available and obligatedâ
            (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
            (B) for the estimated costs associated with a necessary termination of the contract; and
         
         (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
            full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
         
      
      (b) A contract entered into under this sectionâ
         (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
         (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
      SEC. 217. Effective during the period beginning on November 1, 2015 and ending January 1, 2024, any provision of law that refers (including
      through cross-reference to another provision of law) to the current recommendations of the United States Preventive Services
      Task Force with respect to breast cancer screening, mammography, and prevention shall be administered by the Secretary involved
      as ifâ
      (1) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to
         breast cancer screening, mammography, and prevention last issued before 2009; and
      
      (2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social
         Security Act (42 U.S.C. 1395x(jj)).
      '
      			
      (TRANSFER OF FUNDS)SEC. 218. The NIH Director may transfer funds for opioid addiction, opioid alternatives, stimulant misuse and addiction, pain management,
      and addiction treatment to other Institutes and Centers of the NIH to be used for the same purpose 15 days after notifying
      the Committees on Appropriations of the House of Representatives and the Senate: Provided, That the transfer authority provided in the previous proviso is in addition to any other transfer authority provided by
      law.SEC. 219. Funds appropriated in this Act that are available for salaries and expenses of employees of the Department of Health and Human
      Services shall also be available to pay travel and related expenses of such an employee or of a member of his or her family,
      when such employee is assigned to duty, in the United States or in a U.S. territory, during a period and in a location that
      are the subject of a determination of a public health emergency under section 319 of the Public Health Service Act and such
      travel is necessary to obtain medical care for an illness, injury, or medical condition that cannot be adequately addressed
      in that location at that time. For purposes of this section, the term "U.S. territory" means Guam, the Commonwealth of Puerto
      Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, or the Trust Territory of the Pacific Islands.SEC. 220. The Department of Health and Human Services may accept donations from the private sector, nongovernmental organizations, and
      other groups independent of the Federal Government for the care of unaccompanied alien children (as defined in section 462(g)(2)
      of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in the care of the Office of Refugee Resettlement of the Administration
      for Children and Families, including monetary donations, medical goods, and services, which may include early childhood developmental
      screenings, school supplies, toys, clothing, and any other items and services intended to promote the wellbeing of such children.SEC. 221. None of the funds made available in this Act under the heading "Department of Health and Human ServicesâAdministration for
      Children and FamiliesâRefugee and Entrant Assistance" may be obligated to a grantee or contractor to house unaccompanied alien
      children (as such term is defined in section 462(g)(2) of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in any facility
      that is not State-licensed for the care of unaccompanied alien children, except in the case that the Secretary determines
      that housing unaccompanied alien children in such a facility is necessary on a temporary basis due to an influx of such children
      or an emergency, provided thatâ
      (1) the terms of the grant or contract for the operations of any such facility that remains in operation for more than six consecutive
         months shall require compliance withâ
         (A) the same requirements as licensed placements, as listed in Exhibit 1 of the Flores Settlement Agreement that the Secretary
            determines are applicable to non-State licensed facilities; and
         
         (B) staffing ratios of one (1) on-duty Youth Care Worker for every eight (8) children or youth during waking hours, one (1) on-duty
            Youth Care Worker for every sixteen (16) children or youth during sleeping hours, and clinician ratios to children (including
            mental health providers) as required in grantee cooperative agreements;
         
      
      (2) the Secretary may grant a 60-day waiver for a contractor's or grantee's non-compliance with paragraph (1) if the Secretary
         certifies and provides a report to Congress on the contractor's or grantee's good-faith efforts and progress towards compliance;
      
      (3) not more than four consecutive waivers under paragraph (2) may be granted to a contractor or grantee with respect to a specific
         facility;
      
      (4) ORR shall ensure full adherence to the monitoring requirements set forth in section 5.5 of its Policies and Procedures Guide
         as of May 15, 2019;
      
      (5) for any such unlicensed facility in operation for more than three consecutive months, ORR shall conduct a minimum of one comprehensive
         monitoring visit during the first three months of operation, with quarterly monitoring visits thereafter; and
      
      (6) not later than 60 days after the date of enactment of this Act, ORR shall brief the Committees on Appropriations of the House
         of Representatives and the Senate outlining the requirements of ORR for influx facilities including any requirement listed
         in paragraph (1)(A) that the Secretary has determined are not applicable to non-State licensed facilities.
      SEC. 222. In addition to the existing Congressional notification for formal site assessments of potential influx facilities, the Secretary
      shall notify the Committees on Appropriations of the House of Representatives and the Senate at least 15 days before operationalizing
      an unlicensed facility, and shall (1) specify whether the facility is hard-sided or soft-sided, and (2) provide analysis that
      indicates that, in the absence of the influx facility, the likely outcome is that unaccompanied alien children will remain
      in the custody of the Department of Homeland Security for longer than 72 hours or that unaccompanied alien children will be
      otherwise placed in danger. Within 60 days of bringing such a facility online, and monthly thereafter, the Secretary shall
      provide to the Committees on Appropriations of the House of Representatives and the Senate a report detailing the total number
      of children in care at the facility, the average length of stay and average length of care of children at the facility, and,
      for any child that has been at the facility for more than 60 days, their length of stay and reason for delay in release.SEC. 223. None of the funds made available in this Act may be used to prevent a United States Senator or Member of the House of Representatives
      from entering, for the purpose of conducting oversight, any facility in the United States used for the purpose of maintaining
      custody of, or otherwise housing, unaccompanied alien children (as defined in section 462(g)(2) of the Homeland Security Act
      of 2002 (6 U.S.C. 279(g)(2))), provided that such Senator or Member has coordinated the oversight visit with the Office of
      Refugee Resettlement not less than two business days in advance to ensure that such visit would not interfere with the operations
      (including child welfare and child safety operations) of such facility.SEC. 224. Funds appropriated in this Act that are available for salaries and expenses of employees of the Centers for Disease Control
      and Prevention shall also be available for the primary and secondary schooling of eligible dependents of personnel stationed
      in a U.S. territory as defined in section 219 of this Act at costs not in excess of those paid for or reimbursed by the Department
      of Defense.'
      			
      (CANCELLATION)SEC. 225. Of the unobligated balances in the "Nonrecurring Expenses Fund" established in section 223 of division G of Public Law 110â161,
      $500,000,000 are hereby permanently cancelled not later than September 30, 2023.SEC. 226. For purposes of any transfer to appropriations under the heading "Department of Health and Human ServicesâOffice of the SecretaryâPublic
      Health and Social Services Emergency Fund", section 204 of this Act shall be applied by substituting "10 percent" for "3 percent".SEC. 227.  For fiscal year 2023, the notification requirements described in sections 1804(a) and 1851(d) of the Social Security Act
      may be fulfilled by the Secretary in a manner similar to that described in paragraphs (1) and (2) of section 1806(c) of such
      Act.SEC. 228. 
      Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended
      (a) in subsection (a)(5)(C)â
         (1) by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE. A covered entity shall
            permit"; and
         
         (2) by inserting at the end the following:
         
            "(ii) USE OF SAVINGS. A covered entity shall permit the Secretary to audit, at the Secretary's expense, the records of the
               entity to determine how net income from purchases under this section are used by the covered entity."
            
         
         
            "(iii) RECORDS RETENTION. Covered entities shall retain such records and provide such records and reports as deemed necessary
               by the Secretary for carrying out this subparagraph.".
            
         
      
      (b) by adding at the end the following new subsection:
      
         "(f) REGULATIONS. The Secretary may promulgate such regulations as the Secretary determines appropriate to carry out the provisions
            of this section.".
         
      '
      			
      (INCLUDING TRANSFER OF FUNDS)SEC. 229. 
      (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".
      SEC. 230. 
      (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.SEC. 231.  Section 2813 of the Public Health Service Act (42 U.S.C. 300hh-15) is amendedâ
      (1) by redesignating subsection (i) as subsection (j); and 
      (2) by inserting after subsection (h) the following new subsection: 
      
         "(i) TORT CLAIMS AND WORK INJURY COMPENSATION COVERAGE FOR CORPS VOLUNTEERS.â
         
            "(1) IN GENERAL. If under section 223 and regulations pursuant to such section, and through an agreement entered into in accordance
               with such regulations, the Secretary accepts, from an individual in the Corps, services for a specified period that are volunteer
               and without compensation other than reasonable reimbursement or allowance for expenses actually incurred, such individual
               shall, during such period, have the coverages described in paragraphs (2) and (3). 
            
         
         
            "(2) FEDERAL TORT CLAIMS ACT COVERAGE. Such individual shall, while performing such services during such periodâ
            
               "(A) be deemed to be an employee of the Department of Health and Human Services, for purposes of claims under sections 1346(b)
                  and 2672 of title 28, United States Code, for money damages for personal injury, including death, resulting from performance
                  of functions under such agreement; and
               
            
            
               "(B) be deemed to be an employee of the Public Health Service performing medical, surgical, dental, or related functions,
                  for purposes of having the remedy provided by such sections of title 28 be exclusive of any other civil action or proceeding
                  by reason of the same subject matter against such individual or against the estate of such individual.
               
            
         
         
            "(3) COMPENSATION FOR WORK INJURIES. Such individual shall, while performing such services during such period, be deemed to
               be an employee of the Department of Health and Human Services, and an injury sustained by such an individual shall be deemed
               'in the performance of duty', for purposes of chapter 81 of title 5, United States Code, pertaining to compensation for work
               injuries.".
            
         
      SEC. 232.  Notwithstanding any other provision of law, the Secretary of Health and Human Services may use $5,000,000 of the amounts
      appropriated under the heading "Department of Health and Human ServicesâOffice of the SecretaryâGeneral Departmental Management"
      to supplement funds otherwise available to the Secretary for the hire and purchase of zero emission passenger motor vehicles
      and supporting charging or fueling infrastructure, and to cover other costs related to electrifying the motor vehicle fleet
      within HHS: Provided, That supporting charging or fueling infrastructure installed in a parking area with such funds shall
      be deemed personal property under the control and custody of the component of the Department of Health and Human Services
      managing such parking area.SEC. 233.  Section 402A(d) of the Public Health Service Act (42 U.S.C. 282a(d)) is amendedâ
      (1) in the first sentence by striking "under subsection (a)" and inserting "to carry out this title"; and
      (2) in the second sentence by striking "account under subsection (a)(1)".SEC. 234. The Secretary of Health and Human Services may waive penalties and administrative requirements in title XXVI of the Public
      Health Service Act for awards under such title from amounts provided under the heading "Department of Health and Human ServicesâHealth
      Resources and Services Administration" in this or any other appropriations Act for this fiscal year, including amounts made
      available to such heading by transfer.SEC. 235.  None of the funds made available by this Act from the Federal Hospital Insurance Trust Fund or the Federal Supplemental Medical
         Insurance Trust Fund, or transferred from other accounts funded by this Act to the "Centers for Medicare and Medicaid ServicesâProgram
         Management" account, may be used for payments under section 1342(b)(1) of Public Law 111â148 (relating to risk corridors). SEC. 236.   (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 Familiesâ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. SEC. 237.  During this fiscal year, an Operating or Staff Division in HHS may enter into a reimbursable agreement with another major
         organizational unit within HHS or of another agency under which the ordering agency or unit delegates to the servicing agency
         or unit the authority and funding to issue a grant or cooperative agreement on its behalf: Provided, That the head of the
         ordering agency or unit must certify that amounts are available and that the order is in the best interests of the United
         States Government: Provided further, That funding may be provided by way of advance or reimbursement, as deemed appropriate
         by the ordering agency or unit, with proper adjustments of estimated amounts provided in advance to be made based on actual
         costs: Provided further, That an agreement made under this section obligates an appropriation of the ordering agency or unit,
         including for costs to administer such grant or cooperative agreement, and such obligation shall be deemed to be an obligation
         for any purpose of law: Provided further, That an agreement made under this section may be performed for a period that extends
         beyond the current fiscal year. SEC. 238.  Section 317G of the Public Health Service Act (42 U.S.C. 247b-8) is amended by adding at the end the following: "The Secretary
         may, no later than 120 days after the end of an individual's participation in such a fellowship or training program, and without
         regard to any provision in title 5 of the United State Code governing appointments in the competitive service, appoint a participant
         in such a fellowship or training program to a term or permanent position in the Centers for Disease Control and Prevention.". SEC. 239.  In the event of a public health emergency declared by the Secretary of Health and Human Services under section 319 of the
         Public Health Service Act, or where the Secretary determines that there is a significant potential for such an emergency to
         exist that will affect national security or the health and security of United States citizens domestically or internationally,
         the Director of the Centers for Disease Control and Prevention may enter into transactions other than contracts, grants, and
         cooperative agreements that are directly related to preparing for or responding to such emergency or potential emergency. SEC. 240.   (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 114â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 amendedâ (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 amendedâ (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"; 
         (5)  in section 464Nâ (A)  in the section heading, by striking "DRUG ABUSE RESEARCH CENTERS" and inserting "DRUGS AND ADDICTION RESEARCH CENTERS"; 
            (B)  in subsection (a)â (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 
            
            (C)  in subsection (c)â (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 
            
         
         (6)  in section 464Pâ (A)  in subsection (a)â (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 
            
            (B)  in subsection (d)â (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 
               (iii)  by striking "drugs of abuse" and inserting "drugs of addiction". 
            
         
      
      (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. SEC. 241.   (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 amendedâ (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 amendedâ (1)  in section 464Hâ (A)  in subsection (a)â (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 
            
            (B)  in subsection (b)â (i)  in paragraph (3)â (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 
         (4)  in section 464J(a)â (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.  SEC. 242.   (a)  The Public Health Service Act (42 U.S.C. 201 et seq.) is amendedâ (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 amendedâ (1)  in the title heading, by striking "SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION" and inserting "SUBSTANCE USE
               AND MENTAL HEALTH SERVICES ADMINISTRATION"; 
         (2)  in section 501â (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". 
      (h)   (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. 
      
      
         GENERAL PROVISIONâTHIS TITLE(Afghanistan Supplemental Appropriations Act, 2022.)