Appendix - Department of Health and Human Services

For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; in addition to amounts appropriated to the FDA Innovation Account, for carrying out the activities described in section 1002(b)(4) of the 21st Century Cures Act (Public Law 114–255); for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $4,416,025,000: Provided, That of the amount provided under this heading, $32,238,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account and remain available until expended; $29,459,000 shall be derived from generic new animal drug user fees authorized by 21 U.S.C. 379j-21, and shall be credited to this account and remain available until expended; $712,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for animal drug user fees and generic new animal drug user fees that exceed the respective fiscal year 2023 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug and generic new animal drug assessments for fiscal year 2023, including any such fees collected prior to fiscal year 2023 but credited for fiscal year 2023, shall be subject to the fiscal year 2023 limitations: Provided further, That the Secretary may accept payment during fiscal year 2023 of user fees specified under this heading and authorized for fiscal year 2024, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2024 for which the Secretary accepts payment in fiscal year 2023 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: Provided further, That of the total amount appropriated under this heading, $20,000,000 shall be available until September 30, 2025, for the Oncology Center of Excellence to develop and review research, advance regulatory policy, support clinical review of submissions to the Food and Drug Administration related to medical products intended to diagnose or treat cancer, and conduct education and outreach partnerships, in addition to any other amounts available for such purposes: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner: Provided further, That any transfer of funds pursuant to section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd(n)) shall only be from amounts made available under this heading for other activities: Provided further, That of the amounts that are made available under this heading for "other activities", and that are not derived from user fees, $1,500,000 shall be transferred to and merged with the appropriation for "Department of Health and Human Services—Office of Inspector General" for oversight of the programs and operations of the Food and Drug Administration and shall be in addition to funds otherwise made available for oversight of the Food and Drug Administration: Provided further, That funds may be transferred from one specified activity to another with the prior notification to the Committees on Appropriations of both Houses of Congress.

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

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

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


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

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

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

5099	Balance, end of year		1	2


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

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

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

0899	Total reimbursable obligations	32	32	35

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


		2021 actual	2022 est.	2023 est.

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

The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation. FDA also has responsibility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public health and to reduce tobacco use by minors. FDA advances public health by helping to advance innovations that make medicines more effective, safe, and affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by ensuring the security of the food supply and by fostering the development of medical products and countermeasures to respond to deliberate and naturally emerging public health threats. The FY 2023 Budget includes $6.8 billion in total resources for FDA. The Budget invests in priority activities including inspections modernization, critical food safety efforts, medical device cybersecurity, public health employee pay costs, alternative methods to animal testing, and Cancer Moonshot.


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

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

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

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

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


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

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

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

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


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

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

0899	Total reimbursable obligations			2,163

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

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

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

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

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


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

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

99.0	Reimbursable obligations			2,163

99.9	Total new obligations, unexpired accounts			2,163


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

	Obligations by program activity:
0023	Pandemic Prepardness			1,630

0799	Total direct obligations			1,630

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

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

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

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

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


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

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

99.0	Direct obligations			1,630

99.9	Total new obligations, unexpired accounts			1,630


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

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

0900	Total new obligations, unexpired accounts	654	619	619

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

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

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

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

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

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

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

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


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

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent		74	74
11.3	Other than full-time permanent		1	1
11.5	Other personnel compensation		2	2
11.7	Military personnel		1	1

11.9	Total personnel compensation		78	78
12.1	Civilian personnel benefits		26	26
12.2	Military personnel benefits		1	1
21.0	Travel and transportation of persons		1	1
23.3	Communications, utilities, and miscellaneous charges		6	6
24.0	Printing and reproduction		1	1
25.1	Advisory and assistance services		15	15
25.2	Other services from non-Federal sources		77	77
25.3	Other goods and services from Federal sources		54	54
25.4	Operation and maintenance of facilities		3	3
25.7	Operation and maintenance of equipment		56	56
26.0	Supplies and materials		4	4
31.0	Equipment		1	1
42.0	Insurance claims and indemnities		1	1

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

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

99.0	Reimbursable obligations	654	295	295

99.9	Total new obligations, unexpired accounts	654	619	619


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

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


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

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

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

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

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

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

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

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


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

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

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

5099	Balance, end of year


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

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

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

1160	Appropriation, discretionary (total)	70
1930	Total budgetary resources available	118	49	49
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	49	49	49

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	49	54	3
3010	New obligations, unexpired accounts	69
3020	Outlays (gross)	–64	–51

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

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

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

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


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

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

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

99.9	Total new obligations, unexpired accounts	69


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

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


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

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

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

1850	Spending auth from offsetting collections, mand (total)	8	11	11
1900	Budget authority (total)	8	11	11
1930	Total budgetary resources available	10	12	12
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts	9	11	11


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

2001	Reimbursable civilian full-time equivalent employment	41	37	37

Federal Funds

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect to primary health care and the Native Hawaiian Health Care Act of 1988, $1,839,022,000: Provided, That no more than $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $120,000,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of section 224 of the PHS Act, and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative claims made under such law.

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921 of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $1,619,884,000: Provided, That section 751(j)(2) and 762(k) of the PHS Act and the proportional funding amounts in paragraphs (1) through (4) of section 756(f) of the PHS Act shall not apply to funds made available under this heading: Provided further, That for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as the "Secretary") may hereafter waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of 1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the programs authorized by such sections and shall remain available until expended for the National Practitioner Data Bank: Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under such section and subpart: Provided further, That section 756(c) of the PHS Act shall apply to paragraphs (1) through (4) of section 756(a) of the PHS Act: Provided further, That $210,000,000 shall remain available until expended for the purposes of providing primary health services, assigning National Health Service Corps ("NHSC") participants to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of the PHS Act, and making payments under the NHSC Loan Repayment Program under section 338B of such Act: Provided further, That within the amount made available in the previous proviso, $15,000,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs (as those terms are defined by the Secretary), notwithstanding the assignment priorities and limitations under section 333(b) of such Act: Provided further, That within the amount made available in the proviso preceding the previous proviso, $25,000,000 shall remain available until expended for the purposes of making loan repayment awards to mental and behavioral health providers, including peer support specialists, in accordance with section 338B of the PHS Act, notwithstanding the assignment priorities and limitations under sections 333(a)(1)(D), 333(b), 333A(a)(1)(B)(ii), and 334 of the PHS Act: Provided further, That for purposes of the previous three provisos, section 331(a)(3)(D) of the PHS Act shall be applied as if the term "primary health services" includes clinical substance use disorder treatment services, including those provided by masters level, licensed substance use disorder treatment counselors , and services provided by certified peer support specialists: Provided further, That funds made available under this heading may be used to make grants to establish or expand optional community-based nurse practitioner fellowship programs that are accredited or in the accreditation process, with a preference for those in Federally Qualified Health Centers, for practicing postgraduate nurse practitioners in primary care or behavioral health.

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health and title V of the Social Security Act, $1,272,930,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $351,116,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and $10,276,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,654,781,000, of which $2,010,881,000 shall remain available to the Secretary through September 30, 2025, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act; and of which $290,000,000, to remain available until expended, shall be available to the Secretary for carrying out a program of grants and contracts under title XXVI or section 311(c) of such Act focused on ending the nationwide HIV/AIDS epidemic, with any grants issued under such section 311(c) administered in conjunction with title XXVI of the PHS Act, including the limitation on administrative expenses.

For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, $94,009,000, of which $122,000 shall be available until expended for facilities renovations and other facilities-related expenses of the National Hansen's Disease Program.

For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act of 1969, and sections 711 and 1820 of the Social Security Act, $373,709,000, of which $57,509,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program: Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, up to $20,942,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and up to $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) available for the purchase and implementation of telehealth services and other efforts to improve health care coordination for rural veterans between rural providers and the Department of Veterans Affairs electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, $12,500,000 shall be available for State Offices of Rural Health: Provided further, That $12,700,000 shall remain available through September 30, 2025, to support the Rural Residency Development Program.

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $400,000,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office.

For carrying out title III of the Public Health Service Act and for cross-cutting activities and program support for activities funded in other appropriations included in this Act for the Health Resources and Services Administration, $230,709,000, of which $44,500,000 shall be for expenses necessary for the Office for the Advancement of Telehealth, including grants, contracts, and cooperative agreements for the advancement of telehealth activities: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Systems", and "Rural Health".


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

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

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

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

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

0899	Total reimbursable obligations	108	101	101

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

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

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

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

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

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

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

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

3050	Unpaid obligations, end of year	16,456	11,590	9,391
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–17	–18	–18
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	9

3090	Uncollected pymts, Fed sources, end of year	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	10,484	16,438	11,572
3200	Obligated balance, end of year	16,438	11,572	9,373

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

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

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

4060	Additional offsets against budget authority only (total)	15

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

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

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

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


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

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

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

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

233999	Total subsidy budget authority	1	2	2

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

HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL), Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans, the program's revolving account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If the program's revolving account has excess funds that will not be used to provide new loans, these excess funds are returned to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects Academic Year 2020–2021 data reported in the FY 2021 Annual Operating Report.


Program	Account Balance


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

Total	1,002,873,249


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

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

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

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

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


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

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


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

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

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

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

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

For carrying out section 319F-4 of the PHS Act, $15,000,000, to remain available until expended.


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

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

0900	Total new obligations, unexpired accounts	3	9	15

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

1070	Unobligated balance (total)	5	9
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			15
1930	Total budgetary resources available	5	9	15
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1	2	9
3010	New obligations, unexpired accounts	3	9	15
3020	Outlays (gross)	–2	–2	–11

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

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

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

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


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

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

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

99.9	Total new obligations, unexpired accounts	3	9	15


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

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


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

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

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

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

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

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

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

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

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


		2021 actual	2022 est.	2023 est.

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

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


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

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

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

99.9	Total new obligations, unexpired accounts	441	504


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

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


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

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

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

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

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

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

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


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

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

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

99.9	Total new obligations, unexpired accounts			467


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

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


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

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

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


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

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

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

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

2290	Outstanding, end of year	51	112	174

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

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


Identification code 075–4442–0–3–551		2020 actual	2021 actual

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

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

4999	Total liabilities and net position	1	1


Identification code 075–9931–0–3–551		2021 actual	2022 est.	2023 est.

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

1290	Outstanding, end of year	5	5	5

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


Identification code 075–9931–0–3–551		2020 actual	2021 actual

	ASSETS:
1601	Direct loans, gross	5	5

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

3999	Total net position

4999	Total liabilities and net position	5	5

Trust Funds

For payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $26,200,000 shall be available from the Trust Fund to the Secretary.


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

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

1199	Total current law receipts	372	431	443

1999	Total receipts	372	431	443

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

2199	Total current law appropriations	–287	–289	–324

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

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


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

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

0191	Direct program activities, subtotal	38	38	68

0900	Total new obligations, unexpired accounts	287	289	324

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

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

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

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

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts	287	289	324


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

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

Federal Funds


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

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

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

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

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

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

1160	Appropriation, discretionary (total)	5,301	4,346	6,262
	Appropriations, mandatory:
1200	Appropriation (Diabetes)	150	150	150
1200	Appropriation (American Rescue Plan)	5,494
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–3	–3

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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


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

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


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

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

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


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

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

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

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

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

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

4020	Outlays, gross (total)	1,033	1,463	1,142
4180	Budget authority, net (total)	1,182	1,142	1,142
4190	Outlays, net (total)	1,033	1,463	1,142

The Contract Support Costs account provides for the reasonable and allowable costs for direct program expenses for the operation of, and any additional administrative or other expense related to, the overhead incurred by tribes and tribal organizations who operate health programs through self-determination contracts and compacts. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


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

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

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


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

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

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


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

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

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

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

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

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

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

4020	Outlays, gross (total)	110	163	150
4180	Budget authority, net (total)	139	150	150
4190	Outlays, net (total)	110	163	150

The Payments for Tribal Leases account provides for the reasonable and allowable costs for leases with a Tribe or tribal organization for a building owned or leased by the tribe or tribal organization that is used for administration or delivery of services under the Indian Self-Determination and Education Assistance Act. The Budget proposes to shift the four IHS accounts from discretionary to mandatory.


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

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

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


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

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

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

5099	Balance, end of year


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

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

0100	Total direct program	871	769	769

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

0900	Total new obligations, unexpired accounts	976	826	826

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

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

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

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

3050	Unpaid obligations, end of year	947	908	29
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–18	–18	–18

3090	Uncollected pymts, Fed sources, end of year	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	874	929	890
3200	Obligated balance, end of year	929	890	11

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

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

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

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

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


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

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

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

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

99.9	Total new obligations, unexpired accounts	976	826	826


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

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


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

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

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

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

Federal Funds

To carry out titles II, III, IV, VII, XI, XV, XVII, XIX, XXI, XXIII, XXVI, and XXVIII of the Public Health Service Act (PHS Act), sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, sections 20, 21, and 22 of the Occupational Safety and Health Act, titles II and IV of the Immigration and Nationality Act, section 501 of the Refugee Education Assistance Act, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, $9,620,961,000; of which $128,421,000 shall remain available through September 30, 2024 for international HIV/AIDS; $353,200,000 shall remain available through September 30, 2025 for global public health protection; $600,000,000 shall remain available through September 30, 2024 for public health infrastructure and capacity; and $50,000,000 shall remain available through September 30, 2024 for forecasting epidemics and outbreak analytics: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries: Provided further, That of the amounts made available under this heading, up to $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under Federal or State quarantine law: Provided further, That funds made available under this heading may be available for making grants under section 1509 of the PHS Act for not less than 21 States, tribes, or tribal organizations: Provided further, That of the funds made available under this heading, $15,000,000 shall be available to continue and expand community specific extension and outreach programs to combat obesity in counties with the highest levels of obesity: Provided further, That the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available under this heading: Provided further, That of the amounts appropriated under this heading up to $3,000,000 may remain available until expended for carrying out the Vessel Sanitation Program, to the extent that user fee collections are insufficient: Provided further, That of the amounts appropriated under this heading, $55,000,000 shall remain available until September 30, 2027, for costs related to the acquisition of real property, equipment, construction, installation, demolition, and renovation of facilities: Provided further, That funds made available in this or any prior Act that for the acquisition of real property or for construction or improvement of facilities shall be available to make improvements on non-federally owned property, provided that any improvements that are not adjacent to federally owned property do not exceed $2,500,000, and that the primary benefit of such improvements accrues to CDC: Provided further, That funds previously set-aside by CDC for repair and upgrade of the Lake Lynn Experimental Mine and Laboratory shall be used to acquire a replacement mine safety research facility: Provided further, That in addition, the prior year unobligated balance of any amounts assigned to former employees in accounts of CDC made available for Individual Learning Accounts shall be credited to and merged with the amounts made available for buildings and facilities to support the replacement of the mine safety research facility: Provided further, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading: Provided further, That of the amounts made available under this heading, $35,000,000, to remain available until expended, shall be available to the Director of the CDC for deposit in the Infectious Diseases Rapid Response Reserve Fund established by section 231 of division B of Public Law 115–245: Provided further, That funds appropriated under this heading may be used to support a contract for the operation and maintenance of an aircraft in direct support of activities throughout CDC to ensure the agency is prepared to address public health preparedness emergencies: Provided further, That any amounts made available by this Act to the Centers for Disease Control and Prevention may be used to support the salaries and expenses of any CDC employee or fellow responding to an emergency or other urgent public health crisis: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service, or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program and the Respirator Certification Program shall be available through September 30, 2024: Provided further, That in addition to amounts provided herein, $7,000,000 for lead poisoning prevention and $143,540,000 for health statistics shall be made available from amounts available under section 241 of the PHS Act.

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


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

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

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

5099	Balance, end of year		1	2


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

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

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

0809	Reimbursable program activities, subtotal	252	653	668

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


		2021 actual	2022 est.	2023 est.

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

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


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

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

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

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

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


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

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


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

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts			30,088


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

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

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

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts	30	30


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

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

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

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

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

3050	Unpaid obligations, end of year	292	217	217
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–2	–2	–2

3090	Uncollected pymts, Fed sources, end of year	–2	–2	–2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	237	290	215
3200	Obligated balance, end of year	290	215	215

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

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

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


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

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

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

99.9	Total new obligations, unexpired accounts	735	671	671


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

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


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

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

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

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

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

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

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

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

The FY 2023 Budget provides $35 million for the Infectious Diseases Rapid Response Reserve Fund within the Centers for Disease Control and Prevention. This Fund will provide the ability to respond efficiently and rapidly to emerging infectious disease threats or outbreaks.


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

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

99.9	Total new obligations, unexpired accounts	18	10	35

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) and section 3019 of the Solid Waste Disposal Act, $85,020,000: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA, the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation, biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological profiles pursuant to section 104(i) of CERCLA during fiscal year 2023, and existing profiles may be updated as necessary.


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

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

0900	Total new obligations, unexpired accounts	103	92	99

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

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

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

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

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

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

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

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

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

4060	Additional offsets against budget authority only (total)	1

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


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

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

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

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

99.9	Total new obligations, unexpired accounts	103	92	99


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

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


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

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

0900	Total new obligations, unexpired accounts	562	641	789

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

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

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

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

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

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

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

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

HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2022 and 2023 in the Budget reflect estimated Federal obligations for the WTC Health Program.


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

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

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

99.9	Total new obligations, unexpired accounts	562	641	789


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

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

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, $6,497,851,000, of which up to $30,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland.

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, $3,822,961,000.

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

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

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

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

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

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $1,674,941,000.

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

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

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $83,035,000.

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

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

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

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

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

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

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

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

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

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

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

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), $95,801,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $471,998,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2024: Provided further, That in fiscal year 2023, the National Library of Medicine may enter into personal services contracts for the provision of services in facilities owned, operated, or constructed under the jurisdiction of the National Institutes of Health (referred to in this title as "NIH").

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $873,654,000: Provided, That up to $90,000,000 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network: Provided further, That at least $599,349,000 is provided to the Clinical and Translational Sciences Awards program.

For carrying out the responsibilities of the Office of the Director, NIH, $2,302,065,000: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That all funds credited to the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: Provided further, That $645,939,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That up to $30,000,000 shall be used to carry out section 404I of the PHS Act (42 U.S.C. 283k) with respect to the National Primate Research Centers and Caribbean Primate Research Center: Provided further, That $5,000,000 shall be transferred to and merged with the appropriation for the "Office of Inspector General" for oversight of grant programs and operations of the NIH, including agency efforts to ensure the integrity of its grant application evaluation and selection processes, and shall be in addition to funds otherwise made available for oversight of the NIH: Provided further, That the funds provided in the previous proviso may be transferred from one specified activity to another with 15 days prior notification to the Committees on Appropriations of the House of Representatives and the Senate: Provided further, That the Inspector General shall consult with the Committees on Appropriations of the House of Representatives and the Senate before submitting to the Committees an audit plan for fiscal years 2023 and 2024 no later than 30 days after the date of enactment of this Act: Provided further, That amounts available under this heading are also available to establish, operate, and support the Research Policy Board authorized by section 2034(f) of the 21st Century Cures Act.

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

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

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


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

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

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

5099	Balance, end of year


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4060	Additional offsets against budget authority only (total)	185

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

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


		2021 actual	2022 est.	2023 est.

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

This program funds biomedical research and research training. These accounts will continue to be appropriated separately and are displayed in a consolidated format to improve the readability of the presentation. The FY 2023 Budget continues to fund a new Advanced Research Projects Agency for Health within the National Institutes of Health, as first proposed in the FY 2022 Budget. With an initial focus on cancer and other diseases such as diabetes and Alzheimer's, ARPA-H would drive transformational innovation in health research and speed application and implementation of health breakthroughs.


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

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

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

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

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


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

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


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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition to amounts available for such purposes in the appropriations provided to the NIH in this Act, $1,085,000,000, to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act, are to be derived from amounts transferred under section 1001(b)(2)(A) of such Act, and may be transferred by the Director of the National Institutes of Health to other accounts of the National Institutes of Health solely for the purposes provided in such Act: Provided further, That upon a determination by the Director that funds transferred pursuant to the previous proviso are not necessary for the purposes provided, such amounts may be transferred back to the Account: Provided further, That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.


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

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

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

5099	Balance, end of year		92	92


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

	Obligations by program activity:
0001	CURES obligations	96	185	419

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

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

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

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

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

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

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


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

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

99.9	Total new obligations, unexpired accounts	96	185	419


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

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

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

5099	Balance, end of year	4		8


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

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

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

Federal Funds

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, $4,182,687,000: Provided further, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, $21,039,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for mental health activities and to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1920(b) activities shall not exceed 5 percent of the amounts appropriated for subpart I of part B of title XIX: Provided further, That of the funds made available under this heading for subpart I of part B of title XIX of the PHS Act, not less than 10 percent shall be used to support evidence-based crisis systems: Provided further, That up to 10 percent of the amounts made available to carry out the Children's Mental Health Services program may be used to carry out demonstration grants or contracts for early interventions with persons not more than 25 years of age at clinical high risk of developing a first episode of psychosis: Provided further, That section 520E(b)(2) of the PHS Act shall not apply to funds appropriated in this Act for fiscal year 2023: Provided further, That $552,500,000 shall be available until September 30, 2024 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act: Provided further, That of the funds made available under this heading, $21,420,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 note). Provided further, That notwithstanding sections 1911(b) and 1912 of the PHS Act, amounts made available under this heading for subpart I of part B of title XIX of such Act shall also be available to support evidence-based programs that address early intervention and prevention of mental disorders among at-risk children and adults: Provided further, That States shall expend at least 10 percent of the amount each receives for carrying out section 1911 of the PHS Act to support evidence-based programs that address early intervention and prevention of mental disorders for at-risk youth and adults: Provided further, That notwithstanding section 1912 of the PHS Act, the plan described in such section and section 1911(b) of the PHS Act shall also include the evidence-based programs described in the previous proviso pursuant to plan criteria established by the Secretary.

For carrying out titles III and V of the PHS Act with respect to substance use treatment and title XIX of such Act with respect to substance use treatment and prevention, and the SUPPORT for Patients and Communities Act, $5,493,243,000: Provided, That $2,000,000,000 shall be for State Opioid Response Grants for carrying out activities pertaining to opioids and stimulants undertaken by the State agency responsible for administering the substance use prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x-21 et seq.): Provided further, That of such amount $75,000,000 shall be made available to Indian Tribes or tribal organizations: Provided further, That 15 percent of the remaining amount shall be for the States with the highest mortality rate related to opioid use disorders: Provided further, That of the amounts provided for State Opioid Response Grants not more than 2 percent shall be available for Federal administrative expenses, training, technical assistance, and evaluation: Provided further, That of the amount not reserved by the previous three provisos, the Secretary shall make allocations to States, territories, and the District of Columbia according to a formula using national survey results that the Secretary determines are the most objective and reliable measure of drug use and drug-related deaths: Provided further, That prevention and treatment activities funded through such grants may include education, treatment (including the provision of medication), behavioral health services for individuals in treatment programs, referral to treatment services, recovery support, and medical screening associated with such treatment: Provided further, That each State, as well as the District of Columbia, shall receive not less than $4,000,000: Provided further, That in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000 to supplement funds otherwise available for substance use treatment activities to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX; and (2) $2,000,000 to evaluate substance use treatment programs: Provided further, That for purposes of calculating the HIV set-aside under subpart II of part B of title XIX, the rate of cases of HIV shall be used instead of the rate of cases of AIDS: Provided further, That each State that receives funds appropriated under this heading in this Act for carrying out subpart II of part B of title XIX of the PHS Act shall expend not less than 10 percent of such funds for recovery support services: Provided further, That none of the funds provided for section 1921 of the PHS Act or State Opioid Response Grants shall be subject to section 241 of such Act.

For carrying out titles III and V of the PHS Act with respect to substance use prevention, $311,912,000.

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance Use Services", and "Substance Use Prevention Services" in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Use and Mental Health Services Administration, $149,645,000: Provided, That in addition to amounts provided herein, $31,428,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug use and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities: Provided further, That, in addition, fees may be collected for the costs of publications, data, data tabulations, and data analysis completed under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes: Provided further, That amounts made available in this Act for carrying out section 501(o) of the PHS Act shall remain available through September 30, 2023: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health", "Substance Use Services", and "Substance Use Prevention Services".


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

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

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

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

0899	Total reimbursable obligations	318	403	403

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

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

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

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

1260	Appropriations, mandatory (total)	3,572		12

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

(INCLUDING TRANSFERS OF FUNDS)

BUILDINGS AND FACILITIES

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Salaries and Expenses

(Legislative proposal, subject to PAYGO)

FDA Working Capital Fund

Payment to the FDA Innovation Account, CURES Act

FDA INNOVATION ACCOUNT, CURES ACT

(INCLUDING TRANSFER OF FUNDS)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

PRIMARY HEALTH CARE

HEALTH WORKFORCE

MATERNAL AND CHILD HEALTH

RYAN WHITE HIV/AIDS PROGRAM

HEALTH SYSTEMS

RURAL HEALTH

FAMILY PLANNING

HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Maternal, Infant, and Early Childhood Home Visiting Programs

(Legislative proposal, subject to PAYGO)

Health Center Guaranteed Loan Financing Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Indian Health Service

Federal Funds

Indian Health Services

Indian Health Services

(Legislative proposal, not subject to PAYGO)

CONTRACT SUPPORT COSTS

Contract Support Costs

(Legislative proposal, not subject to PAYGO)

PAYMENTS FOR TRIBAL LEASES

Payments for Tribal Leases

(Legislative proposal, not subject to PAYGO)

INDIAN HEALTH FACILITIES

INDIAN HEALTH FACILITIES

(Including Transfers of Funds)

Indian Health Facilities

(Legislative proposal, not subject to PAYGO)

Funding for Indian Health Services

Funding for Indian Health Services

(Legislative proposal, subject to PAYGO)

Centers for Disease Control and Prevention

Federal Funds

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

(INCLUDING TRANSFER OF FUNDS)

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

CDC-wide Activities and Program Support

(Legislative proposal, subject to PAYGO)

BUILDINGS AND FACILITIES

CDC Working Capital Fund

Infectious Diseases Rapid Response Reserve Fund

TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

NATIONAL CANCER INSTITUTE

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

NATIONAL EYE INSTITUTE

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

NATIONAL INSTITUTE ON AGING

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES