[Congressional Record (Bound Edition), Volume 150 (2004), Part 17]
[Extensions of Remarks]
[Page 23650]
[From the U.S. Government Publishing Office, www.gpo.gov]




               PROVIDING CBO COST ESTIMATE FOR H.R. 4453

                                 ______
                                 

                    HON. F. JAMES SENSENBRENNER, JR.

                              of wisconsin

                    in the house of representatives

                       Tuesday, November 16, 2004

  Mr. SENSENBRENNER. Mr. Speaker, on October 5, 2004, the Committee on 
the Judiciary filed its report on H.R. 4453, the ``Access to Rural 
Physicians Improvement Act of 2004.'' At that time, the Committee had 
not received a Congressional Budget Office cost estimate for the bill, 
and it filed the report with a committee cost estimate as provided in 
clause 3(d)(2) of Rule XIII of the Rules of the House of 
Representatives. Subsequently, the Committee received the CBO cost 
estimate on H.R. 4453, and I am submitting it here for the record.
                                                 October 15, 2004.
     Hon. F. James Sensenbrenner, Jr.,
     Chairman, Committee on the Judiciary, U.S. House of 
         Representatives, Washington, DC.
       Dear Mr. Chairman: The Congressional Budget Office has 
     prepared the enclosed cost estimate for H.R. 4453, the Access 
     to Rural Physicians Improvement Act of 2004.
       If you wish further details on this estimate, we will be 
     pleased to provide them. The CBO staff contact is Mark 
     Grabowicz, who can be reached at 226-2860.
           Sincerely,
                                              Douglas Holtz-Eakin.
       Enclosure.

 Congressional Budget Office Cost Estimate H.R. 4453, Access to Rural 
     Physicians Improvement Act of 2004, As passed by the House of 
                   Representatives on October 6, 2004

       CBO estimates that implementing H.R. 4453 would result in 
     no significant net cost to the federal government. The act 
     would affect direct spending, but we estimate that any 
     effects would be insignificant. H.R. 4453 contains no 
     intergovernmental or private-sector mandates as defined in 
     the Unfunded Mandates Reform Act and would impose no costs on 
     state, local, or tribal governments.
       Until June 1, 2004, foreign students attending medical 
     school in the United States were permitted to remain here 
     after graduation if they agreed to work for at least three 
     years in certain regions considered to be underserved by 
     physicians or if they accepted employment with certain 
     federal agencies. That program was limited to 30 individuals 
     a year for each state that participated in the program. Under 
     current law, such individuals must return to their native 
     countries. H.R. 4453 would make several changes to that 
     program and would reestablish it through June 1, 2006.
       Based on the participation of foreign medical students in 
     those employment programs in recent years, CBO expects that 
     the act's provisions would affect no more than 2,000 persons 
     annually. The Bureau of Citizenship and Immigration Services 
     (CIS) would collect fees to provide work permits for those 
     individuals. CIS fees are classified as offsetting receipts 
     (a credit against direct spending). The agency is authorized 
     to spend such fees without further appropriation, so the net 
     impact on CIS spending would be insignificant.
       The CBO staff contact for this estimate is Mark Grabowicz, 
     who may be reached at 226 2860. This estimate was approved by 
     Robert A. Sunshine, Assistant Director for Budget Analysis.

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