    [Senate Report 109-103]
    [From the U.S. Government Publishing Office]

                                                           Calendar No. 163
    109th Congress                                                   Report
                                     SENATE
     1st Session                                                    109-103

    ======================================================================

      DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
                   RELATED AGENCIES APPROPRIATION BILL, 2006
                                    _______

                     July 14, 2005.--Ordered to be printed

                                    _______

              Mr. Specter, from the Committee on Appropriations,
                            submitted the following

                                  R E P O R T

                            [To accompany H.R. 3010]

        The Committee on Appropriations, to which was referred the
    bill (H.R. 3010) making appropriations for the Departments of
    Labor, Health and Human Services, and Education and related
    agencies for the fiscal year ending September 30, 2006, and for
    other purposes, reports the same to the Senate with an
    amendment and recommends that the bill as amended do
    pass.
        The Committee on Appropriations reports the bill (S. 2810)
    making appropriations for Departments of Labor, Health and
    Human Services, and Education and related agencies for the
    fiscal year ending September 30, 2005, and for other purposes,
    reports favorably thereon and recommends that the bill do
    pass. deg.

                           Amount of budget authority
    Total of bill as reported to the Senate.............    $604,436,313,000
    Amount of 2005 appropriations.......................     501,344,991,000
    Amount of 2006 budget estimate......................     600,212,625,000
    Amount of House allowance...........................     601,592,573,000
    Bill as recommended to Senate compared to--
        2005 appropriations.............................    +103,091,322,000
        2006 budget estimate............................      +4,223,688,000
        House allowance.................................      +2,843,740,000

                                C O N T E N T S

                                  ----------
                                                                       Page

    Summary of Budget Estimates and Committee Recommendations........     4
    Overview and Bill Highlights.....................................     4
    Highlights of the Bill...........................................     4
    Title I--Department of Labor:
        Employment and Training Administration.......................     7
        Employee Benefits Security Administration....................    19
        Pension Benefit Guaranty Corporation.........................    19
        Employment Standards Administration..........................    20
        Occupational Safety and Health Administration................    23
        Mine Safety and Health Administration........................    24
        Bureau of Labor Statistics...................................    25
        Office of Disability Employment Policy.......................    25
        Departmental Management......................................    26
        Veterans Employment and Training.............................    29
        Office of the Inspector General..............................    30
        General Provisions...........................................    30
    Title II--Department of Health and Human Services:
        Health Resources and Services Administration.................    32
        Centers for Disease Control and Prevention...................    57
        NIH Preamble.................................................    88
        Substance Abuse and Mental Health Services Administration....   176
        Agency for Healthcare Research and Quality...................   186
        Centers for Medicare and Medicaid Services...................   188
        Administration for Children and Families.....................   196
        Administration on Aging......................................   214
        Office of the Secretary......................................   218
        Office of the Inspector General..............................   224
        General Provisions, Department of Health and Human Services..   225
    Title III--Department of Education:
        Education for the Disadvantaged..............................   228
        Impact Aid...................................................   235
        School Improvement Programs..................................   236
        Indian Education.............................................   243
        Innovation and Improvement...................................   244
        Safe Schools and Citizenship Education.......................   253
        English Language Acquisiton..................................   256
        Special Education............................................   257
        Rehabilitation Services and Disability Research..............   261
        Special Institutions for Persons With Disabilities:
            American Printing House for the Blind....................   267
            National Technical Institute for the Deaf................   267
            Gallaudet University.....................................   268
        Vocational and Adult Education...............................   268
        Student Financial Assistance.................................   273
        Student Aid Administration...................................   275
        Higher Education.............................................   276
        Howard University............................................   284
        College Housing and Academic Facilities Loans................   284
        Historically Black College and University Capital Financing
          Program....................................................   284
        Institute of Education Science...............................   285
        Departmental Management:
            Program Administration...................................   288
            Office for Civil Rights..................................   289
            Office of the Inspector General..........................   290
        General Provisions...........................................   291
    Title IV--Related Agencies:
        Committee for Purchase from People who are Blind or Severely
          Dis-
          abled......................................................   292
        Corporation for National and Community Service...............   292
        Corporation for Public Broadcasting..........................   297
        Federal Mediation and Conciliation Service...................   298
        Federal Mine Safety and Health Review Commission.............   299
        Institute of Museum and Library Services.....................   299
        Medicare Payment Advisory Commission.........................   301
        National Commission on Libraries and Information Science.....   301
        National Council on Disability...............................   301
        National Labor Relations Board...............................   301
        National Mediation Board.....................................   302
        Occupational Safety and Health Review Commission.............   303
        Railroad Retirement Board....................................   303
        Social Security Administration...............................   304
    Title V--General Provisions......................................   308
    Budgetary Impact of Bill.........................................   309
    Compliance With Paragraph 7, Rule XVI of the Standing Rules of
      the Sen-
      ate............................................................   309
    Compliance With Paragraph 7(C), Rule XXVI of the Standing Rules
      of the Senate..................................................   310
    Compliance With Paragraph 12, Rule XXVI of the Standing Rules of
      the Senate.....................................................   310
    Comparative Statement of New Budget Authority....................   313

           SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

        For fiscal year 2006, the Committee recommends total budget
    authority of $604,436,313,000 for the Departments of Labor,
    Health and Human Services, and Education, and Related Agencies.
    Of this amount, $141,653,000,000 is current year discretionary
    funding, including offsets.

                          OVERVIEW AND BILL HIGHLIGHTS

        The Labor, HHS, and Education and Related Agencies bill
    constitutes the largest of the non-defense Federal
    appropriations bills being considered by Congress this year. It
    is the product of extensive deliberations, driven by the
    realization that no task before Congress is more important than
    safeguarding and improving the health and well-being of all
    Americans. This bill is made up of over 300 programs, spanning
    three Federal Departments and numerous related agencies. But
    the bill is more than its component parts. Virtually every
    element of this bill reflects the traditional ideal of
    democracy: that every citizen deserves the right to a basic
    education and job skills training; protection from illness and
    want; and an equal opportunity to reach one's highest
    potential.
        This bill at the same time provides a safety net of social
    protections for the needy while stimulating advances in human
    achievement and the life sciences. At its core, this bill
    embodies those defining principles by which any free society
    must be guided: compassion for the less fortunate; respect for
    family and loved ones; acceptance of personal responsibility
    for one's actions; character development; and the avoidance of
    destructive behavior.

                             HIGHLIGHTS OF THE BILL

        Job Training.--The Committee recommendation includes
    $5,250,806,000 for job training programs, an increase of
    $195,293,000 over the budget request, but $86,966,000 below the
    enacted 2005 level.
        Worker Protection.--The Committee bill includes
    $1,557,000,000 to ensure the health and safety of workers,
    including $252,268,000 for the National Labor Relations Board,
    $477,491,000 for the Occupational Safety and Health
    Administration and $280,490,000 for the Mine Safety and Health
    Administration. The recommendation is an increase of
    $32,000,000 over the 2005 level.
        Child Labor.--The Committee bill includes $93,248,000 for
    activities designed to end abusive child labor. This is
    $80,829,000 above the budget request, but the same as the 2005
    level.
        National Institutes of Health.--A total of $29,414,515,000
    is recommended to fund biomedical research at the 27 Institutes
    and Centers that comprise the NIH. This represents an increase
    of $1,050,000,000 over the fiscal year 2005 level and
    $904,731,000 over the budget request.
        Health Centers.--The recommendation includes $1,839,311,000
    for health centers, $105,000,000 over the fiscal 2005 level.
        Medicare Modernization Act [MMA].--The Committee
    recommendation included $880,000,000, the full amount of the
    budget request, for MMA activities, consisting of $560,000,000
    in the Program Administration account of the Centers for
    Medicare and Medicaid Services, and $320,000,000 for the Social
    Security Administration.
        Substance Abuse.--The Committee bill provides
    $3,260,783,000 for substance abuse prevention and treatment
    programs. Included in this amount is $2,186,646,000 for
    substance abuse treatment, $202,289,000 for substance abuse
    prevention and $901,334,000 for mental health programs.
        Low-income Home Energy Assistance State Grants.--The
    Committee recommends $2,183,000,000 for heating and cooling
    assistance for low-income individuals and families,
    $183,000,000 above the budget request and $601,000 more than
    the 2005 level.
        Head Start.--The Committee recommendation includes
    $6,874,314,000 for the Head Start Program. This represents an
    increase of $31,200,000 over the 2005 level.
        Persons With Disabilities.--To promote independent living
    in home and community-based settings. This includes $47,164,000
    for the Office of Disability Policy at the Department of Labor,
    $14,879,000 for Disabled Voter Services and $40,000,000 for
    Real Choice Systems Change Grants through the Center for
    Medicaid and Medicare Services.
        Education for the Disadvantaged.--The Committee has
    provided $12,839,571,000 in grants to enhance educational
    opportunities for disadvantaged children, an increase of
    $100,000,000 over the fiscal year 2005 level.
        Educator Professional Development.--The Committee
    recommends $2,916,605,000 for State grants to improve teacher
    quality and almost $3,600,000,000 in various programs
    administered by the Department of Education.
        English Language Acquisition.--The Committee recommends
    $675,765,000 for bilingual education.
        Student Financial Aid.--The Committee recommends
    $15,103,795,000 for student financial assistance, an increase
    of $838,046,000 over the fiscal year 2005 level. The amount
    provided for the Pell Grant Program will allow for a maximum
    grant award of $4,050.
        Higher Education Initiatives.--The Committee bill provides
    $2,104,508,000 for initiatives to provide greater opportunities
    for higher education, including $836,543,000 for Federal TRIO
    programs and $306,488,000 for GEAR UP.
        Education for Individuals With Disabilities.--The Committee
    bill provides $11,515,151,000 to help ensure that all children
    have access to a free and appropriate education, and that all
    infants and toddlers with disabilities have access to early
    intervention services. This represents an increase of
    $103,500,000 over the 2005 level.
        Rehabilitation Services.--The bill recommends
    $3,133,638,000 for rehabilitation services, an increase of
    $59,064,000 above the amount provided in 2005. These funds are
    essential for families with disabilities seeking employment.
    The Committee restored funding for several important programs
    proposed for elimination, such as Supported Employment State
    Grants, Projects with Industry, Recreational programs and
    programs for migrant and seasonal farmworkers.
        Services for Older Americans.--For programs serving older
    Americans, the Committee recommendation includes
    $3,170,461,000. This recommendation includes $219,784,000 for
    senior volunteer programs, $436,678,000 for community service
    employment for older Americans, $354,136,000 for supportive
    services and centers, $160,744,000 for family caregiver support
    programs and $718,697,000 for senior nutrition programs. For
    the medical research activities of the National Institute on
    Aging, the Committee recommends $1,090,600,000. The Committee
    recommendation also includes not less than $31,700,000 for the
    Medicare insurance counseling program.
        Corporation for Public Broadcasting.--The Committee bill
    recommends an advance appropriation for fiscal year 2008 of
    $400,000,000 for the Corporation for Public Broadcasting. In
    addition, the Committee bill includes $35,000,000 for
    conversion to digital broadcasting and $40,000,000 for the
    replacement project of the interconnection system in fiscal
    year 2006 funding.

                      REPROGRAMMING AND TRANSFER AUTHORITY

        The Committee has included bill language delineating
    permissible transfer authority in general provisions for each
    of the Departments of Labor, Health and Human Services, and
    Education, as well as specifying reprogramming authority in a
    general provision applying to all funds provided under this
    Act.

                          TITLE I--DEPARTMENT OF LABOR

                     Employment and Training Administration

                        TRAINING AND EMPLOYMENT SERVICES

                            (INCLUDING RESCISSIONS)

    Appropriations, 2005....................................  $5,337,772,000
    Budget estimate, 2006...................................   5,055,513,000
    House allowance.........................................   5,121,792,000
    Committee recommendation................................   5,250,806,000

        The Committee recommends $5,250,806,000 for this account in
    2006 which provides funding primarily for activities under the
    Workforce Investment Act [WIA]. This is $86,966,000 less than
    the 2005 level, $129,014,000 more than the House allowance, and
    $195,293,000 over the administration request.
        Training and employment services is comprised of programs
    designed to enhance the employment and earnings of economically
    disadvantaged and dislocated workers, operated through a
    decentralized system of skill training and related services.
    This appropriation is generally forward-funded on a July-to-
    June cycle. Funds provided for fiscal year 2006 will support
    the program from July 1, 2006 through June 30, 2007.
        Beginning with the fiscal year 2000 appropriation, budget
    constraints required that a portion of this account's funding
    be advance appropriated, with obligations for a portion of
    Adult and Dislocated Worker Employment and Training Activities
    and Job Corps delayed until the following fiscal year. This
    practice will continue in this year's appropriation.
        Pending reauthorization of the Workforce Investment Act the
    Committee is acting on a current law request, deferring without
    prejudice proposed legislative language under the jurisdiction
    of the authorizing committees.
        The Committee is aware of the High Growth Job Training
    Initiative created in 2002 to prepare workers for job
    opportunities in high growth and high demand sectors of the
    American economy. The Committee supports efforts to take a
    proactive approach to job training, tracking workforce trends
    and anticipating industry needs in communities hard-hit by
    recent economic downturns. The Committee has included
    $55,000,000 for this initiative, which shall be awarded based
    on a competitive process.
        The Committee notes that the budget request does not
    include funding for the personal re-employment account
    initiative, and expects that none of the funds provided for
    fiscal year 2006 will be utilized for this initiative unless
    specifically authorized by law.
        The Committee recommendation concurs with the House in
    retaining language from last year's bill requiring that the
    Department take no action to amend, through regulatory or other
    administrative action, the definition established in 20 CFR
    677.220 for functions and activities under title I of the
    Workforce Investment Act until such time as legislation
    reauthorizing the Act is enacted. The Committee expects that,
    while the Workforce Investment Act is in the process of being
    altered and renewed, the Administration will refrain from
    unilateral changes to the administration, operation and
    financing of employment and training programs.
        Adult Employment and Training.--For Adult Employment and
    Training Activities, the Committee recommends $893,618,000,
    which is $27,882,000 more than the budget request and House
    allowance, and $3,000,000 less than the program year 2005
    level. This program is formula-funded to States and further
    distributed to local workforce investment boards. Services for
    adults will be provided through the One-Stop system and most
    customers receiving training will use their individual training
    accounts to determine which programs and providers fit their
    needs. The Act authorizes core services, which will be
    available to all adults with no eligibility requirements, and
    intensive services, for unemployed individuals who are not able
    to find jobs through core services alone.
        Dislocated Worker Assistance.--For Dislocated Worker
    Assistance, the Committee recommends $1,476,064,000 the same as
    the program year 2005 level, $132,480,000 more than the budget
    request, and $70,800,000 more than the House allowance. Of the
    total, $1,193,264,000 is designated for State formula grants.
    This program is a State-operated effort which provides core
    services, intensive services, training, and supportive services
    to help permanently separated workers return to productive,
    unsubsidized employment. In addition, States use these funds
    for rapid response assistance to help workers affected by mass
    layoffs and plant closures. The recommendation includes
    $282,800,000 available to the Secretary for activities such as
    responding to mass layoffs, plant and/or military base
    closings, and natural disasters across the country, which
    cannot be otherwise anticipated, as well as technical
    assistance and training and demonstration projects, including
    community college initiatives.
        The Committee bill continues language authorizing the use
    of funds under the dislocated workers program for projects that
    provide assistance to new entrants in the workforce and
    incumbent workers, as well as to provide assistance where there
    have been dislocations across multiple sectors or local areas
    of a State.
        The Committee recommendation includes, as it has in past
    years, funding for dislocated worker projects aimed at
    assisting the long-term unemployed.
        The Committee was pleased to learn from the Secretary that
    the administration has established an interagency effort to
    address our Nation's nursing shortage. The shortage is
    especially critical in rural America and within various ethnic
    minority populations, such as native Hawaiians. The Department
    is accordingly strongly urged to work with nursing programs
    serving such populations, and in particular, to ensure that
    summer employment opportunities exist for nursing students.
        The Committee is aware of the ever changing agricultural
    worker training needs in Hawaii and recommends continued
    funding for a collaborative and adaptive effort involving the
    Hawaiian Department of Labor and Industrial Relations and the
    Hawaiian Cooperative Extension Service to provide
    multiculturally-sensitive on-farm food safety training,
    agribusiness training, and production training in support of a
    rapidly expanding landscaping and grounds keeping industry.
        Community Based Job Training Initiative.--The Committee
    recommendation includes $125,000,000 to carry out the Community
    College/Community Based Job Training Grant initiative, compared
    to the $250,000,000 request. The House recommendation includes
    a rescission of $125,000,000 in funds provided in fiscal year
    2005 for this program, as well as a total of $125,000,000 for
    2006. The Committee recommendation allocates $125,000,000 from
    National Emergency Grant funds available under section
    132(a)(2)(A) of the Workforce Investment Act, and does not
    rescind funds provided in the fiscal year 2005 bill for this
    initiative. The Secretary is directed to initially use
    resources from the National Emergency Grants account for these
    awards that are designated for non-emergencies under sections
    171(d) and 170(b) of the Workforce Investment Act. Community
    Based Job Training Grant awards will also be subject to the
    limitations of sections 171(c)(4)(A) through 171(c)(4)(C) of
    the Workforce Investment Act to ensure that these grants are
    awarded competitively. Funds used for this initiative should
    strengthen partnerships between workforce investment boards,
    community colleges, and employers, to train workers for high
    growth, high demand industries in the new economy.
        The Committee encourages the Employment and Training
    Administration to consider, in future solicitations for grant
    applications for the Community Based Job Training Initiative,
    including One Stop Career Centers, and in rural areas and other
    communities without community colleges, eligibility of
    alternative education and training providers to apply for these
    grants.
        Youth Training.--For Youth Training, the Committee
    recommends $986,288,000, which is $36,288,000 more than the
    budget request and House allowance, and the same as the program
    year 2005. The Committee recommendation does not address the
    administration's legislative proposals for these activities.
    The purpose of Youth Training is to provide eligible youth with
    assistance in achieving academic and employment success through
    improving educational and skill competencies and providing
    connections to employers. Other activities include providing
    mentoring opportunities, opportunities for training, supportive
    services, summer employment opportunities that are directly
    linked to academic and occupational learning, incentives for
    recognition and achievement, and activities related to
    leadership development, citizenship, and community service.
        Job Corps.--For Job Corps, the Committee recommends
    $1,582,000,000. This is $64,981,000 more than the budget
    request, and $30,140,000 more than the 2005 comparable level.
    The Committee concurs with the House in not including the
    proposed $25,000,000 rescission of funds previously
    appropriated for construction and renovation activities. The
    Committee applauds Job Corps for establishing partnerships with
    national employers, and encourages Job Corps to continue to
    work with both large employers and small businesses to ensure
    that student training meets current labor market needs. Job
    Corps is a nationwide network of residential facilities
    chartered by Federal law to provide a comprehensive and
    intensive array of training, job placement and support services
    to at-risk young adults. The mission of Job Corps is to attract
    eligible young adults, teach them the skills they need to
    become employable and independent, and place them in meaningful
    jobs or further education. Participation in the program is
    voluntary and is open to economically disadvantaged young
    people in the 16-24 age range who are unemployed and out of
    school. Most Job Corps students come from disruptive or
    debilitating environments, and it is important that they be
    relocated to residential facilities where they can benefit from
    the highly structured and carefully integrated services
    provided by the Job Corps program. A limited number of
    opportunities are also available for non-residential
    participation.
        As a national training program, Job Corps is particularly
    well suited to help meet the needs of large, multi-state
    employers for skilled entry-level workers. The Committee
    commends Job Corps for establishing partnerships with national
    employers, and encourages Job Corps to continue to work with
    both larger employers and small businesses to ensure that
    student training meets current labor market needs. The
    Committee urges Job Corps to also strengthen and expand the
    program in order to help meet our Nation's needs for trained,
    entry level workers in three high growth industry sectors:
    health care, homeland security, and national defense. In
    addition, Job Corps should intensify its efforts to upgrade its
    vocational offerings and curricula to reflect industry
    standards and required certifications recognized by employers.
        The Committee commends the Job Corps program for developing
    mutually beneficial partnerships with community colleges across
    the country. Community college partners including the
    Mississippi Gulf Coast Community College and the Cincinnati
    State and Technical Community College find that it is efficient
    to work with Job Corps because they share the same basic goals
    of providing access and opportunity for disadvantaged Americans
    and they have the ability to partner with employers looking for
    high-skilled workers. The Committee encourages the Department
    of Labor's Community College Initiative to collaborate with the
    Job Corps program to offer advanced co-enrollment programs,
    increase opportunities for disadvantaged youth pursuing a
    career in high growth areas, and maximize access to industry-
    recognized certification programs. The Committee also
    recommends a minimum of $10,000,000 of the program year 2005
    Community College Initiative funding be dedicated to community
    colleges partnerships with Job Corps centers. The Committee
    expects this portion be designated to: (1) develop strategic
    partnerships with community colleges, business and industry
    leaders, and Job Corps centers to train students in high,
    growth, high demand industries; and (2) design ``dual
    enrollment'' programs based on reciprocal agreements between
    Job Corps and adjacent community colleges.
        The Committee commends the work of the NJCA Foundation for
    Youth Opportunities [FYO] in its charitable and educational
    activities and programs that benefit youth, especially those
    at-risk. The FYO seeks to provide resources and research that
    helps non-profit, for-profit, and Government agencies further
    education and training opportunities for disadvantaged youth.
        The Committee recognizes the shortage of health care
    professionals and the need to provide access to health care
    vocational opportunities for many disadvantaged young people.
    The Committee is also aware that the Job Corps is uniquely
    qualified to utilize the Department of Health and Human
    Services [HHS] Health Resources and Services Administration
    [HRSA] grant programs to train students to pursue health
    careers while generating more health care professionals to
    serve economically disadvantaged communities.
        The Committee commends the common mission of the Job Corps
    and HRSA in exposing under-represented minorities and
    disadvantaged students to seek strategically important careers.
    Nearly three quarters of the Nation's 122 Job Corps Centers
    offer health occupations training as well as training in health
    care related fields. The Committee recognizes and commends the
    Job Corps success in training students with the skills they
    need to fill critical shortages through major national employer
    partners. Through preferred access to HRSA grant funds, Job
    Corps' training can generate even more qualified and prepared
    allied health professionals in the coming decade.
        The Committee is committed to promoting and expanding cost-
    effective Federal programs that have a proven record of success
    provide consistent and positive results and help address
    national labor shortages. Therefore, the Committee recommends
    $10,000,000 for second year funding for the incremental
    expansion of Job Corps. This in addition to the $10,000,000
    provided in previously appropriated funds to begin the process
    of establishing additional Job Corps centers. In the selection
    process, priority should go to: States that currently do not
    have a Job Corps Center or who work in conjunction with an
    existing center serving the entire State or region; Sites that
    can be started in the short term as satellite Job Corps centers
    (residential or non-residential) and later be converted to
    stand alone facilities.
        The Committee recognizes Project CRAFT (Community,
    Restitution, and Apprenticeship-Focused Training), a program of
    the Home Builders Institute, the workforce development arm of
    the National Association of Home Builders, as a modern
    intervention technique in the rehabilitation and reduced
    recidivism of adjudicated youth. The Committee also
    acknowledges the importance of housing to our Nation's economy
    and the role Project CRAFT plays in preparing young people to
    join the residential construction industry's workforce. The
    Committee therefore encourages the Department to replicate
    Project CRAFT to bring its outcomes-oriented approach to
    adjudicated juveniles throughout the country in order to help
    them become members of this industry's workforce and spur the
    Nation's economy.
        The Committee recognizes that the Weber Basin and
    Clearfield, Utah Job Corps centers are among the highest ranked
    in the Nation. The Committee recognizes the State of Utah for
    its impressive contribution to the Job Corps program.
        Responsible Reintegration of Youthful Offenders.--The
    Committee recommendation includes $50,000,000, to continue
    funding for the current Reintegration of Youthful Offenders
    Program. Neither the budget request in House allowance included
    funding for this program, which was funded at $49,600,000 in
    program year 2005. The Reintegration of Youthful Offenders
    Program targets critical funding to help prepare and assist
    young offenders to return to their communities. The program
    also provides support, opportunities, education and training to
    youth who are court-involved and on probation, in aftercare, on
    parole, or who would benefit from alternatives to incarceration
    or diversion from formal judicial proceedings.
        Prisoner Re-entry.--The recommendation includes the
    $19,840,000 for the prisoner re-entry initiative, to extend
    assistance to a broader population of ex-offenders. This is the
    same as the enacted 2005 level and the House allowance, and
    $15,160,000 below the request.
        Native Americans.--For Native Americans, the Committee
    recommends $54,238,000. This is the same as the budget request,
    the House allowance, and the enacted program year 2005 level.
    This program is designed to improve the economic well-being of
    Native Americans (Indians, Eskimos, Aleuts, and Native
    Hawaiians) through the provision of training, work experience,
    and other employment-related services and opportunities that
    are intended to aid the participants to secure permanent,
    unsubsidized jobs.
        Migrant and Seasonal Farmworkers.--For Migrant and Seasonal
    Farmworkers, the Committee recommends $80,557,000, compared to
    the 2005 enacted level of $75,759,000. Authorized by WIA, this
    program is designed to serve members of economically
    disadvantaged families whose principal livelihood is derived
    from migratory and other forms of seasonal farmwork, or
    fishing, or logging activities. Enrollees and their families
    are provided with employment training and related services
    intended to prepare them for stable, year-round employment
    within and outside of the agriculture industry.
        There are at least 3 million hard-working migrant and
    seasonal farmworkers in America whose annual incomes are below
    $10,000. At a time when most State budgets are shrinking and
    many of the basic services provided by State and local
    governments are being cut back, the Committee recognizes the
    importance of sustaining a national commitment, dating from
    1964, to help alleviate the chronic seasonal unemployment and
    underemployment that traps many farmworker families in a cycle
    of poverty across generations and that deprives many farmworker
    children of educational opportunities and real prospects for
    better jobs at higher wages. The Committee also recognizes that
    many State and local government officials will be reluctant to
    fund this training and related assistance for this vulnerable
    portion of our Nation's workforce who migrate through many
    States every year, even though the work they perform is
    essential to the economic well-being of our Nation's farmers,
    growers, and small businesses.
        The Committee recommendation of $80,557,000 for program
    year 2006 activities authorized under Section 167 of the
    Workforce Investment Act is reflected in two separate line
    items on the table accompanying the Committee Report: ``Migrant
    and Seasonal Farmworkers'' and ``National Activities/Other.''
    Under the Migrant and Seasonal Farmworkers line item, the
    Committee recommends $80,053,000. The Committee recommendation
    includes bill language directing that $5,000,000 of this amount
    be used for migrant and seasonal farmworker housing grants, of
    which not less than 70 percent shall be for permanent housing.
    The principal purpose of these funds is to continue the network
    of local farmworker housing organizations working on permanent
    housing solutions for migrant and seasonal farmworkers. The
    Committee encourages greater emphasis on the southeast region
    for farmworker housing grants. The recommendation also provides
    that the remaining amount of $75,053,000 be used for State
    service area grants, including funding grantees in those States
    impacted by formula reductions to at least the amount they were
    alloted in program year 2004, requiring $3,840,000. Within the
    National Activities/Other line item, the Committee
    recommendation includes $504,000 to be used for Section 167
    training, technical assistance and related activities,
    including funds for migrant rest center activities. The
    Committee urges the Department to continue valuable technical
    assistance services provided by the Association of Farmworker
    Opportunity Programs. Finally, the Committee wishes to again
    advise the Department regarding the requirements of the
    Workforce Investment Act in selecting an eligible entity to
    receive a State service area grant under Section 167. Such an
    entity must have already demonstrated a capacity to administer
    effectively a diversified program of workforce training and
    related assistance for eligible migrant and seasonal
    farmworkers.
        National Programs.--This activity includes WIA-authorized
    programs in support of the workforce system including technical
    assistance and incentive grants, evaluations, pilots,
    demonstrations and research, and the Women in Apprenticeship
    Program.
        Technical Assistance.--The Committee recommends $3,458,000
    for the provision of technical assistance and staff
    development, an increase of $1,458,000 over the budget request
    and House allowance, but the same as the program year 2005
    level. This includes $982,000 for technical assistance to
    employers and unions to assist them in training, placing, and
    retraining women in nontraditional jobs and occupations, as
    authorized under the Women in Apprenticeship and Non-
    Traditional Occupations Act of 1992, Public Law 102-530; this
    amount is specified in bill language, to prevent its being
    diverted to other purposes. As described in the Migrant and
    Seasonal Farmworker section of this report, the recommendation
    also includes $504,000 for WIA Section 167 activities.
        Pilots, Demonstrations, and Research.--The Committee
    recommends $90,367,000, an increase of $60,367,000 over the
    budget request, and $16,367,000 over the House allowance for
    grants or contracts to conduct research, pilots or
    demonstrations that improve techniques or demonstrate the
    effectiveness of programs.
        In addition, the Committee recommends $6,944,000 to
    maintain the current level of for the Denali Commission as
    authorized in Public Law 108-7, for job training in connection
    with infrastructure building projects it funds in rural Alaska.
    Funding will allow unemployed and underemployed rural Alaskans
    to train for high paying jobs in their villages.
        The Committee is deeply concerned about the ability of the
    28 million Americans who are deaf or hard-of-hearing to be
    informed of critical news and information in the post-9/11/01
    environment. The Committee is aware that court reporting
    schools may not be able to meet the ``unfunded mandate'' set by
    the Telecommunications Act of 1996 to provide closed captioning
    of 100 percent of broadcast programming by January 2006. These
    compelling concerns justify continued Federal support to those
    schools to increase their capability to attract and train more
    real time writers and to work closely with the broadcasting
    industry to significantly increase the amount of programming
    that is closed captioned, that 100 million Americans utilize
    closed captioning in some form and the shortage of providers
    need to be addressed immediately.
        The University of Hawaii Center on the Family is dedicated
    to understanding and promoting the factors that foster
    resiliency in families facing personal, social, and financial
    crises. The uniqueness of this program is the emphasis on the
    psychological and behavioral processes, family resilience and
    vulnerability, and includes Asian, Pacific Islander, and
    Caucasian families. The State's diverse multicultural
    population adds to the reliability of the research conclusions.
        Evaluation.--The Committee recommends $7,936,000 to provide
    for the continuing evaluation of programs conducted under the
    Workforce Investment Act, as well as of federally-funded
    employment-related activities under other provisions of law.
        Rescission.--The Committee concurs with the House in
    recommending rescission of $20,000,000 in unobligated Health
    Care Tax Credit Funds and $5,000,000 in unobligated funds
    provided for emergency response activities, as requested by the
    administration.

                COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

    Appropriations, 2005....................................    $436,678,000
    Budget estimate, 2006...................................     436,678,000
    House allowance.........................................     436,678,000
    Committee recommendation................................     436,678,000

        The Committee recommends $436,678,000, the same as the
    budget request, the House allowance, and the program year 2005
    comparable level for community service employment for older
    Americans. This program, authorized by title V of the Older
    Americans Act, provides part-time employment in community
    service activities for unemployed, low-income persons aged 55
    and over. It is forward-funded from July to June, and the 2006
    appropriation will support the program from July 1, 2006,
    through June 30, 2007. The Committee believes that within the
    title V community service employment for older Americans,
    special attention should be paid to providing community service
    jobs for older Americans with poor employment prospects,
    including individuals with a long-term detachment from the
    labor force, older displaced homemakers, aged minorities,
    limited English-speaking persons, and legal immigrants.
        The program provides a direct, efficient, and quick means
    to assist economically disadvantaged older workers because it
    has a proven effective network in every State and in
    practically every county. Administrative costs for the program
    are low, and the vast majority of the money goes directly to
    low-income seniors as wages and fringe benefits.
        The program provides a wide range of vital community
    services that would not otherwise be available, particularly in
    low-income areas and in minority neighborhoods. Senior
    enrollees provide necessary and valuable services at Head Start
    centers, schools, hospitals, libraries, elderly nutrition
    sites, senior center, and elsewhere in the community. These
    services would not be available without the program.
        A large proportion of senior enrollees use their work
    experience and training to obtain employment in the private
    sector. This not only increases our Nation's tax base, but it
    also enables more low-income seniors to participate in the
    program.
        The Committee believes that the program should pay special
    attention to providing community service jobs for older
    Americans with poor employment prospects, including individuals
    with a long-term detachment from the labor force, older
    displaced homemakers, aged minorities, limited English-speaking
    persons, and legal immigrants.

                  FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

    Appropriations, 2005....................................  $1,057,300,000
    Budget estimate, 2006...................................     966,400,000
    House allowance.........................................     966,400,000
    Committee recommendation................................     966,400,000

        The Committee recommends $966,400,000 the same as the
    budget estimate and House allowance for fiscal year 2006, and a
    decrease of $90,900,000 below the fiscal year 2005
    appropriation for Federal Unemployment Benefits and Allowances.
    Trade adjustment benefit payments are expected to decline from
    $750,000,000 in fiscal year 2005 to $655,000,000 in fiscal year
    2006, while trade training in fiscal year 2006 will remain at
    the 2005 level of $259,400,000 with an estimated 80,000
    participants. Wage insurance costs are expected to increase
    form $48,000,000 in fiscal year 2005 to $52,000,000 in fiscal
    year 2006.
        The Committee expects the Department to provide funds to
    the State of Alaska to mitigate negative effects on Alaskan
    fishermen and other Alaskan displaced workers stemming from
    passage of trade legislation in 2002. Funds should be provided
    on a flexible basis to cover costs of job training and
    placement programs, among other uses.
        The Trade Adjustment Assistance Reform Act of 2002 that
    amended the Trade Act of 1974 was signed into law on August 6,
    2002 (Public Law 107-210). This Act consolidated the previous
    Trade Adjustment Assistance [TAA] and NAFTA Transitional
    Adjustment Assistance [NAFTA-TAA] programs, into a single,
    enhanced TAA program with expanded eligibility, services, and
    benefits. Additionally, the Act provides a program of
    Alternative Trade Adjustment Assistance for Older Workers.

         STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

    Appropriations, 2005....................................  $3,636,709,000
    Budget estimate, 2006...................................   3,470,366,000
    House allowance.........................................   3,470,366,000
    Committee recommendation................................   3,499,779,000

        The Committee recommends $3,499,779,000 for this account.
    This is $29,413,000 above the budget request as well as the
    House allowance and $136,930,000 above the 2005 comparable
    level. Included in the total availability is $3,366,954,000
    authorized to be drawn from the ``Employment Security
    Administration'' account of the unemployment trust fund, and
    $132,825,000 to be provided from the general fund of the
    Treasury.
        The funds in this account are used to provide
    administrative grants and assistance to State agencies which
    administer Federal and State unemployment compensation laws and
    operate the public employment service.
        For unemployment insurance [UI] services, the bill provides
    $2,610,000,000. This includes $2,600,000,000 for State
    Operations, and $10,000,000 for UI national activities, which
    is directed to activities that benefit the State/Federal
    unemployment insurance program. The bill provides for a
    contingency reserve amount should the unemployment workload
    exceed an average weekly insured claims volume of 2.8 million.
    This contingency amount would fund the administrative costs of
    unemployment insurance workload over the level of 2.8 million
    insured unemployed per week at a rate of $28,600,000 per
    100,000 insured unemployed, with a pro rata amount granted for
    amounts of less than 100,000 insured unemployed.
        The Committee has provided funds requested by the
    administration from the Unemployment Insurance Trust Fund for
    conducting in person reemployment and eligibility assessments
    of UI beneficiaries and preventing and detecting fraudulent
    claims. The Committee notes that the Social Security Act
    requires the use of merit based staff in the administration of
    the UI program and expects that States will use State merit
    staffed UI personnel to perform these functions.
        For the Employment Service allotments to States, the
    Committee recommends $746,302,000 which includes $23,114,000 in
    general funds together with an authorization to spend
    $723,188,000 from the ``Employment Security Administration''
    account of the unemployment trust fund. This compares to the
    budget request and House allowance of $696,000,000 and the
    enacted level of $780,592,000 for allotments to States. Due to
    tight budget constraints, the Committee recommendation does not
    include Reemployment Services Grants, funded in 2005 at
    $34,291,000, but restores the additional $50,302,000 reduction
    proposed by the administration for Employment Service Grants to
    States. These funds are available for the program year of July
    1, 2006 through June 30, 2007.
        The recommendation also includes $33,766,000 for Employment
    Service national activities, a decrease of $31,210,000 from the
    fiscal year 2005 level. This recommendation reflects the
    transfer of the foreign labor certification program to the
    Employment and Training Administration Program Administration
    account, as requested by the administration. The recommendation
    maintains the 2005 enacted level of $17,856,000 for the work
    opportunity tax credit program.
        The recommendation also includes $90,000,000 for One-Stop
    Career Centers, compared to the budget request and House
    allowance of $87,974,000 and 2005 enacted level of $97,974,000.
    The Committee recommendation includes funding for America's
    Labor Market Information System, including core employment
    statistics, universal access for customers, improving
    efficiency in labor market transactions, and measuring and
    displaying WIA performance information.
        The recommendation includes the budget request level of
    $19,711,000 for the Work Incentives Grants program, to help
    persons with disabilities find and retain jobs through the One-
    Stop Career Center system mandated by the Workforce Investment
    Act. Funding will support systems building grants intended to
    ensure that One-Stop systems integrate and coordinate
    mainstream employment and training programs with essential
    employment-related services for persons with disabilities.

            ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

    Appropriations, 2005....................................    $517,000,000
    Budget estimate, 2006...................................     465,000,000
    House allowance.........................................     465,000,000
    Committee recommendation................................     465,000,000

        The Committee recommends $465,000,000, the same as the
    budget estimate and House allowance for fiscal year 2006, and
    $52,000,000 less than the fiscal year 2005 level. The
    appropriation is available to provide advances to several
    accounts for purposes authorized under various Federal and
    State unemployment compensation laws and the Black Lung
    Disability Trust Fund, whenever balances in such accounts prove
    insufficient. The bill anticipates that fiscal year 2006
    advances will be made to the Black Lung Disability Trust Fund.
    The requested amount is required to provide for loan interest
    payments on Black Lung Trust Fund borrowed amounts.
        The separate appropriations provided by the Committee for
    all other accounts eligible to borrow from this account in
    fiscal year 2006 are expected to be sufficient. Should the need
    arise, due to unanticipated changes in the economic situation,
    laws, or for other legitimate reasons, advances will be made to
    the appropriate accounts to the extent funds are available.
    Funds advanced to the Black Lung Disability Trust Fund are now
    repayable with interest to the general fund of the Treasury.

                             PROGRAM ADMINISTRATION

    Appropriations, 2005....................................    $170,101,000
    Budget estimate, 2006...................................     206,111,000
    House allowance.........................................     206,111,000
    Committee recommendation................................     200,000,000

        The Committee recommendation includes $117,123,000 in
    general funds for this account, as well as authority to expend
    $82,877,000 from the ``Employment Security Administration''
    account of the unemployment trust fund, for a total of
    $200,000,000. This level provides sufficient resources to cover
    built-in cost increases.
        General funds in this account provide the Federal staff to
    administer employment and training programs under the Workforce
    Investment Act, the Older Americans Act, the Trade Act of 1974,
    the Denali Commission Act, the Women in Apprenticeship and Non-
    Traditional Occupations Act of 1992, and the National
    Apprenticeship Act. Trust funds provide for the Federal
    administration of employment security functions under title III
    of the Social Security Act and the Immigration and Nationality
    Act, as amended. Federal staff costs related to the Wagner-
    Peyser Act in this account are split 97 percent to 3 percent
    between unemployment trust funds and general revenue,
    respectively.
        The Committee believes that the public workforce system is
    strengthened by the effective participation of all of the
    stakeholders in the system and urges that the Department use a
    portion of its discretionary funds to support that
    participation through grants and contracts to
    intergovernmental, business, labor, and community-based
    organizations dedicated to training and technical assistance in
    support of Workforce Investment Boards and their members.
        The Committee is concerned that there are limited
    opportunities for Native Hawaiian administrators in health care
    organizations and encourages effective training programs to
    prepare Native Hawaiians with the expertise to excel in these
    areas.
        The Committee instructs that, for the purposes of the
    temporary visa programs, the Department of Labor shall treat
    loggers as agricultural workers and not as non-agricultural
    workers. Presently, the Department classifies loggers as non-
    agricultural; however, since June 1987, it has imposed upon
    them the same worker protections and labor standards as H-2A
    agricultural workers. Employers wishing to hire logger aliens
    must already provide transportation, housing, and meals, and
    must make the same benefits available to U.S. workers based on
    Department policy that predates the 1986 immigration reforms.
    The provision applies strictly to loggers, and shall not affect
    any other H-2B workers.

                         WORKERS COMPENSATION PROGRAMS

                                  (RESCISSION)

    Appropriations, 2002....................................    $175,000,000
    Appropriations, 2005....................................................
    Budget estimate, 2005...................................    -120,000,000
    House allowance.........................................    -120,000,000
    Committee recommendation................................    -120,000,000

        The Committee concurs with the budget request and House
    allowance in rescinding $120,000,000 in unobligated emergency
    response funds.
        The Committee is aware of the long-term health concerns of
    first responders in the wake of the September 11 tragedy. The
    Nation owes a debt to these workers, who reacted with courage
    and bravery in a moment of chaos. The Committee is concerned
    that the needs of the first responders be well documented and
    funds be dispersed in a manner that quickly and efficiently
    serves the needs of these brave men and women. For that reason,
    the Committee has included bill language which retroactively
    authorizes $44,000,000 in spending on behalf of victims and
    first responders.

                   Employee Benefits Security Administration

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $131,213,000
    Budget estimate, 2006...................................     137,000,000
    House allowance.........................................     137,000,000
    Committee recommendation................................     134,900,000

        The Committee recommendation provides $134,900,000 for this
    account which is $3,687,000 above the 2005 comparable level.
    This provides sufficient resources to cover built-in cost
    increases.
        The Employee Benefits Security Administration [EBSA] is
    responsible for the enforcement of title I of the Employee
    Retirement Income Security Act of 1974 [ERISA] in both civil
    and criminal areas. ESBA is also responsible for enforcement of
    sections 8477 and 8478 of the Federal Employees' Retirement
    Security Act of 1986 [FERSA]. In accordance with the
    requirements of FERSA, the Secretary of Labor has promulgated
    regulations and prohibited transactions class exemptions under
    the fiduciary responsibility and fiduciary bonding provisions
    of the law governing the Thrift Savings Plan for Federal
    employees. In addition, the Secretary of Labor has, pursuant to
    the requirement of section 8477(g)(1) of FERSA, established a
    program to carry out audits to determine the level of
    compliance with the fiduciary responsibility provisions of
    FERSA applicable to Thrift Savings Plan fiduciaries. ESBA
    provides funding for the enforcement and compliance; policy,
    regulation, and public services; and program oversight
    activities.

                      PENSION BENEFIT GUARANTY CORPORATION

        The Corporation's estimated obligations for fiscal year
    2006 include single employer benefit payments of
    $5,102,000,000, multiemployer financial assistance of
    $90,000,000 and administrative expenses of $296,978,000.
    Administrative expenses are comprised of three activities: (1)
    pension insurance activities, $41,599,000; (2) operational
    support, $93,749,000; and (3) pension plan termination
    expenses, $161,630,000. Such expenditures will be financed by
    permanent authority.
        The Pension Benefit Guaranty Corporation is a wholly owned
    Government corporation established by the Employee Retirement
    Income Security Act of 1974. The law places it within the
    Department of Labor and makes the Secretary of Labor the Chair
    of its Board of Directors. The Corporation receives its income
    primarily from insurance premiums collected from covered
    pension plans, assets of terminated pension plans, collection
    of employer liabilities imposed by the Act, and investment
    earnings. It is also authorized to borrow up to $100,000,000
    from the Treasury. The primary purpose of the Corporation is to
    guarantee the payment of pension plan benefits to participants
    if covered defined benefit plans fail or go out of existence.
        The 2006 budget does not recommend a discretionary limit on
    administrative expenditures [LAE] for PBGC. The PBGC's budget
    reflects--in a way that is more accountable to the Committee--
    the level of administrative expenditures that the Committee
    believes is appropriate to PBGC's changing responsibilities to
    protect the pensions it insures. PBGC's dollar benefit levels
    and workload change from year to year as specific pension plans
    fail. Most of its workload involves terminating failed pension
    plans, so that pension benefits can be paid. The workload of
    plan termination especially fluctuates from year to year as
    large plans (or a spate of small ones) terminate, and then as
    the terminations are completed. The language provides the PBGC
    the flexibility to respond when dictated by increased workload
    and increased benefit payments, while increasing accountability
    to the Committee by requiring approval by the Office of
    Management and Budget and the Committees on Appropriations.
        The single-employer program protects about 34.6 million
    participants in about 29,600 defined benefit pension plans. The
    multi-employer insurance program protects about 9.8 million
    participants in more than 1,600 plans.

                      Employment Standards Administration

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $400,847,000
    Budget estimate, 2006...................................     416,332,000
    House allowance.........................................     416,332,000
    Committee recommendation................................     412,616,000

        The Committee recommendation includes $412,616,000 for this
    account. The bill contains authority to expend $2,048,000 from
    the special fund established by the Longshore and Harbor
    Workers' Compensation Act; the remainder of $410,568,000 are
    general funds. In addition, an amount of $33,050,000 is
    available by transfer from the black lung disability trust
    fund.
        This recommendation provides sufficient funding to offset
    The impact of inflation, and includes resources for a portion
    of requested program increases, to implement a program of union
    advisory services. The $15,891,000 request for Program
    Direction has been reduced to $15,375,000, an increase of
    $123,000 over the 2005 level to cover built-in costs; an
    addition of $2,000,000 is described in the following paragraph.
        The recommendation includes $2,000,000 to make available
    personnel and other resources to facilitate the expeditious
    startup of a system to resolve claims of victims for bodily
    injury caused by asbestos exposure. This may include contracts
    with individuals or entities having relevant experience to
    assist in jump starting the program, as described in S. 852,
    the Fair Act of 2005. Activities to shorten the lead-time for
    implementation of asbestos activities encompass procedures for
    the processing of claims, including procedures for the
    expediting of exigent health claims, and planning for
    promulgation of regulations.
        The Employment Standards Administration is involved in the
    administration of numerous laws, including the Fair Labor
    Standards Act, the Immigration and Nationality Act, the Migrant
    and Seasonal Agricultural Workers' Protection Act, the Davis-
    Bacon Act, the Family and Medical Leave Act, the Federal
    Employees' Compensation Act [FECA], the Longshore and Harbor
    Workers' Compensation Act, and the Federal Mine Safety and
    Health Act (black lung).

                                SPECIAL BENEFITS

    Appropriations, 2005....................................    $233,000,000
    Budget estimate, 2006...................................     237,000,000
    House allowance.........................................     237,000,000
    Committee recommendation................................     237,000,000

        The Committee recommends $237,000,000, the same as the
    budget estimate for fiscal year 2006, and $4,000,000 more than
    fiscal year 2005. This appropriation primarily provides
    benefits under the Federal Employees' Compensation Act [FECA].
    The payments are prescribed by law. In fiscal year 2006, an
    estimated 155,000 injured Federal workers or their survivors
    will file claims; 55,000 will receive long-term wage
    replacement benefits for job-related injuries, diseases, or
    deaths.
        The Committee recommends continuation of appropriation
    language to provide authority to require disclosure of Social
    Security account numbers by individuals filing claims under the
    Federal Employees' Compensation Act or the Longshore and Harbor
    Workers' Compensation Act and its extensions.
        The Committee recommends continuation of appropriation
    language that provides authority to use the FECA fund to
    reimburse a new employer for a portion of the salary of a newly
    reemployed injured Federal worker. The FECA funds will be used
    to reimburse new employers during the first 3 years of
    employment not to exceed 75 percent of salary in the worker's
    first year, declining thereafter.
        The Committee again includes appropriation language that
    retains the drawdown date of August 15. The drawdown authority
    enables the Agency to meet any immediate shortage of funds
    without requesting supplemental appropriations. The August 15
    drawdown date allows flexibility for continuation of benefit
    payments without interruption.
        The Committee recommends continuation of appropriation
    language to provide authority to deposit into the special
    benefits account of the employees' compensation fund those
    funds that the Postal Service, the Tennessee Valley Authority,
    and other entities are required to pay to cover their fair
    share of the costs of administering the claims filed by their
    employees under FECA. The Committee concurs with requested bill
    language to allow use of fair share collections to fund capital
    investment projects and specific initiatives to strengthen
    compensation fund control and oversight.

                   SPECIAL BENEFITS FOR DISABLED COAL MINERS

    Appropriations, 2005....................................    $275,997,000
    Budget estimate, 2006...................................     232,250,000
    House allowance.........................................     232,250,000
    Committee recommendation................................     232,250,000

        The Black Lung Consolidation of Administrative
    Responsibility Act was enacted on November 2, 2002. The Act
    amends the Black Lung Benefits Act to transfer part B black
    lung benefits responsibility from the Commissioner of Social
    Security to the Secretary of Labor, thus consolidating all
    black lung benefit responsibility under the Secretary. Part B
    benefits are based on claims filed on or before December 31,
    1973. The Secretary of Labor already responsible for the part C
    claims filed after December 31, 1973. In fiscal year 2006, an
    estimated 46,100 beneficiaries (5,100 miners and 41,000
    survivors) will receive benefits.
        The Committee recommends an appropriation of $232,250,000
    in fiscal year 2006 for special benefits for disabled coal
    miners. This is in addition to the $81,000,000 appropriated
    last year as an advance for the first quarter of fiscal year
    2006. The recommendation is the same as the administration
    request and House allowance. These funds are used to provide
    monthly benefits to coal miners disabled by black lung disease
    and to their widows and certain other dependents, as well as to
    pay related administrative costs.
        By law, increases in black lung benefit payments are tied
    directly to Federal pay increases. The year-to-year decrease in
    this account reflects a declining beneficiary population.
        The Committee recommends an advance appropriation of
    $74,000,000 for the first quarter of fiscal year 2007, the same
    as the administration request. These funds will ensure
    uninterrupted benefit payments to coal miners, their widows,
    and dependents.

           ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

    Appropriations, 2005....................................     $40,321,000
    Budget estimate, 2006...................................      96,081,000
    House allowance.........................................      96,081,000
    Committee recommendation................................      96,081,000

        The Committee recommends $96,081,000, the same as the
    budget estimate for fiscal year 2005, and $55,760,000 more than
    2005.
        The mission of the Energy Employees Occupational Illness
    Compensation Program is to deliver benefits to eligible
    employees and former employees of the Department of Energy, its
    contractors and subcontractors or to certain survivors of such
    individuals, as provided in the Energy Employees Occupational
    Illness Compensation Program Act. The mission also includes
    delivering benefits to certain beneficiaries of the Radiation
    Exposure Compensation Act. Benefit costs of $760,515,000 are
    anticipated in fiscal year 2006.
        The Department of Labor's Office of Workers' Compensation
    Programs within the Employment Standards Administration is
    responsible for adjudicating and administering claims filed by
    employees or former employees (or their survivors) under the
    Act. The program went into effect on July 31, 2001.
        In 2006, the volume of incoming claims under Part B of the
    Energy Employees Occupational Illness Compensation Program is
    estimated to remain stable at about 16,500 claims from
    Department of Energy [DOE] employees or survivors, and private
    companies under contract with DOE, who suffer from a radiation-
    related cancer, beryllium-related disease, or chronic silicosis
    as a result of their work in producing or testing nuclear
    weapons.

                        BLACK LUNG DISABILITY TRUST FUND

    Appropriations, 2005....................................  $1,061,969,000
    Budget estimate, 2006...................................   1,068,000,000
    House allowance.........................................   1,068,000,000
    Committee recommendation................................   1,068,000,000

        The Committee recommends $1,068,000,000 for this account in
    2006, an increase of $6,031,000 above the fiscal year 2005
    level, and the same as the budget request and House allowance.
    The appropriation language changed beginning in fiscal year
    2003 for the Black Lung Disability Trust Fund to provide such
    sums as may be necessary to pay for benefits. This change
    eliminated the need for drawdowns from the subsequent year
    appropriation in order to meet current year compensation,
    interest, and other benefit payments.
        The total amount available for fiscal year 2006 will
    provide $314,011,000 for benefits payments, and $57,989,000 for
    administrative expenses for the Department of Labor. Also,
    included is $696,000,000 for interest payments on advances.
        The trust fund pays all black lung compensation/medical and
    survivor benefit expenses when no responsible mine operation
    can be assigned liability for such benefits, or when coal mine
    employment ceased prior to 1970, as well as all administrative
    costs which are incurred in administering the benefits program
    and operating the trust fund.
        It is estimated that 41,400 people will be receiving black
    lung benefits financed through the end of the fiscal year 2006,
    compared to an estimated 44,500 receiving benefits in fiscal
    year 2005.
        The basic financing for the trust fund comes from a coal
    excise tax for underground and surface-mined coal. Additional
    funds come from reimbursement from the Advances to the
    Unemployment Trust Fund and Other Funds as well as payments
    from mine operators for benefit payments made by the trust fund
    before the mine operator is found liable. The advances to the
    fund assure availability of necessary funds when liabilities
    may exceed other income. The Omnibus Budget Reconciliation Act
    of 1987 continues the current tax structure until 2014.

                 Occupational Safety and Health Administration

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $464,158,000
    Budget estimate, 2006...................................     466,981,000
    House allowance.........................................     477,199,000
    Committee recommendation................................     477,491,000

        The Committee recommendation includes $477,491,000 for this
    account. This is an increase of $10,510,000 over the budget
    request and an increase of $13,333,000 above the 2005
    comparable level. This Agency is responsible for enforcing the
    Occupational Safety and Health Act of 1970 in the Nation's
    workplaces.
        This recommendation provides sufficient funding to offset
    the impact of inflation, as well as additional resources to
    expand outreach to non-English speaking workers and small
    businesses.
        In addition, the Committee has included language to allow
    OSHA to retain up to $750,000 per fiscal year of training
    institute course tuition fees to be utilized for occupational
    safety and health training and education grants in the private
    sector.
        The Committee retains language carried in last year's bill
    effectively exempting farms employing 10 or fewer people from
    the provisions of the Act except those farms having a temporary
    labor camp. The Committee also retains language exempting small
    firms in industry classifications having a lost workday injury
    rate less than the national average from general schedule
    safety inspections. These provisions have been in the bill for
    many years.
        The Committee believes that OSHA's worker safety and health
    training and education programs, including the grant program
    that supports such training, are a critical part of a
    comprehensive approach to worker protection. The Committee is
    concerned that OSHA has again cut funding to help establish
    ongoing worker safety and health training programs and has
    therefore restored the Susan Harwood training grant program to
    $10,510,000. Bill language specifies that no less than
    $3,200,000 shall be used to maintain the existing institutional
    competency building training grants, provided that grantees
    demonstrate satisfactory performance.
        The Committee has provided $53,896,000, the budget request
    level, for the State consultation grant program and expects
    that this program will continue to be targeted to provide
    compliance assistance to small businesses.
        The Committee continues to be pleased with OSHA's efforts
    in placing high priority on the voluntary protection programs
    [VPP] and other voluntary cooperative programs. The Committee
    expects OSHA to continue to place high priority on the VPP.
    Cooperative voluntary programs, especially the VPP, are an
    important part of OSHA's ability to assure worker safety and
    health and should be administered in conjunction with an
    effective strong enforcement program.
        The Committee also intends that the Office of Regulatory
    Analysis continue to be funded as close as possible to its
    present level.

                     Mine Safety and Health Administration

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $279,136,000
    Budget estimate, 2006...................................     280,490,000
    House allowance.........................................     280,490,000
    Committee recommendation................................     280,490,000

        The Committee recommendation includes $280,490,000 for this
    account, an increase of $1,354,000 over the 2005 enacted level,
    and the same as the budget request and House allowance.
        This recommendation provides sufficient funding to offset
    the impact of inflation, as well as additional resources for
    enforcement and compliance assistance. It deletes one-time
    funding of projects contained in the 2005 enacted level.
        The Committee recommendation also includes bill language
    providing up to $2,000,000 for mine rescue and recovery
    activities, the same as the fiscal year 2005 comparable level.
    It also retains the provision allowing the Secretary of Labor
    to use any funds available to the Department to provide for the
    costs of mine rescue and survival operations in the event of a
    major disaster.
        This Agency insures the safety and health of the Nation's
    miners by conducting inspections and special investigations of
    mine operations, promulgating mandatory safety and health
    standards, cooperating with the States in developing effective
    State programs, and improving training in conjunction with
    States and the mining industry.
        In addition, bill language is included to allow the
    National Mine Health and Safety Academy to collect not to
    exceed $750,000 for room, board, tuition, and the sale of
    training materials to be available for mine safety and health
    education and training activities. Bill language also allows
    MSHA to retain up to $1,000,000 from fees collected for the
    approval and certification of equipment, materials, and
    explosives for use in mines, and may utilize such sums for such
    activities.

                           Bureau of Labor Statistics

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $529,003,000
    Budget estimate, 2006...................................     542,523,000
    House allowance.........................................     542,523,000
    Committee recommendation................................     542,523,000

        The Committee includes $542,523,000 for this account,
    $13,520,000 more than the 2005 comparable level. This includes
    $77,845,000 from the ``Employment Security Administration''
    account of the unemployment trust fund, and $464,678,000 in
    Federal funds. This funding level will cover the Agency's
    built-in increases, and includes funds to continue the Mass
    Layoff Statistics Program.
        The Bureau of Labor Statistics is the principal fact
    finding Agency in the Federal Government in the broad field of
    labor economics.
        The Committee urges the Bureau of Labor Statistics to
    revamp its website to make it more user friendly.

                     Office of Disability Employment Policy

    Appropriations, 2005....................................     $47,164,000
    Budget estimate, 2006...................................      27,934,000
    House allowance.........................................      27,934,000
    Committee recommendation................................      47,164,000

        The Committee recommends $47,164,000 for this account in
    2006. This is $19,230,000 more than the President's request and
    the same as 2005. The Committee intends that at least 80
    percent of these funds shall be used for demonstration and
    technical assistance grants to develop innovative and effective
    practices to increase the employment of youth and adults with
    disabilities.
        Congress created the Office of Disability Employment Policy
    [ODEP] in the Department of Labor's fiscal year 2001
    appropriation. Programs and staff of the former President's
    Committee on Employment of People with Disabilities [PCEPD]
    have been integrated into this office.
        The Committee is aware of the outstanding success of
    national non-profits working to increase self-employment among
    people with disabilities. Self-employment can provide income,
    assets and other elements of self-sufficiency to people with
    disabilities that are hard to place in traditional work
    environments because of the flexibility inherent in self-
    employment. In addition to the direct benefit to the business
    owner and the savings to the Social Security Disability Income
    program resulting from self-employment, preliminary data
    suggests that business owners with disabilities are far more
    likely to hire other people with disabilities as the business
    expands.
        Within the funds provided for the Office of Disability
    Employment Policy, the Committee has included $5,000,000 for a
    national initiative focusing on self-employment as an option
    for persons with disabilities. As the centerpiece of this new
    initiative, the Committee has included $3,000,000 to assist
    State Job Training Institutions, WIA One Stops, SBA Small
    Business Development Centers, the Vocational Rehabilitation and
    Employment Services of the Department of Veterans Affairs,
    State, and Tribal Vocational Rehabilitation Agencies, and other
    related programs in implementing effective and accessible
    practices for achieving sustainable self employment outcomes
    for individuals with disabilities. Practices should include but
    not be limited to providing public education, training,
    technical assistance and accessible online and print resources
    with the purpose of advancing self employment opportunities for
    Americans with disabilities. The Committee directs that, in
    making the national technical assistance grant, priority be
    given to national non-profits with experience in delivering
    direct consumer services as well as training to public and
    private agencies. The remainder of the funds in the initiative
    should be used to undertake a thorough analysis of the
    structures currently in place that either promote or impede the
    expansion of business ownership in the disability community.
        The Committee recommends that the Office of Disability
    Employment Policy continue the existing, structured, internship
    program for undergraduate college students with disabilities,
    at no less than current appropriation levels. The Committee
    continues to believe that this innovative, structured
    internship program will provide important opportunities for
    undergraduate students with disabilities to pursue academic and
    career development opportunities within the Department of Labor
    and other Federal agencies.

                            Departmental Management

                             SALARIES AND EXPENSES

    Appropriations, 2005....................................    $320,688,000
    Budget estimate, 2006...................................     244,423,000
    House allowance.........................................     239,783,000
    Committee recommendation................................     320,561,000

        The Committee recommendation includes $320,561,000 for this
    account, which is $76,138,000 more than the budget request and
    $127,000 less than the 2005 comparable level. In addition, an
    amount of $24,239,000 is available by transfer from the black
    lung disability trust fund, which is the same as the budget
    request and the House allowance.
        The primary goal of the Department of Labor is to protect
    and promote the interests of American workers. The departmental
    management appropriation finances staff responsible for
    formulating and overseeing the implementation of departmental
    policy and management activities in support of that goal. In
    addition, this appropriation includes a variety of operating
    programs and activities that are not involved in departmental
    management functions, but for which other salaries and expenses
    appropriations are not suitable.
        The Committee recommendation includes $26,720,000 for
    Executive Direction, the same as the fiscal year 2005
    comparable level.
        The Committee recommendation includes $9,764,000 for the
    Women's Bureau. The Committee encourages the Women's Bureau to
    support effective programs such as ``Women Work!'', to provide
    technical assistance and training on programming for women in
    transition to reenter the workforce.
        The Committee is pleased with efforts to investigate the
    impact of the nursing shortage on the overall health care labor
    market across the country, particularly in rural areas, such as
    Hawaii. The Committee urges the Department to work with HRSA in
    creating solutions to remedy the ongoing shortage and report on
    these efforts.
        The University of Hawaii Center on the Family is dedicated
    to understanding and promoting the factors that foster
    resiliency in families facing personal, social, and financial
    crises. The uniqueness of this program is the emphasis on the
    psychological and behavioral processes, family resilience and
    vulnerability, and includes Asians, Pacific Islanders and
    Caucasians families. The State's diverse multicultural
    population adds to the reliability of the research conclusions.
        The Committee is disappointed that the Department of Labor
    has once again put forward a budget for the coming year that
    drastically reduces funding for International Labor Affairs
    Bureau [ILAB], in particular, those initiatives working with
    the International Labor Organization [ILO] to combat abusive
    and exploitative child labor.
        The Committee is aware that the administration is
    aggressively pursing multiple trade agreements that will depend
    upon the United States' ability to provide technical assistance
    on labor standards, including but not limited to the
    eradication of child labor. ILAB is the division of the U.S.
    Government with the mission and authority to provide that
    assistance. A budget request that eliminates all funding for
    multilateral and bilateral technical assistance, elimination of
    child labor, permanent reporting capacity and HIV/AIDS in the
    Workplace promotes a lack of confidence in the United States'
    trade efforts.
        The Committee commends the Department of Labor on its
    report ``Investing In Every Child'' which found that the
    average economic benefit of eliminating child labor around the
    world exceeds the cost of those efforts by a ratio of 6.7 to 1.
    The study also found that each year of additional education
    beyond the age of 14 yields an 11 percent increase in that
    individual's earning power resulting in just over
    $5,000,000,000,000 in global benefits. The Committee views the
    investment made by the United States and the programs run by
    the Department of Labor to eliminate child labor as a proven
    method for improving the economic infrastructure of developing
    nations and providing a market for U.S. goods.
        Given the aggressive trade agenda and the recent commitment
    to capacity building in developing nations as a form of aid,
    the Committee is mystified by the Department's now annual
    effort to eliminate these programs, this year proposing an
    astounding 86 percent reduction.
        Therefore, the Committee recommendation includes
    $93,248,000 for the Bureau of International Labor Affairs. Of
    this amount, the Committee's recommendation includes
    $45,000,000 for the U.S. contribution to sustain and to extend
    to more countries in waiting the successful efforts of the
    ILO's International Program for the Elimination of Child Labor
    [IPEC]. Also included is $37,000,000 for bilateral assistance
    to expand upon the program initiated by the Department in
    fiscal year 2001 to help ensure access to basic education for
    the growing number of children removed from the worst forms of
    child labor in impoverished nations where abusive and
    exploitative child labor is most acute. The Committee expects
    the Department of Labor to work with the governments of host
    countries to eliminate school fees that create a barrier to
    education.
        The Committee notes and welcomes ILAB's technical
    assistance programs that promote the goals of the Harkin-Engel
    protocol, as well as ILAB's ongoing efforts to implement
    Executive Order 13126 and its reporting under the Trade and
    Development Act of 2000. To complement these efforts, the
    Committee directs that $4,500,000 of the basic education funds
    be used to provide critical oversight of both the public and
    private investment in the protocol. The Committee expects that
    at a minimum, this will include an annual public report to both
    the Congress and the Department. The report should cite
    progress made on key points of the Protocol and Joint Statement
    including: development of a child labor monitoring system by
    industry, the effective elimination of the worst forms of child
    labor and forced labor in the supply chain, and the development
    of an industry-wide, public, transparent certification system.
    The Committee directs that funds be awarded with priority given
    to academic institutions with expertise in agriculture and the
    U.N. Norms on Business and Human Rights.
        The Committee deems it very important that ILAB deepen and
    improve its permanent capacity to compile and report to the
    Congress annually on the extent to which each foreign country
    that has trade and investment agreements with the United States
    enforces internationally-recognized worker rights. This report
    is required under multiple U.S. laws and promotes core labor
    standards as embodied in the ILO Declaration on Fundamental
    Principles and Rights at Work as adopted and reaffirmed in
    1998. The Committee is aware that currently this report only
    tracks the progress of countries that are designated as
    beneficiaries under the U.S. Generalized System of Preferences
    [GSP]. The GSP program grants duty-free treatment to specified
    products imported from developing countries and territories. As
    the United States' negotiates separate Free Trade Agreements
    with GSP beneficiaries, the DOL stops tracking their progress
    in the elimination of abusive and exploitative child labor.
    Therefore, the Committee directs the Secretary to include in
    the 2006 report, all former GSP recipients that have achieved a
    Free Trade Agreement with the United States over the preceding
    2 years. The Committee has provided $1,000,000 for the
    compilation of this report, which shall be transmitted to the
    Congress no later than September 1, 2006.
        The Committee is disturbed by recent reports that the
    Department is treating commodities that were purchased with
    grant funds as a sub-grant and requiring re-payment in ways
    that undermine the original purpose of the grants. The
    Committee notes that the U.S. Government has sensible
    procedures in place for the distribution of commodities that
    retain value after the end of the grant. Therefore, the
    Committee directs that the Department adhere to the OMB
    standards for grant-making, including those standards that
    pertain to the disbursement of goods. These standards should be
    applied to all ongoing grants, as well as any new grants.
        For other ILAB programs, including 125 FTE for Federal
    Administration, the Committee recommends $10,248,000.
        Acknowledging the need to upgrade the information
    technology capability in the Department of Labor, the Committee
    recommends $29,760,000 for the information technology fund, and
    $1,700,000 for management cross cut activities. The total
    provided includes support for cross-cutting investments such as
    common office automation suite implementation, architecture
    requirements, equipment, software, and related needs, as well
    as human resource management. In addition, $6,230,000 is
    recommended for a separate Working Capital Fund appropriation,
    for implementation of a new core accounting system for the
    Department of Labor.
        The Committee retains bill language intended to ensure that
    decisions on appeals of Longshore and Harborworker Compensation
    Act claims are reached in a timely manner.

                        VETERANS EMPLOYMENT AND TRAINING

    Appropriations, 2005....................................    $222,833,000
    Budget estimate, 2006...................................     224,334,000
    House allowance.........................................     229,334,000
    Committee recommendation................................     224,334,000

        The Committee recommendation includes $224,334,000 for this
    account, including $194,834,000 in general revenue funding and
    $29,500,000 to be expended from the ``Employment Security
    Administration'' account of the unemployment trust fund. This
    is $1,315,000 more than the 2005 comparable level.
        For State grants the bill provides $162,415,000, which
    includes funding for the Disabled Veterans Outreach Program and
    the Local Veterans Employment Representative Program.
        For Federal administration, the Committee recommends
    $30,435,000, the same as the budget request and the House
    allowance. The Committee supports the concept of the Transition
    Assistance Program administered jointly with the Department of
    Defense which assists soon-to-be-discharged service members in
    transitioning into the civilian work force and includes funding
    to maintain this effective program.
        Individuals leaving the military may be at high risk of
    homelessness due to a lack of job skills transferable to the
    civilian sector, disrupted or dissolved family and social
    support networks, and other risk factors that preceded their
    military service. The Committee expects the Secretary of Labor
    to ensure that a module on homelessness prevention is added to
    the Transition Assistance Program curriculum. The module should
    include a presentation on risk factors for homelessness, a
    self-assessment of risk factors, and contact information for
    preventative assistance associated with homelessness.
        The Committee recommendation includes $1,984,000, the same
    as the budget request, for the National Veterans Training
    Institute [NVTI]. This Institute provides training to the
    Federal and State staff involved in the direct delivery of
    employment and training related services to veterans.
        The Committee recommendation includes $22,000,000 for the
    Homeless Veterans Program, the same as the budget request. Also
    included is $7,500,000 for the Veterans Workforce Investment
    Program, the same as the budget request.
        The Committee is interested in ensuring that qualified job
    training programs of the Department of Labor fully extend
    priority of service for veterans as required by the Jobs for
    Veterans Act. Toward this effort, the Committee urges the
    Secretary to develop a guide for veterans in accessing
    workforce investment planning processes; and a guide to inform
    workforce systems on the employment services needs of veterans
    and the responsibility of such systems to prioritize veterans
    for services and to collaborate with veterans organizations and
    providers. The Committee urges the Secretary to instruct State
    workforce agencies to increase their outstationing of disabled
    veterans outreach program specialists and local veterans
    employment representatives in locations where homeless veterans
    congregate, including grantees under the homeless provider
    grant and per diem program and the homeless veterans
    reintegration program.

                        OFFICE OF THE INSPECTOR GENERAL

    Appropriations, 2005....................................     $68,995,000
    Budget estimate, 2006...................................      70,819,000
    House allowance.........................................      70,819,000
    Committee recommendation................................      72,819,000

        The bill includes $72,819,000 for this account, $3,824,000
    above the 2005 comparable level. The bill includes $67,211,000
    in general funds and authority to transfer $5,608,000 from the
    ``Employment Security Administration'' account of the
    unemployment trust fund. In addition, an amount of $344,000 is
    available by transfer from the black lung disability trust
    fund. This level provides sufficient resources to cover built-
    in cost increases, as well as augmenting program accountability
    activities and expanding the labor racketeering program.
        The Office of the Inspector General [OIG] was created by
    law to protect the integrity of departmental programs as well
    as the welfare of beneficiaries served by those programs.
    Through a comprehensive program of audits, investigations,
    inspections, and program evaluations, the OIG attempts to
    reduce the incidence of fraud, waste, abuse, and mismanagement,
    and to promote economy, efficiency, and effectiveness.

                               General Provisions

        General provision bill language is included to:
        Provide for modified general transfer authority (sec. 101).
        Prohibit funding for the procurement of goods and services
    utilizing forced or indentured child labor in industries and
    host countries already identified by the Labor Department in
    accordance with Executive Order 13126 (sec. 102).
        Authorize funds to be appropriated for job training for
    workers involved in construction projects funded through the
    Denali Commission (sec. 103).
        Provide that certain payments made by the New York Workers'
    Compensation Board in response to terrorist attacks shall be
    deemed to have been made for workers compensation programs
    (sec. 104).
        Require the Department of Labor to submit its fiscal year
    2007 congressional budget justifications in the same format and
    level of detail used by the Department of Education in its
    fiscal year 2006 congressional budget justification (sec. 105).

               TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

                  Health Resources and Services Administration

                         HEALTH RESOURCES AND SERVICES

    Appropriations, 2005....................................  $6,828,012,000
    Budget estimate, 2006...................................   5,991,144,000
    House allowance.........................................   6,468,437,000
    Committee recommendation................................   7,423,434,000

        The Committee provides a program level of $7,423,434,000
    for the Health Resources and Services Administration [HRSA].
    The Committee recommendation includes $7,398,434,000 in budget
    authority and an additional $25,000,000 via transfers available
    under section 241 of the Public Health Services Act. The fiscal
    year 2005 comparable program level was $6,828,012,000, the
    administration request program level was $5,991,144,000, and
    the House provided $6,468,437,000.
        Health Resources and Services Administration activities
    support programs to provide health care services for mothers
    and infants; the underserved, elderly, homeless; migrant farm
    workers; and disadvantaged minorities. This appropriation
    supports cooperative programs in community health, AIDS care,
    health provider training, and health care delivery systems and
    facilities.
        The Committee recognizes the unique needs of frontier and
    rural populations and applauds the Department for establishing
    competitive grants specifically aimed at programs with those
    designations. The Committee likewise recognizes the limited
    accessibility of island communities, whether rural or urban,
    and urges the Department to include an island designation to
    promote programs in areas geographically isolated from the
    mainland and neighbor islands. Criteria for island designation
    includes a clinic, federally qualified health center, or
    hospital located on a land mass surrounded by water and greater
    than 2,000 miles from the United States mainland.

                         BUREAU OF PRIMARY HEALTH CARE

                            COMMUNITY HEALTH CENTERS

        The Committee provides $1,839,311,000 for the community
    health centers. The fiscal year 2005 comparable program level
    was $1,734,311,000, the administration request program level
    was $2,037,871,000, and the House provided $1,834,311,000. This
    group of programs includes community health centers, migrant
    health centers, health care for the homeless, and public
    housing health service grants.
        Within the amount provided, $20,000,000 has been allocated
    to offset the rising cost of health care at existing centers,
    and $5,000,000 has been allocated to resolve specific financial
    situations beyond the control of the local health center, such
    as unusual increases in the number of uninsured patients
    seeking care.
        The Committee includes bill language limiting the amount of
    funds available for the payment of claims under the Federal
    Tort Claims Act to $45,000,000, which is the same as the
    administration request and in fiscal year 2005. Bill language
    has also been included clarifying that these funds are
    available until expended. The Committee has included bill
    language allowing costs associated with the health centers tort
    liability relief to be paid from the fund. The Committee
    intends that the fund be used to pay judgments and settlements,
    occasional witness fees and expenses, and the administrative
    costs of the program, which includes the cost of evaluating
    claims, defending claims, and conducting settlement activities.
    The Committee is aware of legislation that would extend FTCA
    coverage to volunteer physicians and non-grantee health centers
    (commonly referred to as ``look-alikes''). While both proposals
    would extend FTCA coverage to additional providers, the
    Committee expects the amount provided to be adequate to cover
    any increased costs in fiscal year 2006.
        The Committee does not provide additional funds for loan
    guarantee authority under section 330(d) of the Public Health
    Service Act. The Committee notes that $105,000,000 in loan
    guarantee authority from the $160,000,000 appropriated in
    fiscal years 1997 and 1998 continues to remain available for
    guarantees of both loan principal and interest.
        The Committee is concerned by the small number of health
    centers that have been able to utilize the loan guarantee
    program despite sufficient funding being available since fiscal
    year 1997. The Committee urges HRSA to increase the percentages
    at which loan guarantees are provided for managed care plans,
    networks, and facilities to the highest authorized levels in
    order to enhance the number of health centers participating in
    the program.
        The Committee supports the long-standing HRSA policy of
    approving specific qualified applications for future funding.
    This process enables high-quality applicants to take steps to
    develop and implement care delivery systems in their
    communities instead of wasting scarce resources to reapply for
    funding. However, HRSA should limit the use of this mechanism
    in a manner consistent with expected budget requests.
        The Committee is concerned that HHS requires health centers
    and other facilities to have a HPSA priority score of 14 or
    above in order to obtain a J-1 Visa physician placement and
    that this additional criterion has severely limited access to
    J-1 physicians in underserved communities. The Committee
    encourages HRSA to consider using an alternative methodology
    for entities eligible for Federal J-1 Visa physician
    placements.
        The Committee recognizes an important role of the
    consolidated health centers is caring for people living with or
    at risk of hepatitis C. The committee encourages the Bureau of
    Primary Care to provide leadership and training to its grantees
    on hepatitis C prevention, medical management and treatment.
        The Committee recognizes the cultural differences inherent
    in addressing family violence prevention among minority
    populations, such as Native Hawaiians. Additionally, many
    victims of domestic violence seek care through safety net
    providers in community health centers rather than present to
    costly emergency departments. The Committee encourages the
    Department to fund demonstration projects that combine
    integrated family violence prevention models focused on
    minority populations with primary care delivery.
        The Committee commends the efforts of health centers to
    deliver culturally and linguistically appropriate care and
    encourages the Secretary to work with health centers to better
    enable them to provide, to the maximum extent feasible,
    culturally competent and linguistically appropriate services.
    The Committee also urges that attention be given to strategies
    to increase the numbers and diversity of health professionals
    at community health centers.
        The Committee recognizes that Nurse-Managed Health Centers
    [NMHCs] serve a dual function in strengthening the health care
    safety net by providing health care to populations in
    underserved areas and by providing the clinical experiences to
    nursing students that are mandatory for professional
    development. Recognizing that NMHCs are frequently the only
    source of health care to their patients and that a lack of
    clinical education sites for nurses is a contributing factor to
    the nationwide nursing shortage, the Committee encourages HRSA
    to provide alternative means to secure cost-based reimbursement
    for NMHCs, by providing that reimbursement or by granting
    university-based CHCs. In addition, the Committee encourages
    HRSA to research the effectiveness of nurse-managed health
    centers as a national model to reduce health disparities.
        The Committee encourages the Bureau of Primary Health Care
    to consider establishing a grant program within its community
    health center program that would support the establishment and/
    or expansion of nurse practice arrangements commonly referred
    to as nurse-managed health centers that provide the medically
    underserved with access to primary care services and promote
    career advancement among nursing personnel in a variety of
    training settings.
        The Committee is concerned that Federal community health
    center funds are often not available to small, remote
    communities in Alaska, Hawaii, and other similar States because
    the population base is too small. Many of these communities
    have no health service providers and are forced to travel long
    distances by boat or plane even in emergency situations. The
    Committee supports efforts now underway to increase community
    health center funding to address the growing number of
    uninsured persons in this country. The Committee recommends
    that HRSA examine its regulations and applications procedures
    to ensure they do not unduly burden small communities and are
    appropriately flexible to meet the needs of these communities.
    The Committee applauds the agency for its initiatives such as
    the ``Alaska Frontier Health Plan'' and encourages the Agency
    to continue and expand its efforts with this program.

    Native Hawaiian Health Care

        The Committee again includes the legal citation in the bill
    for the Native Hawaiian Health Care Program. The Committee has
    included sufficient funding so that health care activities
    funded under the Native Hawaiian Health Care Program can be
    supported under the broader community health centers line. The
    Committee expects that not less than $14,100,000 be provided
    for these activities in fiscal year 2006.

    Free Clinics Medical Malpractice Coverage

        The Committee provides $99,000 in funding for payments of
    claims under the Federal Tort Claims Act to be made available
    for free clinic health professionals as authorized by U.S.C.
    Title 42, Section 233(o) of the Public Health Service Act. The
    fiscal year 2005 comparable level was $99,000 and neither the
    administration nor the House provided any funding for this
    program. This appropriation continues to extend Federal Tort
    Claims Act coverage to medical volunteers in free clinics in
    order to expand access to health care services to low-income
    individuals in medically underserved areas.

    Radiation and Exposure Screening and Education Program

        The Committee provides $1,958,000 for the Radiation
    Exposure Compensation Act. The fiscal year 2005 comparable
    level was $1,958,000, the administration request was $1,936,000
    and the House provided $1,900,000. This program provides grants
    for the education, prevention, and early detection of
    radiogenic cancers and diseases resulting from exposure to
    uranium during its mining and milling at nuclear test sites.

    Health Care Access for the Uninsured/Community Access Program

        The Committee provides $60,000,000 for the Community Access
    Program. The fiscal year 2005 comparable level was $82,993,000
    and the administration did not request fund for this program in
    fiscal year 2006. This program is designed to increase the
    capacity and effectiveness of community health care
    institutions and providers who serve patients, regardless of
    their ability to pay.
        Community Health Centers have the potential to serve as a
    valuable resource in biomedical and behavioral research aimed
    at reducing health status disparities among minority and
    medically underserved populations. The Committee is pleased
    that HRSA, through the H-CAP program, has prioritized the
    establishment of demonstration projects between Community
    Health Centers and minority health professions schools for the
    purpose of health status disparities research and data
    collection. Such demonstration projects were authorized in the
    ``Health Care Safety Net Amendments of 2002.''

    National Hansen's Disease Program

        The Committee has included $17,066,000 for the National
    Hansen's Disease Program. The fiscal year 2005 comparable level
    was $17,251,000 and the administration request was $16,066,000
    in fiscal year 2006. This program offers Hansen's Disease
    treatment in Baton Rouge at the Center, at other contract
    supported locations in Baton Rouge, and in grant supported
    outpatient regional clinics. These programs provide treatment
    to about 3,000 of the 6,000 Hansen's disease sufferers in the
    United States.

    National Hansen's Disease Program Buildings and Facilities

        The Committee provides $222,000 for buildings and
    facilities. The fiscal year 2005 comparable level was $247,000
    and the administration request was $222,000. This funding
    provides for the repair and maintenance of buildings at the
    Gillis W. Long Hansen's Disease Center.

    Payment to Hawaii for Hansen's Disease Treatment

        The Committee provides $2,017,000 for Hansen's disease
    services. The fiscal year 2005 comparable level was $2,017,000
    and the administration requested $2,016,000.

    Black Lung Clinics

        The Committee provides $5,975,000 for black lung clinics.
    The fiscal year 2005 comparable level was $5,951,000 and the
    administration requested $5,912,000. This program funds clinics
    that treat respiratory and pulmonary diseases of active and
    retired coal miners. These clinics reduce the incidence of
    high-cost inpatient treatment for these conditions.

                          BUREAU OF HEALTH PROFESSIONS

    National Health Service Corps: Field Placements

        The Committee provides $40,705,000 for field placement
    activities. The fiscal year 2005 comparable level was
    $45,068,000 and the administration request was $40,705,000. The
    funds provided for this program are used to support the
    activities of National Health Service Corps obligors and
    volunteers in the field, including travel and transportation
    costs of assignees, training and education, recruitment of
    volunteers, and retention activities. Salary costs of most new
    assignees are paid by the employing entity.
        The Committee is pleased by the increasing proportion of
    NHSC assignees being placed at Community, Migrant, Homeless,
    and Public Housing Health Centers. The Committee encourages
    HRSA to further expand this effort to ensure that the health
    center expansion effort has access to a sufficient level of
    health professionals through the NHSC.
        The Committee is concerned by reports that the current HPSA
    scoring process used by HRSA to place physicians disadvantages
    many health centers located in medically underserved areas of
    the country. The Committee urges HRSA to reconsider the
    decision to score FQHCs under the newly authorized automatic
    designation process based on data and criteria that virtually
    eliminate all such FQHCs from eligibility for the placement of
    NHSC scholars, Ready Responders, and HHS' J-1 Visa waiver
    program.

    National Health Service Corps: Recruitment

        The Committee provides $86,091,000 for recruitment
    activities. The fiscal year 2005 comparable level was
    $86,380,000 and the administration request was $86,091,000.
    This program provides major benefits to students (full-cost
    scholarships or sizable loan repayment) in exchange for an
    agreement to serve as a primary care provider in a high
    priority federally designated health professional shortage
    area. These funds should support multi-year, rather than
    single-year, commitments.
        The Committee believes that the inclusion of Optometrists
    in the National Health Service Corps' [NHSC] Student Loan
    Repayment Program will result in the expanded accessibility of
    eye care in communities where it is most needed. Accordingly,
    the Committee urges the Health Resources and Services
    Administration to take immediate steps to fully utilize Doctors
    of Optometry in the NHSC Student Loan Repayment Program as part
    of an effort to make preventive eye care services more
    accessible in community health centers within rural and urban
    primary care health professional shortage areas.

                               HEALTH PROFESSIONS

        The Committee provides $454,393,000 for all HRSA health
    professions programs. The fiscal year 2005 comparable level was
    $450,213,000 and the administration requested $160,534,000 in
    fiscal year 2006.
        The Committee recognizes that physicians trained in
    combined Internal Medicine-Pediatrics [Med-Peds] residency
    training programs are particularly well suited to care for
    patients with chronic medical illnesses who transition from
    pediatric to adult-centered care. These physicians receive
    intensive training in the care of children with chronic
    illnesses as well as primary care for adults. The Committee
    believes that Med-Peds physicians may fill the emerging need of
    caring for these patients. The Committee encourages HRSA to
    consider developing model demonstration projects on transition
    care. The goal would be to address the healthcare needs of this
    underserved population and to train future physicians to
    provide care for them.
        The Committee understands that nearly three quarters of the
    Nation's 122 Job Corps Centers offer health occupations
    training as well as training in health care related fields. The
    Committee recognizes the Job Corps success in training students
    with the skills they need to fill critical shortages through
    major national employer partners. The Committee encourages HRSA
    to consider making Job Corps Centers eligible for HRSA funding
    for allied health training programs.
        The Committee commends HRSA for its continuing efforts to
    address the growing gap between the size of the Nation's aging
    baby boom population and the number of pulmonary/critical care
    physicians. The Committee is aware that HRSA has prepared a
    report on the healthcare workforce shortage issue, and that the
    portion of the report that will attempt to identify the causes
    of, and potential responses to, the critical care workforce
    shortage will be informed, in part, by The Critical Care
    Medicine Crisis: A Call for Federal Action prepared by the
    American College of Chest Physicians and the members of the
    Critical Care Workforce Partnership. The Committee requests
    HRSA provide a copy of this report to the Committee by July 1,
    2006. The Committee continues to encourage HRSA to address the
    critical care workforce shortage issue and use the pulmonary/
    critical care specialty as a model for developing and testing
    policy approaches to address workforce shortage issues.

    Training for Diversity

                Centers of Excellence
        The Committee provides $33,609,000 for the Centers of
    Excellence program. The fiscal year 2005 comparable level was
    $33,609,000 and the administration did not request any funds
    for this program in fiscal year 2006. This program was
    established to fund institutions that train a significant
    portion of the Nation's minority health professionals. Funds
    are used for the recruitment and retention of students, faculty
    training, and the development of plans to achieve institutional
    improvements. The institutions that are designated as centers
    of excellence are private institutions whose mission is to
    train disadvantaged minority students for service in
    underserved areas. Located in poor communities and usually with
    little State funding, they serve the health care needs of their
    patients often without remuneration.
        The Committee is pleased that HRSA has re-focused the
    Minority Centers of Excellence program on providing support to
    historically minority health professions institutions. The
    Committee recognizes the important role of this program in
    supporting faculty and other academic programs at minority
    institutions.

                Health Careers Opportunity Program
        The Committee provides $35,647,000 for the Health Careers
    Opportunity Program. The fiscal year 2005 comparable level was
    $35,647,000 and the administration did not request any funds
    for this program in fiscal year 2006. This program provides
    funds to medical and other health professions schools for
    recruitment of disadvantaged students and pre-professional
    school preparations.
        The Committee is concerned about the reduced level of
    support provided to minority health professions schools through
    the H-COP program in recent fiscal years. For fiscal year 2006,
    the Committee urges HRSA to give priority consideration to
    awarding grants to those institutions with a historic mission
    of training minorities in the health professions. HRSA should
    report to the Committee within 6 weeks of enactment of this Act
    with the steps it has taken to address this issue.

                Faculty Loan Repayment
        The Committee provides $1,302,000 for the Faculty Loan
    Repayment program. The fiscal year 2005 comparable level was
    $1,302,000 and the administration did not request any funds for
    this program in fiscal year 2006. This program provides for the
    repayment of education loans for individuals from disadvantaged
    backgrounds who are health professions students or graduates,
    and who have agreed to serve for not less than 2 years as a
    faculty member of a health professions school.

                Scholarships for Disadvantaged Students
        The Committee provides $47,128,000 for the Scholarships for
    Disadvantaged Students program. The fiscal year 2005 comparable
    level was $47,128,000 and the administration requested
    $9,381,000 for this program in fiscal year 2006. This program
    provides grants to health professions schools for student
    scholarships to individuals who are from disadvantaged
    backgrounds and are enrolled as full-time students in such
    schools. The Committee continues to intend that all health
    professions disciplines made eligible by statute be able to
    participate in the scholarships program.

    Training in Primary Care Medicine and Dentistry

        The Committee provides $90,000,000 for Training in Primary
    Care Medicine and Dentistry programs. The fiscal year 2005
    comparable level was $88,816,000 and the administration did not
    request funding for this program in fiscal year 2006.

                Family Medicine Training
        Family medicine activities support grants for graduate
    training in family medicine, grants for pre-doctoral training
    in family medicine, grants for faculty development in family
    medicine, and grants for the establishment of departments of
    family medicine. The Committee reiterates its support for this
    program and recognizes its importance in increasing the number
    of primary care physicians in underserved areas.

                General Internal Medicine and Pediatrics Training
        This program provides funds to public and private nonprofit
    hospitals and schools of medicine and osteopathic medicine to
    support residencies in internal medicine and pediatrics. Grants
    may also include support for faculty.

                Physician Assistants
        This program supports planning, development, and operation
    of physician assistant training programs.

                General Dentistry and Pediatric Dental Residencies
        This program assists dental schools and postgraduate dental
    training institutions to meet the costs of planning,
    developing, and operating residency training and advanced
    education programs in general practice of dentistry and funds
    innovative models for postdoctoral general dentistry and
    pediatric dentistry.

    Interdisciplinary, Community-based Linkages

                Area Health Education Centers
        The Committee provides $28,971,000 for the Area Health
    Education Centers program. The fiscal year 2005 comparable
    level was $28,971,000 and the administration did not request
    any funds for this program in fiscal year 2006. This program
    links university health science centers with community health
    service delivery systems to provide training sites for
    students, faculty, and practitioners. The program supports
    three types of projects: Core grants to plan and implement
    programs; special initiative funding for schools that have
    previously received Area Health Education Centers [AHEC]
    grants; and model programs to extend AHEC programs with 50
    percent Federal funding.

                Health Education and Training Centers
        The Committee provides $3,819,000 for the Health Education
    and Training Centers program. The fiscal year 2005 comparable
    level was $3,819,000 and the administration did not request any
    funds for this program in fiscal year 2006. These centers
    provide training to improve the supply, distribution, and
    quality of personnel providing health services in the State of
    Florida or along the border between the United States and
    Mexico and in other urban and rural areas with populations with
    serious unmet health care needs.

                Allied Health and Other Disciplines
        The Committee provides $11,753,000 for the Allied Health
    and Other Disciplines programs. The fiscal year 2005 comparable
    level was $11,753,000 and the administration did not request
    any funds for this program in fiscal year 2006. The Committee
    intends that these funds be used to support existing programs
    at not less than last year's level. These programs seek to
    improve access, diversity, and distribution of allied health
    practitioners to areas of need. The program improves access to
    comprehensive and culturally competent health care services for
    underserved populations.
        The Committee is concerned about the emerging shortage of
    occupational therapists needed to work with baby boom retirees
    and encourages HRSA to give priority consideration to projects
    for schools that address these manpower shortages by both
    training faculty and students for entry level service.
        The Committee is aware that dental disease
    disproportionately affects our Nation's most vulnerable
    populations, including many in rural America. New ways of
    bringing oral health care to rural and underserved populations
    are needed. The Committee encourages HRSA to explore
    alternative methods of delivering preventive and restorative
    oral health services in rural America. Specifically, the
    Committee encourages HRSA to explore development of an advanced
    dental hygiene practitioner who would be a graduate of an
    accredited dental hygiene program and complete an advanced
    educational curriculum, which prepares the dental hygienist to
    provide diagnostic, preventive, restorative and therapeutic
    services directly to the public in rural and underserved areas.
        The Committee notes that since 1999 HRSA has not provided a
    focus, through a request for proposals or other program
    initiatives, on pediatric occupational therapy. In view of the
    importance of this health profession to children with
    disabilities, the Committee encourages HRSA to identify a
    competitive category specifically for pediatric occupational
    therapy training grants in 2006.

                Geriatric Education Centers and Training
        The Committee provides $29,548,000 for the Geriatrics
    Education Centers and Training programs. The fiscal year 2005
    comparable level was $31,548,000 and the administration did not
    request any funds for this program in fiscal year 2006. This
    program supports grants to health professions schools to
    establish geriatric education centers and to support geriatric
    training projects. These centers and geriatric training
    programs play a vital role in enhancing the skill-base of
    health care professionals to care for our Nation's growing
    elderly population.

                Quentin N. Burdick Program for Rural Health
                        Interdisciplinary Training
        The Committee provides $6,076,000 for these programs. The
    fiscal year 2005 comparable level was $6,076,000 and the
    administration did not request any funds for this program in
    fiscal year 2006. This program addresses shortages of health
    professionals in rural areas through interdisciplinary training
    projects that prepare students from various disciplines to
    practice together, and offers clinical training experiences in
    rural health and mental health care settings to expose students
    to rural practice.

                Podiatric Primary Care Training
        This program provides grants to hospitals and schools of
    podiatric medicine for residency training in primary care. In
    addition to providing grants to hospitals and schools of
    podiatric medicine for residency training in primary care, the
    program also permits HRSA to study and explore ways to more
    effectively administer postdoctoral training in an ever
    changing health care environment.

                Chiropractic Demonstration Grants
        This program provides grants to colleges and universities
    of chiropractic to carry out demonstration projects in which
    chiropractors and physicians collaborate to identify and
    provide effective treatment of spinal and lower back
    conditions. The Committee continues to support the chiropractic
    research and demonstration grant program, originally authorized
    under section 782 of Public Law 102-408, and funded by the
    Committee in previous years. The Committee recommends that the
    chiropractic-medical school demonstration grant program be
    continued.

    Workforce Information and Analysis

        The Committee provides $712,000 for these programs. The
    fiscal year 2005 comparable level was $716,000 and the
    administration requested $712,000.

                Health Professions Data and Analysis
        This program supports the collection and analysis of data
    on the labor supply in various health professions and on future
    workforce configurations.

                Research on Certain Health Professions Issues
        This program supports research on the extent to which debt
    has a detrimental effect on students entering primary care
    specialties; the effects of federally funded education programs
    for minorities attending and completing health professions
    schools; and the effectiveness of State investigations in
    protecting the health of the public.

    Public Health Workforce Development

        With the continued need for public health training
    throughout the country, the Committee believes these programs
    serve an important role in maintaining the country's public
    health infrastructure.

                Public Health, Preventive Medicine, and Dental Public
                        Health Programs
        The Committee provides $9,097,000 for these programs. The
    fiscal year 2005 comparable level was $9,097,000 and the
    administration did not request any funds for this program in
    fiscal year 2006. This program supports awards to schools of
    medicine, osteopathic medicine, public health, and dentistry
    for support of residency training programs in preventive
    medicine and dental public health; and for financial assistance
    to trainees enrolled in such programs.

                Health Administration Programs
        The Committee provides $1,070,000 for the Health
    Administration programs. The fiscal year 2005 comparable level
    was $1,070,000 and the administration did not request any funds
    for this program in fiscal year 2006. These programs provide
    grants to public or nonprofit private educational entities,
    including schools of social work, but not schools of public
    health, to expand and improve graduate programs in health
    administration, hospital administration, and health policy
    analysis and planning; and assists educational institutions to
    prepare students for employment with public or nonprofit
    private agencies.
        Although the majority of Native Hawaiians receive services
    in federally qualified community health centers, there is only
    one Native Hawaiian health care administrator working in these
    centers. The Committee is concerned that limited mentoring and
    training opportunities exist for Native Hawaiian administrators
    in health care organizations. The Committee urges that a
    portion of money appropriated for Native Hawaiian Health Care
    Act programs be used to prepare Native Hawaiians with the
    expertise to excel in administrative health care positions.

    Nursing Workforce Development Programs

        The Committee provides $155,661,000 for the Nursing
    Workforce Development programs. The fiscal year 2005 comparable
    level was $150,661,000 and the administration requested
    $149,991,000 for these programs in fiscal year 2005. The
    Committee recognizes that the current nursing shortage has
    reached a crisis state across America. The situation only
    promises to worsen due to a lack of young nurses in the
    profession, an aging existing workforce, and inadequate
    availability of nursing faculty to prepare future nurses. The
    Committee urges HRSA to support programs aimed at increasing
    nursing faculty and encouraging a diverse population's entry
    into nursing.

                Advanced Education Nursing
        The Committee provides $58,160,000 for the Advanced
    Education Nursing programs. The fiscal year 2005 comparable
    level was $58,160,000 and the administration requested
    $42,806,000 for this program in fiscal year 2006. This program
    funds nursing schools to prepare nurses at the master's degree
    or higher level for teaching, administration, or service in
    other professional nursing specialties.
        The Committee understands that advanced practice nurses
    provide high quality, cost-effective care in whatever
    geographic locations they practice and that often they are a
    patient's only option for care. The Committee requests the
    Administrator to report to the Committee within 6 weeks of
    enactment of this Act on the number of advanced practice nurse
    candidates that receive traineeships and the number that then
    work in rural, isolated or underserved areas across the United
    States.

                Nurse Education, Practice, and Retention
        The Committee provides $40,468,000 for the Nurse Education,
    Practice, and Retention Programs. The fiscal year 2005
    comparable level was $36,468,000 and the administration
    requested $46,325,000 for this program in fiscal year 2006. The
    goal of this program is to improve the quality of nursing
    practice. Activities under this program will initiate new
    projects that will change the educational mix of the nursing
    workforce and empower the workforce to meet the demands of the
    current health care system.

                Nursing Workforce Diversity
        The Committee provides $17,270,000 for the Nursing
    Workforce Diversity program. The fiscal year 2005 comparable
    level was $16,270,000 and the administration requested
    $21,244,000 for this program in fiscal year 2006. The goal of
    this program is to improve the diversity of the nursing
    workforce through increased educational opportunities for
    individuals from disadvantaged backgrounds. The Committee urges
    the Division of Nursing to develop and increase cultural
    competence in nursing and to increase the number of
    underrepresented racial and ethnic minorities in all areas of
    nursing education and practice to enhance nurses' ability to
    provide quality health care services to the increasingly
    diverse community it serves.

                Nurse Loan Repayment and Scholarship Program
        The Committee provides $31,482,000 for the Nurse Loan
    Repayment and Scholarship programs. The fiscal year 2005
    comparable level was $31,482,000 and the administration
    requested $31,369,000 for this program in fiscal year 2006.
    This program offers student loan repayment to nurses in
    exchange for an agreement to serve not less than 2 years in an
    Indian Health Service health center, Native Hawaiian health
    center, public hospital, community or migrant health center, or
    rural health clinic.
                Nurse Faculty Loan Program
        The Committee provides $4,831,000 for the Nursing Faculty
    Loan program. The fiscal year 2005 comparable level was
    $4,831,000 and the administration requested $4,821,000 for this
    program in fiscal year 2006. This program supports the
    development of a student loan fund in schools of nursing to
    increase the number of qualified nursing faculty.

                Comprehensive Geriatric Education
        The Committee provides $3,450,000 for Comprehensive
    Geriatric Education grants. The fiscal year 2005 comparable
    level was $3,450,000 and the administration requested
    $3,426,000 for this program in fiscal year 2006. These grants
    prepare nursing personnel to care for the aging population.

    Children's Hospitals Graduate Medical Education Program

        The Committee has provided $300,000,000 for the Children's
    Hospitals Graduate Medical Education [GME] program. The fiscal
    year 2005 comparable level was $300,730,000 and the
    administration requested $200,000,000 for this program in
    fiscal year 2006.
        The program provides support for health professions
    training in children's teaching hospitals that have a separate
    Medicare provider number (``free-standing'' children's
    hospitals). Children's hospitals are statutorily defined under
    Medicare as those whose inpatients are predominantly under the
    age of 18. The funds in this program are intended to make the
    level of Federal Graduate Medical Education support more
    consistent with other teaching hospitals, including children's
    hospitals, which share provider numbers with other teaching
    hospitals. Payments are determined by formula, based on a
    national per-resident amount. Payments support training of
    resident physicians as defined by Medicare in both ambulatory
    and inpatient settings.

    National Practitioner Data Bank

        The Committee provides $15,700,000 for the national
    practitioner data bank. The fiscal year 2005 comparable level
    was $15,700,000 and the administration request was $15,700,000.
    The Committee and the administration assume that full funding
    will be provided entirely through the collection of user fees
    and will cover the full cost of operating the data bank. Bill
    language is included to ensure that user fees are collected to
    cover all costs of processing requests and providing such
    information to data bank users.

    Health Care Integrity and Protection Data Bank

        The Committee provides $4,000,000 for the health care
    integrity and protection data bank. The fiscal year 2005
    comparable level was $4,000,000 and the administration request
    was $4,000,000. The Committee and the administration assume
    that full funding will be provided entirely through the
    collection of user fees and will cover the full cost of
    operating the data bank. The data bank is intended to collect,
    maintain, and report on certain actions taken against health
    care providers, suppliers, and practitioners.

                        MATERNAL AND CHILD HEALTH BUREAU

    Maternal and Child Health Block Grant

        The Committee provides $710,000,000 for the maternal and
    child health [MCH] block grant. The fiscal year 2005 comparable
    level was $723,928,000 and the administration request was
    $723,928,000.
        The Maternal and Child Health Block Grant program provides
    a flexible source of funding that allows States to target their
    most urgent maternal and child health needs through development
    of community-based networks of preventive and primary care that
    coordinate and integrate public and private sector resources
    and programs for pregnant women, mothers, infants, children,
    and adolescents. The program supports a broad range of
    activities including prenatal care, well child services and
    immunizations, reducing infant mortality, preventing injury and
    violence, expanding access to oral health care, addressing
    racial and ethnic disparities and providing comprehensive care
    for children, adolescents, and families through clinics, home
    visits and school-based health programs.
        The MCH block grant funds are provided to States to support
    health care for mothers and children. According to statute, 85
    percent of appropriated funds up to $600,000,000 are
    distributed to States and 15 percent are set aside for special
    projects of regional and national significance [SPRANS]. Also
    according to statute, 12.75 percent of funds over $600,000,000
    are to be used for community-integrated service systems [CISS]
    programs. The remaining funds over $600,000,000 are distributed
    on the same 85/15 percent split as the basic block grant.
        The Committee has included bill language identifying
    $121,396,250 for the SPRANS set-aside. Within that total, the
    Committee intends that $4,000,000 be used to continue the
    sickle cell newborn screening program and its locally based
    outreach and counseling efforts; $5,000,000 be used to continue
    the oral health demonstration programs and activities in the
    States; $2,000,000 be used for mental health programs and
    activities in the States; $3,000,000 be used for epilepsy
    demonstration projects; $1,000,000 be used for a fetal alcohol
    syndrome demonstration program; and $2,000,000 be used for
    newborn and child screening for heritable disorders as
    authorized in title XXVI of the Children's Health Act of 2000.
        The Committee has provided $5,000,000 for the continuation
    of oral health programs in the States. Through grants,
    cooperative agreements or contracts, these funds may be used to
    increase access to dental care for the most vulnerable low-
    income children, such as Medicaid, SCHIP, and Head Start
    eligible children and to implement State identified objectives
    for improving oral health. Anticipated activities include those
    targeting the reduction of early childhood caries, and
    strengthening school-linked dental sealant programs.
        The Committee also provides $2,000,000 for mental health
    programs and activities in the States. The Committee expects
    that the programs will include mental health grants for
    prevention and early intervention services for children and
    youth ages 0 to 24 years and for women's mental health as it
    relates to their role in the family, particularly for women
    diagnosed with postpartum depression [PPD]. One out of every
    ten new mothers suffers from PPD, a treatable condition that
    presents a range of emotional and physical changes.
    Unfortunately, half of these women never get help. The
    Committee encourages the Bureau to utilize this funding to
    focus on low-income women and mothers of children with low
    birth weight. The Committee recommends that funding be used on
    science-based programs or models such as the Starting Early
    Starting Smart Program that was funded by the Substance Abuse
    and Mental Health Service Administration [SAMHSA] and the Casey
    Family Programs to specifically target early intervention and
    prevention.
        The Committee has provided $3,000,000 for the continuation
    of epilepsy demonstration programs to improve access to health
    and other services regarding seizures and to encourage early
    detection and treatment in children and others residing in
    medically underserved and rural areas. Of the amount provided,
    the Committee recommends 30 percent be used to continue to fund
    the development and testing of a national public health
    awareness campaign to increase seizure recognition and improve
    access to care among minorities and underserved populations. In
    implementing this program, the Committee encourages HRSA to
    partner with a national organization whose mission is to
    improve the lives of children and adults affected by seizure
    through research, education, advocacy and service.
        The Committee has included $1,000,000 to continue the
    demonstration program on fetal alcohol syndrome begun in last
    year's appropriation. Each year, 40,000 children are born with
    fetal alcohol spectrum disorders [FASD], the leading known
    cause of mental retardation and birth defects. The
    demonstration program should continue to coordinate services
    between the National Organization on Fetal Alcohol Syndrome and
    community health centers to improve the prevention,
    identification, and support of individuals with fetal alcohol
    syndrome. In addition, funds have been included to engage and
    include maternal child health sites in this successful
    demonstration.
        Newborn screening is a public health activity used for
    early identification of infants affected by certain genetic,
    metabolic, hormonal and or functional conditions for which
    there are effective treatments or interventions. Screening
    detects disorders in newborns that, left untreated, can cause
    death, disability, mental retardation and other serious
    illnesses.
        The Committee again provides $2,000,000 within the SPRANS
    amount for the heritable disorders program authorized in title
    XXVI of the Children's Health Act. This program is designed to
    strengthen States' newborn screening programs and improve
    States' ability to develop, evaluate, and acquire innovative
    testing technologies, and establish and improve programs to
    provide screening, counseling, testing and special services for
    newborns and children at risk for heritable disorders. The
    Committee urges HRSA to include additional conditions, such as
    biliary atresia, Fragile X, and abnormally elevated levels of
    bilirubin, in this evaluation of testing programs with the goal
    of implementing cost-effective public health screening programs
    for these and other disorders. The Committee requests a report
    by July 15, 2006 on the steps taken to validate a screening
    tool for Fragile X and to launch a screening program across the
    country. Given the potential of Fragile X screening as a viable
    prototype for newborn and infant screening, the Committee
    encourages HRSA to allocate funding from the heritable
    disorders screening program toward screening and
    epidemiological research activities related to Fragile X.
        The Committee is aware of the extreme disparities that
    exist among State newborn screening programs for metabolic and
    genetic disorders. Parents and healthcare providers responsible
    for the care of newborns should be able to provide the best
    chance at a healthy start on life. For this reason, the
    Committee strongly urges HRSA to include as a requirement for
    funding a provision that parents be informed in writing of the
    availability of additional tests that may not be required under
    State law.
        The Committee reiterates its long-standing support for the
    continuation of funding that the Maternal and Child Health
    Block Grant has provided to comprehensive thalassemia treatment
    centers under the SPRANS program. The Committee strongly
    encourages MCHB to continue this program, expand it to include
    additional centers around the country, and to coordinate
    closely its activities with the Cooley's Anemia Foundation.
        The most crucial need for individuals suffering from
    Chronic Fatigue Syndrome is for effective, compassionate
    medical care. Through its demonstration grants program, HRSA
    has piloted effective ways of delivering health care services
    to those with emerging illnesses. The Committee encourages HRSA
    to provide demonstration grants to develop model CFS clinical
    centers with the goal of delivering effective,
    multidisciplinary clinical care to persons with CFS.
        The Committee recognizes the critical role of hemophilia
    treatment centers in providing needed comprehensive care for
    persons with bleeding disorders and the expanded role of these
    centers in addressing the needs of women with bleeding
    disorders and persons with clotting disorders such as
    thrombophilia. The Committee urges HRSA to continue its support
    of this model disease management network.
        The Committee is aware that many school-age children with
    vision problems significant enough to affect their learning are
    not screened for vision problems prior to entering school. In
    an effort to stimulate a national effort to reduce the
    occurrence of vision loss and its accompanying disabilities,
    the Committee encourages HRSA to consider developing a National
    Core Performance Measure for children's vision.

    Sickle Cell Anemia Demonstration Program

        The Committee provides $500,000 for the sickle cell anemia
    demonstration program. The fiscal year 2005 comparable level
    was $198,000 and the administration did not request funding for
    this program in fiscal year 2006.

    Traumatic Brain Injury Program

        The Committee provides $9,297,000 for the traumatic brain
    injury program. The fiscal year 2005 comparable level was
    $9,297,000 and the administration did not request funding for
    this program in fiscal year 2006. The program supports
    implementation and planning grants to States for coordination
    and improvement of services to individuals and families with
    traumatic brain injuries as well as protection and advocacy.
    Such services can include: pre-hospital care, emergency
    department care, hospital care, rehabilitation, transitional
    services, education, employment, and long-term support. The
    Committee includes $3,000,000 for protection and advocacy
    services, as authorized under section 1305 of Public Law 106-
    310.

    Healthy Start Initiative

        The Committee provides $104,000,000 for the healthy start
    infant mortality initiative. The fiscal year 2005 comparable
    level was $102,543,000 and the administration request was
    $97,747,000.
        The healthy start initiative was developed to respond to
    persistently high rates of infant mortality in this Nation. The
    initiative was expanded in fiscal year 1994 by a special
    projects program, which supported an additional seven urban and
    rural communities to implement infant mortality reduction
    strategies and interventions. The Children's Health Act of 2000
    fully authorized this initiative as an independent program.
        The Committee urges HRSA to give preference to current and
    former grantees with expiring or recently expired project
    periods. This should include grantees whose grant applications
    were approved but not funded during fiscal year 2005.

    Universal Newborn Hearing Screening and Early Intervention

        The Committee provides $9,792,000 for universal newborn
    hearing screening and early intervention activities. The fiscal
    year 2005 comparable level was $9,792,000 and the
    administration did not request funds for this program in fiscal
    year 2006.
        The Committee has included sufficient funding to continue
    the initiative begun several years ago to provide grants to
    States to establish universal newborn hearing screening and
    early intervention programs. The Committee is pleased by the
    success of the initiative and the substantial response from
    States.
        The Committee expects HRSA to coordinate projects funded
    with this appropriation with projects related to early hearing
    detection and intervention by the National Center on Birth
    Defects and Developmental Disabilities, the National Institute
    on Deafness and Other Communication Disorders, the National
    Institute on Disability and Rehabilitation Research, and the
    Office of Special Education and Rehabilitative Services.

    Emergency Medical Services for Children

        The Committee provides $20,000,000 for emergency medical
    services for children. The fiscal year 2005 comparable level
    was $19,830,000 and the administration did not request funding
    for this program in fiscal year 2006. The program supports
    demonstration grants for the delivery of emergency medical
    services to acutely ill and seriously injured children.
        The Committee notes that this program is the only Federal
    source of funding and expertise for improving EMS systems for
    children. The Committee commends the EMSC program for its 20
    years of achievement and applauds its commitment to improving
    the delivery of emergency medical services to ill and injured
    children.

    Poison Control Centers

        The Committee provides $23,301,000 for poison control
    center activities. The fiscal year 2005 comparable level was
    $23,499,000 and the administration requested $23,301,000 for
    this program in fiscal year 2006. The funds provided support
    activities authorized in the Poison Control Center Enforcement
    and Enhancement Act as well as the development and assessment
    of uniform patient management guidelines.

                                HIV/AIDS BUREAU

                      ACQUIRED IMMUNE DEFICIENCY SYNDROME

    Ryan White AIDS Programs

        The Committee provides $2,083,296,000 for Ryan White AIDS
    programs. The recommendation includes $25,000,000 in transfers
    available under section 241 of the Public Health Service Act.
    The fiscal year 2005 comparable level was $2,073,296,000 and
    the administration request was $2,083,296,000.
        Next to the Medicaid program, the Ryan White CARE Act (the
    CARE Act) is the largest Federal investment in the care and
    treatment of people living with HIV/AIDS in the United States.
    The CARE Act provides a wide range of community-based services,
    including primary and home health care, case management,
    substance abuse treatment, mental health services, and
    nutritional services.
        Within the total provided, the Committee intends that Ryan
    White AIDS activities that are targeted to address the growing
    HIV/AIDS epidemic and its disproportionate impact upon
    communities of color, including African-Americans, Latinos,
    Native Americans, Asian Americans, Native Hawaiians, and
    Pacific Islanders continue with at least the level of funding
    provided in fiscal year 2005.
        The Committee is concerned that at least 30 percent of
    persons living with HIV are co-infected with hepatitis C, and
    that hepatitis C related complications are emerging as the
    leading cause of death among persons living with HIV/AIDS. The
    Committee requests that HRSA provide both more guidance to
    grantees on providing services to co-infected individuals, and
    more education and training to medical providers on treating
    persons co-infected with HIV and HCV.

    Emergency Assistance--Title I

        The Committee provides $610,094,000 for emergency
    assistance grants to eligible metropolitan areas
    disproportionately affected by the HIV/AIDS epidemic. These
    funds are provided to metropolitan areas meeting certain
    criteria. Half of the funds are awarded by formula and the
    other half are awarded through supplemental competitive grants.

    Comprehensive Care Programs--Title II

        The Committee provides $1,131,836,000 for HIV health care
    and support services. These funds are awarded to States to
    support HIV service delivery consortia, the provision of home
    and community-based care services for individuals with HIV
    disease, continuation of health insurance coverage for low-
    income persons with HIV disease and support for State AIDS drug
    assistance programs [ADAP].
        The Committee continues to be encouraged by the progress of
    anti-retroviral therapy in reducing the mortality rates
    associated with HIV infection and in enhancing the quality of
    life of patients on medication. The Committee has approved bill
    language for $797,521,000 for AIDS medications.
        The Committee is concerned that Title II base award amounts
    have been reduced by $14,000,000 over the past 2 fiscal years,
    thereby reducing the ability of State and territory health
    departments to provide comprehensive health care services to
    all those living with HIV/AIDS in need. The Committee
    recognizes the unique role that State health departments play
    in coordinating HIV/AIDS care and treatment programs within
    their State, regardless of funding source. The Committee
    encourages HRSA, in collaboration with state health
    departments, to seek meaningful measures by which coordination
    between all Ryan White CARE Act grantees and other Federal HIV/
    AIDS programs can occur within States and territories, with
    inclusion of State representatives in HRSA's monitoring visits
    of Title III and IV grantees, as well as notification to states
    of new grantees within their jurisdictions.
        The Committee recognizes the importance of ADAP in making
    it possible for low-income Americans to access and afford the
    drugs to treat HIV/AIDS. Today, more than 150,000 Americans
    depend on ADAP to preserve and extend their lives.
    Unfortunately, dozens of States find themselves unable to keep
    up with the demand for patients in need of coverage under ADAP,
    and many states have been forced to take drastic action to
    offset funding shortfalls. The Committee encourages HRSA to
    explore methods of redistributing unobligated funds to help
    address the ADAP crisis.

    Early Intervention Program--Title III-B

        The Committee provides $195,578,000 for early intervention
    grants. These funds are awarded competitively to primary health
    care providers to enhance health care services available to
    people at risk of HIV and AIDS. Funds are used for
    comprehensive primary care, including counseling, testing,
    diagnostic, and therapeutic services.

    Women, Infants, Children, and Youth--Title IV

        The Committee provides $72,519,000 for title IV pediatric
    AIDS. Funds are awarded to community health centers, family
    planning agencies, comprehensive hemophilia diagnostic and
    treatment centers, federally qualified health centers under
    section 1905(1)(2)(B) of the Social Security Act, county and
    municipal health departments and other nonprofit community-
    based programs that provide comprehensive primary health care
    services to populations with or at risk for HIV disease.
        Title IV of the CARE Act provides a program of grants for
    coordinated services and access to research for women, infants,
    children and youth. Title IV grantees may engage in a broad
    range of activities to reduce mother-to-child transmission,
    including voluntary testing of pregnant women and treatment to
    reduce mother-to-child transmission. In addition, title IV
    grantees are required to provide individuals with information
    and education on opportunities to participate in HIV/AIDS
    clinical research.
        The Committee expects HRSA to maximize available funds
    under this part to existing grantees. The Committee is
    concerned that instructions to HRSA regarding the analysis of
    data pertaining to administrative costs in title IV have still
    not been followed, making it almost impossible for HRSA to
    impose a cap in fiscal year 2006. The Committee strongly urges
    HRSA to collaborate with grantees under this title to produce
    necessary tools for the accurate collection of expense data.
    Unless HRSA can produce data regarding administrative expenses
    with a precise definition to ensure accuracy and comparability,
    the Agency will be unable to impose a limitation on such
    expenses without harming the ability of grantees to provide
    services for women, children, youth and families infected with
    HIV.
        The Committee is aware of the efforts of title IV grantees
    to care for youth infected with HIV and urges HRSA to
    disseminate the effective practices and models of care
    developed by title IV grantees across all Ryan White CARE Act
    providers.
        Technical assistance may be provided to title IV grantees
    using up to 2 percent of the funds appropriated under this
    section. Within this amount sufficient funds exist to maintain
    agreements to provide technical assistance to title IV grantees
    and to conduct policy analysis and research.

    AIDS Education and Training Centers

        The Committee provides $35,051,000 for the AIDS education
    and training centers [AETC's]. AIDS education and training
    centers train health care practitioners, faculty, and students
    who care for AIDS patients outside of the traditional health
    professions education venues, and support curriculum
    development on diagnosis and treatment of HIV infection for
    health professions schools and training organizations. The
    targeted education efforts by AETC's are needed to ensure the
    cost-effective use of the significant expenditures in Ryan
    White programs and the AIDS drugs assistance program. The
    Agency is urged to fully utilize the AETC's to ensure the
    quality of medical care and to ensure, as much as possible,
    that no individual with HIV receives suboptimal therapy due to
    the lack of health care provider information.

    AIDS Dental Services

        The Committee provides $13,218,000 for AIDS Dental
    Services. This program provides grants to dental schools,
    dental hygiene schools, and postdoctoral dental education
    programs to assist with the cost of providing unreimbursed oral
    health care to patients with HIV disease.

    Telehealth

        The Committee provides $3,888,000 for telehealth
    activities. The fiscal year 2005 comparable level was
    $3,916,000 and the administration request was $3,888,000. The
    telehealth program funded through the Office for the
    Advancement of Telehealth promotes the effective use of
    technologies to improve access to health services for people
    who are isolated from healthcare and distance education for
    health professionals.

                            SPECIAL PROGRAMS BUREAU

    Organ Donation and Transplantation

        The Committee provides $24,413,000 for organ transplant
    activities. The fiscal year 2005 comparable level was
    $24,413,000 and the administration request was $23,282,000.
    These funds support a scientific registry of organ transplant
    recipients and the National Organ Procurement and
    Transplantation Network to match donors and potential
    recipients of organs. A portion of the appropriated funds may
    be used for education of the public and health professionals
    about organ donations and transplants, and to support agency
    staff providing clearinghouse and technical assistance
    functions.
        The Committee notes that Public Law 108-216, the Organ
    Donation Recovery and Improvement Act of 2004 has provided new
    program authorizations and urges efforts to implement the new
    law. Funding provided by the Committee may be used to implement
    the provisions of the new law and the Committee notes that the
    new provisions may have a direct impact on increasing the rate
    of successful transplantations.
        The Committee is concerned that pregnant women and their
    families are unaware of the benefits of umbilical cord blood in
    treating many congenital and genetic diseases. The Committee
    encourages HRSA to consider adding umbilical cord blood to
    organ and tissue donation education programs operated by HRSA
    to provide education on all options for umbilical cord blood
    storage including public donation and private banking.
        The Committee is encouraged by the continuing success of
    the Organ Donation Collaborative Project and has included funds
    for its continuation. This project is focused on the Nation's
    largest hospitals and has adopted the goal of helping these
    hospitals achieve organ donation rates of 75 percent or higher,
    which will result in at least 6,000 additional organs available
    for transplantation. The Committee notes that this project has
    made important progress toward this goal over the last year and
    urges its continuation. The Committee also urges the agency to
    facilitate the adoption of a national system of simultaneous
    referrals of available organs as opposed to the current system
    of sequential or serial referrals.

    National Cord Blood Stem Cell Bank Program

        The Committee has provided $9,859,000 for the National Cord
    Blood Stem Cell Bank Network. The fiscal year 2005 comparable
    level was $9,859,000 and the administration did not request
    funds for this activity in fiscal year 2006.
        The Committee continues to be supportive of the effort to
    build the Nation's supply of cord blood stem cells available
    for therapy and research. The Committee notes that the
    Institute of Medicine study required by House Report 108-401
    has been completed and submitted to the Committee and HRSA. The
    Committee expects HRSA to begin implementation of this program
    as soon as possible.

    National Bone Marrow Donor Program

        The Committee provides $22,916,000 for the National Bone
    Marrow Donor Registry. The fiscal year 2005 comparable level
    was $25,416,000 and the administration request was $22,916,000.
    The National Bone Marrow Donor Registry is a network, operated
    under contract, which helps patients suffering from leukemia or
    other blood diseases find matching volunteer unrelated bone
    marrow donors for transplants. The program also conducts
    research on the effectiveness of unrelated marrow transplants
    and related treatments.

    Trauma Care

        The Committee provides $3,418,000 for trauma/emergency
    medical services. The fiscal year 2005 comparable level was
    $3,418,000 and the administration did not request funds for
    this program in fiscal year 2006. This program is intended to
    improve the Nation's overall emergency medical systems, which
    are constantly activated to respond to a wide range of natural
    and man-made disasters.

    State Planning Grants for Health Care Access

        The Committee has not provided funding for State Planning
    Grants for Health Care Access in fiscal year 2006. The fiscal
    year 2005 comparable level was $10,910,000 and the
    administration did not request funding for this activity in
    fiscal year 2006.

                             RURAL HEALTH PROGRAMS

    Rural Health Policy Development Program

        The Committee provides $8,825,000 for the Rural Health
    Policy Development Program. The fiscal year 2005 comparable
    level was $8,825,000 and the administration request was
    $8,528,000. The funds provide support for the Office of Rural
    Health Policy to be the focal point for the Department's
    efforts to improve the delivery of health services to rural
    communities and populations. Funds are used for rural health
    research centers, the National Advisory Committee on Rural
    Health, and a reference and information service.

    Rural Health Care Services Outreach Grants

        The Committee provides $39,278,000 for health outreach
    grants. The fiscal year 2005 comparable level was $39,278,000
    and the administration request was $10,767,000. This program
    supports projects that demonstrate new and innovative models of
    outreach in rural areas such as integration and coordination of
    health services.
        The Committee understands that many primary care clinics in
    isolated, remote locations are providing extended stay services
    and are not staffed or receiving appropriate compensation to
    provide this service. The Committee encourages HRSA to continue
    its support for a demonstration project authorized in the
    Medicare Modernization Act to evaluate the effectiveness of a
    new type of provider, the ``Frontier Extended Stay Clinic,'' to
    provide expanded services in remote and isolated primary care
    clinics to meet the needs of seriously ill or injured patients
    who cannot be transferred quickly to acute care referral
    centers, and patients who require monitoring and observation
    for a limited time.
        Mississippi's Delta is a community in which residents
    disproportionately experience disease risk factors and children
    are significantly mentally and physically developmentally
    behind. The Committee recognizes that communities such as this
    show positive behavioral change when community-based programs
    and infrastructure are in place. The Committee believes that
    collaborative programs offering health education, coordination
    of health services and health-related research offer the best
    hope for breaking the cycle of poor health in underprivileged
    areas such as the Mississippi Delta. Therefore, the Committee
    recommends the continued funding of these activities as already
    initiated and undertaken by the coordinated efforts of the
    Mississippi Delta Health Alliance, which is a collaboration
    involving Delta State University, Mississippi State University,
    the University of Mississippi Medical Center, and the
    Mississippi State Department of Health.

    Rural and Community Access to Emergency Devices

        The Committee provides $8,927,000 for rural and community
    access to emergency devices. The fiscal year 2005 comparable
    level was $8,927,000 and the administration request was
    $1,960,000. This provides funding for both the rural program
    under section 413 of the Public Health Service Act and the
    community access demonstration under section 313. These
    programs provide grants to expand placement of automatic
    external defibrillators [AEDs] and to ensure that first
    responders and emergency medical personnel are appropriately
    trained.

    Rural Hospital Flexibility Grants

        The Committee provides $64,180,000 for rural hospital
    flexibility grants. The fiscal year 2005 comparable level was
    $39,180,000 and the administration did not request funds for
    this program in fiscal year 2006.
        Under this program, eligible rural hospitals may convert
    themselves into limited service facilities termed Critical
    Access Hospitals. Such entities are then eligible to receive
    cost-based payments from Medicare. The grant component of the
    program assists States with the development and implementation
    of State rural health plans, conversion assistance, and
    associated activities.
        Of the amount provided, the Committee includes $15,000,000
    to continue the Small Rural Hospital Improvement Grant Program,
    as authorized by section 1820(g)(3) of the Social Security Act
    and Public Law 107-116 and outlined in House Report 107-342.
        The Committee has included $25,000,000 for a Rural Health,
    Education, and Workforce Infrastructure Demonstration Program
    which shall solicit and fund proposals from local governments,
    hospitals, universities, and rural public health-related
    entities and organizations for research development,
    educational programs, job training, and construction of public
    health-related facilities.

    State Offices of Rural Health

        The Committee provides $8,321,000 for the State Offices of
    Rural Health. The fiscal year 2005 comparable level was
    $8,321,000 and the administration request was $8,223,000. The
    State Office of Rural Health program helps the States
    strengthen rural heath care delivery systems by allowing them
    to better coordinate care and improve support and outreach in
    rural areas. The Committee believes that continued funds for
    this purpose are critical to improving access and quality
    health care services throughout rural communities.

    Rural Emergency Medical Services

        The Committee has provided $500,000 for the Rural EMS
    Training and Assistance Grants program. The comparable fiscal
    year 2005 level was $496,000 and the administration did not
    request funding for this program in fiscal year 2006.

    Native and Rural Alaskan Health Care

        The Committee provides $39,680,000 for the Denali
    Commission. The fiscal year 2005 comparable level was
    $39,680,000 and the administration did not request funding for
    this program in fiscal year 2006. These funds support
    construction and renovation of health clinics, hospitals and
    social service facilities in rural Alaska, as authorized by
    Public Law 106-113, to help remote communities in Alaska
    develop critically needed health and social service
    infrastructure for which no other funding sources are
    available, thereby providing health and social services to
    Alaskans in remote rural communities as they are in other
    communities throughout the country. The Committee expects the
    Denali Commission to allocate funds to a mix of rural hospital,
    clinic, long-term care and social service facilities, rather
    than focusing exclusively on clinic funding.

    Terrorism Preparedness

        The Committee provides $510,500,000 for bioterrorism
    preparedness related activities at HRSA. Within this total,
    $483,000,000 is provided for hospital preparedness grants and
    $27,500,000 is provided for education and curriculum
    development.
        The Committee intends that, at the discretion of the
    Secretary of Health and Human Services, funds provided for the
    hospital preparedness grants may be used for deployable mass
    casualty units (as requested in the Strategic National
    Stockpile), credentialing integration (as requested in the
    Office of the Secretary), and training a medical reserve corps
    (as requested in the Office of the Secretary). These deployable
    mass casualty units could provide key hospital surge capacity
    in the event of a terrorist attack or natural disaster. HRSA
    should continue to work with the Department and other HHS
    agencies to coordinate their terrorism preparedness activities.
        Within the total provided for hospital preparedness grants,
    the Committee approves the request for $25,000,000 to create a
    medical surge capacity national demonstration at Washington
    Hospital Center. The funding will increase emergency care
    capacity for the Nation's Capital, and serve as a national
    demonstration center for advanced mass casualty emergency
    facility design, training, and care.
        The Committee is concerned about the current HRSA strategy
    for providing training to health care professionals on
    bioterrorism preparedness. Many expert analyses, including
    several presented at the Secretary's Council on Public Health
    Preparedness, have stressed the need for a consistent, national
    curriculum for bioterrorism preparedness training. The
    Committee is troubled that, instead of adopting a consistent,
    national approach to training, HRSA has instead chosen to issue
    19 separate grants for continuing education on bioterrorism
    training, and a further 12 grants for curriculum development.
    The Committee believes that this approach risks producing a
    fragmented and uncoordinated bioterrorism preparedness training
    program instead of the integrated and coordinated program that
    is needed. The Committee instructs HRSA to seek ways to improve
    the coordination and consistency of its bioterrorism training
    program, and to report to the Committee on recommendations for
    achieving a consistent, national strategy for bioterrorism
    preparedness training no later than 6 weeks after the date of
    enactment of this Act.

    Family Planning

        The Committee provides $285,963,000 for the title X family
    planning program. The fiscal year 2005 comparable level was
    $285,963,000 and the administration request was $285,963,000.
        Title X grants support primary health care services at more
    than 4,600 clinics nationwide. About 85 percent of family
    planning clients are women at or below 150 percent of poverty
    level. Title X of the Public Health Service Act, which
    established the family planning program, authorizes the
    provision of a broad range of acceptable and effective family
    planning methods and preventive health services. This includes
    FDA-approved methods of contraception. The Committee believes
    that the authority for making grants under title X must remain
    unchanged.
        The Committee is aware of the findings of a recent HHS
    Inspector General's report, which documents efforts by the
    Office of Population Affairs to inform and periodically remind
    title X grantees of their responsibilities regarding State
    child abuse and sexual abuse reporting requirements. The report
    notes that OPA includes State reporting requirements in its
    reviews and site visits of grantees, and cites an extensive
    amount of effort and training that goes on within the program
    to ensure that clinicians are conversant with State reporting
    requirements, and trained to both recognize signs of sexual
    coercion and sexual violence and follow appropriate procedures
    when dealing with such cases.

    Health Care-related Facilities and Activities

        The Committee provides $480,751,000 for the construction
    and renovation (including equipment) of health care-related
    facilities and other health care-related activities. The fiscal
    year 2005 comparable level was $482,729,000 and the
    administration did not request funds for this program in fiscal
    year 2006. This account makes funds available to public and
    private entities for the construction and renovation of health
    care-related facilities and other health care-related
    activities.

    Program Management

        The Committee provides $143,992,000 for program management
    activities for fiscal year 2006. The fiscal year 2005
    comparable level was $147,080,000 and the administration
    request was $145,992,000.
        Section 340B of the Public Health Service Act created the
    340B Drug Discount Program to lower drug prices for over 10,000
    public health grantees including community health centers and
    public hospitals. The Committee notes that the program is
    growing rapidly due the growth in the number of Community
    Health Centers and an expansion of the number of rural and
    small hospitals eligible to be recognized as disproportionate
    share hospitals, contained in the Medicare Modernization Act.
    The Committee is deeply concerned that the Department lacks the
    oversight capability to ensure that safety-net organizations
    participating in the program receive the full statutory
    discounts. The Committee agrees with the Inspector General that
    participating entities must have the ability to independently
    verify that they are receiving the mandated discounts, and
    strongly urges HRSA to develop a mechanism by which this
    verification can take place.

                       HEALTH EDUCATION ASSISTANCE LOANS

        The Committee provides $4,000,000 to liquidate obligations
    from loans guaranteed before 1992. The fiscal year 2005
    comparable level was $4,000,000 and the administration request
    was $4,000,000. For administration of the HEAL Program
    including the Office of Default Reduction, the Committee
    provides $2,916,000. The fiscal year 2004 comparable level was
    $3,244,000 and the administration request was $2,916,000.
        The HEAL Program insures loans to students in the health
    professions. The Budget Enforcement Act of 1990, changed the
    accounting of the HEAL Program. One account is used to pay
    obligations arising from loans guaranteed prior to 1992. A
    second account was created to pay obligations and collect
    premiums on loans guaranteed in 1992 and after. Administration
    of the HEAL Program is separate from administration of other
    HRSA programs.

                  NATIONAL VACCINE INJURY COMPENSATION PROGRAM

        The Committee provides that $74,484,000 be released from
    the vaccine injury compensation trust fund in fiscal year 2006,
    of which $3,600,000 is for administrative costs. The total
    fiscal year 2005 comparable level was $69,151,000 and the total
    administration request was $73,716,000.
        The National Vaccine Injury Compensation Program provides
    compensation for individuals with vaccine-associated injuries
    or deaths. Funds are awarded to reimburse medical expenses,
    lost earnings, pain and suffering, legal expenses, and a death
    benefit. The vaccine injury compensation trust fund is funded
    by excise taxes on certain childhood vaccines.

                   Centers for Disease Control and Prevention

                    DISEASE CONTROL, RESEARCH, AND TRAINING

    Appropriations, 2005....................................  $4,775,810,000
    Budget estimate, 2006...................................   4,306,063,000
    House allowance.........................................   6,105,586,000
    Committee recommendation................................   6,254,215,000

        The Committee provides a program level of $6,254,215,000
    for the Centers for Disease Control and Prevention [CDC]. The
    Committee recommendation includes $5,989,115,000 in budget
    authority and an additional $265,100,000 via transfers
    available under section 241 of the Public Health Services Act.
    The fiscal year 2005 comparable program level was
    $4,775,810,000 and the administration requested program level
    was $4,306,063,000.
        The activities of the CDC focus on several major
    priorities: provide core public health functions; respond to
    urgent health threats; monitor the Nation's health using sound
    scientific methods; build the Nation's health infrastructure to
    insure our national security against bioterrorist threats;
    promote women's health; and provide leadership in the
    implementation of nationwide prevention strategies to encourage
    responsible behavior and adoption of lifestyles that are
    conducive to good health.

                              INFECTIOUS DISEASES

        The Committee recommends $1,709,361,000 for infectious
    disease related programs at the CDC. The fiscal year 2005
    comparable level was $1,679,889,000 and the administration
    requested a comparable level of $1,709,758,000 for fiscal year
    2006. The Committee recommendation includes $12,794,000 in
    transfers available under section 241 of the Public Health
    Services Act.
        The Coordinating Center for Infectious Diseases includes
    the National Center for Infectious Diseases, the National
    Center for STD, TB, and HIV Prevention, and the National
    Immunization Program.

    Infectious Diseases Control

        The Committee has provided $3,848,000 above the comparable
    amount for fiscal year 2005 to expand infectious diseases
    control activities. The Committee intends that all infectious
    diseases control activities be funded at least at the level of
    the administration's request and that the additional funds be
    used to address emerging issues as determined by CDC.
        These activities focus on: national surveillance of
    infectious disease; applied research to develop new or improved
    diagnoses; prevention and control strategies; working with
    State and local departments and private health care providers
    to transfer application of infectious disease prevention
    technologies; and strengthening the capability to respond to
    outbreaks of new or reemerging disease.
        Disease outbreaks endanger U.S. citizens at home and
    abroad, threaten U.S. Armed Forces overseas, and exacerbate
    social and political instability. Outbreaks can interfere with
    the global marketplace, affecting tourism, trade, and foreign
    investment. CDC's strategies to combat infectious diseases
    invest in and build upon both the public health system that was
    established over a century ago to increase the preparedness to
    address the emergence of dangerous new threats.
        Chronic Fatigue.--With near-completion of the restoration
    of $12,900,000 to the Chronic Fatigue Syndrome [CFS] research
    program in response to a report from the Inspector General
    dated May 12, 1999, the Committee commends CDC for developing a
    comprehensive CFS program. The Committee encourages CDC to
    provide sufficient resources to sustain efforts to identify
    biomarkers for CFS, educate health care providers about the
    diagnosis and treatment of CFS, and better inform the public
    about it to aid early detection and improve patient care. The
    Committee requests a report by May 1, 2006 providing a detailed
    accounting of how the $12,900,000 in restored funding has been
    used.
        Collaboration With Asia.--The Committee recognizes that
    strong collaborative ties with Asian countries are among the
    mechanisms which may contribute to the stability of the Asia/
    Pacific region. The multiethnic and multicultural population of
    Hawaii and its geographic location provide an ideal pathway for
    a CDC supported initiative with a focus on emerging infectious
    and chronic disease problems in Asia. The Committee also
    recognizes this has the potential for providing frontline
    protection for the United States mainland from emerging
    diseases, as well as assisting Asian countries with treatment
    for such diseases. The Committee encourages CDC to explore
    collaboration and joint funding of projects with Asian
    governments, such as Korea, to study immigrants in Hawaii as a
    mechanism for addressing both infectious and chronic disease
    burden and treatment in the Pacific.
        Hepatitis.--The Committee is concerned that more than 75
    percent of the 4 million people with hepatitis C are unaware of
    their condition. The Committee encourages CDC to collaborate
    with national voluntary health organizations to raise awareness
    of appropriate screening and medical follow up of target
    populations. The Committee is also aware of increasing rates of
    hepatitis A and B infections among select adult populations, as
    well as the alarming rate of individuals co-infected with both
    hepatitis C and HIV. The Committee encourages CDC to help
    increase hepatitis screening initiatives in the States. In
    addition, The Committee encourages CDC to consider focusing on
    education and awareness programs targeted at specific
    populations where there is a high prevalence of hepatitis B and
    where therapeutic interventions are increasingly effective.
        Liver Wellness.--The Committee continues to be concerned
    about the prevalence of hepatitis and encourages CDC to
    consider working with voluntary health organizations and
    professional societies to promote liver wellness with increased
    attention toward education and prevention.
        Meningococcal Disease.--Meningococcal disease is one of the
    few diseases that can be fatal or severely debilitating to a
    victim within a matter of hours of initial onset and yet is
    vaccine-preventable in most cases. The Committee is aware of
    the recent improvements in the meningitis vaccine and of recent
    CDC efforts to increase the availability and focus of
    information on Meningococcal disease and ways to prevent it so
    that the general public will be better educated on the symptoms
    and prevention methods. The Committee encourages the CDC to
    improve meningococcal education and adolescent immunization
    programs through partnerships with associations, such as the
    National Meningitis Association, to ensure that all families,
    especially those with adolescents and young adults, are
    effectively educated on this disease, vaccine availability, and
    all methods of prevention.
        Prevention Epicenter Program.--The Committee applauds CDC's
    support for the Prevention Epicenter Program and encourages CDC
    to continue and expand this program to address patient safety
    issues.
        Sepsis.--The Committee is aware that sepsis, an
    overwhelming systemic response to infection that leads to organ
    dysfunction and death, kills more that 215,000 Americans every
    year. The Committee understands that new treatments have been
    developed which significantly improve prognosis when sepsis is
    diagnosed in a timely fashion. In addition, new guidelines have
    been developed to aid health care professionals in identifying
    the syndrome. Unfortunately, too few medical personnel know how
    to properly diagnose sepsis. To improve patient outcomes, the
    Committee encourages CDC to develop a sepsis education program
    to train infectious disease physicians, emergency room doctors,
    and critical care nurses in the proper identification of
    sepsis.

    HIV, STD, and TB Prevention

        Recognizing the intersection among these diseases, and the
    need for a focal point for leadership and accountability, CDC
    combines HIV, STD, and TB activities to provide leadership in
    preventing and controlling human immunodeficiency virus
    infection, other sexually transmitted diseases [STDs], and
    tuberculosis. CDC works in collaboration with partners at
    community, State, national, and international levels, applying
    multi-disciplinary programs of research, surveillance,
    technical assistance, and evaluation. These diseases are not
    yet vaccine preventable and must be controlled and prevented by
    identifying, diagnosing, and treating infected persons;
    provision of confidential, culturally competent counseling to
    identify and reach those who have been exposed to infection and
    who may not know it; and individual and population level health
    promotion to reduce high risk behaviors.
        Within the total provided, $637,000 above the comparable
    amount for fiscal year 2005 has been provided for tuberculosis-
    related activities. All other activities are funded at the
    level of the administration's request.
        HIV/AIDS Prevention.--CDC's HIV/AIDS prevention programs
    are working in every State and territory to prevent new
    infections, link people who are already infected to medical
    care, and translate scientific research findings into practical
    prevention programs available to every person at risk. CDC will
    continue to adapt these prevention programs to meet new and
    different needs.
        Infertility Prevention.--The Committee notes that CDC is
    charged legislatively with instituting programs to help prevent
    infertility. CDC's current program activities in this matter
    are undertaken by the division of HIV/STD/TB and are limited to
    the prevention of venereal diseases. The Committee understands
    that there are numerous additional causes of infertility beyond
    sexually transmitted diseases, such as delayed child bearing,
    smoking, low or excessive body weight, exposure to hazardous
    environmental toxins, drug and alcohol abuse and, particularly
    for men, exposure to high temperatures. The Committee
    encourages CDC to consider expanding the scope of this program
    and provide greater support to public education on the risks to
    fertility.
        Oral Fluid Rapid HIV Tests.--The Committee is supportive of
    CDC's use of the oral fluid rapid HIV test in its HIV/AIDS
    activities. The Committee strongly encourages CDC to move
    forward as quickly as possible with the purchase of additional
    tests to sustain and expand these successful efforts.
        Tuberculosis.--The Committee is pleased with the efforts of
    the tuberculosis control program, which has reduced the number
    of new tuberculosis cases for the past 10 years. However, the
    number of new tuberculosis cases in foreign-born individuals in
    the United States remains a concern. Although tuberculosis
    rates have been falling, the Committee is aware that similar
    low rates have been achieved in the past only to see a
    reemergence of the disease due to inadequate control efforts.
    In the end, any savings achieved during that period were more
    than used to again gain control of the incidence of the
    disease. The Committee has provided $637,000 over the fiscal
    year 2005 level to expand tuberculosis control efforts to
    prevent a similar reemergence.
        The Committee understands that TB is an enormous health
    crisis in the developing world, killing 2 million people every
    year. In recent years, several new vaccine candidates for TB
    have been developed and have shown promising results when
    tested in animals. The Committee strongly encourages CDC to
    continue and, if possible, expand the existing TB vaccine
    research cooperative agreement.
        The Committee is aware that refugees entering the United
    States with TB pose a serious public health threat. In
    particular, multidrug resistant TB cases pose the deadliest and
    costliest risk. The Committee recognizes that over the past
    year an outbreak of TB has occurred among Hmong refugees from
    Thailand who have resettled in the United States, mainly in
    California, Minnesota and Wisconsin. In California alone, local
    health departments have detected 25 TB cases among 3,400 Hmong
    refugees from Thailand in the last 10 months, four of which are
    multidrug resistant. The Committee urges CDC to make resources
    available to States facing TB outbreaks among their refugee
    population.
        The Committee understands that the CDC plans to undertake a
    new initiative, the Intensified Support and Activities to
    Accelerate Control [ISAAC]. ISAAC targets tuberculosis in
    African Americans, tuberculosis along the U.S./Mexico border,
    allows for universal genotyping of all culture positive TB
    cases, and expands clinical trials for new tools for the
    diagnosis and treatment of TB. The Committee encourages the CDC
    to implement ISSAC to enhance and maximize strategies to
    accelerate the control and elimination of TB.

    Immunization

        The Committee recommends $510,706,000 for the program
    authorized under section 317 of the Public Health Service Act.
    The fiscal year 2005 comparable level was $480,794,000 and the
    administration requested $515,920,000 for fiscal year 2006. The
    Committee recommendation includes $12,794,000 in transfers
    available under section 241 of the Public Health Service Act.
    Within the total provided, all activities are funded at the
    level requested by the administration. The Committee has
    transferred $5,214,000 from Immunization to Global Health to
    continue to support global vaccination efforts. This is a
    technical change and should not result in any programmatic
    decrease in Immunization activities.
        The Omnibus Reconciliation Act of 1993 established a
    vaccine purchase and distribution system that provides, free of
    charge, all pediatric vaccines recommended for routine use by
    the Advisory Committee on Immunization Practices to all
    Medicaid-eligible children, uninsured children, underinsured,
    and native Americans through program-registered providers.
        Despite great success in lowering disease levels and
    raising immunization coverage rates, much remains to be done to
    ensure the protection of children and adults worldwide.
    Approximately 1 million 2-year-old children in the United
    States have not received one or more of the more established,
    recommended vaccines. New vaccines, although greatly beneficial
    to public health, complicate an already complex immunization
    schedule and make it increasingly difficult to ensure complete
    immunization. One of our Nation's greatest challenges is
    extending our success in childhood immunization to the adult
    population. The burden due to the occurrence of vaccine-
    preventable diseases in adults in the United States is
    staggering. As many as 50,000 U.S. adults die of influenza,
    pneumococcal infections and hepatitis B. CDC is addressing
    these obstacles to the greatest extent possible and continues
    to provide leadership to reduce disability and death resulting
    from diseases that can be prevented through vaccination.
        The Committee encourages CDC to increase section 317 grant
    support for infrastructure development and purchase of vaccines
    for the State of Alaska's universal immunization program. It
    has been brought to the Committee's attention that
    infrastructure costs of delivering vaccines to children in
    Alaska are substantially higher than in other areas of the
    country, because of the many small, remote communities which
    must be served primarily by air. The Committee encourages the
    agency to give careful consideration to Alaska's request for
    sufficient funding for the purchase of vaccines needed for 90
    percent of Alaskan children and to provide infrastructure
    support needed to deliver these vaccines at the community
    level, including development of a statewide immunization
    registry to ensure that all children in Alaska are immunized.
    The Committee notes that failure to immunize children in remote
    areas of Alaska results in deaths each year from exposure to
    open sewage lagoons and contaminated water.
        Vaccine Tracking.--The Committee is pleased by CDC's
    development of the Surveillance, Preparedness, Awareness and
    Response System and has included sufficient resources to
    provide the same level of support of these activities as in
    fiscal year 2005. In light of vaccine shortages that have
    occurred over the past several flu seasons, the Committee
    understands that this system could serve as a valuable
    surveillance and tracking system for private and public sector
    inventory levels of vaccine.

                                HEALTH PROMOTION

        The Coordinating Center for Health Promotion includes the
    National Center for Chronic Disease Prevention and Health
    Promotion and the National Center for Birth Defects and
    Developmental Disabilities.
        The Committee recommends $974,080,000 for Health Promotion
    related activities at the CDC. The fiscal year 2005 comparable
    level was $1,021,709,000 and the administration requested
    $964,421,000.
        The Committee recognizes the important role national non-
    governmental health organizations play in increasing the
    awareness of chronic disease prevention and birth defects and
    development disabilities issues. Therefore, the Committee has
    included $2,421,000 to allow for the award of projects to
    support the dissemination of information on the condition or
    disease and effective public health interventions or to conduct
    public and professional health awareness and education efforts.
    Using a competitive review process, each project should be
    awarded for a 3-year project period and should not exceed
    $1,000,000 per year.

                CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

        Within the total provided, the following amounts are
    provided for the specified activities above the comparable
    amount for fiscal year 2005: $300,000 to expand Heart Disease
    and Stroke related activities; $300,000 to expand Diabetes
    related activities; $404,000 to expand Cancer Prevention and
    Control activities; $3,000,000 to expand Tobacco related
    activities; $50,000 to expand oral health related activities;
    $310,000 to expand Prevention Center activities; $100,000 to
    expand the Racial and Ethnic Approach to Community Health
    Program; and $84,000 to expand Primary Immune Deficiency
    Syndrome-related activites. All other activities are funded at
    the level of the administration's request or as specified
    below.
        Chronic diseases have had a profound human and economic
    toll on our Nation. Nearly 125 million Americans today are
    living with some form of chronic condition, including cancer,
    cardiovascular disease, diabetes, arthritis, and various
    neurological conditions such as epilepsy. These and other
    chronic diseases now account for nearly 70 percent of all
    health care costs, as well as 70 percent of all deaths
    annually. A few modifiable risk factors bring suffering and
    early death to millions of Americans. Three such factors--
    tobacco use, poor nutrition, and lack of physical activity--are
    major contributors to our Nation's leading causes of death.
        Alzheimer's Disease and Healthy Aging.--The Committee
    understands that a growing body of evidence suggests that many
    of the same strategies that preserve overall health may also
    help prevent or delay the onset of Alzheimer's disease and
    dementia. Epidemiological studies reveal that individuals
    taking anti-inflammatory drugs to treat conditions such as
    arthritis have a lower-than-expected occurrence of Alzheimer's.
    Other studies appear to link known risk factors for diabetes
    and heart disease and risk factors for Alzheimer's and
    dementia. CDC, in cooperation with the Alzheimer's Association,
    is launching a new program aimed at educating the general
    public and health professionals on ways to reduce the risks of
    developing Alzheimer's disease by maintaining a healthy
    lifestyle. In light of the threat Alzheimer's presents as well
    as growing public interest in learning how to remain brain-
    healthy, the Committee recommends $1,700,000 to continue this
    important initiative.
        Amyotrophic Lateral Sclerosis.--The Committee understands
    that a national Amyotrophic Lateral Sclerosis [ALS] registry
    may enable unprecedented progress in understanding ALS.
    Although several sources of ALS patient information currently
    exist in varying forms around the world, this information is
    not as comprehensive as required for the needed research. The
    Committee provides $1,000,000 for pilot programs to begin to
    gather data for a nationwide ALS registry that will estimate
    the incidence and prevalence of the disease, promote a better
    understanding of the epidemiology of the disease, and provide
    data that will be useful for research on improving disease
    management and developing standards of care. CDC should, to the
    extent practicable, identify and coordinate with existing data,
    surveillance systems and registries, such as state-based ALS
    registries, the Department of Veterans Affairs ALS registry and
    the National Institute for Neurological Disorders and Stroke
    repository.
        Autoimmune Diseases.--The Committee encourages CDC to
    provide resources for the awareness and prevention of
    autoimmune diseases.
        Breast and Cervical Cancer.--The Committee commends the CDC
    for creating partnerships to address the early detection of
    breast cancer, particularly in historically underserved
    communities including the Native American, Hispanic, Asian
    Pacific Islander, and African American populations. As part of
    this initiative, the Committee is very interested in the
    innovative approaches, such as that of the Men Against Breast
    Cancer Partners In Survival Program, which focuses on the role
    of the male support-giver as an integral component of the early
    detection, patient care and survivorship of breast cancer.
        Cancer Prevention and Control.--The Committee is strongly
    supportive of the CDC cancer programs focused on awareness,
    education and early detection and has included a significant
    increase for these programs.
        The growth of cancer prevention and control programs within
    State health agencies has resulted in the recognition that
    improved coordination of cancer control activities is essential
    to maximizing resources and achieving desired cancer prevention
    and control outcomes. The Committee commends CDC for its work
    with health agencies to enhance the number and quality of
    cancer-related programs that are available to the U.S.
    population and to develop an integrated and coordinated
    approach to reduce the cancer burden through prevention, early
    detection, treatment, and rehabilitation.
        Within the amounts provided, the following amounts are
    provided for the specified activities above the comparable
    amount for fiscal year 2005: $136,000 to expand comprehensive
    cancer activities and $200,000 to expand activities related to
    the Geraldine Ferraro Cancer Education Program. All other
    activities are funded at the level of the administration's
    request.
        Cancer Survivorship Resource Center.--The Committee
    supports the ongoing partnership between CDC and the Lance
    Armstrong Foundation to address the needs of the approximately
    10 million cancer survivors and their families and friends. The
    Committee has included sufficient resources to provide at least
    the same level of support for LiveStrong, the National Cancer
    Survivorship Resource Center, as was provided in fiscal year
    2005.
        Chronic Kidney Disease.--The Committee previously has
    expressed concern regarding the need to expand public health
    strategies to combat chronic kidney disease [CKD] given that
    many individuals are diagnosed too late to initiate treatment
    regimens that could reduce morbidity and mortality. Twenty
    million Americans have CKD, and another 20 million are at risk
    of developing the disease. Individuals with diabetes or
    hypertension have especially high vulnerability. Kidney disease
    is the 9th leading cause of death in the United States, and
    death by cardiovascular disease is 10 to 30 times higher in
    kidney dialysis patients than in the general population.
    Further, the number of individuals with end stage renal disease
    [ESRD], irreversible kidney failure requiring either dialysis
    or a transplant to remain alive, is expected to increase from
    372,000 patients in 2000 to over 660,000 by 2010. Therefore,
    the Committee has included an increase of $1,800,000 for CKD to
    develop capacity and infrastructure at CDC for a kidney disease
    surveillance, epidemiology, and health outcomes program; award
    grants to support several State-based demonstration projects
    for CKD prevention and control; and under the leadership of a
    national voluntary health organization and in collaboration
    with CDC, convene a consensus conference of experts in the area
    of kidney disease and other stakeholders to lay the groundwork
    for a formal Public Health Kidney Disease Action Plan for
    prevention and control of kidney disease.
        Chronic Obstructive Pulmonary Disease.--Chronic Obstructive
    Pulmonary Disease [COPD] is the fourth leading cause of death
    in the United States and the only one of the top 10 causes of
    death that is on the increase. The Committee urges the CDC to
    expand its data collection efforts on COPD. Specifically, the
    Committee encourages the CDC to include questions on COPD in
    the National Health and Nutrition Examination Survey, the
    National Health Interview Study and the Behavioral Risk Factor
    Surveillance Survey that asks about COPD by name.
        Colorectal Cancer.--The Committee understands that
    colorectal cancer is the third most commonly diagnosed cancer
    among both men and woman in the United States, and the second
    leading cause of cancer related deaths. When colorectal cancer
    is detected and treated early, survival is greatly enhanced.
    However, despite the availability of proven screening tests,
    only 37 percent of colorectal cancers are diagnosed while the
    disease in still in a localized stage.
        The Committee is pleased with the leadership of CDC's
    National Colorectal Cancer Roundtable in promoting the
    availability and advisability of screening to both health care
    providers and the general public. The Committee encourages the
    CDC to continue to expand its partnerships with State health
    departments, professional and patient organizations, and
    private industry to combat this devastating disease.
        Delta Health Initiative.--The Mississippi Delta Region
    experiences some of the Nation's highest rates of chronic
    diseases, such as diabetes, hypertension, obesity, heart
    disease and stroke. The Committee recognizes the efforts of the
    Delta Health Alliance in health education, coordination of
    health services and health-related research in the Mississippi
    Delta. The Committee believes that such collaborative,
    community-based programs offer the best hope for breaking the
    cycle of poor health in underprivileged areas such as the
    Mississippi Delta. The Committee recommends that the CDC
    collaborate with the Delta Health Alliance in addressing the
    chronic health issues of the Mississippi Delta.
        Diabetes.--The Committee commends CDC for implementation of
    SEARCH, a pilot study to determine the incidence and prevalence
    of diabetes in youth under the age of 20 years in six locations
    around the United States. The Committee encourages CDC to
    consider developing a plan to use the information gathered from
    SEARCH to create a national registry of patients afflicted with
    juvenile diabetes. In addition, the Committee encourages CDC to
    take advantage of the opportunity to also collect information
    about the standard of care available to people with diabetes
    nationwide. Samples from this study may represent a valuable
    scientific resource, and the Committee encourages CDC to
    consider making these samples and information available to the
    research community.
        The Committee encourages the CDC to continue and expand its
    efforts to standardize the measurement of C-peptide as a
    surrogate marker for pancreatic beta cell function. The
    development and validation of reliable, standard assays for C-
    peptide have the potential to significantly accelerate
    regulatory approval of new therapies to prevent or reverse
    autoimmune diabetes.
        Diabetes and Obesity in Minority Populations.--The
    Committee is concerned by the toll that the twin epidemics of
    diabetes and obesity are taking on the health of minorities. An
    effective culturally-sensitive response is urgently needed to
    address this escalating epidemic. The Committee encourages CDC
    to fund initiatives of national and community organizations
    that have the capacity to carry out coordinated health
    promotion programs that will focus on diabetes and obesity in
    minority communities. The Committee encourages CDC to seek out
    organizations directed by and serving individuals from
    communities with disproportionate diabetes and obesity rates.
        The high incidence of diabetes among Native American,
    Native Alaskan, and Native Hawaiian populations persists. The
    Committee is pleased with the CDC's efforts to target this
    population, in particular, to assist the leadership of Native
    Hawaiian and Pacific Basin Islander communities. It is
    important to incorporate traditional healing concepts and to
    develop partnerships with community health centers. The
    Committee encourages CDC to build on all its historical efforts
    in this regard.
        Epilepsy.--The Committee supports the CDC epilepsy program,
    which is making progress in research, epidemiology and
    surveillance, early detection, improved treatment, public
    education and expansion of interventions to support people with
    epilepsy and their families in their communities. The Committee
    applauds CDC's partnership with the Epilepsy Foundation in
    developing the recommendations of Living Well with Epilepsy II.
    Sufficient funding has been provided to continue this
    partnership and to implement ongoing epilepsy public health
    programs.
        Genomic Medicine.--The Committee is aware that steps need
    to be taken today to prepare the public health system for the
    coming widespread use of genetic technologies in healthcare.
    Failing to do so may exacerbate existing health disparities and
    seriously limit progress generated by the Human Genome Project.
    The Committee urges CDC to move forward aggressively with the
    creation and implementation of partnerships with industry and
    the nonprofit sector to achieve the widest benefits from the
    coming era of genomic medicine.
        Geraldine Ferraro Cancer Education Program.--In fiscal year
    2004, Congress provided funding to initiate the Geraldine
    Ferraro Cancer Education Program, as authorized by the
    Hematological Cancer Research Investment and Education Act of
    2002. The Committee is pleased that CDC has established a
    cooperative agreement program with national health
    organizations to develop strategies to provide information and
    education for patients, their family members, friends, and
    caregivers with respect to hematologic cancers. The Committee
    expects CDC to increase efforts to address hematologic cancer
    survivorship issues and improve quality of national hematologic
    data. With the additional funds provided, the Committee
    strongly encourages CDC to support activities related to the
    development of interactive web based education for health care
    providers on the signs, symptoms and current treatment of blood
    cancer by comprehensive cancer centers.
        Glaucoma and Other Vision Disorders.--Age-related threats
    to sight, including age-related macular degeneration, glaucoma,
    cataracts and diabetic retinopathy are expected to nearly
    double by the year 2030 with the aging of the baby-boomer
    generation. Recognizing this emerging public health threat, the
    Committee is aware of the demonstrated success of vision
    screening programs in preventing blindness and vision
    impairments among many of the more than 30 million adults that
    suffer from eye-related disorders.
        The Committee is encouraged by the CDC's exploration of
    strategies to implement a national initiative to combat the
    effects of eye-related disorders, especially glaucoma. The
    Committee has included sufficient resources to maintain at
    least the fiscal year 2005 level for vision screening and
    education programs in partnership with national voluntary
    health agencies and for CDC to continue to develop a national
    surveillance system to monitor trends over time and assess the
    economic costs of vision loss especially related to glaucoma.
    In addition, the Committee has again included sufficient
    resources to maintain at least the fiscal year 2005 level of
    funding for a model project that is testing and evaluating the
    efficacy of glaucoma screening using mobile units.
        Heart Disease and Stroke.--The Committee understands that
    CDC is establishing a Heart Disease and Stroke Division to
    consolidate and elevate its efforts to prevent and control
    heart disease, stroke and other cardiovascular diseases. The
    Committee supports the goal of establishing a Heart Disease and
    Stroke Prevention program in each State. The Committee
    encourages CDC to maintain support for these activities in
    fiscal year 2006 within the funds provided.
        Inflammatory Bowel Disease.--The Committee understands that
    an estimated 1 million people in the United States may suffer
    from Crohn's disease or ulcerative colitis, collectively known
    as inflammatory bowel disease [IBD]. In fiscal year 2005, the
    Committee provided funds to continue a national IBD
    epidemiology program established through a partnership between
    CDC and the Crohn's and Colitis Foundation of America. The
    Committee encourages the CDC to continue this important
    initiative and has provided sufficient resources to do so.
        Interstitial Cystitis.--The Committee is pleased by the
    establishment of a cooperative agreement between the CDC and
    the Interstitial Cystitis Association and has included funds to
    continue the public and professional education initiative
    regarding interstitial cystitis.
        Lung Disease.--The Committee encourages the CDC to consider
    supporting efforts to validate the importance of spirometry
    screenings in early detection of lung disease. Such efforts
    include further research and development of projects to
    facilitate the translation of new scientific knowledge into
    spirometry public health screening programs. The Committee
    urges the CDC to coordinate with the National Heart, Lung and
    Blood Institute in translating the results of these efforts
    into guidance for public health programs, including vital signs
    and screening programs.
        Lupus.--The Committee recognizes that lupus is a serious,
    complex, debilitating chronic autoimmune disease that can cause
    inflammation and tissue damage to virtually any organ system in
    the body and impacts between 1.5 and 2 million individuals. The
    Committee is concerned by the lack of reliable epidemiological
    data on the incidence and prevalence of all forms of lupus
    among various ethnic and racial groups. The Committee
    encourages CDC to consider modifying the National Lupus Patient
    Registry to create a common data entry and management system
    across all study sites, to collaborate with a consortium of
    academic health centers with an expertise in lupus
    epidemiology, and to ensure that study sites represent
    different geographic regions of the United States that have a
    sufficient number of individuals of all racial and ethnic
    backgrounds disproportionately affected by Lupus, including
    Hispanics, Asians, Native Americans, and African Americans.
        Mind-Body Research.--The Committee continues to support
    mind-body research and has provided sufficient funding to
    continue these efforts in the same form and at the same level
    as in fiscal year 2005.
        National Information Center on Vision Loss.--The Committee
    encourages CDC to create a National Information Center on
    Vision Loss to address the need for access to appropriate
    public health information to improve the well being and prevent
    further disability and disease among persons who are blind or
    visually impaired. The Committee encourages CDC to partner with
    a national nonprofit organization that has regional offices
    throughout the United States and is recognized for its
    dedication and leadership in providing information to persons
    who are blind.
        Nutrition, Physical Activity and Obesity.--Obesity is
    rampant in the United States. Between 1980 and 1994, the
    prevalence of obesity in the United States has increased by 100
    percent in children and adolescents. More than 20 percent of
    the adult population is 30 pounds or more overweight and 10 to
    15 percent of children and adolescents are overweight. Risk
    factors associated with obesity--physical inactivity and
    unhealthy eating--account for at least 300,000 preventable
    deaths each year and increase the risk for many chronic
    diseases like diabetes, heart disease and cancer. The Committee
    is aware that the CDC's own statistics show that Native
    Americans, including Native Alaskans and Native Hawaiians
    suffer higher rates of obesity than other Americans. The
    Committee has included sufficient resources to provide the same
    level of support provided in fiscal year 2005 for Nutrition,
    Physical Activity, and Obesity related activities.
        The multiple factors contributing to the overweight and
    obesity epidemic took years to develop. Reversing the epidemic
    will require a long-term, well-coordinated, concerted approach
    to reach Americans where they live, work, play, and pray.
    Effective collaboration among the public, voluntary, and
    private sectors is critical to reshape the social and physical
    environment of our Nation's communities and provide the
    necessary support, information, tools, and realistic strategies
    needed to reverse the current obesity trends nationwide.
        To reduce consumer confusion about the myriad of health
    messages about obesity, diabetes, and cardiovascular disease,
    the Committee encourages CDC to design and develop mechanisms
    for fast-tracked translation of research into reasoned guidance
    for the American public.
        To prevent unhealthy weight gain and maintain healthy
    weight among children and adolescents, CDC is encouraged to
    work with the U.S. Department of Education to issue a report
    with recommendations about reintroducing physical education
    into the school day.
        Oral Health.--The Committee recognizes that to effectively
    reduce disparities in oral disease will require improvements at
    the State and local levels. The Committee has provided
    additional funding to States to strengthen their capacities to
    assess the prevalence of oral diseases, to target
    interventions, such as additional water fluoridation and
    school-linked sealant programs, and resources to the
    underserved, and to evaluate changes in policies, programs and
    disease burden. The Committee encourages the CDC to advance
    efforts to reduce the disparities and health burden from oral
    cancers that are closely linked to chronic diseases such as
    diabetes and heart disease.
        The Committee is concerned about the rising obesity rate
    among American's youth. Some eating habits can adversely affect
    not only body weight but also oral health. The Committee has
    provided $50,000 above the fiscal year 2005 level for the CDC
    Division of Oral Health to develop an instructional video for
    school age children on the harmful effects of excessive
    consumption of soft drinks. The Committee understands that the
    dental community has already developed some instructional
    materials and urges CDC to work with the American Dental
    Association in producing the video.
        Osteoporosis and Bone Health Action Plan.--The Committee is
    aware of the Surgeon General's report on Bone Health and
    Osteoporosis. The Surgeon General calls for a national action
    plan for bone health. The Committee encourages CDC to
    collaborate with a leading national voluntary health
    organization focused on osteoporosis and bone health to confer
    with other relevant Federal agencies and public and private
    stakeholders to develop a National Action Plan on Bone Health
    and Osteoporosis.
        Prevention Centers.--The Committee encourages the continued
    support of center activities aimed at improving knowledge about
    the effective models for health promotion programs for persons
    with disabilities.
        The Committee continues to support within the prevention
    center program a Tobacco Prevention Research Network to
    increase the knowledge base on the most effective strategies
    for preventing and reducing youth tobacco use, as well as on
    the social, physiological, and cultural reasons for tobacco use
    among children.
        Primary Immunodeficiency Diseases.--Congress has made funds
    available for CDC to support the national physician education
    and public awareness campaign developed by the Jeffrey Modell
    Foundation. The Foundation program has generated more than
    $35,000,000 in donated media coverage, resulted in substantial
    increases in the number of diagnosed patients, and is a model
    of public-private cooperation. The campaign has featured public
    service announcements, physician symposia, publications, and
    the development of website and educational materials, as well
    as mailings to physicians, school nurses, daycare centers, and
    others. The campaign was expanded to reach the underserved
    African-American population in fiscal year 2005, and the
    Committee has provided $84,000 above the fiscal year 2005 level
    to further expand the program to Hispanic communities in fiscal
    year 2006.
        Prostatitis.--The Committee understands that up to 10
    percent of the male population worldwide may benefit from
    better methods to diagnose and prevent prostatitis. The
    Committee encourages CDC to consider expanding its
    investigation of the etiology of prostatitis.
        Psoriasis.--The Committee urges CDC to consider working
    with a national organization to develop a surveillance program
    to ascertain and monitor psoriasis and psoriatic arthritis
    prevalence and comorbidities.
        Pulmonary Hypertension.--The Committee continues to be
    interested in pulmonary hypertension [PH], a rare, progressive
    and fatal disease that predominantly affects women, regardless
    of age or race. PH causes deadly deterioration of the heart and
    lungs and is a secondary condition in many other serious
    disorders such as scleroderma and lupus. Because early
    detection of PH is critical to a patient's survival and quality
    of life, the Committee encourages CDC to consider supporting a
    cooperative agreement with the pulmonary hypertension community
    to foster greater awareness of the disease.
        Reorganization.--The Committee understands that the CDC is
    considering the reorganization of programs under the
    Coordinating Center on Health Promotion, particularly programs
    under the National Center on Chronic Disease Prevention and
    Health Promotion. The Committee encourages the Director to work
    closely with external partners to adopt changes that will
    streamline administrative functions, improve and strengthen
    collaboration among programs, and increase public awareness of
    these serious illnesses.
        REACH Initiative.--The Committee recognizes the strengths
    that national/multi-geographical minority organizations may be
    able to provide to the REACH Initiative. Such organizations
    could have the capacity to influence communities through pre-
    existing coalitions and collaborative relationships. Such
    organizations may also be able to provide key support to local
    organizations that may lack the infrastructure needed to fully
    implement the programmatic activities required for this
    important program. The Committee urges CDC to include such
    organizations among the entities that are eligible to compete
    for funding without preventing other applicants from receiving
    these grants.
        Sleep Disorders.--The Committee continues to be concerned
    about the prevalence of sleep disorders and recognizes the need
    for enhanced public and professional awareness on sleep and
    sleep disorders. The Committee encourages CDC to consider
    working with other agencies and voluntary health organizations
    to support the development of a sleep education and public
    awareness initiative.
        Steps to a Healthier United States.--The Committee applauds
    the Department's continued commitment to tackling the problems
    of obesity, diabetes, and asthma. The Committee agrees that
    these are three of the most critical chronic conditions
    afflicting Americans. The Committee is concerned that existing
    programs that address these problems have not yet been
    implemented in all of the States. The Committee has provided
    sufficient resources to continue this initiative and existing
    programs within CDC that are aimed at obesity, diabetes, and
    asthma. The Committee strongly urges CDC to coordinate the
    efforts of these programs such that the best possible outcome
    is achieved using these funds.
        Thrombosis.--The Committee understands that thrombosis is a
    serious public health problem and that there is a great need to
    increase public awareness of thrombosis and thrombophilia among
    the public and the medical community. Information on the basic
    epidemiology of thrombosis and thrombophilia remains to be
    collected. The Committee encourages CDC to expand its efforts
    by partnering with a volunteer health organization to expand
    its outreach and education programs regarding thrombosis and
    thrombophilia.
        Tobacco Use.--The Committee recognizes the effectiveness of
    State and national counter-marketing campaigns in reducing
    youth tobacco use and the diminishing resources at the State
    and national levels for such efforts. The Committee has
    provided increased funding for tobacco activities to support
    counter marketing programs targeting areas with the highest
    rates of youth tobacco use.
        Vision Screening.--The Committee commends CDC for its
    partnership with a leading voluntary health association
    dedicated to fighting blindness and saving sight, improving
    education and early detection of potentially blinding eye
    diseases. Despite the fact that half of all blindness can be
    prevented through education, early detection and treatment, it
    is estimated that the number of blind and visually impaired
    people will double by 2030 if nothing is done to curb vision
    problems. To address this growing public health problem, the
    Committee has provided sufficient resources to continue this
    partnership with the same association.

    Birth Defects, Developmental Disabilities, Disability and Health

        Within the total provided, the following amounts are
    provided for the specified activities above the comparable
    amount for fiscal year 2005: $200,000 to expand autism
    surveillance, awareness, and education activities; $75,000 to
    expand the National Spina Bifida Program; $73,000 to expand
    surveillance and epidemiological efforts of Duchenne and Becker
    muscular dystrophies; $48,000 to expand support for the Special
    Olympics Healthy Athletes Initiative and $500,000 to expand the
    activities of the Christopher and Dana Reeve Paralysis Resource
    Center; all other sub-activities are funded at the level of the
    administration's request. In addition, the Committee has
    provided $936,000 over the fiscal year 2005 level for
    undesignated birth defect-related activities.
        Autism.--The Committee is aware of the progress that has
    been made with the autism programs at CDC. The Committee
    acknowledges the importance of this work by the CDC in the area
    of autism surveillance and research, and urges this work to
    continue in a timely manner. Within funds provided, $100,000 in
    new funding is available to fund the Center's surveillance and
    research programs including the CADDRE and ADDM Network. The
    Committee is pleased to see the work being done in the area of
    the national awareness campaign and provides an additional
    $100,000 for the Center to expand its work on this initiative.
        Centers for Birth Defects Research and Prevention.--The
    Committee encourages CDC to consider expanding the promising
    research being conducted by the regional Centers for Birth
    Defects Research and Prevention and maintain assistance to
    States to implement and expand community-based birth defects
    tracking systems, programs to prevent birth defects, and
    activities to improve access to health services for children
    with birth defects. The Committee also encourages CDC to
    continue to support collaboration among the States on issues
    related to surveillance, research and prevention through
    support of the National Birth Defects Prevention Network.
        CHADD Resource Center.--The Committee is aware that some
    estimates indicate that as many as 7 percent of school-age
    children have Attention-Deficit/Hyperactivity-Disorder [AD/HD]
    and more than two-thirds of these children will continue to
    experience symptoms through adulthood. The Committee has been
    informed that only half of all children with AD/HD receive
    necessary treatment with lower diagnostic and treatment rates
    among girls, minorities and children in foster care. The
    Committee continues to support the National Resource Center on
    AD/HD and has provided sufficient resources to provide the same
    level of support as was provided in fiscal year 2005.
        Christopher and Dana Reeve Paralysis Resource Center.--The
    Committee understands the growing demand for information,
    resources, and public health services by individuals with
    paralysis. The Committee has included $500,000 above the fiscal
    year 2005 level for the Paralysis Resource Center and the
    associated rehabilitation therapy program. The Committee
    encourages CDC to evaluate the public health effectiveness of
    the paralysis programs and explore the feasibility of health
    care system-wide implementation of new rehabilitation programs.
        Cooley's Anemia.--The Committee is pleased with the
    progress that CDC has made with regard to the establishment of
    a blood safety surveillance program for Cooley's anemia
    patients, who are the largest consumers of red blood cells. Six
    treatment centers throughout the Nation handle the medical
    monitoring and treatment; the Cooley's Anemia Foundation
    provides education and awareness, patient recruitment, and
    other services; and, CDC has created an archive of tested and
    analyzed blood samples. The Committee expects CDC to direct an
    increasing amount of the funds available to education and
    awareness, patient recruitment and other related services.
        Craniofacial Malformation.--The Committee has continued
    funding for CDC's initiatives to help families of children with
    craniofacial malformations. The Committee commends CDC for
    their work with the National Foundation for Facial
    Reconstruction and has provided funds to continue the
    Foundation's efforts with Arkansas, Iowa, and New York and
    possibly other States to collect data on the prevalence of
    these malformations, the ability of families to access
    services, and the long-term outcomes associated with
    craniofacial malformation. Funds are also available to analyze
    and disseminate this information to families and health care
    professionals and to define and categorize established
    standards of optimal care.
        Diamond Blackfan Anemia.--The Committee has provided
    sufficient funds to continue CDC's public health outreach and
    surveillance program for Diamond Blackfan Anemia [DBA]. These
    funds should continue to be used to (a) educate clinicians and
    blood disorder treatment centers about DBA and how to diagnose
    it and (b) collaborate with a Clinical Care Center, which
    already has significant experience in treating DBA patients, to
    create a critical mass of DBA expertise where DBA patients may
    be referred.
        Disabilities Prevention.--The Committee continues to
    strongly support the CDC disabilities prevention program, which
    provides support to States and academic centers to reduce the
    incidence and severity of disabilities, especially
    developmental and secondary disabilities.
        Down Syndrome.--The Committee understands that CDC is
    performing a study to estimate the number of people in the
    United States living with Down syndrome and identify them by
    age and ethnic group and expects to have preliminary results by
    the end of fiscal year 2005. A second study will document the
    onset and course of secondary and related developmental and
    mental disorders in individuals with Down syndrome. The
    Committee has provided sufficient resources to further develop
    this studies in fiscal year 2006.
        Duchenne and Becker Muscular Dystrophy.--The Committee has
    provided $6,000,000 to continue and expand surveillance,
    epidemiological, and education efforts for Duchenne and Becker
    muscular dystrophy. The Committee is pleased that the CDC and
    the Parent Project Muscular Dystrophy have established a
    coordinated education and outreach initiative and has provided
    sufficient resources to continue this initiative at least at
    the fiscal year 2005 level. The Committee requests that CDC
    develop and submit to the Committee a 5-year strategic plan for
    the Duchenne and Becker Muscular Dystrophy program by May 1,
    2006.
        Fetal Alcohol Spectrum Disorders.--The Committee is
    concerned by the prevalence of Fetal Alcohol Spectrum Disorders
    [FASD] in the United States and notes that drinking during
    pregnancy is the Nation's leading known preventable cause of
    mental retardation and birth defects. FASD affects 1 in 100
    live births or as many as 40,000 infants each year, and an
    individual with fetal alcohol syndrome can incur a lifetime
    health cost of over $800,000. To publicize and promote
    awareness of this critical updated public health information,
    the Committee has provided sufficient resources to continue
    these activities.
        Fetal Deaths.--CDC has reported that fetal deaths at 20
    weeks gestation or greater account for nearly as many deaths as
    those that occur to infants during the first year of life. In
    fiscal year 2005, the Committee included funding to implement a
    demonstration project with several States to link existing
    birth defect surveillance systems and fetal death registries
    and to use that data to help develop strategies to reduce fetal
    deaths. The Committee is aware that the first year of the
    demonstration project was highly successful. A review of the
    public health burden of fetal deaths, identification of data
    gaps related to surveillance and risk factors, and a plan to
    expand broader birth defects surveillance to include
    surveillance of fetal deaths were produced. The Committee
    supports continued funding of the project at the same level in
    fiscal year 2006 to develop a detailed protocol for the
    surveillance project, which should include identifying possible
    data sources, developing and testing data collection
    instruments and standard methods for surveillance of fetal
    deaths, and pilot testing and evaluating the surveillance
    project.
        Fragile X.--The Committee is encouraged by the CDC's
    progress in establishing a Fragile X public health program to
    expand surveillance and epidemiological research of Fragile X,
    as well as provide patient and provider outreach on Fragile X
    and other developmental disabilities. The Committee has
    provided sufficient resources to continue these activities.
        Genomic Medicine.--The Committee is aware that steps need
    to be taken today to prepare the public health system for the
    coming widespread use of genetic technologies in healthcare.
    Failing to do so may exacerbate existing health disparities and
    seriously limit progress generated by the Human Genome Project.
        Hemophilia.--The Committee supports CDC's continued efforts
    with the National Hemophilia Foundation to carry out needed
    education, prevention, blood safety surveillance, and outreach
    programs for the millions of people in the United States
    affected by bleeding and clotting disorders, including
    hemophilia, women's bleeding disorders, and thrombophilia. The
    Committee encourages CDC to consider enhancing its support of
    the network to ensure continued access to this comprehensive
    chronic care model for all persons with bleeding and clotting
    disorders.
        The Committee recognizes the important work of all
    voluntary organizations concerned with hemophilia, and
    encourages CDC to take steps to ensure that additional patient-
    based organizations can participate in its hemophilia grant
    program on an annual basis.
        Hereditary Hemorrhagic Telangiectasia.--The Committee is
    aware of interest in the establishment of a Hereditary
    Hemorrhagic Telangiectasia [HHT] National Resource Center
    through a partnership between the CDC and the national
    voluntary agency representing HHT families. The Committee
    encourages the CDC to examine carefully proposals to establish
    such a center and give appropriate consideration to supporting
    it within the funds provided.
        Human Genome Project.--The Committee urges CDC to move
    forward aggressively with the creation and implementation of
    partnerships with industry and the nonprofit sector to achieve
    the widest benefits from the coming era of genomic medicine.
        Limb Loss Information Center.--The Committee understands
    that more than 1.5 million Americans are living with limb loss
    due to diabetes, heart disease, trauma, and cancer. A key
    challenge facing individuals with limb loss is gaining access
    to necessary health and rehabilitative services. The Committee
    commends CDC for its collaborations with voluntary
    organizations, such as the Amputee Coalition of America, to
    identify strategies to remove these barriers. The Committee
    continues to support the CDC's resource and information center,
    which assists individuals living with disabilities, and their
    families, in need of information on medical, physical, and
    emotional needs, and resources and support to reintegrate
    socially and economically into society. The Committee
    encourages CDC to continue its support of the existing Center
    at no less than the fiscal year 2005 level.
        Special Olympics Healthy Athletes Initiative.--To address
    the unmet health needs among its athletes, Special Olympics
    created the Healthy Athletes Program, which provides Special
    Olympics athletes access to an array of health assessment,
    education, preventive health services and supplies, and
    referral for follow-up care where needed. These services are
    provided to athletes without cost in conjunction with
    competitions at local, State, national, and international
    levels. The Committee has included $48,000 above the fiscal
    year 2005 level for this program.
        Spina Bifida.--The Committee recognizes that Spina Bifida
    is the leading permanently disabling birth defect in the United
    States. While Spina Bifida and related neural tube defects are
    highly preventable through proper nutrition, including
    appropriate folic acid consumption, and its secondary effects
    can be mitigated through appropriate and proactive medical care
    and management, such efforts have not been adequately supported
    or coordinated to result in significant reductions in these
    costly conditions. Also, the Committee supports the Memorandum
    of Understanding between CDC and the Agency for Healthcare
    Research and Quality to examine clinical treatment of Spina
    Bifida and improve quality of life.

                         HEALTH INFORMATION AND SERVICE

        The Coordinating Center for Health Information and Services
    includes the National Center for Health Statistics [NCHS], a
    new National Center for Health Marketing, and a new National
    Center for Public Health Informatics.
        The Committee recommends a program level of $223,799,000
    for Health Information and Service related activities at the
    CDC. This recommendation includes $134,235,000 in transfers
    available under section 241 of the Public Health Service Act.
    The fiscal year 2005 comparable program level was $228,673,000
    and the administration requested $223,799,000.

    Health Statistics

        CDC's statistics give context and perspective on which we
    can base important public health decisions. By aggregating the
    experience of individuals, CDC gains a collective understanding
    of health, collective experience with the health care system,
    and our problems and public health challenges. NCHS data are
    used to create a basis for comparisons between population
    groups or geographic areas, as well as an understanding of how
    trends in health change and develop over time.
        The NCHS is the Nation's preeminent source of health
    statistics and therefore provides the foundation for assessing
    National health trends and developing sound programs and
    policies to protect and enhance the Nation's health. The
    Committee is concerned with the adequacy and overall
    coordination of the various Federal programs that collect,
    analyze, and report the health statistics necessary for policy
    development and public health interventions. During this period
    of rapid advance in health and welfare policy, medical
    practice, and biomedical knowledge, the Committee is committed
    to ensuring that timely and relevant health statistics are
    available to guide policy decisions. The Committee has provided
    additional funds for the NCHS to strengthen its data collection
    infrastructure.
        Eating Disorders.--The Committee is concerned about the
    growing incidence and health consequences of eating disorders
    among the population. The extent of the problem while estimated
    by several long-term outcome studies as being high remains
    unknown. The Committee urges the CDC to research the incidence
    and morbidity and mortality rates of eating disorders,
    including anorexia nervosa, bulimia nervosa, binge eating
    disorder, and eating disorders not otherwise specified across
    age, race, and sex.

                   ENVIRONMENTAL HEALTH AND INJURY PREVENTION

        The Coordinating Center for Environmental Health and Injury
    Prevention includes the National Center for Environmental
    Health, the Agency for Toxic Substances and Disease Registry,
    and the National Center for Injury Prevention and Control.
        The Committee recommends $288,982,000 for environmental
    health and injury prevention related activities at the CDC. The
    fiscal year 2005 comparable level was $285,721,000 and the
    administration requested $284,820,000 for fiscal year 2006.

    Environmental Health

        Within the total provided, $400,000 above the fiscal year
    2005 level is to expand the Health Tracking Network. All other
    activities are funded at the level of the administration's
    request.
        Many of the public health successes that were achieved in
    the 20th century can be traced to innovations in environmental
    health practices. However, emerging pathogens and environmental
    toxins continue to pose risks to our health and significant
    challenges to public health. The task of protecting people's
    health from hazards in their environment requires a broad set
    of tools. First among these tools are surveillance and data
    collection to determine which substances in the environment are
    getting into people and to what degree. It also must be
    determined whether or not these substances are harmful to
    humans, and at what level of exposure. Many scientists estimate
    that about two-thirds of all cancers result from environmental
    exposure, but much better data are needed to improve this
    estimate and determine which exposures cause cancer and other
    diseases.
        Asthma.--The Committee is pleased with the work that the
    CDC has done to address the increasing prevalence of asthma.
    However, the increase in asthma among children remains
    alarming. The Committee urges CDC to expand its outreach aimed
    at increasing public awareness of asthma control and prevention
    strategies, particularly among at-risk populations in
    underserved communities. To further facilitate this effort, CDC
    is encouraged to partner with voluntary health organizations to
    support program activity consistent with the CDC's efforts to
    fund community-based interventions that apply effective
    approaches demonstrated in research projects within the
    scientific and public health community.
        Biomonitoring.--The CDC's National Report on Human Exposure
    to Environmental Chemicals is a significant new exposure tool
    that provides invaluable information for setting research
    priorities and for tracking trends in human exposures over
    time. The Committee continues to support the CDC environmental
    health laboratory's efforts to provide exposure information
    about environmental chemicals. The Committee understands that
    for most chemicals it is currently difficult to interpret
    biomonitoring information in a health risk context. Therefore,
    the Committee encourages CDC to develop the necessary methods
    to better interpret human biomonitoring concentrations in the
    context of potential health risks. The Committee applauds the
    CDC's biomonitoring efforts and encourages the Agency to
    continue this program and continue to improve its efforts to
    communicate these results in context.
        Childhood Lead Poisoning Prevention.--The Committee
    commends the CDC for its commitment to support the enhanced
    development of a portable, hand-held lead screening device that
    holds great promise for increasing childhood screening rates in
    underserved communities. Further development of this device
    will help ensure its application in community health settings.
        Environmental Health Laboratory.--The CDC environmental
    health laboratory performs assessments for State investigations
    of diseases (such as cancer and birth defects) and
    investigations of chemical exposures, such as dioxin,
    pesticides, mercury and cadmium. CDC is also working with
    States to improve public health laboratories that assess State
    level biomonitoring needs. CDC works closely with academic
    institutions, other Federal agencies, and other partners to
    measure human exposure to toxic substances and the adverse
    effects of that exposure.
        Health Tracking Network.--The Committee has provided
    $400,000 over the fiscal year 2005 level to continue and expand
    the development of a Health Tracking Network, which seeks to
    develop a surveillance system that can integrate environmental
    hazards data with human exposure and health effects data that
    have possible links to the environment. With health tracking,
    public health officials can better target preventive services,
    health care providers can offer better health care, and the
    public will be able to develop a clear understanding of what is
    occurring in their communities and how overall health can be
    improved.
        Landmine Survivor Network.--The Committee commends CDC for
    its partnership with the Landmine Survivor Network that has
    developed peer support networks for landmine survivors in six
    mine-affected countries. The Committee has included sufficient
    resources to continue support of the network at no less than
    the fiscal year 2005 level. These funds will be used to expand
    peer support networks and the number of survivors that are
    reached in network and non-network countries; strengthen the
    capacity of medical and rehabilitative care facilities to
    address the needs of amputees; enhance economic opportunities
    for survivors; and further CDC programs and research for
    victims of landmines, civil strife and warfare.
        Volcanic Emission and Asthma.--The problem of asthma in
    Hawaii remains a serious health threat and challenge,
    especially among the medically underserved. In particular, the
    problem of volcanic emissions in Hawaii contributes to this and
    other respiratory problems. The Committee encourages CDC to
    consider potential interventions that may be helpful.

    Injury Prevention and Control

        CDC is the lead Federal Agency for injury prevention and
    control. Programs are designed to prevent premature death and
    disability and reduce human suffering and medical costs caused
    by: fires and burns; poisoning; drowning; violence; lack of
    bicycle helmet use; lack of seatbelt and proper baby seat use;
    and other injuries. The national injury control program at CDC
    encompasses non-occupational injury and applied research in
    acute care and rehabilitation of the injured. Funds are
    utilized for both intramural and extramural research as well as
    assisting State and local health agencies in implementing
    injury prevention programs. The Committee recognizes the vital
    role CDC serves as a focal point for all Federal injury control
    activities.
        Within the total provided, the Committee has provided
    $2,500,000 over the fiscal year 2005 level for Youth Violence
    Prevention base funding; sufficient resources to support the
    National Violent Death Reporting System at the fiscal year 2005
    level; and undesignated funding of $780,000 to the National
    Center for Injury Prevention and Control. Sufficient funds have
    been included to continue or increase support for all existing
    Injury Control Research Centers.
        National Violent Death Reporting System.--The Committee is
    supportive of the National Violent Death Reporting System,
    which is a State-based system that collects data from medical
    examiners, coroners, police, crime labs, and death certificates
    to understand the circumstances surrounding violent deaths. The
    information can be used to develop, inform, and evaluate
    violence prevention programs. The Committee has provided
    sufficient resources to continue this program with at least the
    fiscal year 2005 level of funding. The Committee urges the CDC
    to continue to work with private health and education agencies
    as well as State agencies in the development and implementation
    of an injury reporting system.
        Suicide Prevention.--The Committee is aware that suicide
    remains the third leading cause of death among adolescents aged
    10-19. Research has determined that those adolescents most at
    risk often suffer from mental disorders, including depressive
    disorders and substance abuse. Other risk factors, which
    interact with mental disorders to increase risk for adolescent
    suicide, may include family discord, school-related problems,
    obesity, contact with the juvenile justice system and exposure
    to the suicide of others. The Committee encourages CDC to
    consider the extent to which mental health screenings
    incorporated into ongoing prevention efforts regarding obesity,
    STDs and self-injury may serve to identify youth at risk. The
    Committee requests that CDC report on its findings to the
    Committee by May 1, 2006.
        The Committee encourages CDC to consider supporting the
    evaluation of suicide prevention planning, programs, and
    communication efforts to change knowledge and attitudes and to
    reduce suicide and suicidal behavior. These evaluation efforts
    would support communities to identify promising and effective
    suicide prevention strategies that follow the public health
    model and build community resilience.
        Violence Against Women.--The Committee urges CDC to
    increase research on the psychological sequelae of violence
    against women and expand research on special populations and
    their risk for violence including adolescents, older women,
    ethnic minorities, women with disabilities, and other affected
    populations.
        Youth Violence.--The Committee has included $2,500,000
    above the fiscal year 2005 level for CDC's youth violence
    prevention activities. The Committee notes that the level of
    youth violence in cities around the Nation is troubling. The
    city of Philadelphia, in particular, has experienced a spike in
    youth violence. The Committee encourages CDC to use some of the
    increase to address the growing number and seriousness of
    violent acts committed by youth in urban areas such as
    Philadelphia.

                         OCCUPATIONAL SAFETY AND HEALTH

        The Committee recommends $257,121,000 for occupational
    safety and health programs. The fiscal year 2005 level was
    $286,041,000 and the administration requested $285,930,000 for
    fiscal year 2006. The Committee recommendation includes
    $87,071,000 in transfers available under section 241 of the
    Public Health Service Act. Sufficient funds have been included
    to maintain staffing levels at the Morgantown facility.
        The CDC's National Institute for Occupational Safety and
    Health [NIOSH] is the only Federal Agency responsible for
    conducting research and making recommendations for the
    prevention of work-related illness and injury. The NIOSH
    mission spans the spectrum of activities necessary for the
    prevention of work-related illness, injury, disability, and
    death by gathering information, conducting scientific
    biomedical research (both applied and basic), and translating
    the knowledge gained into products and services that impact
    workers in settings from corporate offices to construction
    sites to coal mines.
        The Committee recognizes NIOSH as one of the Agency's 5
    coordinating centers. Given its unique statutory requirements,
    this is the appropriate placement of NIOSH within CDC's current
    structure. It is the expectation of the Committee that CDC will
    afford NIOSH all the rights and privileges of this status in
    the organization including participation on CDC's Executive
    Leadership Board as well as the Management Council given that
    these are the policy and decision-making bodies of the Agency.
        In fiscal year 2005, the Committee separated actual program
    costs from the administration of those programs by reallocating
    all administrative costs (except those of NIOSH) to a new
    account: Business Services Support. This enabled CDC to more
    easily interpret Congress' intent with funding increases meant
    for either programs or administration of those programs. In
    fiscal year 2006, the Committee recommends reallocating
    $34,800,000 from the NIOSH line item to the Business Services
    and Support line item. This reallocation is equal to the
    administrative costs associated with NIOSH in fiscal years 2004
    and 2005 and will end the need for continued central business
    services assessments, except those that are assessed across the
    entire Department of Health & Human Services. A reprogramming
    request will be required for any additional CDC assessment on
    the NIOSH budget line. All comparisons to fiscal year 2005
    levels and the budget request have been adjusted to reflect
    this reallocation.
        The Committee recognizes that NIOSH, as the only Federal
    Agency for occupational safety and health research and
    prevention, provides national and international leadership to
    prevent work-related illness, injury, and death by gathering
    information, conducting scientific research, and translating
    the knowledge gained into products and services. Examples
    include the recently launched Research to Practice [r2p]
    initiative, which continues to gain momentum, and the next
    decade of the National Occupational Research Agenda [NORA-2].
    The Committee applauds the goal of r2p, which is to reduce or
    eliminate occupational disease and injury by helping to ensure
    an increased impact of NIOSH-funded research in the workplace.
    The Committee notes that NIOSH is now consulting with partners
    and stakeholders to plan for NORA-2, which will be a review of
    the decade for the 21 priority research areas, examining the
    state of the science, noting key changes, identifying NORA
    contributions, discussing gaps and lessons learned, and making
    recommendations for the future.
        Construction Safety and Health.--The Committee once again
    is very pleased with the progress that NIOSH has made in its
    program directed at occupational illnesses and injuries in the
    building and construction industry and has included funding to
    continue this important worker safety initiative.
        Education and Research Centers.--The Committee recognizes
    the important role Education and Research Centers [ERCs] play
    in preventive health research and the training of occupational
    safety and health professionals, and includes an increase of
    $500,000 for ERCs over the amount appropriated for ERCs in
    fiscal year 2005.
        Energy Employees Occupational Illnesses.--Not later than 6
    months after enactment of this Act, NIOSH should provide a
    report to the Committee which: (1) identifies the cancer types
    which are not included in the list of 22 ``specified cancers''
    under the Energy Employees Occupational Illness Compensation
    Program Act (42 U.S.C. 7384 et seq.) but for which exposure to
    internal or external ionizing radiation of any type can be
    shown to cause or contribute to the development of a cancer;
    (2) recommend the cancer types to be added to the list of
    specified cancers for individuals covered in the Special
    Exposure Cohort, with a justification for including such
    cancers and a ranking in order of priority based on
    radiosensitivity; (3) for each Special Exposure Cohort in
    effect on the date of submission of this report to Congress,
    identify the number of cases by facility for which there is a
    Special Exposure Cohort for each cancer type listed in item
    (2). The Secretaries of Labor and Health and Human Services are
    encouraged to amend their respective implementing regulations
    to include the list of cancers covered in the above referenced
    report for purposes of defining specified cancers for members
    of special exposure cohorts.
        Farm Health and Safety.--The Committee has included funding
    to continue the farm health and safety initiative. This
    important initiative, begun in fiscal year 1990, has a primary
    focus of reducing the incidence of fatal and nonfatal injuries
    and occupational diseases among the millions of agricultural
    workers and their families in the United States. The Committee
    is particularly pleased with the research being undertaken by
    the Agricultural Research Centers.
        Miners' Choice Health Screening Program.--The Committee is
    concerned that sufficient resources were not allocated to
    implement the Miners' Choice Health Screening Program in fiscal
    year 2005. The Committee urges NIOSH to implement this program
    in fiscal year 2006. This program was initiated to encourage
    all miners to obtain free and confidential chest x-rays to
    obtain more data on the prevalence of Coal Workers'
    Pneumonconiosis in support of development of new respirable
    coal dust rules. The Committee is strongly supportive of these
    efforts and urges NIOSH to work to improve this health
    screening program thereby helping to protect the health and
    safety our Nation's miners.
        Mining Research Program.--The Committee has provided
    sufficient resources to maintain the fiscal year 2005 level of
    funding for NIOSH's Mining Research Program.
        National Occupational Research Agenda.--The Committee
    recommendation includes sufficient resources to maintain
    funding at the fiscal year 2005 level for CDC's National
    Occupational Research Agenda [NORA]. The Committee believes
    that NORA is a critical scientific research program that
    protects employees and employers from the high personal and
    financial costs of work site health and safety losses.
    Industries such as agriculture, construction, health care, and
    mining benefit from the scientific research supported by NORA.
    The program's research agenda focuses on prevention of disease
    and injury resulting from infectious diseases, cancer, asthma,
    hearing loss, musculoskeletal disorders, traumatic injuries,
    and allergic reactions, among others. The Committee continues
    to strongly support NORA and encourages expansion of its
    research program to cover additional causes of work place
    health and safety problems.
        National Mesothelioma Registry.--The Committee has provided
    $1,000,000 for the establishment of a National Mesothelioma
    Registry to collect data regarding symptoms, pathology,
    evaluation, treatment, outcomes, and quality of life and a
    Tissue Bank to include the pre- and post-treatment blood (serum
    and blood cells) specimens as well as tissue specimens from
    biopsies and surgery. The Committee intends that not less than
    $500,000 of this amount should be allocated for the collection
    and maintenance of tissue specimens.
        National Personal Protective Technologies Laboratory.--The
    Committee provides sufficient resources to maintain the fiscal
    year 2005 level of funding for the NIOSH National Personal
    Protective Technologies Laboratory to expedite research and
    development in, and certification of, protective equipment,
    such as powered air purifying respirators, and combined self-
    contained breathing apparatus/escape sets.

                                 GLOBAL HEALTH

        The Committee recommends $313,227,000 for global health
    related activities at the CDC in fiscal year 2006. The fiscal
    year 2005 comparable level was $308,863,000 and the
    administration requested $306,079,000 for fiscal year 2006. The
    Office of Global Health will lead and coordinate CDC's global
    programs to promote health and prevent disease in the United
    States and abroad, including ensuring rapid detection and
    response to emerging health threats. Within the total provided,
    all of the programs, except the global immunization program and
    the global malaria program, have been funded at the level
    requested by the administration.
        Global HIV/AIDS.--CDC works with governments in 25
    countries in Africa, Asia and Latin America and the Caribbean
    focusing on primary prevention of HIV/AIDS; care and treatment
    of tuberculosis and other opportunistic infections, palliative
    care and appropriate use of antiretroviral medications; and
    infrastructure and capacity development.
        The Committee notes that funding for continuation of the
    International Mother and Child HIV Prevention Initiative [MTCT]
    has been requested in the budget for the Department of State
    under the jurisdiction of the Foreign Operations Appropriations
    Subcommittee. Therefore, the Committee does not provide any
    funding for the program in the CDC, however, the Committee
    remains supportive of this critical program. The Committee
    encourages CDC to ensure that funds provided to the MTCT
    program, the CDC GAP initiative, and the Global Fund for HIV/
    AIDS, Tuberculosis, and Malaria are used in a coordinated and
    complementary fashion.
        Global Disease Detection.--The Committee commends CDC for
    its role in strengthening the capacity of the public health
    community, both at home and abroad, to respond to global
    threats, such as SARS, monkeypox, West Nile virus, pandemic flu
    and bioterrorism. CDC's Global Disease Detection System is
    integral to these efforts. This system is designed to provide
    worldwide technical support to ensure rapid and accurate
    diagnoses of emerging infectious disease events, and to provide
    a secure link between clinicians and laboratories and CDC and
    the World Health Organization to ensure real-time reporting of
    emerging threats. The Global Disease Detection System also will
    support sentinel sites in key regions around the globe to
    ensure prompt disease detection and referral to a regional
    laboratory service. These capacities are critical to mitigate
    the consequences of a catastrophic public health event, whether
    the cause is an intentional act of terrorism or the natural
    emergence of a deadly infectious virus, like SARS. The
    Committee has provided $12,077,000 over the fiscal year 2005
    level for these efforts.
        Global Immunization Activities.--The Committee includes
    $144,455,000 for global immunization activities, including
    $101,254,000 for polio vaccine, surveillance, and program
    operations for the highly successful, yet unfinished polio
    eradication efforts; and $43,201,000 for the purchase of
    measles vaccine for measles mortality reduction and regional
    measles elimination initiatives and to expand epidemiologic,
    laboratory, and programmatic/operational support to WHO and its
    member countries.
        The increased funding levels in Global Health and decreases
    in Immunization capture the proper alignment of programmatic
    costs within CDC under the new budget structure and will be
    directed to support programmatic activities to eradicate polio
    and eliminate measles worldwide. They do not represent a
    decrease in support of the immunization program.
        The Committee appreciates CDC's contribution to global
    immunization efforts to eradicate polio and eliminate measles
    worldwide. Federal dollars help leverage private dollars in
    both the Polio Eradication Campaign and the Measles Initiative,
    partnerships among international agencies, NGOs and CDC. Polio
    eradication is close to completion; however, polio is still
    endemic in six countries. Any ground lost in maintaining
    ``immunization days,'' surveillance and labs is disastrous.
    Immunization is respected in these developing countries to the
    point that they cause temporary ceasefires in countries at war.
        The Committee notes that the fiscal year 2006 appropriation
    recommended here assumes full funding of the Congressional
    intent in the fiscal year 2005 appropriation. Accordingly,
    funds requested in Immunization and Business Services support
    related to Global Immunization Activities have been provided
    here.

                             PUBLIC HEALTH RESEARCH

        Public Health Research.--The Committee has provided
    $31,000,000 in transfers available under section 241 of the
    Public Health Service Act to fund the Public Health Research
    program. The fiscal year 2005 comparable level was $31,000,000
    and the administration requested $31,000,000 for this program
    in fiscal year 2006. The Committee is strongly supportive of
    public health and prevention research, which bridge the gap
    between medical research discoveries and behaviors that people
    adopt by identifying the best strategies for detecting new
    diseases, assessing the health status of populations,
    motivating healthy lifestyles, communicating effective health
    promotion messages, and acquiring and disseminating information
    in times of crisis.
        Alternative Therapies.--As more and more Americans use
    alternative and complementary therapies to maintain and improve
    their health, there is a growing need for better consumer
    information about these therapies. The Committee encourages CDC
    to consider expanding their efforts in this area. Practice-
    based assessments and the identification and study of promising
    and heavily used complementary and alternative therapies and
    practices should be undertaken and results published. The
    Committee urges CDC to collaborate with the National Center for
    Complementary and Alternative Medicine [NCCAM] to assure that
    its efforts complement efforts by NCCAM.
        Food Marketing.--The Committee commends the CDC for its
    role and participation in the Food Marketing and the Diets and
    Health of Children and Youth study done in partnership with the
    Institute of Medicine through the Food and Nutrition Board and
    the Board on Children, Youth, and Families. The Committee
    encourages CDC to continue its efforts to identify the causes
    of obesity, particularly the science-based effects of food
    marketing on the diets and health of children and youth in the
    United States.
        Poor Diet and Inactivity.--Hundreds of thousands of people
    die prematurely each year from heart attack, stroke, and
    diabetes, and scientists agree that poor diet, physical
    inactivity, and being obese puts one at greater risk for those
    conditions. The Committee is concerned that the recent
    controversy regarding the estimates of the number of deaths due
    to obesity has resulted in public confusion and ignores other
    diet and physical inactivity disease rates, related deaths and
    health care costs.
        The Committee urges the CDC to conduct a study to estimate
    the number of premature deaths, diseases, and costs due to poor
    diet and physical inactivity. The study should include diet-
    and inactivity-related deaths, diseases, and costs due to heart
    disease, cancer, stroke, diabetes, and other diseases and those
    due to a range of dietary factors. The number of diet- and
    inactivity-related deaths, diseases, and costs should be
    compared to other leading causes including tobacco, alcohol,
    infectious diseases, etc.

                    PUBLIC HEALTH IMPROVEMENT AND LEADERSHIP

        The Committee provides $269,055,000 for public health
    improvement and leadership activities at the CDC. The fiscal
    year 2005 comparable level was $266,842,000 and the
    administration requested a comparable program level of
    $206,541,000 for fiscal year 2006.

    Leadership and Management

        The Committee provides $178,672,000 for leadership and
    management costs at the CDC in fiscal year 2006. The fiscal
    year 2005 comparable level was $178,541,000 and the
    administration requested a comparable level of $178,672,000 for
    fiscal year 2006.
        Director's Discretionary Fund.--The Committee has provided
    $10,000,000 for a Director's Discretionary Fund. This fund will
    allow the Director to quickly respond to emerging public health
    issues and threats not contemplated at the time of enactment of
    the appropriations.
        Epidemic Services and Response.--CDC's epidemic services
    and response program provides resources and scientific
    expertise for operating and evaluating surveillance systems;
    developing and refining research methods and strategies to the
    benefit of public health practice; training public health
    professionals who are prepared to respond to public health
    emergencies, outbreaks and other assistance requests; and
    communicating with multi-faceted audiences accurate public
    health information and effective messages. The Committee
    recognizes that CDC maintains a keen appreciation for the fact
    that local outbreaks of illness can develop rapidly into
    epidemics, that previously unidentified health problems can
    appear at any time, that contaminated food or defective
    products may appear in the community without warning, and that
    the threat of bioterrorism is present in many areas of the
    world. When CDC participates in an investigation, all of the
    resources of the Agency are at the disposal of the affected
    area, including its state-of-the-art laboratories.
        Leadership and Management Savings.--The Committee strongly
    believes that as large a portion as possible of CDC funding
    should go to programs and initiatives that improve the health
    and safety of Americans. To facilitate this goal, any savings
    in leadership and management may be reallocated to the
    Director's Discretionary Fund upon notification of the
    Committee.

              PREVENTATIVE HEALTH AND HEALTH SERVICES BLOCK GRANT

        The Committee has provided $100,000,000 for the
    Preventative Health & Health Services Block grant. The fiscal
    year 2005 comparable level was $118,526,000 and the
    administration requested no funding for this program in fiscal
    year 2006.
        The block grant provides funding for primary prevention
    activities and health services that address urgent health
    problems in local communities. This flexible source of funding
    can be used to target concerns where other funds do not exist
    or where they are inadequate to address the extent of the
    health problem. The grants are made to the 50 States, the
    District of Columbia, two American Indian tribes, and eight
    U.S. territories.

                            BUILDINGS AND FACILITIES

        The Committee has provided $225,000,000 for the planning,
    design, and construction of new facilities, repair and
    renovation of existing CDC facilities, and data security and
    storage. The fiscal year 2005 comparable level was $269,708,000
    and the administration requested $30,000,000 for fiscal year
    2006.
        The Committee recommendation includes $200,000,000 for the
    continuation of CDC's Buildings and Facilities Master Plan in
    Atlanta, Georgia and $25,000,000 to complete construction of
    CDC's Division of Vector Borne Infectious Diseases Laboratory
    in Fort Collins, Colorado.
        The Committee has again provided bill language to allow CDC
    to enter into a single contract or related contracts for the
    full scope of development and construction of facilities and
    instructs CDC to utilize this authority, when necessary, in
    constructing the Atlanta and Fort Collins facilities.

                         BUSINESS SERVICES AND SUPPORT

        The Committee provides $296,119,000 for business services
    support functions at the CDC. The fiscal year 2005 comparable
    level was $278,838,000 and the administration requested a
    comparable level of $263,715,000 for fiscal year 2006. These
    funds will be used to support CDC-wide support functions.
        The recommendation includes $34,800,000 within Business
    Services and Support that was provided in fiscal year 2005, and
    in the administration request, in NIOSH. The reason for this is
    to provide the NIOSH share of CDC central services and support
    within this activity and to eliminate the need for additional
    taps and assessments.
        The Committee strongly believes that as large a portion as
    possible of CDC funding should go to programs and initiatives
    that improve the health and safety of Americans. To facilitate
    this goal, any savings in business services support may be
    reallocated to the Director's Discretionary Fund upon
    notification of the Committee.

                                   TERRORISM

        The Committee provides $1,566,471,000 for CDC terrorism
    preparedness activities. The comparable fiscal year 2005 level
    was $1,622,757,000 and the administration requested
    $1,616,723,000 for these activities in fiscal year 2006.
    Although these funds have been provided in the Public Health
    and Social Services Emergency Fund [PHSSEF] in past
    appropriations, they have always been managed by CDC. The
    Committee expects that CDC will continue to closely coordinate
    its terrorism preparedness activities with those of the
    Department and other HHS Agencies.
        Within the funds provided, $735,391,000 is for Upgrading
    State and Local Capacity through grants and cooperative
    agreements; $29,425,000 is for the Centers for Public Health
    Preparedness; $5,424,000 is for the Advanced Practice Centers;
    $26,899,000 is for other State and Local Capacity; $137,972,000
    is for upgrading CDC Capacity; $10,000,000 is for anthrax
    vaccine studies; $79,361,000 is for the Biosurveillance
    Initiative; and $542,000,000 is for the Strategic National
    Stockpile.
        Blood Safety.--The Committee understands that the American
    Red Cross [ARC] supplies blood to approximately one-half the
    Nation's hospitals, operates the only blood system with the
    capacity to deliver blood anywhere and anytime it is needed,
    and is the only non-governmental organization with mandated
    primary agency responsibilities under the National Response
    Plan [NRP]. Among its NRP obligations, the ARC serves as a
    support agency to HHS for the provision of blood and blood
    products. The Committee is aware that the ARC has initiated a
    Biomedical Technology Assurance Initiative to protect its
    capacity to manage national blood supplies against cyber- and
    bio-security threats. The Committee supports this effort and
    encourages CDC to consider providing support to the Initiative
    from within the funds made available for biosurvelliance,
    capacity enhancement and stockpile activities.
        Clinician Update Service.--The conferees are aware of the
    Clinician Update Service, which the CDC has begun with World
    Medical Leaders to disseminate news, information, and alerts to
    physicians who are on the front lines in the effort to
    recognize biological, chemical, and radiological events. The
    Committee encourages CDC to consider supporting the completion
    of Phase II of the project.
        Modified Vaccinia Ankara.--The Committee is concerned that
    individuals with weak immune systems, an estimated 20 percent
    of the U.S. population, cannot take the existing animal-derived
    and cell-derived smallpox vaccines currently stored in the
    Strategic National Stockpile for emergency purposes. Funds have
    already been appropriated under the Project Bioshield Act for
    the planned stockpiling of the Modified Vaccinia Ankara [MVA]
    Smallpox Vaccine for immuno-compromised Americans. The
    Committee supports plans to purchase the new vaccine.
        Pandemic Influenza.--The Committee notes that several
    outside organizations, including the Trust for America's
    Health, have made recommendations regarding pandemic
    preparedness. The Committee encourages CDC to consult with
    outside experts in its preparations for, and response to, a
    potential pandemic.
        The Committee is aware that the Department is developing a
    pandemic influenza response plan. The Committee recognizes that
    local public health departments, working with their States,
    play essential roles in responding to influenza outbreaks,
    including monitoring of local vaccine availability,
    distribution and redistribution of vaccines and antiviral
    medications to high priority populations, implementation of
    necessary epidemic containment measures, and communication to
    the public. Therefore, Committee encourages the Department to
    assure that all aspects of Federal pandemic influenza planning
    are consistent with operational realities at the local level
    and will have the intended public health results when
    implemented locally. The Committee further urges the Department
    to assure that Federal pandemic flu planning avoid duplication
    and inconsistency with other Federal directives concerning
    public health preparedness.
        State and Local Capacity.--The Committee continues to
    recognize that bioterrorism events will occur at the local
    level and will require local capacity, preparedness and initial
    response. It is the Committee's intent that significant funding
    for State and local public health infrastructure be used to
    improve local public health capacity and meet the needs
    determined by local public health agencies. The Committee notes
    that HHS' cooperative agreement guidance now includes explicit
    requirements for local concurrence with State spending plans
    for public health emergency preparedness and urges CDC to
    monitor and enforce these requirements.
        The Committee also recognizes that HHS has incorporated the
    National Response Plan into the cooperative agreement guidance
    and established new CDC Preparedness Goals. The Committee urges
    the Department to assure that the performance metrics for the
    CDC Preparedness Goals, by which local health department
    preparedness will be measured, are fully consistent with all
    requirements in the Target Capabilities being developed under
    Homeland Security Presidential Directive 8 by the Department of
    Homeland Security.
        Funds for bioterrorism prevention and response are
    distributed through grants to 50 States and four metropolitan
    areas. The Committee strongly recommends that these funds be
    distributed based on a formula that includes factors for risk
    of a terrorist event. Risk is challenging to quantify, but the
    Committee suggests that CDC, in coordination with the Secretary
    of Health and Human Services, consider the following and other
    factors: (1) Site of headquarters or major offices of
    multinational organizations; (2) site of major financial
    markets; (3) site of previous incidents of international
    terrorism; (4) some measure of population density versus just
    population; (5) internationally recognized icons; (6) percent
    of national daily mass transit riders; (7) proximity to a major
    port, including major port ranked on number of cargo containers
    arriving at the port per year.
        Strategic National Stockpile.--The Committee appreciates
    that planning and exercising plans for distribution of the
    Strategic National Stockpile is an integral aspect of overall
    local bioterrorism preparedness. The Committee urges CDC to
    assure that requirements for and evaluation of State and local
    activities with respect to the stockpile, including the Cities
    Readiness Initiative, are fully integrated into and consistent
    with requirements of the guidance for overall bioterrorism
    preparedness.

                                  NIH Preamble

        No task before this country is more important than
    safeguarding and improving the health of all Americans. For
    protecting the public's health, together with educating our
    citizenry, represent the mainspring of our economic and social
    progress. Without question, the Nation's strength can be no
    greater than the health and vitality of its population. Beyond
    its human toll, needless suffering and death erode
    productivity, undermine our leadership role on the global
    stage, weaken our defenses and threaten to bankrupt Federal,
    State, and family budgets.
        History has shown that it is imperative to maintain our
    long-term commitment to medical research regardless of short-
    term economic conditions. Since World War II, the life span of
    the average American has risen steadily, from 65 to nearly 77
    years. While no single entity nor action can be credited for
    that success, one organization has played a significant role--
    the National Institutes of Health. The Nation's investment in
    NIH has yielded a myriad of scientific achievements that are
    helping to save lives, prevent illness and improve the quality
    of life. From drugs to control high blood pressure, lower
    cholesterol and prevent blood clots to the development of a
    vaccine that eliminates the leading cause of mental retardation
    in infants, NIH has played a significant role. But that role
    has broadened and taken on even greater immediacy, as NIH has
    taken the lead in protecting our Nation against bioterrorism
    and other public health emergencies including anthrax, plague,
    tularemia and West Nile virus. With these and other threats
    looming, now is not the time for retrenchment; rather, it is
    the time to exploit fully any opportunity that could lead to
    improved health.
        The Committee also encourages new initiatives to reshape
    the conduct of research such as the ``NIH Roadmap for Medical
    Research,'' an approach that would bring together multiple
    institutes and scientific disciplines to tackle a handful of
    public health concerns. Similarly, the Committee strongly urges
    NIH to focus greater effort and resources on transforming basic
    science discoveries into preventive measures, improved
    diagnostics, drugs and treatments. The backbone of clinical
    research in this country, the Nation's academic health centers,
    should be nurtured and new, innovative ways should be found to
    re-energize this enterprise.
        To these ends, the Committee recommends $29,414,515,000 for
    the NIH. This amount is $1,050,000,000 above the fiscal year
    2005 appropriation and $904,731,000 over the budget request.
        Biomedical Research and Development Price Index.--The
    Committee is once again disappointed that the budget request
    would require NIH to break its funding commitments to existing
    grantees. Forcing grantees to reduce the scope of research that
    is already underway would establish an unfortunate precedent
    and could erode confidence in NIH. As a result, this reduction
    would have caused a disproportionate impact on more junior
    researchers and trainees, who need continued encouragement to
    pursue careers in research. Therefore, the Committee has
    included sufficient funding to enable NIH to fully pay the
    committed levels on its grants. The Committee is also
    disappointed that the budget request's proposed average cost
    assumptions would keep NIH from purchasing the same amount of
    research as in fiscal year 2005 with its new research project
    grants [RPGs], when biomedical inflation, as measured by the
    Department of Commerce's Biomedical Research and Development
    Price Index [BRDPI], is taken into account. The funding level
    recommended by the Committee will permit the average cost of
    new and competing RPGs to rise by the BRDPI inflator, or 3.2
    percent, instead of being held flat, as proposed in the budget
    request.
        Human Embryonic Stem Cell Research.--The Committee
    continues to be concerned that the current administration
    policy relating to human embryonic stem cell research is so
    narrow that it is stifling the pace of stem cell research. The
    Committee strongly believes that embryonic stem cell research
    holds enormous potential for the treatment of cardiovascular
    disease, Parkinson's, spinal cord injury and a vast array of
    other diseases and injuries. After convening 16 in-depth
    hearings on the subject, the Committee believes that with the
    proper safeguards in place, this field of investigation ought
    to be widened. While it originally appeared that 78 embryonic
    stem cell lines would be available for research under the
    Federal policy, now, nearly 4 years after the President's
    announcement on August 9, 2001, only 22 lines are available to
    researchers. Moreover, scientists have told the Committee that
    all available stem cell lines were grown with mouse feeder
    cells, making their therapeutic use for humans uncertain. The
    Committee strongly urges the administration to modify the
    current embryonic stem cell policy so that it provides this
    area of research the greatest opportunity to lead to the
    treatments and cures for which we are all hoping.
        The Committee also strongly urges that the NIH explore all
    avenues of stem cell research including adult stem cells and
    alternative methods of establishing human embryonic stem cell
    lines that do not involve the destruction of an embryo.
        The Committee is also deeply concerned with the slow pace
    of implementation of the current stem cell policy. The
    Committee was informed by NIH this year that anticipated
    spending on human embryonic stem cell research is just
    $24,300,000. The Committee strongly urges the NIH to commit a
    substantial amount of resources to all methods of human
    embryonic stem cell research.

                           NATIONAL CANCER INSTITUTE

    Appropriations, 2005....................................  $4,825,259,000
    Budget estimate, 2006...................................   4,841,774,000
    House allowance.........................................   4,841,774,000
    Committee recommendation................................   4,960,828,000

        The Committee recommends an appropriation of $4,960,828,000
    for the National Cancer Institute [NCI]. The budget request was
    $4,841,774,000. The fiscal year 2005 appropriation was
    $4,825,259,000. The comparable amounts for the budget estimate
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--The NCI conducts and supports basic and applied
    cancer research in prevention, early detection, diagnosis,
    treatment, and rehabilitation. The Institute provides training
    support for research scientists, clinicians, and educators, and
    maintains a national network of cancer centers, clinical
    cooperative groups, community clinical oncology programs,
    cancer prevention and control initiatives, and outreach
    programs to rapidly translate basic research findings into
    clinical practice.
        Blood Cancers.--The Committee acknowledges some notable
    advances in the treatment of blood cancers, including leukemia,
    lymphoma, and multiple myeloma. These include several new drugs
    that have been approved and introduced to the market in the
    last 3 years, products of a strong public-private partnership.
    Despite new treatments, these cancers represent a serious
    health crisis. Almost 115,000 Americans will be diagnosed with
    these cancers in 2005, and nearly 55,000 will die from them.
    Moreover, the 5-year survival rates for these cancers lag
    behind the 64 percent 5-year survival rate for all cancers; the
    rate for multiple myeloma is only 32 percent, and for non-
    Hodgkin's lymphoma it stands at 59 percent. The Commmittee
    encourages the Institute to strengthen its support for
    translational and clinical blood cancer research. The blood
    cancers strike individuals of all ages, races, and each gender,
    and serve as valuable prototypes for the development of
    therapies for all types of malignant disorders. The Committee
    urges the institute to explore all mechanisms to support blood
    cancer research to improve treatment options and rapidly move
    discoveries from the laboratory bench to the patient's bedside.
        Bone Marrow Failure Diseases.--The Committee encourages NCI
    to expand its research efforts into bone marrow failure
    diseases, including aplastic anemia, myelodysplastic disorders
    [MDS], and paroxysmal nocturnal hemoglobinuria [PNH]. Each
    year, between 20,000 and 30,000 Americans are diagnosed with
    these diseases. In some cases, MDS, the most prevalent of these
    diseases, can progress over time to become acute leukemia. More
    research is critically needed to understand the causes of these
    diseases, develop effective treatments and cures, and prevent
    the progression of certain cases into leukemia. Furthermore,
    cancer patients who undergo chemotherapy often develop bone
    marrow failure diseases. The Committee encourages NCI to gain a
    better understanding of the link between chemotherapy and these
    diseases, and to explore the development of alternatives means
    of treating cancer without causing the subsequent development
    of bone marrow failure diseases.
        Brain Tumors.--The Committee believes that increased
    attention should be given by NCI and NINDS to brain tumor
    research. The Committee encourages NCI to fund at least five
    Specialized Programs of Research Excellence in Brain Tumors
    [SPORE] grants in the upcoming fiscal year, with particular
    emphasis on those proposals which include both basic research
    and clinical treatment applications.
        Breast Cancer.--Breast cancer's toll continues to threaten
    the lives and the quality of life of thousands of women across
    all walks of life. In addition to ongoing research activities
    underway at the National Cancer Institute, the Committee
    strongly urges the NCI to give increased attention to areas of
    research that focus on helping women to more fully restore and
    improve their quality of life after treatment, including
    further breast cancer research on lymphadema, stress,
    nutrition, exercise, weight, and the environment.
        The Committee remains concerned about missed opportunities
    in breast cancer screening, detection, prevention, control, and
    early diagnosis including those in mammogram detection, reading
    and analysis. The Committee strongly urges the NCI to further
    accelerate advances in breast cancer screening technology and
    to capitalize on existing and create new technologies that
    improve early diagnosis, health outcomes, and survival.
        Cancer Biobank.--The Committee believes that the cancer
    biobank, because it will centralize and standardize molecular
    annotation of tissues, has the potential to greatly accelerate
    the understanding of cancer and the discovery and development
    of new biomarkers, new diagnostics and new therapeutic
    approaches. Once established, the Committee believes that it
    will be most efficient to utilize existing technologies such as
    high-density microarrays, given the long time frame for the
    development of new technologies.
        Cancer Centers and Minorities.--The Committee commends NCI
    on the success of its cancer centers program. Given that
    minority populations suffer disproportionately from virtually
    every form of cancer, the Committee encourages NCI to provide
    continued support for comprehensive cancer centers at minority
    institutions focused on research, treatment, and prevention of
    cancer in African American, Native Hawaiian, and other minority
    communities.
        Cancer Metastasis.--The NCI is encouraged to develop an
    interdisciplinary and integrated approach to study bone
    metastasis, by combining the expertise of oncologists, bone
    biologists and metastasis experts. Key issues to address
    include the generation of novel organ-like or mouse models
    which closely mimic tumor bone interactions that will pave the
    way for delineating novel mechanisms of how tumor cells go to
    the bone; the development of novel targets for better
    prognosis; and effective therapeutic targeting. Designing new
    strategies to make the bone microenvironment hostile to
    invading tumor cells is of high clinical relevance. The
    Committee also urges NCI to expand research on osteosarcoma to
    improve survival and quality of life and to prevent metastatic
    osteosarcoma in children and teenagers who develop this cancer.
        Chronic Lymphocytic Leukemia [CLL].--This incurable disease
    is the most common form of adult leukemia in the United States.
    The Committee once again urges the NCI to increase research
    into CLL, including improved therapies and their rapid movement
    from the laboratory to the bedside. The Committee strongly
    urges the NCI to give favorable consideration to continuing and
    expanding the scope of research activities funded through the
    CLL Research Consortium as it works to defeat this devastating
    blood disorder.
        Complementary and Alternative Cancer Therapies.--The
    Committee expects NCI to continue and expand its collaborative
    efforts with NCCAM to support research on promising
    complementary and alternative cancer therapies as well as on
    their integration with traditional therapies.
        DES.--The Committee continues to support increased efforts
    to study and educate the public and health professionals about
    the impact of exposure to the synthetic hormone
    diethylstilbestrol [DES]. The Committee expects NCI to continue
    to consult with organizations representing individuals impacted
    by DES as it carries out DES research and education efforts.
        Gynecologic Cancers.--In the last 5 years, approximately
    130,000 women in the United States have lost their lives to
    gynecologic cancer. The Committee commends the NCI for creating
    a cervical cancer and endometrial cancer SPORE, bringing the
    total number of gynecologic cancers SPORES to six, and expects
    that the NCI will expand the number of centers in the future.
    Unfortunately, 70 percent of ovarian cancer patients continue
    to be diagnosed in advanced stages when 5-year survival rates
    remain less then 25 percent. The Committee encourages continued
    research by the four ovarian SPORES that will lead to a better
    understanding of prevention and the development of a screening
    tool offering women earlier diagnosis when this cancer is more
    curable. The Committee also supports the expansion of NCI's
    collaboration with the NICHD for faculty development of
    gynecologic oncologists.
        Health Cognition.--The Committee encourages NCI's Division
    of Cancer Control and Population Sciences to continue to build
    innovative collaborations such as the Health Cognition Group.
    The activities of this group of researchers are designed to
    plumb knowledge from basic research on how people process and
    use health information and synthesize it with the development
    and evaluation of theory-based interventions to promote healthy
    behavior. Although these efforts are directed primarily to
    behaviors relevant to cancer, they will also serve the broader
    goal of developing theoretical frameworks that can be applied
    across a range of behavioral domains and conditions.
        Health Communication.--The Committee acknowledges NCI's
    Division of Cancer Control and Population Sciences for
    developing HINTS, the first-ever survey to collect nationally
    representative information on the American public's need for,
    access to, and use of cancer information. Such a database is
    useful to practicing physicians, public health departments and
    policymakers, among others. HINTS provides an invaluable
    snapshot of how adults use the many information resources
    around them to lead healthier lives and to reduce the burden of
    cancer in America.
        Hemophilia Cohort Study.--The Committee understands that
    NCI has made plans to discontinue research funding support of
    the Multi-Center Hemophilia Cohort Study. This cohort offers a
    database for improving the understanding of HCV and has served
    as the basis of significant peer-reviewed findings. The
    Committee strongly urges the NCI to take all necessary steps to
    ensure the samples obtained through this cohort are preserved
    and accessible for future research. The Committee also requests
    a report by May 1, 2006 on possible future research
    opportunities using the cohort samples.
        Imaging Systems Technologies.--The Committee is encouraged
    by progress made by the NCI following its August 1999
    conference on biomedical imaging, and it urges the NCI to
    continue to take a leadership role with the Centers for
    Medicare and Medicaid Services and the Food and Drug
    Administration to avoid duplicative reviews of new imaging
    technologies which may prevent their benefits from reaching
    patients on a timely basis. The Committee is aware of the great
    potential for improved patient care and disease management
    represented by molecular imaging technologies, especially
    positron emission tomography [PET] through its ability to image
    the biology of many kinds of cancer and other diseases. The
    Committee continues to support the NCI's increased emphasis on
    examining the molecular basis of disease through imaging
    technologies such as PET and MicroPET. The Committee also
    continues to encourage the large-scale testing of women for
    breast cancer and men for prostate cancer to demonstrate and
    quantify the increased diagnostic and staging capabilities of
    PET relative to conventional diagnostic and staging
    technologies, including mammography.
        Liver Cancer.--The Committee remains concerned with the
    increasing incidence of primary liver cancer, which is in sharp
    contrast to many other forms of cancer where the incidence is
    declining and the treatment options are rapidly increasing. The
    Committee is aware that NCI, working with NIDDK, has convened
    an Experts Conference and is moving ahead with plans to
    increase resources dedicated to this disease. The Committee
    urges NCI to make a substantial commitment to research on
    primary liver cancer with particular focus on the development
    of drugs that target the cancer without killing healthy cells
    by interfering with the cellular pathways of the disease. The
    Committee further urges NCI to continue to support the NIDDK
    sponsored HALT-C clinical trial which has particular relevance
    to the NCI mission.
        Lung Cancer.--Lung cancer remains a major public health
    issue and is the leading cause of cancer death among women and
    minority populations. The death rate is expected to escalate as
    the population ages. The Committee is encouraged by the success
    of new targeted drug therapies demonstrated in recent clinical
    trials in stage 4 patients. The Committee encourages the NCI to
    work with the thoracic surgical community to initiate new
    clinical trials that involve patients at an early stage of the
    disease when surgery is a treatment option. The trials should
    test the effectiveness of these new drugs as adjuvant therapy
    to improve the outcome of established thoracic surgical therapy
    for lung cancer.
        Lymphoma.--The Committee strongly urges that the NCI take
    bold action to address lymphoma as a public health problem and
    to capitalize on important research advances to date. While new
    treatments have become available for patients, more and
    improved treatment options are needed. The Committee strongly
    encourages the NCI to boost its investment in translational and
    clinical lymphoma research. The Committee commends the NCI and
    the NIEHS for convening a workshop on the viral and
    environmental links to lymphoma and recommends that steps be
    taken to strengthen the NCI investment in this area. The
    Committee encourages the NCI to direct resources to: (1)
    studies of adequate scope to assure the identification of
    environmental risk factors for specific subtypes of lymphoma;
    (2) small studies designed to improve detection and
    quantification of historically difficult-to-measure
    environmental factors; (3) studies that are directed toward
    enhancing the understanding of the role of the immune system in
    the initiation and progression of lymphoma; and (4) studies
    that examine the simultaneous presence of a wide profile of
    infectious agents among individuals with lymphoma. The
    Committee also encourages that resources be used for research
    related to long-term survivors of both non-Hodgkin's lymphoma
    and Hodgkin's lymphoma. The Committee strongly supports the
    recommendation of the Leukemia, Lymphoma, and Myeloma Progress
    Review Group [LLM PRG] that resources be invested in
    identifying the populations of patients that are at high risk
    of adverse outcomes from their treatment for lymphoma.
        Mesothelioma Research.--The Committee is concerned with the
    pace of mesothelimoma research. This aggressive disease invades
    the lining of the lungs, heart, or stomach resulting in death
    in 4 to 14 months. To address these concerns, the Committee
    strongly encourages the NCI to establish up to 10 mesothelioma
    centers, increase research, including clinical trials,
    detection and prevention methods, palliation of disease
    symptoms and pain management. The Committee requests that the
    NCI issue a report, by June 1, 2006 on steps taken to address
    mesothelioma research.
        Multidisciplinary Research.--The NCI is commended for its
    innovative support of multidisciplinary training programs to
    enhance the scientific workforce. The Committee encourages NCI
    to explore new opportunities with the Office of Behavioral and
    Social Sciences Research to increase the number of scientists
    who can bridge the realms of behavioral and social science
    research and public health or biomedical research.
        Nanosystems Biology.--The Committee encourages NCI and the
    Office of the NIH Director to support a collaborative effort to
    bring nanotechnology, systems biology and molecular imaging
    together to examine the molecular basis of cancer. Initial
    efforts have shown that cancers such as breast cancer are not a
    single disease, but may encompass many different diseases, when
    examined at the molecular level. Many clinical trials of new
    drugs are now considered to fail if only 10 percent of patients
    benefit, yet the 10 percent may represent a specific type of
    the disease, where the drug may be 100 percent effective.
    Bringing these three disciplines together may allow researchers
    to identify specific sub-types of cancer and to better target
    new interventions. Successful results of such an effort could
    lead to a molecular classification of many types of cancer and
    to targeted molecular treatments for molecular-specific
    diseases.
        Native Hawaiians.--The Committee remains concerned about
    the high incidence of breast, colon, and lung cancer among the
    Native Hawaiian population. The Committee commends the NCI for
    its progress toward understanding and addressing the needs of
    the Hawaiian and Pacific Basin populations through its
    cooperative agreement with Papa Ola Lokahi and looks forward to
    a report of the prioritized health needs identified by those
    assessments.
        Neurofibromatosis. The Committee commends NCI for
    conducting clinical trials of NF1 patients. The Committee is
    concerned about recent large drops in funding for NF research,
    and recognizing NF's connection to many of the most common
    forms of human cancer, the Committee encourages NCI to
    substantially increase its NF research portfolio in such areas
    as further development of animal models, natural history
    studies, therapeutic experimentation, and clinical trials. The
    Committee recognizes that basic research has successfully
    brought NF into the clinical era and encourages NCI to create,
    fund, and implement NF clinical trials infrastructures
    including NF centers, patient data bases, and tissue banks. The
    Committee further encourages NCI to apply existing cancer drugs
    to NF patients in clinical trials both extramurally and
    intramurally, and to develop new drugs for NF which could then
    apply to the general population because of NF's connection to
    most forms of human cancer. The Committee is aware of
    significant new advances in NF research in the past few years
    in the area of tumor suppression, and encourages NCI to
    continue to coordinate its efforts with other NIH institutes
    and government agencies.
        Ovarian Cancer.--Congress remains concerned that mortality
    rates associated with ovarian cancer have not seen the
    decreases that other cancer sites have experienced in the past
    5 years. As the deadliest of all gynecologic cancers, ovarian
    cancer takes the lives of three-quarters of all women diagnosed
    with it within 5 years. Congress commends the National Cancer
    Institute for its recognition of the importance of studying
    this deadly women's disease and appreciates the NCI's recent
    investment that is helping to increase the understanding of the
    unique molecular pathways associated with ovarian cancer
    through its Specialized Programs of Research Excellence
    [SPOREs] program. As such, Congress strongly encourages NCI to
    sustain and strengthen its commitment to and investment in
    ovarian cancer and maintain the SPOREs initiatives directed
    toward ovarian cancer in fiscal year 2006.
        Pancreatic Cancer.--Pancreatic cancer is the country's
    fourth leading cause of cancer death, killing over 32,000
    individuals this year. Its 99 percent mortality rate is the
    highest of all cancers, and the average life expectancy after
    diagnosis with metastatic disease is just 3 to 6 months. The
    Committee is pleased that the NCI is moving forward to
    implement the recommendations outlined in the 2001 report by
    the Pancreatic Cancer Progress Review Group [PRG] and that the
    Institute is funding three pancreatic cancer SPORE grants.
    However, the Committee is concerned that the current level of
    funding for pancreatic cancer research does not allow for the
    implementation of the PRG report and that only one of the three
    SPORE grants is fully funded. In addition, the Committee
    strongly urges the NCI to maintain or increase the number of
    pancreatic SPOREs as it undertakes a review of its
    translational research activities. Finally, the Committee notes
    that the NCI's September 2004 report titled ``Pancreatic Cancer
    Research'' includes a single, overall budget figure for
    implementing the immediate and short-term strategies of the
    Institute's strategic plan to address the PRG's
    recommendations, with no details about how the money would be
    used. Therefore, the Committee requests the NCI to develop a
    professional judgment budget that specifically details the cost
    of fully implementing the pancreatic cancer PRG and provide
    this professional judgment budget to the Committee by May 1,
    2006.
        Prostate Cancer.--The Committee commends the NCI for the
    considerable investment in prostate cancer, the leading cause
    of non-cutaneous cancer death among men, and encourages NCI to
    continue to support research to improve the accuracy of
    screening and early detection of prostate cancer.
        Radio Waves.--The Committee urges the NCI to support
    research using radio waves that could prove promising in
    reducing cancerous tumors. While current radio frequency
    ablation requires placing electrodes directly into the tumor,
    this new non-invasive technique would target only the cancer
    cells while avoiding healthy tissue.
        Social Work.--The Committee encourages NCI to coordinate
    with the Centers for Disease Control and Prevention to conduct
    further research on the outcome of social work interventions to
    meet patient and family psychosocial needs in hospitals and
    cancer treatment centers.
        SPORE Program.--The Specialized Programs of Research
    Excellence [SPORE] Program at the NCI was established to
    support efforts to move laboratory findings into clinical
    practice to benefit patients in the near term. The Committee
    understands that the program has resulted in the translation of
    some exciting research into cancer clinical trials for
    vaccines, chemoprevention and dietary interventions. The
    results to date from SPORE funding include multi-center
    clinical trials, biomarker studies, prevention studies, genetic
    registries, data sharing, and tissue banking projects, all with
    critical patient focus. The Committee strongly encourages the
    NCI to continue to keep this translational goal at its
    forefront. The Committee further understands that the SPORE
    program has been extremely successful in rapidly moving science
    to practices that benefit patients; funded research that
    requires a team approach to cancer; supports collaboration
    across basic science, population science and clinical
    investigation; and provides a rapid translation from the
    laboratory to patient care. The Committee further urges that
    the translational research momentum, developed under the SPORE
    program, be maintained by the NCI.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
    TSC, is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body, including the brain,
    heart, kidneys, lungs, liver, eyes or skin. In light of its
    similarities to the uncontrolled growth of cancer cells, many
    scientists believe that determining the cause of tumor growth
    in TSC could open the way for cures and treatments for cancer
    as well. The Committee is encouraged that NCI is participating
    in a Trans-NIH Tuberous Sclerosis Coordinating Committee, and
    urges NCI's continued involvement in this process. The
    Committee also urges NCI to collaborate with NIDDK on a
    conference on nutrient sensing and insulin-signaling in cells
    with inclusion of TSC research.
        War on Cancer.--The Committee applauds the Director of the
    National Cancer Institute for setting a bold goal to eliminate
    suffering and death due to cancer by 2015. To assist Congress
    in establishing priorities, the Committee requests the Director
    to report to the Committee, by June 1, 2006, an outline of the
    progress made since the war on cancer was declared in 1971 and
    detail the specific steps that must be taken to achieve this
    goal by 2010.

                   NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

    Appropriations, 2005....................................  $2,941,201,000
    Budget estimate, 2006...................................   2,951,270,000
    House allowance.........................................   2,951,270,000
    Committee recommendation................................   3,023,381,000

        The Committee recommendation includes $3,023,381,000 for
    the National Heart, Lung, and Blood Institute [NHLBI]. The
    fiscal year 2005 appropriation was $2,941,201,000 and the
    budget request was $2,951,270,000. The comparable amounts for
    the budget estimate include funds to be transferred from the
    Office of AIDS Research.
        Mission.--The National Heart, Lung, and Blood Institute
    provides leadership for a national research program in diseases
    of the heart, blood vessels, lungs and blood, in transfusion
    medicine, and in sleep disorders through support of basic,
    clinical, population-based, and health education research.
        Advanced Imaging Technology for Heart Disease and Stroke.--
    The Committee is aware that heart perfusion PET scans using
    Rubidium-82 are considered the ``gold standard'' for
    determining the extent of muscle damage to the heart following
    a heart attack. The Committee encourages the NHLBI to expand
    its research efforts into the role of biological imaging and
    PET in delivering more accurate information to determine
    appropriate treatment for heart disease patients.
        Behavioral Research Grants.--For many years NIH has
    required that any proposed research project grant with a budget
    over $500,000 in direct costs be subject to additional review
    and scrutiny. The Committee is interested to know whether at
    NHLBI this additional layer of review may differentially impact
    large behavioral science research grants. The Committee
    requests a report from NHLBI of all requests to fund research
    grants over $500,000, and whether they were approved, comparing
    behavioral grants to others in the pool, during fiscal years
    2000-2004. The report should be transmitted no later than May
    1, 2006.
        Bleeding and Clotting Disorders.--The Committee commends
    NHLBI for its leadership in advancing research on bleeding and
    clotting disorders and their complications. The Committee
    encourages NHBLI to maintain its work in this area and applauds
    the Institute for its efforts, in cooperation with the National
    Hemophilia Foundation, to support research on improved and
    novel therapies for these disorders.
        Bone Marrow Failure Diseases.--The Committee encourages
    NHLBI to expand its research efforts into bone marrow failure
    diseases, including aplastic anemia, myelodysplastic disorders
    [MDS], and paroxysmal nocturnal hemoglobinuria [PNH]. Each
    year, in some cases, MDS, the most prevalent of these diseases,
    can progress over time to become acute leukemia. More research
    is critically needed to understand the causes of these
    diseases, to develop effective treatments and cures, and to
    prevent the progression of certain cases into leukemia.
        Cardiothoracic Surgery.--The Committee recognizes the
    contributions of cardiothoracic surgery to the improvement in
    cardiac health in this country and looks forward to the
    advances that will come from further clinical research in the
    field. The Committee is encouraged by the steps the Institute
    is taking to establish a network for cardiothoracic surgical
    investigations, and urges rapid implementation of this plan
    with sufficient funding to continue the progress being made in
    the treatment of heart disease.
        Cardiovascular Diseases.--The Committee continues to
    strongly urge the Institute to place the highest priority on
    research for heart disease, stroke and other cardiovascular
    diseases. Therefore, the Committee urges the NHLBI to expand
    its research portfolio and increase its resources into the
    causes, cure, prevention and treatment of cardiovascular
    diseases. The Committee remains concerned that funding over the
    years for cardiovascular disease research has not kept pace
    with the scientific opportunities available, the number of
    Americans afflicted with cardiovascular diseases, or their
    economic toll. The Committee urges NHLBI to expand existing
    studies and to invest in promising initiatives.
        Cardiovascular Disease, Hypertension, and Kidney Disease.--
    The Committee is aware that chronic kidney dysfunction is an
    important risk factor for the development of cardiovascular
    disease. Additionally, hypertension, or high blood pressure, is
    the second leading cause of end-stage renal disease [ESRD],
    accounting for 23.6 percent of ESRD patients. ESRD and kidney
    dysfunction together affect millions of Americans and is
    especially prevalent among elderly persons, African-Americans
    and patients with diabetes. Given the significant morbidity and
    mortality associated with cardiovascular disease among patients
    with kidney disease, the Committee recognizes the urgency to
    examine the relationship between cardiovascular disease and
    kidney disease. The Committee encourages NHBLI and NIDDK to
    work together to develop appropriate basic and clinical
    research initiatives addressing the pathogenesis of
    cardiovascular events in patients with kidney disease, while
    exploring therapeutic and preventive interventions. The
    Committee also encourages NHBLI to work with the renal
    community to support ongoing educational programs directed to
    health professionals, patients and the public to raise the
    awareness of the relationship between cardiovascular disease,
    hypertension and kidney disease.
        Cardiovascular Disease With Juvenile Diabetes.--The
    Committee commends NIDDK and NHLBI for their efforts in
    developing new opportunities for studies on the pathogenesis of
    cardiovascular disease complications among patients with
    juvenile diabetes, and to evaluate opportunities for
    intervention studies to reduce CVD complications among patients
    with juvenile diabetes. The Committee encourages the Institutes
    to closely monitor research progress in this field and to
    continue to promote the clinical translation of research
    findings into new therapies.
        Chronic Obstructive Pulmonary Disease [COPD] National
    Education and Prevention Program.--The Committee is pleased
    that NHLBI held a preliminary workshop to formulate strategies
    toward implementing a National Chronic Obstructive Pulmonary
    Disease [COPD] Education and Prevention Program. Since COPD is
    the fourth leading cause of death in the United States, the
    Committee urges the NHLBI to continue its education efforts to
    bring advances in medical care to the public.
        Early identification of those at-risk for or who have COPD
    is essential in the effort to stem the growth of the population
    with COPD. The Committee encourages NHLBI to continue its
    efforts in this area, including working with national lung
    organizations such as the American Thoracic Society and the
    American Lung Association to develop a national education
    campaign for providers and the public about COPD.
        Cooley's Anemia.--The Committee remains strongly supportive
    of the focused research effort that is being undertaken by the
    Thalassemia Clinical Research Network, which is comprised of
    the leading research institutions in the field of thalassemia,
    or Cooley's anemia. The Committee believes that this network is
    just beginning to meet its promise and urges the Institute to
    continue it and support the research projects undertaken by it.
        Diamond-Blackfan Anemia.--The Committee is pleased that
    NHLBI has awarded grants for research initiatives to
    investigate the rare bone marrow deficiency disorder, Diamond
    Blackfan Anemia [DBA]. The Committee understands that
    breakthroughs in this disorder may lead to important strides in
    research especially relating to blood cell formation (recovery
    from cancer chemotherapy), cancer predisposition, gene
    discovery, and the effectiveness of steroids and blood
    transfusions as treatment options for all bone marrow failure
    syndromes. The Committee commends NHLBI for its attention to
    this disorder.
        Down Syndrome.--The Committee encourages NHLBI to review
    the causes of congenital heart disease in children with Down
    Syndrome. Studies should also be encouraged in analyzing the
    increased risk of leukemia in persons with Down Syndrome.
        Duchenne Muscular Dystrophy.--The Committee is pleased that
    NLHBI has enhanced its research and related activities
    surrounding cardiac complications associated with DMD and urges
    the Institute to continue to expand and enhance this work going
    forward. The Committee urges NHLBI to become more involved with
    NIH Muscular Dystrophy activities by joining the Muscular
    Dystrophy Coordinating Committee.
        Heart Failure Clinical Research Network.--The Committee is
    concerned that in spite of advances in treatment, both the
    number of newly diagnosed cases and the number of Americans
    suffering from heart failure continues to grow, while the long-
    term prognosis for patients still remains poor. The Committee
    urges the NHLBI to initiate a planned research network to
    conduct clinical studies using burgeoning new approaches to
    improve outcomes for heart failure patients, and provide an
    infrastructure to enable rapid translation of promising
    research findings into enhanced patient care. The network would
    have the capability of implementing multiple concurrent
    clinical studies that may show promise for new therapies and
    provide background for larger clinical trials.
        Hemoglobinopathies.--Sickle cell anemia and thalassemia are
    inherited blood disorders caused by mutations in the genes for
    the hemoglobin molecule, the protein in red blood cells that
    carries oxygen to all parts of the body. These conditions cause
    many problems including moderate to severe anemia, chronic
    pain, iron overload with its associated diabetes, liver and
    heart failure, enlarged spleen, bone weakness, pulmonary
    hypertension, and stroke. The Committee recognizes NHLBI's
    continued commitment to invest in basic and clinical research
    in sickle cell anemia and thalassemia, and encourages NHLBI to
    sponsor a conference of experts to develop a report focused on
    the science and management issues that are common to these
    hemoglobinopathies. The Committee supports a cooperative effort
    to identify areas of scientific collaboration and promising new
    research directions in sickle cell anemia and thalassemia.
        Hemophilia.--The Committee commends the NHLBI for its
    leadership in advancing research on bleeding and clotting
    disorders and the complications of these disorders. The
    Committee encourages the NHBLI to maintain its work in this
    area and support research on improved and novel therapies.
        Innovative Technologies for Engineering Small Blood
    Vessels.--The Committee understands that the supply of natural
    blood vessels for multiple grafts does not meet the demand for
    patients undergoing heart artery bypass surgery, and that
    prosthetic grafts for children born with complex heart defects
    fail at an unacceptable rate. To advance the development of
    substitutes for natural blood vessels, the Committee urges the
    NHLBI to continue to invest in research to address this matter.
        Lung Cancer.--Chronic Obstructive Pulmonary Disease [COPD]
    is the fourth leading cause of death in the United States. Lung
    cancer is the leading cancer killer in both men and women and
    in 2005. The Committee understands that COPD may be a predictor
    of future onset of lung cancer. With 24 million people having
    decreased lung function, and in the face of an ever-aging
    population, the need to develop better treatment and prevention
    strategies to address this linkage will only increase over the
    coming decade. The Committee encourages NHLBI to collaborate
    more extensively with NCI to develop appropriate research
    initiatives that can be undertaken cooperatively, and
    encourages NHLBI to sponsor a workshop on COPD as it relates to
    lung cancer with input from the lung community.
        Marfan Syndrome.--The Committee commends the NHLBI for its
    support of research on this life-threatening, degenerative
    genetic disorder, which is characterized by aortic aneurysms
    and dissections, painful orthopedic issues, pulmonary issues
    and ocular manifestations that can result in blindness. Years
    of basic research are ready to be translated into a clinical
    trial for a drug therapy that may potentially prevent aneurysm
    development, which may benefit not only the Marfan population
    but thousands of people who are afflicted with genetically
    triggered aneurysms and others with similar connective tissue
    disorders. The Committee urges the NHLBI to support this effort
    through all available mechanisms, as deemed appropriate.
        Novel Targets and Therapy Development for Clot-based
    Stroke.--The Committee recognizes that an urgent need exists to
    develop new therapies to reduce bleeding risk, minimize brain
    damage and loss of function from stroke. The Committee urges
    the NHLBI and the National Institute of Neurological Disorders
    and Stroke to initiate a planned collaborative effort to
    identify new molecular targets, explore promising agents, and
    develop innovative therapies to quickly restore blood flow to
    the brain to limit stroke damage.
        Primary Immunodeficiency Diseases.--The Committee
    understands that NHLBI has begun to work with the Jeffrey
    Modell Foundation as part of its national physician education
    and public awareness campaign for primary immunodeficiency
    diseases, including co-sponsorship of physician conferences at
    the NIH. The Institute also has supported the Foundation's 10
    Warning Signs Poster distribution, which is widely utilized by
    healthcare professionals in the Nation and globally. The
    Committee encourages NHLBI to take further action in this
    regard and to continue to be an active participant in the
    development of educational materials, conferences, and related
    initiatives, as appropriate.
        Pulmonary Fibrosis.--The Committee urges the NHLBI to
    increase funding for lung research, particularly in the area of
    pulmonary fibrosis, a disease that is terminal and for which
    there is currently no effective treatment.
        Pulmonary Hypertension.--Pulmonary Hypertension [PH] is a
    rare, progressive and fatal disease that predominantly affects
    women, regardless of age or race. PH causes deadly
    deterioration of the heart and lungs and is a secondary
    condition in many other serious disorders such as scleroderma
    and lupus. The Committee continues to view research in this
    area as a high priority and commends NHLBI's efforts to promote
    PH related research. For fiscal year 2006, the Committee
    encourages the Institute to increase funding for basic
    research, gene therapy and clinical trials of promising
    pharmaceuticals, and to take appropriate measures to ensure the
    submission of high quality proposals in this area.
        Scleroderma.--The Committee is encouraged by NHLBI's
    growing interest in scleroderma, a chronic and progressive
    disease that predominantly strikes women. Scleroderma is
    disfiguring and can be life-threatening, affecting multiple
    systems including the heart and lungs. The Committee commends
    the NHLBI for funding the Scleroderma Lung Study, a large
    multi-center trial whose focus is to find a therapy that may
    alter the course of the inflammation of the lungs that occurs
    in approximately 40 percent of those diagnosed with systemic
    scleroderma. The Committee also commends NHLBI for its
    increasing commitment to finding a cause and improved therapies
    for pulmonary arterial hypertension. Pulmonary arterial
    hypertension occurs in approximately 50 percent of those
    diagnosed with systemic scleroderma. More research is needed
    for the continued development of safe, effective treatments
    where few exist for some and none for others and to identify
    the causes of the complications of scleroderma that include
    pulmonary fibrosis, pulmonary hypertension, myocardial
    fibrosis, cardiac arrhythmias, pericarditis, and Raynaud's
    Phenomenon.
        Sleep Disorders.--The Committee continues to urge the
    National Center on Sleep Disorders Research to partner with
    other Federal agencies, such as the Centers for Disease Control
    and Prevention, as well as voluntary health organizations, such
    as the National Sleep Foundation, to develop a sleep education
    and public awareness initiative to serve as an ongoing,
    inclusive mechanism for public and professional awareness on
    sleep and sleep disorders.
        Specialized Centers of Clinically Oriented Research [SCCOR]
    for Vascular Injury, Repair, and Remodeling.--Vascular diseases
    result from clogged, weakened or otherwise damaged blood
    vessels. The Committee encourages the NHLBI to initiate a
    planned new SCCOR program to conduct interdependent clinical
    and multidisciplinary basic research projects on the molecular
    and cellular mechanisms of vascular injury, repair, and
    remodeling. This program would promote patient-oriented
    research to improve prevention, detection, and treatment of
    vascular diseases, such as heart attack and stroke. The SCCOR
    would provide resources to enable new clinical investigators to
    develop skills and research capabilities to conduct relevant
    research in this area.
        Thrombosis and Thrombophilia.--The Committee is very
    concerned about the basic science of thrombosis and
    thrombophilia, major causes of death and disability in this
    country. The Committee strongly urges the Institute to expand
    its support for basic research into their underlying causes in
    order to improve diagnosis and treatment for these conditions.
    The Committee also strongly urges the Institute to support this
    research and urges collaboration with the thrombophilia centers
    funded by CDC.
        Vascular Biology.--The Committee is very supportive of the
    Institute's research initiatives and encourages NHLBI to
    continue to advance the field of vascular biology, the study of
    blood and blood vessels and their interactions. Vascular
    biology research provides the foundation for understanding the
    underlying causes of atherosclerosis, angiogenesis,
    inflammation, and thrombosis. Venous and arterial thrombosis,
    blood clots that can lead to heart attacks, strokes, or
    respiratory dysfunction, are a particularly important and
    understudied area of vascular biology. Much remains to be
    learned about the basic mechanisms of pathologic thrombosis,
    but research has determined that age is one of the most
    important risk factors. The Committee encourages NHLBI, in
    collaboration with NIA, to develop a research agenda on
    thrombosis and its impact on the elderly, to improve the
    diagnosis and treatment of this potentially fatal complication
    of many diseases.

             NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

    Appropriations, 2005....................................    $391,829,000
    Budget estimate, 2006...................................     393,269,000
    House allowance.........................................     393,269,000
    Committee recommendation................................     405,269,000

        The Committee recommendation includes $405,269,000 for the
    National Institute of Dental and Craniofacial Research [NIDCR].
    The fiscal year 2005 appropriation was $391,829,000 and the
    budget requested $393,269,000. The comparable amounts for the
    budget estimate include funds to be transferred from the Office
    of AIDS Research.
        Mission.--The NIDCR supports research and research training
    to improve the oral health of Americans. The Institute
    emphasizes ways to prevent disease in high-risk groups,
    including the elderly, minority populations, and individuals
    with medical conditions and medications that compromise oral
    health. The research agenda includes studies of craniofacial
    genes and birth defects; bone and joint diseases; AIDS, other
    infections, and immunity; oral cancer; chronic pain;
    epidemiology; biomaterials; and diagnostic systems.
        Dental Abnormalities.--NIDCR is encouraged to continue its
    support of research aimed at the health of oral mineralized
    tissues. This includes studying the role of genetic factors and
    the potential for cell-based and pharmacological therapy and
    early screening for osteoporosis. Additionally, NIDCR is urged
    to continue research on fibrous dysplasia/McCune Albright
    syndrome and to focus on the dental abnormalities associated
    with Paget's disease.
        Scleroderma.--The Committee is encouraged by NIDCR's
    interest in scleroderma, a chronic and progressive disease that
    predominantly strikes women. Scleroderma is disfiguring and
    life-threatening, and effective treatments are lacking.
    Scleroderma is often associated with a number of dental and
    craniofacial complications. The most major and common problems
    are xerostomia and microstomia. Additional concerns are
    increased frequency of caries, periodontal disease, fibrotic
    changes, fungal infections, telangectasia and bone resorption
    of the mandible. Additional research is needed to develop safe
    and effective treatments and to identify the cause or causes of
    the serious complications of scleroderma.
        Temporomandibular Joint Disorders [TMJ].--The Committee
    agrees with and is encouraged by recent public statements by
    NIH officials that because of past and current investments in
    research and patient registries, the field is now ready to
    support a substantial new research investment in this complex
    set of disorders. The Committee therefore strongly urges that
    NIDCR take its appropriate leadership role in a substantially
    expanded effort to complete the research needs and
    opportunities agenda outlined in the June 2005 NIH TMJ Report
    to Congress. As noted previously, the Committee expects NIDCR
    to continue to collaborate and coordinate with all relevant
    ICs.
        Because patient advocacy groups are often the best sources
    of information about affected populations and have established
    mechanisms for communicating with them, the Committee urges
    NIDCR to regularly consult with the TMJ Association and other
    relevant groups as it develops and operates its patient
    registry activities. In addition, the Committee urges NIDCR to
    fund an effort to categorize and analyze the symptoms of people
    with TMJ disorders that are collected in a patient advocacy
    group database, in an effort to enhance future TMJ research
    agendas.

        NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

    Appropriations, 2005....................................  $1,713,584,000
    Budget estimate, 2006...................................   1,722,146,000
    House allowance.........................................   1,722,146,000
    Committee recommendation................................   1,767,919,000

        The Committee recommends an appropriation of $1,767,919,000
    for the National Institute of Diabetes and Digestive and Kidney
    Diseases [NIDDK]. The fiscal year 2005 appropriation was
    $1,713,584,000 and the administration's request is
    $1,722,146,000. The comparable amounts for the budget estimates
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--The NIDDK provides leadership for a national
    program in three major disease categories: diabetes,
    endocrinology, and metabolic diseases; digestive diseases and
    nutrition; and kidney, urologic, and hematologic diseases. The
    NIDDK plans, conducts, fosters, and supports a coordinated
    program of fundamental and clinical research and demonstration
    projects relating to the causes, prevention, diagnosis, and
    treatment of diseases within these categories. The Institute
    also supports efforts to transfer the knowledge gained from its
    research program to health professionals, patients, and the
    general public.
        Cooley's Anemia.--The Committee continues to support the
    high quality research being conducted by the NIDDK on such
    issues as iron chelation, non-invasive iron measurement, fetal
    hemoglobin, and other topics critical to improving the lives of
    Cooley's anemia patients. The development of a less burdensome
    means of iron chelation is urgently needed. In addition, the
    Committee encourages NIDDK to continue to work closely with
    NIBIB to develop and perfect non-invasive means of iron
    measurement.
        Cystic Fibrosis [CF].--The Committee encourages NIDDK to
    continue its support of CF research efforts, including
    proteomics research. CF researchers are looking at the many
    proteins that play a role in CF, in hopes of identifying new
    drug targets to treat CF. The Committee commends the NIDDK for
    its support of the program announcement for research proposals
    focusing on discovery and development of compounds that will
    correct protein misfolding. The Committee encourages NIDDK to
    further support this especially promising area of research.
        Diamond-Blackfan Anemia.--The Committee is pleased that
    NIDDK will be hosting a workshop to understand the state of the
    science of Diamond-Blackfan Anemia [DBA] as it relates to
    research important to NIDDK, including red cell formation,
    ribosomal proteins, DBA animal models, gene therapy, mechanisms
    of iron overload and the development of treatment options for
    patients with iron overload. The Committee strongly encourages
    NIDDK to develop grant opportunities to support DBA research
    initiatives in these areas.
        Digestive Diseases.--Serious disorders such as colorectal
    cancer, inflammatory bowel disease, irritable bowel syndrome,
    hemochromatosis, celiac disease, and hepatitis take a
    tremendous toll in terms of human suffering, mortality, and
    economic burden. The Committee commends NIDDK on the success of
    its Digestive Disease Centers program in addressing a wide
    range of disorders that result in tremendous human suffering
    and economic cost. The Committee continues to encourage NIDDK
    to expand this important program with an increased emphasis on
    irritable bowel syndrome.
        Diabetes in Native Hawaiians.--The Committee commends the
    NIDDK for its focused research on diabetes in Native American,
    Native Alaskan, and Native Hawaiian populations. The Committee
    is pleased with the innovative multicultural diabetes
    prevention campaign tailored specifically for native
    populations and the collaboration with CDC in the SEARCH
    epidemiological study. Additionally, the Committee requests an
    update in the fiscal year 2007 appropriations justification on
    recommendations resulting from the NIDDK and IHS conference
    scheduled to convene in 2005, and looks forward to similar
    conferences addressing prevention and treatment strategies in
    Native Hawaiian communities.
        Fatty Liver Disease.--The Committee notes that there is an
    emerging obesity-related chronic liver disease, which may
    affect as many as one in four adults and a significant number
    of obese children. This diagnosis encompasses a spectrum of
    severity with many cases evolving into non-alcoholic
    steatohepatitis [NASH] and, ultimately, cirrhosis. NASH-related
    liver disease has already become an important indicator for
    liver transplantation, and in the absence of better treatments,
    the need for NASH-related liver transplantation will increase
    significantly over time. The Committee is pleased that NIDDK is
    funding a fatty liver disease clinical trial that includes both
    adult and pediatric populations. The Committee urges NIDDK to
    focus research on the progression of fatty liver disease to
    cirrhosis and the impact of alcohol on the progression of fatty
    liver disease. The Committee notes that the recently published
    new USDA nutrition guidelines regarding alcohol consumption may
    not be appropriate for individuals with fatty liver disease,
    and therefore urges NIDDK to focus research on this matter to
    support a clarification of the USDA guidelines.
        Fragile X.--Fragile X mental retardation is a single-gene
    disorder that results from an unusual kind of mutation. Study
    of the chain of events set in motion by this mutation may lead
    to the identification of points in the process at which
    interventions may ameliorate symptoms. The Committee urges
    NIDDK to expand its research activities on Fragile X and to
    coordinate these efforts with other Institutes working on
    related activities, including NIMH and NICHD.
        Glomerular Disease Research.--The Committee continues to be
    pleased with the work of NIDDK in the area of glomerular
    disease research, particularly as it relates to focal segmental
    glomerulosclerosis. The Committee commends NIDDK for conducting
    the recent Glomerular Disease Workshop in January 2005, and
    urges NIDDK to issue a program announcement or other
    appropriate mechanism to ensure the initiation of grant
    proposals, training positions, and other activities to expand
    the NIDDK portfolio in this important area of research.
        Hepatitis B.--The Committee is concerned that a consensus
    treatment protocol for hepatitis B does not yet exist, but is
    pleased to learn that NIDDK is actively supporting preliminary
    research to convene a research workshop to plan a Hepatitis B
    Consensus Development Conference. The Committee is pleased that
    NIDDK is taking all necessary steps to plan a successful
    conference, and urges that this conference be convened as soon
    as possible.
        Hepatitis C.--The Committee is pleased to learn that there
    have been 50 patent applications filed for new therapies for
    hepatitis C and there are at least six drugs currently in early
    human trials. In addition to developing new drugs, the
    Committee urges NIDDK to encourage the improvement of existing
    drugs to reduce their toxicity and negative side effects. The
    Committee applauds NIDDK for formally adopting the goal of a 90
    percent treatment effectiveness rate for hepatitis C within 10
    years. The Committee encourages NIDDK to work with the National
    Hemophilia Foundation in developing and advancing research
    initiatives for addressing HCV within the bleeding disorders
    community.
        Hematology.--The Committee is aware of the high-quality
    hematology research in iron metabolism, gene regulation, and
    stem cell plasticity currently funded by the Institute. The
    Committee encourages NIDDK to set priorities for future
    research in these and new areas that significantly impact a
    broad array of blood disorders, such as erythroid
    differentiation, oxidant injury, and metabolomics.
        Incontinence.--Many otherwise healthy, active individuals
    suffer from incontinence. Fecal incontinence, also called bowel
    incontinence, affects people of all ages and is associated with
    a wide variety of causes. The Committee is pleased that NIDDK
    is contributing to the development of standardized approaches
    to measure incontinence and urges NIDDK to continue
    collaborating with NICHD on the incontinence state-of-the-
    science conference and on appropriate follow-up to this
    conference.
        Inflammatory Bowel Disease.--The Committee has been
    encouraged in recent years by discoveries related to Crohn's
    disease and ulcerative colitis, collectively known as
    inflammatory bowel disease [IBD]. These extremely complex
    disorders represent the major cause of morbidity from
    intestinal illness. The Committee commends NIDDK for its strong
    leadership in this area and encourages the Institute to
    increase funding for research focused on: (1) the cellular,
    molecular and genetic structure of IBD; (2) identification of
    the genes that determine susceptibility or resistance to IBD in
    various patient subgroups; and (3) translation of basic
    research findings into patient clinical trials as outlined in
    the research agenda developed by the scientific community
    titled ``Challenges in Inflammatory Bowel Disease.'' The
    Committee also encourages NIDDK to continue to strengthen its
    partnership with the IBD community and increase funding for its
    successful Digestive Disease Centers program with an emphasis
    on IBD.
        Integration of Type 1 Diabetes Research.--The Committee
    urges the NIH to facilitate the effective integration of the
    various research programs funded by the special funding for
    Type 1 Diabetes Research.
        Interstitial Cystitis.--The Committee notes that RFAs have
    been very helpful in stimulating scientific interest in
    interstitial cystitis [IC]. Therefore, the Committee urges the
    NIDDK to continue using this funding mechanism when investing
    in IC-specific basic science research, particularly in the area
    of urinary markers. The Committee also encourages the NIDDK to
    sponsor a scientific symposium on IC in 2006 to follow up on
    the very successful 2003 symposium. The Committee also urges
    the NIDDK to hold a separate meeting of leading international
    opinion leaders involved in IC research to seek clarity on the
    definition of IC. The absence of a uniform definition that
    accurately captures the condition and the affected population
    is negatively impacting patients in terms of diagnosis and
    treatment as well as researchers in terms of literature review
    and their research activities. The Committee was encouraged to
    learn that the NIDDK is launching an IC awareness campaign, and
    it hopes the NIDDK will continue to work closely with the IC
    patient community on both developing the content and executing
    the campaign.
        Irritable Bowel Syndrome.--The Committee is pleased that
    NIDDK is formulating an action plan for digestive diseases and
    that irritable bowel syndrome [IBS] will be a focus area of
    this overall plan. However, given the increasing frequency of
    IBS and the Committee's long-standing interest in this
    condition, the Committee strongly urges the NIDDK to complete
    this digestive disease plan as quickly as possible.
        Kidney Disease.--Kidney disease is a rapidly growing health
    problem in the United States, where an estimated 15 million
    people have lost 50 percent of their kidney function and
    another 20 million more Americans are at increased risk of
    developing kidney disease. The marked increase in the end-stage
    renal disease [ESRD] population is fueled by the large number
    of patients with diabetes. Diabetes is the most common cause of
    kidney disease and accounts for 34 percent of patients on
    dialysis. Chronic kidney disease has emerged as a major
    contributing factor to cardiovascular disease. The Committee
    therefore encourages NIDDK to assign priority to expand the
    kidney disease research infrastructure through a robust program
    of kidney research core centers to promulgate collaborative
    research on a local, regional and national level. In addition,
    the Committee recommends expanded support for investigator-
    initiated research projects in five priority areas of greatest
    clinical importance: acute renal failure, diabetic nephropathy,
    hypertension, transplantation, and uremic cardiovascular
    toxicity. Research grant applications in these areas should be
    encouraged with appropriate program announcements and requests
    for proposals. Continued funding of grants to support
    development of investigator-initiated clinical and basic
    studies in these areas of high priority is essential. The
    Committee wishes to commend NIDDK for moving forward with the
    Clinical Trials Cooperative Group and supports collaboration
    with the renal community to seek new strategies and energize
    clinical investigation in the above mentioned areas.
        Liver Disease Research Action Plan.--The Committee is
    pleased to note that NIDDK, working with the leading scientific
    experts in the field, has published a comprehensive Liver
    Disease Research Action Plan to guide future research
    activities. The Plan is organized into 16 chapters and
    identifies numerous areas of research important to virtually
    every aspect of liver disease. The Committee urges that steps
    be taken to implement the plan immediately and submit a report
    to the Committee prior to next year's hearings detailing what
    has been accomplished to that point, as well as future plans,
    with a specific timeline, for implementation of the balance of
    the plan.
        Mucopolysaccharidosis [MPS].--The Committee recognizes the
    efforts of the NIDDK to enhance research efforts to achieve a
    greater understanding and pursue development of effective
    therapies for MPS disorders. In addition to the general overall
    support of broad-based MPS research, the Committee supports
    efforts by NIDDK to reach out to NIAMS to improve collaborative
    bone and joint disease research in MPS disorders. Research
    focused on the underlying pathophysiology of bone and joint
    lesions, the gene mutations and substrates that are stored, and
    potential therapeutic approaches continue to be of significant
    interest to the Committee. The Committee commends the NIDDK on
    its collaborations with NINDS, NICHD, NCRR, and ORD in
    advancing broad-based MPS-related research.
        Osteoporosis.--NIDDK is encouraged to support research
    targeting new technologies and therapies to increase bone mass
    and combat osteoporosis, through focus on: (1) genetics,
    environmental and lifestyle factors, and (2) the effects of
    disease, in order to address the critical research questions
    highlighted in the Surgeon General's Report on Bone Health and
    Osteoporosis.
        Paget's Disease.--NIDDK is urged to study the functional
    consequences of the recently identified gene mutations in
    Paget's disease as a means of identifying new therapeutic
    treatments for the disease.
        Pediatric Kidney Disease.--Kidney disease remains a
    persistent and poorly understood problem among infants,
    children and adolescents, impairing normal growth and
    development and often resulting in learning disabilities and
    mental retardation. Of urgent concern today is the explosion in
    the incidence of obesity among children and adolescents, a
    morbidity that places more than 15 percent of America's
    children at risk for developing type 2 diabetes, hypertension,
    and chronic kidney disease [CKD]. These morbidities not only
    represent a significant financial burden to the health care
    system but also are important risk factors for the development
    of cardiovascular disease. The Committee urges NIDDK to
    continue to support research focused on the pathogenesis,
    prevention, and treatment of kidney disease in children. The
    Committee recommends that emphasis be placed on exploring the
    contributions of obesity, type 2 diabetes, and hypertension to
    progression of disease, and interventions that may limit
    cardiovascular morbidity in patients with CKD.
        Pediatric Liver Disease.--The Committee is pleased that the
    NIDDK has taken steps to increase research on biliary atresia,
    the most common cause of liver transplantation in children, by
    creating 10 centers within the Biliary Atresia Clinical
    Research Consortium. The Committee is also pleased that centers
    have been added with a special focus on additional neonatal
    liver diseases.
        Polycystic Kidney Disease.--The Committee is pleased to
    learn of the first clinical drug trial for PKD in humans and
    the development of additional, innovative PKD therapies. This
    progress directly benefits more than 600,000 Americans
    suffering from PKD and could potentially save billions of
    Medicare and Medicaid dollars for renal replacement therapy and
    free up thousands of spots on the kidney transplant waiting
    list. These discoveries have produced a cohesive,
    interdisciplinary body of scientific work benefiting PKD
    research; engendered a broad range of alternative model
    research systems and reagents shared worldwide among PKD
    investigators; and drawn a host of talented investigators from
    other disciplines into the PKD field. The Committee urges NIDDK
    to pursue fulfillment of its PKD Strategic Plan by facilitating
    PKD clinical trials, expanding studies of pathophysiology and
    cellular pathobiology, expanding the PKD research
    infrastructure, and enhancing resources to create a supportive
    environment for PKD investigators to develop new interventional
    strategies and pursue long-range planning.
        Primary Biliary Cirrhosis [PBC].--PBC is a rare, chronic
    and progressive liver disease that causes irreversible
    destruction of the bile ducts. The cause of PBC is still
    unknown, but current studies suggest it may involve
    autoimmunity, infection, or genetic predisposition, and does
    seem to appear more often in certain families. Women are
    affected 10 times more than men, and PBC is usually diagnosed
    in patients between the ages of 35 to 60 years. The Committee
    encourages NIDDK to further study this rare disease to
    determine among other things, why women are predominantly
    affected and whether there are successful treatment options
    other than liver transplantation.
        Prostatitis.--The Committee encourages the Institute to
    provide more diverse medical specialties to supplement and
    build upon the insufficient treatment options and the
    background of basic information now available for prostatitis.
    The genetic and molecular epidemiology, the management of
    pelvic pain, the infectious origins and the symptoms of
    prostatitis that are identical to symptoms of prostate cancer
    need special attention.
        The Committee applauds the work the Chronic Prostatitis
    Collaborative Research Network [CPCRN] has undertaken. The
    genetic and other possibilities linking prostate diseases is
    virtually unexplored. The Committee encourage microscopic
    studies of the prostatic fluid and tissue by infectious disease
    specialists, pathologists, immunologists and others. The
    Committee further encourages the NIDDK to increase research,
    public awareness, and public education to erase the stigma
    attached to this affliction that attacks young men.
        Scleroderma.--The Committee encourages the NIDDK to support
    scleroderma-relevant research. Scleroderma is a chronic and
    progressive disease that predominantly strikes women. It is
    estimated that 90 percent of patients with systemic sclerosis
    have gastrointestinal [GI] involvement and that of that number
    50 percent have clinically significant manifestations. GI
    involvement can manifest as gastroesophageal reflux disease,
    dysphagia, Barrett's esophagus, gastroparesis, ``watermelon
    stomach'', malabsorption, and fibrosis of the small and large
    intestines. Renal crisis affects 20 percent of those with
    systemic sclerosis often within the first 5 years after
    diagnosis. More research is needed in order to develop safe and
    effective treatments and to identify the cause or causes of the
    complications of scleroderma.
        TEDDY.--The Committee commends the NIDDK for launching
    TEDDY, a long-term study to identify the environmental causes
    of autoimmune diabetes. The Committee urges the NIDDK to
    communicate details of the study to the research community, to
    provide access to study materials and data, and to develop
    mechanisms to integrate new technologies into the study design.
        TrialNet.--The Committee commends the NIDDK for its support
    of the Type 1 Diabetes TrialNet, which has launched a natural
    history study and a clinical intervention trial for juvenile
    diabetes. The Committee encourages the NIDDK to continue its
    efforts to translate basic and preclinical research on juvenile
    diabetes into a pipeline of new therapeutic strategies that can
    be evaluated through the TrialNet clinical trials network. The
    Committee urges the NIDDK to develop biomarkers for the
    evaluation of efficacy and the efficient operation of clinical
    trials and to develop more efficient approaches to subject
    recruitment for clinical trials.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
    TSC, is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body including the kidneys,
    where patients are at risk for polycystic kidney disease,
    cancer or, most commonly, benign growths know as angiomyolipoma
    that can result in kidney failure. The Committee is encouraged
    that NIDDK is participating in a Trans-NIH Tuberous Sclerosis
    Coordinating Committee, and urges NIDDK's continued involvement
    in this process. The Committee also urges NIDDK to collaborate
    with NCI on a conference on nutrient sensing and insulin-
    signaling in cells with inclusion of TSC research.

            NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

    Appropriations, 2005....................................  $1,539,448,000
    Budget estimate, 2006...................................   1,550,260,000
    House allowance.........................................   1,550,260,000
    Committee recommendation................................   1,591,924,000

        The Committee recommends an appropriation of $1,591,924,000
    for the National Institute of Neurological Disorders and Stroke
    [NINDS]. The fiscal year 2005 appropriation was $1,539,448,000
    and the budget request is $1,550,260,000. The comparable
    amounts for the budget estimates include funds to be
    transferred from the Office of AIDS Research.
        Mission.--The NINDS conducts and supports a broad range of
    research and research training on the normal function of the
    brain, spinal cord, and peripheral nerves, and on neurological
    and neuromuscular disorders. Neurological research includes
    epidemiology studies to identify risk factors for disease;
    laboratory studies to examine the structure and function of
    nerve cells; and brain imaging studies to understand how the
    brain is affected by disease and how it operates to carry out
    tasks such as learning and memory. New approaches for the
    diagnosis, treatment, and prevention of brain disorders are
    evaluated in studies with patients and those at risk for brain
    disorders.
        Alzheimer's Disease.--NINDS is currently supporting both
    pre-clinical and translational research intended to expand the
    pool of therapeutic agents for treating Alzheimer's disease.
    For example, a recent NINDS-supported study tested a drug that
    interferes at a specific point in the cholesterol pathway that
    contributes to the generation of amyloid protein, a hallmark of
    Alzheimer's. The study resulted in a 99 percent reduction in
    brain amyloid in a mouse model of the disease, suggesting that
    this may provide a novel approach for developing a therapeutic
    intervention for Alzheimer's disease. The Committee encourages
    NINDS to continue to assign a high priority to Alzheimer
    research, and to work closely with NIA, NIMH and other
    institutes.
        Amyotrophic Lateral Sclerosis [ALS].--The Committee is
    pleased by the increased number of NINDS research programs on
    ALS, including participation in the NIH partnership of 14
    Institutes to accelerate neuroscience research, the NIH
    Blueprint for Neuroscience Research, plus new interdisciplinary
    collaborations with other organizations and appropriate NIH
    Institutes, particularly NIEHS. The Committee commends NINDS on
    its multiple initiatives involving high-throughput screening
    and assay development to identify compounds with activity in
    neurodegenerative disorders, including ALS. The Committee is
    gratified by the development of translational research and the
    clinical trials programs at NINDS and by the public's new
    opportunities to benefit from better access to and
    dissemination of information. The Committee is also pleased by
    the series of scientific workshops held since 2003 with the
    Department of Veterans Affairs [VA], the Department of Defense
    [DOD], and with leading scientists from academic centers
    throughout the Nation. The Committee encourages NINDS to
    continue and to grow its collaborative initiatives with
    voluntary health associations, other NIH Institutes, the DOD
    and the VA in the effort to advance ALS research and identify
    treatments and a cure for the disease.
        Ataxia Telangiectasia [A-T].--A-T is a genetic disease that
    attacks in early childhood. It progressively affects
    coordination and severely compromises the immune system.
    Children with A-T are highly likely to develop cancer, and
    rarely live beyond their teens. The Committee encourages the
    NINDS to work with the NCI and other appropriate Institutes to
    support research aimed at understanding the underlying causes
    of A-T, with the goal of translating this basic research into
    treatments for the disease.
        Basic Behavioral and Social Sciences Research.--The
    Committee encourages NINDS to participate in trans-institute
    initiatives organized by OBSSR or another institute to
    strengthen basic behavioral research and enhance opportunities
    for behavioral science research training.
        Batten Disease.--The Committee strongly urges the Institute
    to increase funding for Batten Disease research by actively
    soliciting grant applications and taking aggressive steps to
    assure that a vigorous research program is established. The
    Committee expects to be informed of the steps taken to increase
    research on Batten disease.
        Brain Tumors.--The Committee continues to believe that
    additional attention should be given by NINDS to identifying
    causes of and treatments for brain tumors and encourages NINDS
    to continue working with NCI to carry out the recommendations
    of the Report of the Brain Tumor Progress Review Group.
        Charcot-Marie-Tooth Disease.--The Committee continues to be
    concerned about NIH support for research on Charcot-Marie-Tooth
    [CMT] disease. The Committee welcomes the upcoming NINDS
    workshop on peripheral neuropathies, but remains unclear as to
    the degree this workshop will focus on CMT. The Committee urges
    the NIH to include a significant focus on CMT in the upcoming
    workshop with a goal of producing outcomes which will be
    directly relevant to CMT research and lead to a relevant
    program announcement or request for applications on CMT. The
    Committee encourages that relevant Institutes and Centers will
    participate in the workshop. In addition, the Committee
    requests NIH incorporate CMT research into its Blueprint for
    the Neurosciences initiative.
        Down Syndrome.--The Committee commends NINDS for sponsoring
    a Down Syndrome Workshop to address research priorities
    relating to optimizing synaptic structure and function in
    neuronal circuits important for cognition. The Committee
    encourages NINDS to identify opportunities for investigating
    the genetic and cellular basis for abnormalities in the
    structure and function of these circuits in both the developing
    and mature nervous system. In addition, NINDS is encouraged to
    develop strategies to understand the incidence and impact on
    cognition of obstructive sleep apnea and other disorders of
    sleep. The NINDS is also encouraged to work with the NIA to
    develop strategies to investigate the biology of age-related
    disorders, such as Alzheimer's disease and Parkinson's disease,
    in people with Down syndrome. NINDS is also encouraged to work
    with the Office of the Director to develop a strategic plan for
    Down syndrome research and to coordinate its research with
    NICHD, NIA, NIMH and other institutes.
        Duchenne Muscular Dystrophy.--The Committee remains
    concerned with the amount of time taken by the NIH to comply
    with requirements of the MD Care Act, which became law in
    December 2001. However, the Committee is pleased NIH has funded
    one additional Wellstone Muscular Dystrophy Cooperative
    Research Center and is working to fund two more for a full
    complement of six. The Committee further encourages the
    Institute to provide adequate funding and resources for each
    center. The Committee further requests that NINDS coordinate
    with NIAMS on timelines for translational research, the
    consensus conference and the strategic plan.
        Epilepsy.--The Committee seeks intensified efforts by the
    NINDS to produce breakthroughs in the prevention, treatment,
    and eventual cure of epilepsy. The Committee applauds the
    development of benchmarks for epilepsy research resulting from
    the ``Curing Epilepsy: Focus on the Future'' conference held in
    March 2000 and encourages the Institute to address important
    research issues raised at the ``Living Well with Epilepsy II''
    conference held in July 2003. The Committee encourages NINDS to
    continue to dedicate resources for carrying out its benchmark
    priorities, to develop plans and goals for the anti-epileptic
    drug development program, and to report to the Committee on its
    activities to further these important areas of research.
        Fragile X.--The Committee urges the NINDS to intensify its
    research into these issues as they relate to Fragile X, and to
    coordinate this research with other Institutes working on
    Fragile X, including but not limited to NIMH and NICHD.
        Fragile X-associated Tremor/Ataxia Syndrome [FXTAS].--FXTAS
    is a newly discovered, progressive neurological disorder that
    affects older men who are carriers of a premutation in the same
    gene that causes Fragile X syndrome. Identification of older
    male carriers will lead to a better understanding of the true
    incidence of Fragile X syndrome and afford at-risk families of
    child-bearing age the opportunity to pursue genetic counseling.
    NINDS, in collaboration with the National Institute on Aging,
    is urged to commit additional resources and expand research
    into FXTAS, including working with the other NIH institutes as
    well as the Centers for Disease Control and Prevention in the
    development of genetic counseling protocols for families
    affected by both Fragile X and FXTAS.
        Learning Disabilities.--The Committee commends NINDS for
    the work conducted to explore the neurological aspects of
    learning disabilities. The Committee looks forward to learning
    the results of this work and encourages the Institute to
    continue to coordinate with other Institutes working on related
    activities.
        Mucopolysaccharidosis [MPS].--The Committee commends NINDS
    efforts to collaborate with the Lysosomal Storage Disorder
    Research Consortium [LSDRC] in the development and release of
    the July 2004 program announcement titled ``CNS Therapy
    Development for Lysosomal Storage Disorders'' and the stated
    intent to enhance blood brain barrier research in lysosomal
    storage disorders. The Committee continues to encourage NINDS
    to collaborate with all appropriate Institutes and Centers to
    support ongoing MPS research, including study of the blood
    brain barrier as an impediment to treatment, and use all
    available mechanisms to further stimulate and enhance efforts
    to better understand and treat MPS disorders.
        Neurofibromatosis.--The Committee encourages NINDS to
    aggressively expand its NF clinical and basic research
    portfolios. The Committee commends NINDS for its leadership
    role in NF research and in coordinating efforts with other
    Institutes engaged in NF research. The Committee recognizes
    that basic research has now successfully brought NF research
    into the clinical era. The Committee therefore encourages NINDS
    to continue its exemplary efforts in the creation,
    implementation and funding of NF clinical trials
    infrastructures and clinical trials using existing and new
    drugs on NF patients. The Committee calls upon NINDS to
    continue to coordinate its efforts with the other institutes at
    NIH as well as other government agencies.
        Neuroprosthetics.--The Committee strongly supports research
    on neuroprosthetics, such as the Brain Machine Interface (or
    Human Assisted Neurological Device) project. This research
    offers great promise in restoring movement in individuals
    suffering from a variety of neurological disorders, including
    paralysis, stroke and wound-related trauma, and should be
    expanded.
        PET Imaging and Alzheimer's Disease.--The Committee urges
    the NINDS, in collaboration with the NIA and NIMH, to expand
    its research into early diagnosis of Alzheimer's using PET
    imaging of the brain, and to share its results with the Centers
    for Medicare and Medicaid Services.
        Parkinson's Disease.--The Committee supports the innovative
    multidisciplinary research and training concerning Parkinson's
    disease provided by the Morris K. Udall Parkinson's Disease
    Research Centers of Excellence. The Committee urges NINDS to
    continue support for the Udall Centers. The Committee further
    encourages the Director to create an additional Coordinating
    Udall Center to further focus and manage the interdisciplinary
    efforts of the Udall Centers. The additional research
    opportunities and discoveries made by Udall Center scientists
    are leading to improved diagnosis and treatment of patients
    with Parkinson's. The Committee commends both the basic and
    clinical objectives of the Centers that, together, enhance
    research effectiveness in a multidisciplinary setting. The
    Committee commends the NINDS for participating in a community-
    wide examination of private and public Parkinson's disease
    research funding through the Parkinson's Community Research
    Advisory Council. The Committee strongly encourages NINDS to
    continue to participate in this effort. The Committee commends
    the Director for implementing the Neuroscience Blueprint, which
    creates new opportunities for collaborative, directed research
    across institutes and through public-private partnerships. As
    the NINDS develops Blueprint initiatives for this and future
    years, the Committee encourages continued collaborations
    including additional intramural activities between NINDS, NIMH,
    and NIA to enhance understanding of neurodegenerative diseases,
    particularly Parkinson's disease. Specifically, the Committee
    encourages collaborations with other institutes in the areas of
    genetics, cell biology, pathology/epidemiology, non-human
    models, biomarkers, neuroimaging, gene therapy, surgical
    approaches, drug development, cell replacement therapy (i.e.,
    stem cells), and mental health which will lead to better
    treatments or a cure for this devastating and costly disease.
    In particular, the Committee urges continued research on
    biomarkers, for early detection of Parkinson's, and
    neuroprotective compounds, to slow or stop the disease until
    cures can be found. As the results of neuroprotection trials
    become known, the Committee urges the Director to provide
    funding for Phase III clinical trials of all the
    neuroprotection compounds found to be effective, including
    combinations of them. As Parkinson's is affecting men and women
    at progressively younger ages, causing many to have to stop
    working within a few years of their diagnosis, early diagnosis
    and identification of neuroprotective compounds are critical.
        Peripheral Neuropathy.--As many as 20 million Americans
    suffer from peripheral neuropathy, a neurological disorder that
    causes debilitating pain, weakness in the arms and legs, and
    difficulty walking. Peripheral neuropathy affects approximately
    one-third of diabetics, or about 5.1 million persons, while
    other forms of neuropathy are inherited; associated with
    cancer, kidney disease or infections like hepatitis, HIV/AIDS
    or Lyme disease; or caused by autoimmunity, traumatic injuries,
    poor nutrition, toxins and certain medications. While
    significant research is underway on diabetic neuropathy and
    HIV/AIDS-related neuropathy, the Committee strongly urges NINDS
    to strengthen its research portfolio on other forms of
    neuropathy. The Committee is pleased to learn that NINDS plans
    to convene a workshop with distinguished scientists to identify
    research goals aimed at expanding the research knowledge base
    and identifying potential therapies.
        Picks Disease.--The Committee urges the NINDS to initiate
    funding for drug discovery efforts that focus on specific
    targets relevant to treating the mechanisms underlying brain
    degeneration due to frontotemporal dementia [FTD]. The
    Committee further encourages the NINDS to conduct multicenter
    treatment trials for symptomatic management of Pick's disease
    and other FTDs. The Committee encourages the Institute to focus
    on methods for discovering the causes of this family of
    diseases, improving diagnostic accuracy, and providing
    longitudinal characterizations so that the success of
    intervention can be determined.
        Rett Syndrome.--The Committee remains concerned at the
    level of funding dedicated toward research into the genetic
    cause of Rett syndrome, an incurable childhood neurological
    disorder that is the leading cause of severe neurologic
    impairment in females and the only autism spectrum disorder
    that is known to have a genetic cause. While once considered
    rare, increased diagnosis suggests that the prevalence of Rett
    syndrome may be much greater than the current estimated
    incidence of 1 in every 10,000 females. The discovery of the
    specific genetic cause of Rett syndrome could help elucidate a
    host of other disorders, including autism, schizophrenia,
    Parkinson's, anxiety and autonomic nervous system disorders.
    Accordingly, the Committee strongly urges NIH to dedicate
    enhanced resources to research on the genetic cause of Rett
    syndrome. The Committee also encourages NIH to coordinate with
    private organizations supporting research initiatives in this
    area in order to ensure the most efficient use of resources.
        Spinal Muscular Atrophy.--The Committee understands that
    the severity of SMA, its relatively high incidence, and the
    possibility of imminent treatments have led NINDS to initiate
    the SMA Therapeutics Development Program. The Committee
    commends NINDS for this initiative and strongly urges NIH/NINDS
    to continue to commit the resources to ensure a timely
    completion of the project mission--to identify and complete
    preclinical research and development of candidate therapeutics
    for treating SMA by 2007. To maximize program efficiency, it is
    also critical that NINDS lead efforts to integrate Therapeutics
    Development efforts with emerging programs in the biotech and
    pharmaceuticals industry, academic medical centers and
    collaborations with voluntary health organizations to ensure
    that duplication of effort is avoided. The Committee encourages
    NINDS to aggressively expand its SMA basic, translational and
    clinical research portfolio. The Committee understands that the
    strategy for developing a treatment for SMA will guide
    therapeutics development for other diseases including: Duchenne
    Muscular Dystrophy, ALS, Huntington's and Alzheimer's. The
    Committee strongly urges NINDS to successfully and
    expeditiously execute the SMA Therapeutics Development Program
    for the benefit of patients of SMA and countless other
    diseases. The Committee requests that NIH report back to the
    Committee, no later than June 1, 2006 with a progress report on
    all aspects of SMA research.
        Stroke.--The Committee continues to place a high priority
    on stroke research and strongly encourages the NINDS to
    increase resources for basic, clinical and translational
    research and related activities into stroke. The Committee
    remains concerned that funding for stroke research over the
    years has not kept pace with the scientific opportunities, the
    number of Americans afflicted with stroke, and the economic
    toll of this disease. Therefore, the Committee encourages the
    NINDS to aggressively expand its stroke education program, to
    implement the long-range strategic plan for stroke research and
    to continue searching for novel approaches to improve stroke
    diagnosis, treatment, rehabilitation and prevention. The
    Committee supports implementation of the Stroke Progress Review
    Group Report and expects prior to the fiscal year 2007 hearings
    a written update, including specific activities and initiatives
    in this regard.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
    TSC, is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body, including the brain,
    heart, kidneys, lungs, liver, eyes and/or skin. Individuals
    with TSC--many of whom are infants and young children--face a
    lifetime of suffering with kidney failure, seizures, behavioral
    disorders, autism and mental retardation. The Committee is
    encouraged that NINDS has organized a Trans-NIH Tuberous
    Sclerosis Coordinating Committee, and urges NINDS to continue
    to take a leadership role in convening meetings of this
    Committee, facilitating communication between the participating
    institutes, and encouraging funding of TSC-related research.
    The Committee also encourages NINDS to host a pre-clinical
    translational research workshop on TSC and to include TSC in
    the NINDS Pilot Therapeutic Network [NPTUNE].
        Vulvodynia.--The recently published findings of NIH-
    supported research indicates that millions of women suffer from
    chronic pelvic and genitourinary pain conditions such as
    vulvodynia. Therefore, the Committee calls on NINDS to expand
    its support of research in this area, in coordination with
    NICHD, ORWH, the NIH Pain Consortium and other ICs, with a
    focus on etiology and multi-center therapeutic trials.

             NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

    Appropriations, 2005....................................  $4,402,840,000
    Budget estimate, 2006...................................   4,459,395,000
    House allowance.........................................   4,359,395,000
    Committee recommendation................................   4,547,136,000

        The Committee recommends an appropriation of $4,547,136,000
    for the National Institute of Allergy and Infectious Diseases
    [NIAID]. The budget request was $4,459,395,000. The fiscal year
    2005 appropriation was $4,402,840,000. Included in these funds
    is $100,000,000 to be transferred to the Global Fund to Fight
    HIV/ AIDS, Malaria, and Tuberculosis. Also included is bill
    language permitting up to $30,000,000 for extramural facilities
    construction grants. The comparable amounts for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        Mission.--The NIAID is the lead NIH Institute charged with
    developing vaccines and supporting research on allergies,
    acquired immunodeficiency syndrome [AIDS], sexually transmitted
    diseases, tuberculosis, tropical diseases, and other infectious
    diseases--including those likely to be used as agents of
    bioterrorism. To accomplish this mission, the NIAID supports
    and conducts basic and clinical research and research training
    programs in infectious diseases, whether they are naturally
    occurring or the result of a bioterrorist attack, and in
    diseases caused by, or associated with, disorders of the immune
    system.
        Anaphylaxis.--In recent years, the Committee has encouraged
    the NIAID to expand research in the areas of food and drug
    allergy. The Committee was pleased to learn of the Institute's
    co-sponsorship of a symposium on the definition and management
    of anaphylaxis, a particularly severe reaction often resulting
    from allergic responses to food or medications. A recent
    published report of the meeting emphasized the need for
    expanded research to improve methods for diagnosing, treating,
    and preventing the condition. The Committee urges the NIAID to
    work with interested organizations to develop a comprehensive
    research agenda on anaphylaxis. The Committee requests a report
    by May 1, 2006, on how it plans to stimulate research in this
    area.
        Asthma.--The Committee is very pleased with NIAID's
    leadership regarding asthma research and management. The
    Committee urges NIAID to continue to improve its focus and
    effort on asthma management, especially as it relates to
    children. The Committee also urges the NIAID to collaborate
    more aggressively with voluntary health organizations to
    support asthma prevention, treatment, and research activities.
    Additionally, recent studies suggest that a variety of viral
    and bacterial agents, including agents used for immunization
    may play a role in the development of asthma. The Committee
    urges the Institute to expand research into the role that
    infections and vaccines play in the development of asthma.
        Atopic Dermatitis.--The Committee was pleased to learn
    about NIAID research efforts related to atopic dermatitis
    undertaken through projects such as the Immune Tolerance
    Network and the Atopic Dermatitis and Vaccinia Immunization
    Network. Last year, the Committee encouraged NIAID to
    complement these efforts by working with NIAMS to spearhead a
    multidisciplinary, multi-institute initiative to encourage
    investigator-initiated research projects on AD as it relates to
    smallpox vaccination as well as the progression to asthma and
    other allergic diseases. The Committee requests an update in
    the fiscal year 2007 appropriations justification on efforts
    that have been made to foster investigator-initiated research
    in this area.
        Autoimmune Diseases.--The Committee applauds the formation
    of two cooperative research groups, the Autoimmune Centers of
    Excellence and the Cooperative Study Group for Autoimmune
    Disease Prevention, which support multidisciplinary research to
    understand and treat autoimmune diseases. The Committee urges
    NIAID to continue its support for the prevention centers and to
    encourage the participation of the wider research community in
    this initiative.
        Bioterrorism.--Respiratory pathogens that cause life-
    threatening pneumonia are commonly proposed agents of
    bioterrorism. The following are associated with acute
    pneumonia/lung injury: anthrax, smallpox, plague, and
    tularemia. The Committee encourages further research on the
    mechanisms of pneumonia by these respiratory pathogens and the
    development of new therapeutic interventions to reduce injury
    and death.
        Coinfection Research.--The Committee is concerned that
    there is growing evidence of liver toxicity of highly active
    antiretroviral therapy [HAART] in those with chronic viral
    hepatitis and in particular those with decompensated liver
    disease awaiting liver transplantation. There also appears to
    be an emerging problem of liver cancer in co-infected patients
    (HCV and/or HBV with HIV). The Committee encourages NIAID to
    initiate significant research initiatives in both of these
    areas.
        Dystonia.--The Committee continues to support the expansion
    of research and treatment developments regarding the
    neurological movement disorder dystonia, given that dystonia is
    the third most common movement disorder after tremor and
    Parkinson's disease. The Committee encourages NINDS to support
    additional research on both focal and generalized dystonia, and
    commends NINDS for its study of the DYT1 gene and encourages
    expansion in this area of research. The Committee is pleased
    with progress made in expanding the dystonia research portfolio
    resulting from the joint dystonia research program announcement
    [PA], and urges NINDS to consider options for continued
    progress once the program announcement expires in August 2005.
        Hemophilia.--The Committee urges NIAID to continue its
    efforts to develop and advance research initiatives for
    addressing HCV within the bleeding disorders community. The
    Committee understands that HCV continues to have a devastating
    impact on this community, with nearly half of all persons with
    hemophilia having contracted HCV from blood clotting factor
    products.
        Hepatitis.--The Committee continues to be concerned about
    the prevalence of hepatitis and urges NIAID to work with public
    health organizations to promote liver wellness, education, and
    prevention of hepatitis.
        Hepatitis C Vaccine Development.--The Committee is
    encouraged to learn that a small hepatitis C vaccine human
    trial has been successfully completed. The Committee urges
    NIAID to implement the results of the recent workshop that was
    held to discuss and evaluate efforts toward development of HCV
    vaccines with the goal of spurring their development and
    testing. The Committee also urges NIAID to proceed with phase
    two of the human clinical trial as soon as it is scientifically
    practicable. Additionally, NIAID is urged to foster the
    development of an in vitro culture system for HCV as well as
    new animal models for basic research and for adequately testing
    vaccine candidates and antiviral drugs.
        Immune Tolerance.--The Committee is encouraged by the
    progress of the Immune Tolerance Network in launching clinical
    trials of protocols to induce immune tolerance in patients with
    Type 1 diabetes. These trials have the potential to prevent the
    recurrence of autoimmunity in patients with long-standing
    diabetes who have undergone islet transplantation and halt the
    autoimmune attack in recently diagnosed Type 1 diabetes
    patients. The Committee encourages the NIAID to continue its
    strong support of this clinical network and to expand its
    clinical studies promoting the translation of promising basic
    discoveries.
        Immune Surveillance Cell Proteomes.--The Committee
    recognizes the potential threat to national security posed by
    terror attacks involving biological, chemical, nuclear, and
    radiological weapons. One of the challenges facing public
    health officials responding to such an attack is their limited
    ability to diagnose individuals who have been exposed to these
    agents and do not show illness. Recent disease outbreaks--such
    as SARS in Asia and Canada, avian influenza in East Asia, and
    Ebola and Marburg virus in Africa--demonstrate that the speed
    of diagnosis and implementation of public health measures can
    mean the difference between an isolated outbreak and a global
    pandemic. Therefore, the Committee strongly supports research
    on immune surveillance cell proteomes (e.g. monocytes,
    neutrophils, dendritic cells, B cells and NK cells) and their
    response to chemical and biological pathogens. The Committee
    also urges the NIAID to fund the development of a searchable
    electronic database for biological proteomes, the proteomics of
    immune surveillance cell interaction with pathogens (biological
    and chemical), and proteins derived from the immune
    surveillance cells themselves, as well as their interaction
    with pathogens.
        Inflammatory Bowel Disease.--The Committee continues to
    note with interest a scientific research agenda for Crohn's
    disease and ulcerative colitis (collectively known as
    inflammatory bowel disease) titled ``Challenges in Inflammatory
    Bowel Disease [IBD].'' This report identifies strong linkages
    between the functions of the immune system and IBD. The
    Committee encourages the Institute to expand its research
    partnerships with the IBD community in fiscal year 2006 and
    increase funding for research focused on: (1) the immunology of
    IBD and (2) the interaction of genetics and environmental
    factors in the development of the disease.
        Infectious Disease Research.--The Committee believes that,
    with regard to both biodefense and public health, the
    development by NIAID of multi-pathogen identification arrays
    that can be used to identify infectious agents through
    epidemiological outbreak surveillance is critically important.
    The use of whole genome expression, all exon transcription
    analysis and whole genome SNP analysis studies to identify and
    understand host biomarkers that may identify the type, severity
    and likely response to therapeutics of infectious agents hold
    great promise for the most immediate results and the Committee
    encourages NIAID to pursue these lines of inquiry.
        Lupus.--The Committee recognizes that Lupus is a serious,
    complex, debilitating chronic autoimmune disease that causes
    inflammation and tissue damage to virtually any organ system in
    the body and impacts between 1.5 and 2 million individuals. The
    Committee strongly urges the National Institute of Allergy and
    Infectious Diseases to expand and intensify research and
    related activities with respect to Lupus.
        Primary Immunodeficiency Diseases.--NIAID is the lead
    agency for research into this class of diseases that is known
    to afflict about 500,000 Americans and may affect an equal
    amount that have not yet been diagnosed. To address the complex
    research needs of this group of about 140 separate diseases,
    the Institute has created a research consortium comprised of
    the leading experts in PI. Because of the importance of these
    diseases to public health and the impact they have on the
    economics of health care in this country, the Committee
    believes that it is critical that the consortium be managed
    efficiently, from both a scientific and an economic
    perspective. The Committee requests that NIAID report to it by
    May 1, 2006 on the management of the consortium, as well as its
    plans for future research in this field.
        Psoriasis.--Psoriasis is a common, chronic, immune-mediated
    skin disease. The Committee urges NIAID to support additional
    research on psoriasis and psoriatic arthritis pathogenesis,
    research to develop diagnostic tests for psoriatic arthritis
    and clinical research to identify new safe and effective
    therapies for these diseases.
        Scleroderma.--The Committee commends the NIAID for its
    growing commitment to understanding the cause and to finding
    improved treatments for scleroderma, a chronic and progressive
    disease that predominantly strikes women. Scleroderma is
    disfiguring and can be life threatening, affecting multiple
    systems including the heart, lungs, kidneys, and
    gastrointestinal tract. NIAID has provided a grant to fund the
    SCOT Study (Scleroderma Cytoxan or Transplant). This study will
    compare the differences between autologous stem cell transplant
    (stem cells that are taken from the blood of the patient)
    versus high dose cytoxan for the treatment of progressive
    systemic scleroderma. The Committee encourages the NIAID to
    continue this commitment through expanded inclusion of
    scleroderma in the Autoimmune Centers of Excellence and for
    continued dialogue with the Institutes that are part of the
    Autoimmune Disease Coordinating Committee.
        Transplantation Research.--The Committee is aware that
    while 1-year organ transplantation survival has improved
    remarkably over the last 15 years, there has been little
    success in reversing the decline in long-term graft and patient
    survival. Therefore, the Committee urges NIAID to convene an
    expert conference during fiscal year 2006, in collaboration
    with NIDDK and NHLBI, to develop a 5-year Transplantation
    Research Action Plan identifying the most urgently needed
    research to facilitate an increase in the success of organ
    transplantation. The expert conference is also urged to focus
    on promising new technologies in pre-transplant organ care and
    post-transplant patient therapies. The Committee requests a
    report by May 1, 2006 on the results of this conference
    including a trans-NIH breakdown of resources committed to this
    category of research. The Committee also urges the initiation
    of a cohort study to assess the health outcomes of living
    donors not only for the period immediately following the
    donation, but for the quality of life implications in the
    decades post donation.
        Tuberculosis.--The World Health Organization [WHO]
    estimates that nearly one-third of the world's population will
    become infected with tuberculosis [TB]; and by 2020, 70 million
    people will die worldwide of this disease. The Committee is
    pleased with NIAID's efforts to develop an effective TB
    vaccine. The Committee encourages the Institute to continue its
    TB vaccine development work and expand efforts to develop new
    drugs, including multi-drug resistant drugs to treat TB.

                 NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

    Appropriations, 2005....................................  $1,944,067,000
    Budget estimate, 2006...................................   1,955,170,000
    House allowance.........................................   1,955,170,000
    Committee recommendation................................   2,002,622,000

        The Committee recommendation includes $2,002,622,000 for
    the National Institute of General Medical Sciences [NIGMS]. The
    fiscal year 2004 appropriation was $1,955,170,000 and the
    administration's request is $1,944,067,000. The comparable
    amounts for the budget estimate include funds to be transferred
    from the Office of AIDS Research.
        Mission.--NIGMS supports research and research training in
    the basic biomedical sciences. Institute grantees, working in
    such fields as cell biology, biophysics, genetics,
    developmental biology, pharmacology, physiology, biological
    chemistry, bioinformatics, and computational biology, study
    normal biological processes to better understand what goes
    wrong when disease occurs. In this way, NIGMS supplies the new
    knowledge, theories, and technologies that can then be applied
    to the disease-targeted studies supported by other NIH
    components. NIGMS-supported basic research advances also
    regularly find applications in the biotechnology and
    pharmaceutical industries. The Institute's training programs
    help provide the scientists needed by industry and academia to
    maintain United States leadership in biomedical science.
        Basic Behavioral Research.--The Committee notes the lack of
    a positive response to Congressional requests that the NIH
    establish a basic behavioral research and training program
    within the National Institute of General Medical Sciences as
    authorized within the statutory language establishing the
    Institute. The Committee notes that this recommendation was
    also made to the Director of NIH by a special task force
    created by the NIH to review this matter. The Committee
    believes that this research will support important advances in
    understanding the wide range of fundamental behavioral topics
    relevant to a variety of diseases and health conditions. The
    Committee strongly urges the NIGMS to consider establishing a
    basic behavioral research and training program as part of its
    portfolio, especially in the areas of learning, memory, and
    cognition; behavioral neuroscience; behavioral genetics; the
    biological basis of behavior; behavior change; stress;
    psychophysiology; social psychology; methodology and
    evaluation; and experimental psychology.
        Basic Research on Pre-disease Pathways.--The Committee is
    pleased that NIGMS, NIMH, NCI and OBSSR are collaborating to
    identify scientific opportunities and areas of basic behavioral
    research that should be supported by NIH. The Committee
    requests a report of the recommendations from the working group
    and the NIGMS's plan for implementation of the recommendations
    by May 1, 2006.
        Basic Behavioral Research in Roadmap.--The Committee
    requests that NIGMS study the feasibility of developing one or
    more funding initiatives specific to basic behavioral and
    social sciences research, which is significantly
    underrepresented in the New Pathways to Discovery segment.
        Minorities in Research.--The Committee commends NIGMS and
    its Division of Minority Opportunities in Research for their
    success in increasing the number and capabilities of ethnic
    minority students in the educational pipeline for biomedical
    research careers in psychology and other biomedical sciences
    and for mentoring them as they make the transition to graduate
    school. The Committee notes the role of behavior in racial and
    ethnic health disparities and that six of the ten leading
    causes of death are behaviorally based. The biomedical field
    involves a wide range of psychological research that addresses
    critical health and behavior concerns, such as HIV/AIDS,
    stress, cardiovascular disease, diabetes, cancer, substance
    abuse, and mental disorders, which have disproportionately
    negative effects on the health and lifespan of ethnic
    minorities.
        Training Programs.--The Committee continues to be pleased
    with the quality of NIGMS's training programs, particularly
    those that have a special focus on increasing the number of
    minority scientists such as the Minority Access to Research
    Careers [MARC] and Minority Biomedical Research Support [MBRS]
    programs. The Committee encourages NIGMS to continue to support
    these important initiatives, and is particularly pleased that
    NIGMS has supported biomedical career opportunity programs for
    high school and undergraduate college students in conjunction
    with historically black health professions schools. The
    Committee urges continued, long-term support of this program.

            NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

    Appropriations, 2005....................................  $1,270,321,000
    Budget estimate, 2006...................................   1,277,544,000
    House allowance.........................................   1,277,544,000
    Committee recommendation................................   1,310,989,000

        The Committee recommends an appropriation of $1,310,989,000
    for the National Institute of Child Health and Human
    Development [NICHD]. The fiscal year 2005 appropriation was
    $1,270,321,000 and the administration's request is
    $1,277,544,000. The comparable amounts for the budget estimate
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--The NICHD is that component of the NIH
    responsible for conducting and supporting research on maternal
    and child health, the population sciences, and medical
    rehabilitation. Research encompassed by these areas targets
    infant mortality; genetic diseases, including birth defects;
    mental retardation; gynecological health and contraceptive
    development and evaluation; pediatric, maternal, and adolescent
    AIDS; developmental biology; vaccine development; demographic
    and behavioral research; and restoration or enhancement of
    function in individuals experiencing physical disability due to
    injury, disease, or birth defect.
        Autism.--The Committee is aware of the important research
    into the genetic basis of autism spectrum disorders and of its
    support for the Baby SIBS study on the incidence of autism
    among children in the same families. Accordingly, the Committee
    encourages the Institute to expand its support and funding for
    the Baby SIBS study, and encourages the Institute to expand its
    work with and support for similar public-private partnerships.
        Behavioral Science.--The Committee emphasizes its strong
    support for the broad portfolio of behavioral research at NICHD
    and supports its efforts to determine the biological,
    behavioral, and social factors that affect cognitive, social,
    and personality development of children in a variety of
    settings. The Committee encourages the institute to maintain
    its support for research and training in behavioral science as
    it engages in its priority setting process.
        Childhood Diseases on the Growing Skeleton.--NICHD is urged
    to support studies investigating the effects of
    pharmaceuticals, lifestyle, and chronic childhood diseases on
    the growing skeleton and fracture risk and bone-formation
    interventions for children. The Institute is encouraged to
    expand the Osteogenesis Imperfecta Clinic and osteogenesis
    imperfecta research, especially in genetic therapies, animal
    models, drug treatment and rehabilitation. To the extent
    feasible, NICHD is encouraged to work with NIAMS to study the
    rare disorders osteopetrosis and juvenile Paget's disease.
        Childhood Obesity.--The Committee continues to be concerned
    about rising rates of childhood obesity and would like to see
    additional clinical trials that focus on the effectiveness of
    behavioral interventions. The Committee recognizes the critical
    importance of prevention efforts in this area and supports
    continued initiatives to promote healthy behaviors in children
    and adolescents, and research to prevent health risk behaviors
    that contribute to this growing public health challenge.
        Demographic Research.--The Committee commends NICHD for its
    strong support of demographic research. Given the tremendous
    changes occurring in the U.S. population, demographic research
    is necessary to analyze trends and determine consequences for
    the health and well-being of our Nation. The Committee strongly
    encourages the Institute to assure adequate support for
    demographic training and for critical databases such as
    National Longitudinal Study of Adolescent Health and Fragile
    Families. NICHD-supported studies like these yield objective
    information about population trends and provide unbiased,
    accurate data to inform policy, programs, and practices to
    improve the health and productivity of the American people.
        Down Syndrome.--The Committee commends NICHD for increasing
    support for production of an experimental mouse model for Down
    Syndrome, the Ts65Dn mouse which allowed for the first time a
    pre-clinical model to test possible drugs or other treatments.
    The Committee encourages the NICHD to partner with NINDS and
    other agencies to define additional mouse models needed to link
    important structural and functional abnormalities that underlie
    cognitive difficulties to the actions of specific genes and
    gene pathways. The Committee also encourages NICHD to work with
    the Office of Director to develop a strategic plan for Down
    Syndrome research and to coordinate its research with NICHD,
    NIA, NIMH and other institutes. The Committee further
    encourages the Institute to ursue clinicl trials for Down
    Syndrome.
        Drug Safety for Children.--The Committee recognizes the
    importance of ensuring that drugs are safe and effective for
    use by children and are appropriately labeled for pediatric
    use. The Committee supports continued implementation of the
    Best Pharmaceuticals for Children Act of 2003, which supports
    the pediatric testing of off-patent drugs, as well as on-patent
    drugs not being studied through existing mechanisms. The
    Committee is pleased to note that in fiscal year 2004, six
    studies were initiated and five additional studies are planned
    for fiscal year 2005. The Committee notes that NICHD has made
    numerous outreach efforts to other Institutes and Federal
    agencies to further refine the priority listing process. The
    Committee requests that NIH provide an update during its annual
    appropriations testimony that shall include the role of other
    Federal agencies in implementing the Best Pharmaceuticals for
    Children Act of 2003; information on the number of studies
    supported through the Research Fund; the estimated cost of each
    study undertaken; the nature and type of studies undertaken,
    the number of label changes resulting form completed studies;
    the patent status of the drug studies; the number of drugs
    remaining on the priority list and a summary of NICHD's
    findings on the frequency of pediatric use for medications that
    many be considered for the priority list.
        Epilepsy.--Epilepsy often begins in childhood and can have
    potentially devastating effects when seizures are not
    controlled. This disease has a severe impact on cognition and,
    even in its mildest forms, lifelong effects on employment and
    other quality of life measures. Recurring seizures are also a
    heavy burden for children with autism, brain tumors, cerebral
    palsy, mental retardation, tuberous sclerosis and a variety of
    genetic syndromes. The Committee urges the Institute to make
    research in epilepsy a priority, with particular emphasis on
    developmental effects, and to coordinate research efforts with
    the NINDS.
        Family Formation.--Families constitute the key environment
    for children's development, and parents are crucial to
    children's health and academic outcomes. The Committee
    encourages research on effective ways to promote and sustain
    healthy family formations, particularly for low-income families
    and families of color. Additional research is encouraged on the
    immediate and long-term impact of chronic and acute exposures
    to violence on child health and development. The institute is
    encouraged to include research related to family, community and
    cultural factors that serve as risk or protective factors and
    promote resilience from exposure to violence in the home,
    communities, and schools.
        Fragile X.--Title II of the Children's Health Act of 2000
    authorized the establishment of at least three Fragile X
    research centers. The Committee is pleased that the NICHD has
    funded three Centers, and urges the NICHD to increase the
    funding for existing centers of excellence by the end of fiscal
    year 2006, with the goal of enhancing the Centers and
    recruiting new researchers to the Fragile X field. The
    Committee also encourages the NICHD to coordinate its Fragile X
    research efforts internally, by partnering with others, and by
    relating Fragile X research with that in other developmental
    disorders, such as autism research.
        Genomics and Proteomics Research.--The Committee is pleased
    that NICHD has launched a major new initiative to address the
    public health problem of premature birth, which affects one in
    eight babies born in this country and is the leading cause of
    newborn death. NICHD is encouraged to move forward with this
    initiative, which focuses on genomic and proteomics, in an
    effort to accelerate knowledge in the mechanisms responsible
    for premature birth. The Committee intends to closely monitor
    this effort because it assigns a high priority to promoting the
    birth of healthy infants.
        Human Infertility.--The Committee understands that the
    NICHD is planning to merge its National Cooperative Program for
    Infertility Research with its Specialized Cooperative Centers
    Program in Reproduction Research to form the Specialized
    Cooperative Centers Program in Reproduction and Infertility
    Research. The Committee understands that the merger of these
    center programs will allow a greater focus on human infertility
    research by permitting more efficient translation of knowledge
    from non-human animal models to humans. This will ensure the
    rapid development of novel approaches for the diagnosis,
    treatment and amelioration of such reproductive diseases and
    disorders as polycystic ovarian syndrome, endometriosis,
    hypogonadotropic hypogoandism and idiopathic male infertility.
        Infertility and Contraceptive Research.--The Committee
    notes that infertility is a disease which affects over 6
    million people in the United States and is concerned that the
    number appears to be growing as age, lifestyle, and
    environmental factors increasingly impact reproductive health
    outcomes. The Committee urges that additional research be
    undertaken to improve reproductive health intervention
    outcomes, as this research will not only increase the efficacy
    and effectiveness of reproductive health interventions but will
    significantly lower costs by reducing the number of
    interventions necessary to achieve a successful outcome.
        Learning Disabilities.--The Committee is pleased that NICHD
    continues to place a high priority on learning disabilities
    research. The efforts to address the special needs of children
    affected by a learning disability and improve literacy are
    showing promising results. The Committee encourages NICHD to
    continue to focus on reading disability and mathematics
    development research. Additionally, the Committee urges NICHD
    to lead a cooperative effort to collaborate on research efforts
    with other Institutes working on related activities. The
    Committee encourages cooperation in areas where work can be
    shared across Institutes on behalf of individuals with learning
    disabilities.
        Learning and School Readiness.--The Committee continues to
    support NICHD's commitment to research in reading, learning
    disabilities and math and science cognition. The Committee is
    encouraged that NICHD has made progress on developing
    comprehensive, culturally neutral and developmentally
    appropriate assessments and instruments to measure cognitive,
    social and emotional skills for pre-school aged children that
    are necessary for school readiness.
        Maternal-Fetal Medicine Units Network.--The Committee
    recognizes the efforts of NICHD, through its Maternal Fetal
    Medicine Units Network [MFMU], to achieve a greater
    understanding and pursue development of effective treatments
    for the prevention of pre-term births, low birth weight
    infants, and medical complications during pregnancy such as
    pregnancy-related hypertension and diabetes. The Committee is
    pleased to learn that the NICHD is proceeding with a competing
    renewal of the MFMU's in 2006 and encourages a sustained
    research investment in this program to facilitate resolution of
    these problems and promote the birth of healthy infants.
        National Children's Study.--The Committee is pleased with
    NICHD efforts to launch the National Children's Study, which
    would be the largest study of children ever undertaken in the
    United States and is intended to follow 100,000 children to age
    21, examining the impacts and influences of many environmental
    and genetic factors on children's health and development. The
    Committee urges that the National Children's Study include an
    adequate sample of children to enable examination of the health
    and development outcomes of children conceived with the
    assistance of reproductive health technologies.
        The Committee further urges the NICHD to coordinate the
    involvement of the Department, the lead Federal partners--CDC,
    EPA and NIEHS--and other interested institutes, agencies and
    non-Federal partners conducting research on children's
    environmental health and development, such that this study is
    ready for the field by no later than 2007.
        National Cooperative Program for Infertility Research.--The
    Committee understands that the NICHD is planning to merge its
    National Cooperative Program for Infertility Research with its
    Specialized Cooperative Centers Program in Reproduction
    Research to form the Specialized Cooperative Centers Program in
    Reproduction and Infertility Research. The Committee
    understands that this merger will allow a greater focus on
    human infertility research and a more efficient translation of
    knowledge from non-human animal models to humans to ensure
    rapid development of novel approaches for the diagnosis,
    treatment and amelioration of such reproductive diseases and
    disorders as polycystic ovarian syndrome, endometriosis,
    hypogonadotropic, hypogoandism, and idiopathic male
    infertility. The Committee looks forward to hearing more about
    the progress towards this merger.
        Neurofibromatosis.--Learning disabilities occur with high
    frequency (30-65 percent) in children with NF and in
    approximately 5 percent of the entire world's population.
    Enormous advances have been made in the past few years in the
    successful treatment and curing of learning disabilities in
    pre-clinical NF animal models. Therefore the Committee
    encourages NICHD to issue RFAs for NF research and aggressively
    pursue and expand funding of clinical trials for NF patients in
    the area of learning disabilities. The Committee is mindful
    that finding a treatment and cure for learning disabilities
    will not only benefit children, but also reduce costs of
    special education.
        Pediatric Kidney Disease.--The National Children's Study
    provides a unique opportunity to identify pre- and post-natal
    exposures that increase the risk of kidney disease,
    hypertension, and the progression of chronic kidney disease
    from birth to early adulthood. The Committee urges NICHD to
    support research toward understanding the physiologic
    mechanisms responsible for these risks to further prevent the
    development of kidney diseases and the antecedents of
    cardiovascular disease.
        Prader-Willi Syndrome.--Prader-Willi Syndrome is the most
    common known genetic cause of life threatening obesity in
    children. The Committee strongly encourages the NICHD to place
    a high priority on Prader-Willi Syndrome research to study
    childhood obesity. Furthermore, the NICHD is urged to
    incorporate Prader-Willi Syndrome into the planning process for
    The National Children's Study.
        Preterm Birth.--Last year, the National Center for Health
    Statistics reported the first increase in the U.S. infant
    mortality rate since 1958; 61 percent of this increase is
    attributed to an increase in the birth of premature and low
    birth weight babies. An analysis of Agency for Healthcare
    Research and Quality data conducted by the March of Dimes
    Perinatal Data Center estimated that the total national
    hospital bill for premature babies was $15,500,000,000 in 2002.
    The financial burden of prematurity is expected to continue to
    worsen until prevention of preterm births is better understood
    and clinical interventions are developed. The Committee is
    pleased that NICHD is one of the sponsors of an Institute of
    Medicine study now underway to define and address the health-
    related and economic consequences of premature birth.
        Primary Immunodeficiency Diseases.--The Committee continues
    to be impressed with the dedication of financial and personnel
    resources by NICHD to the physician education and public
    awareness program conducted by the Jeffrey Modell Foundation to
    reach earliest diagnosis of this class of about 140 diseases.
    With regard to research on PI, the Committee is strongly
    encouraged by the Institute's commitment to develop newborn
    screening procedures for PI, particularly X-linked SCID,
    utilizing microarray technologies. The Committee believes that
    NICHD should move ahead aggressively with this initiative, in
    partnership with the Foundation and private industry.
        Spinal Muscular Atrophy [SMA].--SMA is the leading genetic
    killer of infants and toddlers, and is the most prevalent
    genetic motor neuron disease. The severity of the disease, its
    relatively high incidence, and the possibility of imminent
    treatments have led NINDS to initiate the SMA Project. The
    Committee believes that the treatment of SMA, and the SMA
    Project at NINDS, is strategically consistent with the mission
    of the NICHD, with the NIH Roadmap initiative and its specific
    emphasis on cross-institute research integration. The Committee
    is concerned that, to date, the NICHD has not made any progress
    toward working collaboratively with NINDS to support and expand
    the SMA Project. The Committee strongly urges NICHD to do so
    expeditiously and to report back to the Committee no later than
    May 1, 2006.
        Vulvodynia.--The Committee commends NICHD for its
    commitment to chronic pain conditions including vulvodynia.
    This condition has profound impacts on the health and quality
    of life for millions of women. As a result of efforts funded by
    NICHD, the number of high-quality researchers interested in
    research on vulvodynia has increased. NICHD is strongly
    encouraged to reissue its request for applications in this area
    and to fund high-quality applications, with a particular
    emphasis on etiology and multi-center therapeutic trials.

                             NATIONAL EYE INSTITUTE

    Appropriations, 2005....................................    $669,070,000
    Budget estimate, 2006...................................     673,491,000
    House allowance.........................................     673,491,000
    Committee recommendation................................     693,559,000

        The Committee recommends an appropriation of $693,559,000
    for the National Eye Institute [NEI]. The budget request was
    $673,491,000and the fiscal year 2005 appropriation was
    $$669,070,000. The comparable amounts for the budget estimate
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--The NEI is the Nation's Federal resource for the
    conduct and support of laboratory and clinical research,
    research training, and other programs with respect to blinding
    eye diseases, visual disorders, mechanisms of visual function,
    preservation of sight, and the special health problems and
    needs of individuals who are visually impaired or blind. In
    addition, the NEI is responsible for the dissemination of
    information, specifically public and professional education
    programs aimed at the prevention of blindness.
        Basic Behavioral and Social Sciences Research.--Committee
    encourages NEI to participate in trans-institute initiatives
    organized by OBSSR or another institute to strengthen basic
    behavioral research and enhance opportunities for behavioral
    science research training.
        Ocular Albinism.--The Committee recognizes recent advances
    in the treatment of ocular albinism by using gene therapy. The
    Committee encourages the National Eye Institute to favorably
    consider research grant proposals that seek to expand upon
    these important findings.

              NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

    Appropriations, 2005....................................    $644,505,000
    Budget estimate, 2006...................................     647,608,000
    House allowance.........................................     647,608,000
    Committee recommendation................................     667,372,000

        The Committee recommends an appropriation of $667,372,000
    for the National Institute of Environmental Health Sciences
    [NIEHS]. The budget request was $647,608,000 and the fiscal
    year 2005 appropriation was $644,505,000. The comparable
    amounts for the budget estimate include funds to be transferred
    from the Office of AIDS Research.
        Mission.--The mission of the NIEHS is to define how
    environmental exposures affect health; how individuals differ
    in their susceptibility to these effects; and how these
    susceptibilities change with time. This knowledge, coupled with
    prevention and communication programs, can lead to a reduction
    in environmentally associated diseases and dysfunctions.
        Asthma.--Given the link between environmental factors and
    the onset of asthma, COPD, and pulmonary fibrosis, the
    Committee encourages NIEHS to further develop research
    initiatives, such as a large multi-center, long-term
    longitudinal, and maternal/birth cohort to understand the
    environmental and genetic risk factors for predisposing some
    individuals to and in controlling the severity of these lung
    diseases.
        Basic Behavioral and Social Sciences Research.--The
    Committee encourages NIEHS to participate in trans-institute
    initiatives organized by OBSSR or another institute to
    strengthen basic behavioral or social science research, and to
    enhance opportunities for behavioral and social science
    research training.
        Breast Cancer.--The Committee believes that it is essential
    to support research on environmental factors that may be
    related to the etiology of breast cancer. The Committee
    recognizes the important first step the Institute has taken
    with its recently awarded grants to four research centers to
    begin to study the prenatal-to-adult environmental exposures
    that may predispose a woman to breast cancer. However, the
    recent awards are only a small down payment in terms of
    dollars, process, and focus on the comprehensive and
    collaborative research that is needed. The need for more
    funding and a comprehensive research strategy, as outlined by
    the Breast Cancer and Environmental Research Act, is clear. The
    Committee understands that the Institute will establish an
    advisory board to make recommendations to the Director with
    regard to the development of the research centers. The
    Committee is pleased that the board will include
    representatives from the breast cancer community who have had
    the disease. The Committee asks that the director provide an
    update in the fiscal year 2007 appropriations justification on
    the progress of the centers.
        Built Environment.--The Committee is pleased with the
    research that NIEHS is supporting on environmental factors,
    including built environment, and their relationship to the
    rising prevalence of obesity among youth and adults. The
    Committee urges NIEHS to continue work in this area, including
    transportation choices and their impact on public health
    outcomes.
        Environmental Health and Nursing.--The Committee is pleased
    with the coordination efforts of the NIEHS, NINR, CDC, HRSA and
    EPA to address the recommendations outlined in the 2002
    Roundtable Report and the IOM Report, ``Nursing, Health and
    Environment.'' The Committee encourages the establishment of a
    nursing research fellowship in environmental health issues.
        Interagency Coordinating Committee for the Validation of
    Alternative Methods [ICCVAM].--In order for the Interagency
    Coordinating Committee for the Validation of Alternative
    Methods [ICCVAM] to carry out its responsibilities under the
    ICCVAM Authorization Act of 2000, the Committee encourages the
    NIEHS to strengthen the resources for the National Toxicology
    Program's Interagency Center for the Evaluation of Alternative
    Toxicological Methods [NICEATM] for ICCVAM for methods
    validation reviews in fiscal year 2006. The Committee is
    encouraged by the National Toxicology Program's [NTP] Road Map
    and Vision for NTP's toxicology program in the 21st century and
    encourages NIEHS to move rapidly to implement the programs,
    especially those directly aimed at strengthening the scientific
    basis for many alternative methods (such as Quantitative
    Structure-Activity Relationships), mechanistic screens, high
    throughput assays, and toxicogenomics.
        Parkinson's Disease.--The Committee encourages NIEHS to
    continue funding research into environmental influences of
    Parkinson's disease. The causes of Parkinson's and other
    neurodegenerative disorders are increasingly shown to be a
    result of the inter-relation of environment and genes. Possible
    environmental triggers of Parkinson's are pesticides and/or
    heavy metals. If these environmental toxins can be identified
    and the mechanisms elucidated, appropriate prevention or
    treatment may prevent many cases of Parkinson's, especially
    concerning increasingly younger persons at risk.
        Pacific Center for Environmental Health.--The Committee
    commends the NIEHS for its prompt attention to the concerns of
    the citizens of Hawaii related to volcanic emissions, food and
    waterborne illnesses, fish contamination by pesticides and
    heavy metals, and pesticide residue in food and water. The
    Committee urges NIEHS to pursue an Environmental Health
    Sciences Center in Hawaii to research and address these
    environmental concerns and to seek workable solutions to
    improve the health of Pacific Islanders.
        Perchlorate.--The Committee encourages the Institute to
    support clinical, mechanistic, and epidemiological studies that
    focus on establishing a better understanding of the long-term
    health effects of perchlorate exposure on humans and
    determining with greater certainty what perchlorate exposures
    are safe for the most vulnerable populations. The Committee
    encourages the NIEHS to give priority in the following areas:
    (1) clinical studies on humans or primates designed to provide
    information on the effects of long-term exposures to low doses
    of perchlorate; (2) the design and implementation of innovative
    epidemiological studies that assess the possible health effects
    of perchlorate exposure on the most vulnerable populations,
    including pregnant women and their fetuses and newborns, and
    involve appropriate control populations; and/or (3) in vitro
    studies of the perchlorate influence on placental and breast
    iodide transport using human tissues and animals studies, and
    the effects of perchlorate on development independent of
    effects on iodide transport.
        Risk Sciences.--The Committee encourages NIEHS to establish
    a competitive, peer-reviewed extramural program to conduct
    research in risk sciences, including methodologies for
    assessment, management, analysis, and communication of risks
    from exposure to environmental chemicals.

                          NATIONAL INSTITUTE ON AGING

    Appropriations, 2005....................................  $1,051,990,000
    Budget estimate, 2006...................................   1,057,203,000
    House allowance.........................................   1,057,203,000
    Committee recommendation................................   1,090,600,000

        The Committee recommendation includes $1,090,600,000 for
    the National Institute on Aging [NIA]. The budget request was
    $1,057,203,000 and the fiscal year 2005 appropriation was
    $1,057,203,000. The comparable amounts for the budget estimate
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--The NIA conducts biomedical, behavioral, and
    social research related to the aging process to prevent disease
    and other problems of the aged, and to maintain the health and
    independence of older Americans. Research in aging over the
    last two decades demonstrates that aging should not be equated
    with inevitable decline and disease.
        Age-related Bone Health.--The Committee is aware that the
    costs of age-related bone loss top $17,000,000,000 annually.
    NIA is urged to address cell senescence and altered cell
    phenotype in age-related bone diseases; aging's impact on bone
    response to loading, bone matrix and quality, and bone marrow;
    and the role of exercise, new anabolics, and stem cells in
    elderly bone.
        Alzheimer's Disease.--The most common cause of dementia,
    Alzheimer's disease has become one of the most serious threats
    to the Nation's health and economic well-being. Today, an
    estimated 4.5 million Americans--1 in 10 persons over age 65
    and nearly half of those over 85--suffer from Alzheimer's
    disease. That toll will rise to 5.1 million by 2010 and 7.7
    million by 2030 unless scientists find ways to stop or slow the
    progression of the disease process. And unless answers are
    found soon, Alzheimer's disease will wreak havoc, not only on
    family budgets but public funds as well. Over the next decade,
    Medicare spending on beneficiaries with Alzheimer's will more
    than triple, to $189,000,000,000, while Medicaid spending over
    the same period will rise to $27,000,000,000. In light of these
    social and economic imperatives, the Committee was troubled to
    learn that NIA's investment in Alzheimer research actually
    declined in fiscal year 2004 from the previous year. Given the
    enormous human and financial toll this disease is exacting on
    society, the Committee strongly urges NIH to expand its
    investment in Alzheimer research toward an overall goal of
    $1,000,000,000. NIA should continue to assign the highest
    priority to this effort.
        Bone Marrow Failure Diseases.--Every year, between 20,000
    and 30,000 Americans are diagnosed with bone marrow failure
    diseases, which include aplastic anemia, myelodysplastic
    disorders [MDS], and paroxysmal nocturnal hemoglobinuria [PNH].
    The highest incidence of these diseases occurs with people age
    60 or older, and the number of cases of these diseases will
    increase each year as the American population continues to age.
    The Committee urges NIA to collaborate with NHLBI and NCI on
    research aimed at gaining a better understanding of the causes
    of these diseases and effective treatments and cures.
        Claude D. Pepper Older American Independence Centers.--The
    Committee continues to strongly support these successful
    centers, which focus on developing innovative and cost-
    effective ways to enhance the independence of older Americans,
    and on developing top-level experts in geriatrics.
        Demographic and Economic Research.--The Committee commends
    NIA for supporting the Centers on the Demography of Aging
    program and expanding its program to include four new centers
    in 2004 and for supporting the economic and demographic
    components of the Roybal Centers for Applied Gerontology
    program. The Committee encourages the Institute to sustain the
    economic viability of these centers programs in their quest to
    conduct essential economic and demographic population research
    as the United States and world age rapidly. The Committee
    encourages NIA to provide the scientific knowledge on
    population aging issues, especially by fully supporting the
    Health and Retirement Survey and National Long-Term Care
    Survey. Data from these surveys are particularly important for
    understanding the budgetary impact of population aging and for
    Congress as it deliberates potential changes to the Social
    Security, Medicare, and Medicaid programs.
        Down Syndrome.--The Committee commends NIA for its support
    of studies to examine the cellular, molecular and genetic bases
    for age-related neuropathological and cognitive abnormalities
    in people with Down syndrome. The Committee encourages NIA to
    further examine these abnormalities and to devise new methods
    for diagnosing and treating them. Given that all people with
    Down syndrome develop the neuropathological changes of
    Alzheimer's disease, and that many or most go on to suffer
    dementia, the NIA is encouraged to consider how studies of the
    Down syndrome population might enhance the ability to
    understand, diagnose and treat Alzheimer's disease. The
    Committee encourages NIA to coordinate its research with NICHD,
    NINDS, NIMH and other Institutes.
        Epilepsy.--As the population ages, the Committee is
    concerned about the rapidly growing incidence of epilepsy in
    senior citizens. Age-related epilepsy caused by stroke,
    cardiovascular disease, brain tumors and Alzheimer's disease
    severely impacts the well-being, independence and health care
    needs of these vulnerable patients. The Committee urges the
    Institute to make research in epilepsy a priority and to
    coordinate research efforts with the NINDS.
        Health of Older Workers.--The Committee acknowledges NIA's
    efforts to build a research agenda focused on maximizing older
    workers' safety, health, productivity and life satisfaction.
    NIA is encouraged to collaborate with other agencies,
    institutes and centers to further develop this research agenda.
    In particular, the Committee supports efforts to develop new
    surveys or piggyback on existing surveys as appropriate, to
    enhance the data available to NIA on aging workers, the designs
    and parameters of various jobs and related health information.
    Research should be conducted to assess the effectiveness,
    benefits, and costs of worksite health promotion programs and
    techniques tailored to older workers, and other workplace
    policies that may influence health and safety.
        Osteoporosis.--The Committee encourages studies on quality
    of life in patients with osteoporosis before and after
    treatment and strategies for optimizing treatment of frail
    nursing home patients at high risk for osteoporotic fracture.
    The Committee further urges NIA to expand research on the role
    of environmental and lifestyle factors associated with
    osteoporosis, Paget's disease, and osteogenesis imperfecta and
    to work in conjunction with NIAMS on models for Paget's
    disease.
        Parkinson's Disease.--The Committee commends the NIA on its
    collaboration with Parkinson's researchers at National
    Institute of Neurological Disorders and Stroke [NINDS] Udall
    Centers in helping to discover new Parkinson's susceptibility
    genes, including dardarin, the most recently discovered
    Parkinson's gene by a NIA scientist. This research will prove
    to be invaluable in the development of improved methods of
    diagnosis, as well as neuroprotective and neurorestorative
    treatment of Parkinson's disease. The Committee encourages
    continued collaborations including additional intramural
    activities between NINDS, NIMH, and NIA to enhance
    understanding of neurodegenerative diseases, particularly
    Parkinson's.
        Racial and Ethnic Health Disparities in Later Life.--The
    Committee commends NIA's systematic attempts to build a
    research agenda to help understand racial and ethnic health
    disparities in later life. NIA is encouraged to build on its
    behavioral genetics research program in order to assess genetic
    and environmental factors in racial and ethnic differences
    simultaneously, in studies that permit identification of main
    effects and of interactions.
        Social Psychology.--NIA is requested to study the
    feasibility of expanding its portfolio of basic research on
    social psychology, particularly basic research on stigma and
    race; well-being; and emotion, health and disease.
        Thrombosis.--The Committee is very pleased with the
    Institute's plans to further research on anemia and its impact
    on the elderly, and encourages NIA to continue its
    collaborative research efforts with other Institutes on the
    best strategies to diagnose and treat elderly patients with
    anemia. The Committee believes that NIA collaboration could
    also be helpful for another area of age-related hematology
    research, the study of venous and arterial thrombosis, blood
    clots that can lead to heart attacks, strokes, or respiratory
    dysfunction. In light of research findings that age is one of
    the most important risk factors for thrombosis, the Committee
    urges NIA and NHLBI to collaborate on a research agenda
    exploring the underlying causes of thrombosis and its impact on
    the elderly.

     NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

    Appropriations, 2005....................................    $511,157,000
    Budget estimate, 2006...................................     513,063,000
    House allowance.........................................     513,063,000
    Committee recommendation................................     525,758,000

        The Committee recommends an appropriation of $525,758,000
    for the National Institute of Arthritis and Musculoskeletal and
    Skin Diseases [NIAMS]. The budget requested $513,063,000 and
    the fiscal year 2005 appropriation was $511,157,000. The
    comparable amounts for the budget estimate include funds to be
    transferred from the Office of AIDS Research.
        Mission.--NIAMS conducts and supports basic and clinical
    research and research training, and the dissemination of health
    information on the more than 100 forms of arthritis;
    osteoporosis and other bone diseases; muscle biology and muscle
    diseases; orthopedic disorders, such as back pain and sports
    injuries; and numerous skin diseases. The research agenda of
    NIAMS addresses many devastating and debilitating diseases that
    afflict millions of Americans. These diseases of the joints,
    muscles, bones, connective tissues, and skin, in the aggregate,
    will affect nearly every American at some point in their lives,
    causing tremendous human suffering and costing the Nation
    billions of dollars in both health care expenditures and lost
    productivity. The research activities of this Institute serve
    the concerns of many different special populations, including
    women, minorities, children, and the elderly.
        Bone Formation and Remodeling.--The Committee encourages
    NIAMS to increase support of research on models, methods and
    modalities to increase bone formation and alter bone
    remodeling, and address the impact of aging, genetics, obesity,
    inactivity and exercise on bone at molecular, cellular, and
    tissue levels. NIAMS should work with NICHD and NIDDK to expand
    research on the genetics and new treatments for the rare
    disorder osteopetrosis.
        Burden of Skin Diseases.--The Committee notes the release
    of the recent report, ``Burden of Skin Diseases'', which
    supports evidence gathered at the September 2002 workshop on
    the burden of skin diseases sponsored by NIAMS. Based on these
    findings, the Committee urges NIAMS to continue to expand the
    research portfolio on skin disease. The Committee also
    encourages that NIAMS consider potential partnerships with the
    skin disease research community to address the challenges
    outlined by the ``Burden of Skin Diseases'' findings.
        Duchenne Muscular Dystrophy.--The Committee continues to be
    concerned with the amount of time taken by NIAMS to complying
    with the MD Care Act. The Committee encourages the NIAMS to
    increase research for Duchenne Muscular Dystrophy. The
    Committee further requests that NIAMS coordinate with NINDS on
    timelines for translational research, a consensus conference
    and the strategic plan.
        Lupus.--The Committee recognizes lupus is a serious,
    complex, debilitating chronic autoimmune disease that can cause
    inflammation and tissue damage to virtually any organ system in
    the body and impacts between 1.5 and 2 million individuals.
    This autoimmune disorder affects the skin, bones, joints,
    connective tissue and vital organs. The Committee is
    disappointed with the pace of research regarding lupus and
    strongly urges the Director of the National Institute of
    Arthritis and Musculoskeletal and Skin Diseases to expand and
    intensify research and related activities with respect to
    lupus.
        Marfan Syndrome.--The Committee commends NIAMS and its
    collaborative efforts with other Institutes to provide vital
    research on Marfan syndrome, a life-threatening, progressive
    and degenerative genetic disorder that is characterized by
    aortic aneurysms, painful orthopedic issues, pulmonary issues
    and ocular manifestations. Years of basic research are ready to
    be translated into a clinical trial for a drug therapy that may
    potentially prevent and reverse many of the life-threatening
    aspects of this syndrome. In addition, it may help many of the
    disabling characteristics not only of Marfan syndrome but also
    of other connective tissue disorders. The Committee urges NIAMS
    to support this effort through all available mechanisms, as
    deemed appropriate.
        Mucopolysaccharidosis [MPS].--The Committee encourages the
    NIAMS to work collaboratively with NIDDK in an effort to
    achieve a greater understanding of the underlying
    pathophysiology of bone and joint lesions in MPS disorders, the
    gene mutations and substrates that are stored, and potential
    therapeutic approaches to treating these debilitating aspects
    of MPS and related disorders.
        Osteogenesis Imperfecta.--The Committee commends NIAMS for
    its support of the promising gene targeting stem cells research
    that represents a potential cure for osteogenesis imperfecta
    and encourages continued support of this research.
        Osteoporosis.--The Committee urges the study of genetics of
    osteoporosis, including studies to determine the causes of
    variation in peak bone mass and rates of bone loss and
    therapies to lower fracture risk in patients at high risk for
    osteoporotic fractures.
        Paget's Disease.--The Committee urges NIAMS to study the
    role of genes and the underlying abnormal functioning of cells
    involved in bone breakdown in Paget's disease patients. Further
    research is needed on the role the bone microenvironment plays
    in the development of Paget's disease and the molecular
    processes involved.
        Psoriasis.--Ten to 30 percent of psoriasis patients develop
    psoriatic arthritis, a painful and potentially destructive
    joint disease. The Committee urges NIAMS to support additional
    genetic research to identify the genes responsible for
    psoriasis susceptibility, basic research to understand the
    mechanism of disease and clinical research to identify new safe
    and effective therapies for these diseases.
        Scleroderma.--The Committee is encouraged by NIAMS's
    continued interest in scleroderma, a chronic and progressive
    disease that predominantly strikes women. Scleroderma is
    disfiguring and can be life-threatening, and effective
    treatments are lacking. The Committee encourages NIAMS to
    continue to collaborate with other Institutes, including NHLBI,
    NIAID, NIDDK, NIDCR, and through the NIH Autoimmune
    Coordinating Committee to generate additional research
    opportunities for scleroderma that may assist to identify
    genetic risk factors and the development of safe and effective
    treatments.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
    TSC, is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body, including the skin. The
    Committee is encouraged that NIAMS is participating in a Trans-
    NIH Tuberous Sclerosis Coordinating Committee, and strongly
    encourages NIAMS to continue to assist the clinical research
    community in the development of standardized protocols for skin
    assessment and the development of pilot clinical trials.

        NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

    Appropriations, 2005....................................    $394,259,000
    Budget estimate, 2006...................................     397,432,000
    House allowance.........................................     397,432,000
    Committee recommendation................................     409,432,000

        The Committee recommends an appropriation of $409,432,000
    for the National Institute on Deafness and Other Communication
    Disorders [NIDCD]. The budget requested $397,432,000 and the
    fiscal year 2005 appropriation was $394,259,000. The comparable
    amounts for the budget estimate include funds to be transferred
    from the Office of AIDS Research.
        Mission.--The NIDCD funds and conducts research and
    research training in the normal and disordered processes of
    human communication, specifically in the areas of hearing,
    balance, smell, taste, voice, speech, and language. The
    Institute addresses the special biomedical and behavioral
    problems of people who have communication impairments or
    disorders; contributes to health promotion and disease
    prevention; and supports efforts to create devices that
    substitute for lost and impaired sensory and communication
    functions.
        Animal Models of Hearing Loss.--It is now clear that
    peripheral hearing loss leads to profound changes in the
    central nervous system, including cell death and loss of
    synapse function. The Committee encourages research to focus on
    animal models of conductive and sensorineural hearing loss,
    particularly changes in brain physiology from deafness during
    development. Understanding these mechanisms is essential to
    implementation of ameliorative strategies such as hearing aids
    and cochlear implants.
        Balance Disorders.--The Committee is aware that over 124
    million Americans have experienced dizziness or a balance
    problem, and the cost of medical care for patients with balance
    disorders exceeds $1,400,000,000 annually. Over 50 percent of
    elderly patients interviewed at home complain of balance
    disorders. Despite research into the organization and function
    of these balance receptors located in the inner ear, there is a
    need to study the genes expressed in these tissues in order to
    understand why receptors commonly fail or become dysfunctional.
    Gene discovery techniques including cDNA libraries and
    microarray expression profiling are likely to lead to new drugs
    to treat or prevent vestibular disorders and greater
    understanding of how these systems work. The Institute is urged
    to expand its support of research in this promising area.
        Clinical Evaluation of Hearing Loss.--The Committee
    encourages NIDCD to partner with other Institutes at NIH to
    support the development of functional neuroimaging technology
    with more precise spatial and temporal resolution, as well as
    better molecular probes to monitor brain activity.
        Early Detection and Intervention.--The Committee urges the
    NIDCD to continue to use its newsletter and website to promote
    awareness among parents and clinicians that early
    identification and treatment of hearing loss are essential for
    normal language acquisition. Therefore, the Committee
    encourages expanded research on the early detection, diagnosis
    and intervention of infants with deafness and other
    communication disorders, including progressive hearing
    impairment from cytomegalovirus exposure. It is also critical
    to recognize that otitis media, or middle ear infection, is
    among the most frequent reasons for a sick child to visit the
    doctor during the first few years of life. The Committee
    recommends that the NIDCD continue to support research to
    develop novel therapeutic preventative strategies to lessen
    dependence on antibiotic therapies.
        Environmentally-induced Hearing Loss.--The Committee
    continues to be concerned by the number of Americans who suffer
    from chemical and noise-induced hearing loss and strongly
    supports the expansion of NIDCD's Wise Ears! Campaign among
    school-age children. The Committee also supports expanded
    research on prosthetic and pharmacological therapies for
    hearing loss from noise stress and ototoxic drugs.
        Hearing Devices for Children.--Everything that is known
    about hearing aids and cochlear implants is based on adult
    needs. Hearing aids also need to be optimized for children's
    needs, because there are so many differences between adults and
    children. Therefore the Committee encourages the NIDCD to
    support a collaborative effort of researchers to participate in
    a multi-center, longitudinal research project to track auditory
    development and speech perception in hearing-impaired infants.
    Also, the Committee encourages NIDCD to explore the feasibility
    of electrical stimulation applied to the vestibular system
    (analogous to the cochlear implant) to treat balance disorders.
        Hereditary Hearing Loss.--The Committee applauds the
    remarkable progress towards understanding the molecular basis
    for hereditary hearing impairment and encourages the NIDCD to
    continue to support research to identify the structure,
    regulation and function of genes whose mutation results in
    human communication disorders, including deafness. The
    Committee continues to encourage efforts to screen for the
    single and multi-genetic bases of hearing loss through
    contemporary techniques, including diagnostic gene chips. The
    Committee encourages the development of animal models to better
    assess how gene mutations result in impaired central auditory
    function.
        Inner Ear Hair Cell Regeneration.--The Committee applauds
    past support of regenerative studies, such as those in guinea
    pigs, and urges the NIDCD to continue to give a high priority
    to new and important directions in restoring hair cells of the
    cochlea, such as gene therapy, adenovirus vectors and stem
    cells. The Committee also encourages the NIDCD to request more
    collaborative applications among scientists working on the
    isolation of stem cells in the brain and scientists working in
    the inner ear hair cell field.
        Language Acquisition.--The Committee encourages the NIDCD
    to explore the biological bases of infant speech perception and
    language acquisition. This should include studies on the impact
    of partial or profound hearing loss.
        Learning Disabilities.--The Committee is pleased that NIDCD
    continues to support research activities focused on speech
    processing and on the development of expressive and receptive
    language. The Committee encourages continued activity and looks
    forward to learning the results of this work as they hold
    significant promise for individuals with learning disabilities.
    The Committee encourages the Institute to continue to
    coordinate with other Institutes working on related activities.
        Neurofibromatosis.--NF2 accounts for approximately 5
    percent of genetic forms of deafness. Unlike other genetic
    forms of deafness, NF2-associated deafness is potentially
    preventable or curable if tumor growth is halted before damage
    has been done to the adjacent nerve. Research is now being
    conducted to cure deafness in NF2 mice through gene therapy,
    with enormous implications for gene therapy in general and for
    patients suffering from meningiomas and other tumors in
    particular. The Committee therefore encourages NIDCD to expand
    its NF2 research portfolio through all suitable mechanisms
    including RFAs and clinical trials.
        Pharmaceutical Research.--Recognizing the promise of new
    technologies to deliver pharmaceutical agents to the inner ear,
    the Committee encourages the NIDCD to initiate molecular
    studies analyzing effectiveness of drugs, genes and gene
    products on cell death pathways and cascades, followed by
    trials to assess safety and benefits of pharmaceuticals to
    prevent and better treat sensorineural hearing loss from
    various causes.
        Presbycusis.--Presbycusis, the gradual loss of hearing from
    aging, is the most prevalent type of hearing loss and the third
    leading chronic disease (following hypertension and arthritis)
    in people over 65. It will become more common as the Nation's
    population grows older. To improve the quality life of millions
    of senior citizens, the Committee encourages research into
    declining stria vascularis metabolism, an important factor, as
    well as continuing studies on the central mechanisms of
    presbycusis.
        Tinnitus.--Recognizing that tinnitus compromises the lives
    of tens of millions of Americans, the Committee encourages the
    NIDCD to expand its research into causal mechanisms underlying
    peripheral and central tinnitus and continue exploring
    potential treatments for this affliction.
        Translational Research.--The Committee encourages the NIDCD
    to establish a Translational Research Branch to support
    research activities aimed at accelerating the translations of
    new findings in the molecular and basic sciences into new
    interventions and technologies clinicians can use to treat
    individuals with communication disorders.

                     NATIONAL INSTITUTE OF NURSING RESEARCH

    Appropriations, 2005....................................    $138,072,000
    Budget estimate, 2006...................................     138,729,000
    House allowance.........................................     138,729,000
    Committee recommendation................................     142,549,000

        The Committee recommends an appropriation of $142,549,000
    for the National Institute of Nursing Research [NINR]. The
    budget request was $138,729,000 and the fiscal year 2005
    appropriation was $138,072,000. The comparable amounts for the
    budget estimate include funds to be transferred from the Office
    of AIDS Research.
        Mission.--The National Institute of Nursing Research [NINR]
    supports clinical and basic research on biological and
    behavioral aspects of critical national health problems. The
    Institute's programs have established a scientific basis for
    research that seeks to reduce the burden of acute and chronic
    illness and disability for individuals of all ages; improve the
    quality of life by preventing and delaying the onset of disease
    or slowing its progression; and establishing better approaches
    to promoting health and preventing disease. The NINR supports
    programs essential to improving clinical environments by
    testing interventions which influence patient health outcomes
    and reduce costs and demands for care.
        Nurse-managed Health Centers.--The Committee urges the NINR
    to increase funding for research and demonstrations projects
    involving nurse-managed health centers and advanced practice
    nurses.
        Nursing Shortage.--The nursing shortage has an adverse
    effect on the health care delivery system as well as the health
    of our Nation's citizens. A shortage of nurse faculty caused
    schools of nursing to turn away thousands of qualified students
    last year. NINR confronts this issue by directing 8 percent of
    its budget to research training to help develop the pool of
    nurse researchers who also become faculty. Training support for
    fast-track baccalaureate-to-doctoral program participants is
    one important initiative. The 17 recently-funded Nursing
    Partnership Centers to Reduce Health Disparities is another
    initiative that helps produce an adequate number of nurse
    researchers. The Committee encourages these ongoing efforts.
    The Committee also encourages NINR to fund research projects
    located in rural areas that serve minority nursing students
    through community colleges. Not only will these partnerships
    between research-intensive schools of nursing and minority
    serving schools of nursing train more minority nurses, but they
    also expand opportunities for health disparities research.

               NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

    Appropriations, 2005....................................    $438,277,000
    Budget estimate, 2006...................................     440,333,000
    House allowance.........................................     440,333,000
    Committee recommendation................................     452,271,000

        The Committee recommends an appropriation of $452,271,000
    for the National Institute on Alcohol Abuse and Alcoholism
    [NIAAA]. The budget request was $440,333,000 and the fiscal
    year 2005 appropriation was $438,277,000. The comparable
    amounts for the budget estimate include funds to be transferred
    from the Office of AIDS Research.
        Mission.--The NIAAA conducts biomedical and behavioral
    research for improving prevention and treatment and reducing or
    eliminating the associated health, economic, and social
    consequences of alcohol abuse and alcoholism. NIAAA provides
    leadership in the country's effort to combat these problems by
    developing new knowledge that will decrease the incidence and
    prevalence of alcohol abuse and alcoholism and associated
    morbidity and mortality. NIAAA addresses these questions
    through an integrated program of biomedical, behavioral, and
    epidemiologic research on alcoholism, alcohol abuse, and
    related problems. This broad-based program includes various
    areas of special emphasis such as medications development,
    fetal alcohol syndrome, genetics, neuroscience, and moderate
    drinking.
        Alaska Substance Abuse.--The Committee is aware of serious
    problems with alcohol and substance abuse, especially among its
    Alaska Native population, and of the need for translating
    research into clinical applications for this population. The
    Committee urges NIAAA to sponsor a Research to Practice Forum
    with the Substance Abuse and Mental Health Services
    Administration to focus on bridging the gap between researchers
    and practitioners and translating scientific research into
    clinical applications, and encourages NIAAA to support the
    implementation of any recommendations developed at the forum.
        Alcohol Abuse by College Students.--Colleges continue to
    struggle with the consequences of alcohol abuse by students.
    The Committee encourages NIAAA to continue its program of fast-
    track approval for research grants to be carried out
    collaboratively by scientists and college administrators who
    express an urgent need for intervention. The Committee
    understands that NIAAA is updating the 2001 report of the NIAAA
    Task Force on College Drinking, to incorporate new findings.
    The Committee further encourages NIAAA to provide this update
    to college presidents and other relevant organizations.
        Alcohol Dependence as a Developmental Disorder.--
    Epidemiology studies show that alcohol is the drug of choice
    for youth and that it is associated with a host of consequences
    in this age group, including death and increased risk of harm
    and other negative outcomes. The Committee is aware of more
    recent data showing that 18- to 24-year-olds have the highest
    prevalence of alcohol dependence of any age group. These and
    other data make it clear to the Committee that alcohol has
    become entrenched in the developmental processes of
    adolescence, and that the developmental changes of adolescence
    appear to make this age group particularly vulnerable to
    alcohol's effects. The Committee urges NIAAA to continue its
    youth initiative, to work toward understanding how to extricate
    alcohol from adolescent development and how to change
    adolescents' behaviors toward alcohol. The Committee recognizes
    the importance of including scientists from several
    disciplines, from behavior to genetics, to reflect the many
    factors that contribute to underage drinking, and encourages
    NIAAA to continue guiding the research through its team
    approach.
        Alcohol, Obesity, and Liver Disease.--The relationship
    among the use of alcohol, the occurrence of obesity, and the
    presence of liver disease has become increasingly worrisome for
    clinicians. While alcohol's negative impact on weight and liver
    wellness is long established, the current epidemic of obesity
    and its consequent increase in liver disease creates a new
    focus for research. The Committee urges NIAAA to bring greater
    attention and resources to this relationship with special
    emphasis on the differentiation of impact of alcohol
    consumption on the liver for specific populations, such as
    women, minorities, the elderly, and others.
        Brain Development.--The Committee is aware of recent
    evidence that the human brain continues to develop for a longer
    period than previously thought, and that NIAAA has found
    physical differences in how adult brains and adolescent brains
    respond to certain stimuli. Biochemical and physiological
    events in the brain translate into behaviors. NIAAA is urged to
    continue research that will reveal biological links between
    adolescent brain changes, alcohol-related behaviors, and
    capacity for alcohol, and research that will reveal alcohol's
    short- and long-term impact on developmental changes in the
    adolescent brain.
        Underage Drinking.--The Committee recognizes that alcohol
    consumption represents one of the most important public health
    problems among youth today and commends the NIAAA on its
    efforts to collect data on the influence of environment and
    genetics on adolescent drinking behaviors.
        Treatments for Alcohol-use Disorders.--The Committee is
    aware that 18 million American adults abuse or are dependent on
    alcohol. The Committee encourages NIAAA to conduct research
    that will advance behavioral and pharmaceutical treatments,
    alone and in combination, for these disorders. The Committee
    understands that NIAAA recently convened more than 40 experts
    to establish priorities for accelerating development of
    medications to treat alcohol-use disorders, and requests a copy
    of the report on the outcome of that meeting, when it is
    completed.

                        NATIONAL INSTITUTE ON DRUG ABUSE

    Appropriations, 2005....................................  $1,006,419,000
    Budget estimate, 2006...................................   1,010,130,000
    House allowance.........................................   1,010,130,000
    Committee recommendation................................   1,035,167,000

        The Committee recommends an appropriation of $1,035,167,000
    for the National Institute on Drug Abuse [NIDA]. The budget
    request was $1,010,130,000. The fiscal year 2005 appropriation
    was $1,006,419,000. The comparable numbers for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        Mission.--Created in 1974, NIDA supports about 85 percent
    of the world's biomedical research in the area of drug abuse
    and addiction. The Committee commends NIDA for demonstrating
    through research that drug use is a preventable behavior and
    that addiction is a treatable disease. NIDA's basic research
    plays a fundamental role in furthering knowledge about the ways
    in which drugs act on the brain to produce dependence, and
    contributes to understanding how the brain works. In addition,
    NIDA research identifies the most effective pharmacological and
    behavioral drug abuse treatments. NIDA conducts research on the
    nature and extent of drug abuse in the United States and
    monitors drug abuse trends nationwide to provide information
    for planning both prevention and treatment services. An
    important component of NIDA's mission is also to study the
    outcomes, effectiveness, and cost benefits of drug abuse
    services delivered in a variety of settings and to assure
    dissemination of information with respect to prevention of drug
    abuse and treatment of drug abusers.
        Adolescent Brain Development.--The Committee notes
    neuroimaging research by NIDA and others showing that the human
    brain does not fully develop until about age 25. This adds to
    the rationale for referring to addiction as a ``developmental
    disease.'' The Committee encourages NIDA to continue its
    emphasis on adolescent brain development to better understand
    how developmental processes and outcomes are affected by drug
    exposure, the environment and genetics.
        Clinical Trials Network.--The Committee is pleased with the
    success and progress of NIDA's National Drug Abuse Treatment
    Clinical Trials Network [CTN]. The CTN provides an
    infrastructure to test the effectiveness of new and improved
    interventions in real-life community settings with diverse
    populations, enabling an expansion of treatment options for
    providers and patients. The Committee suggests NIDA develop
    ways to use the CTN as a vehicle to address emerging public
    health needs.
        Collaboration with Single State Authorities [SSAs].--The
    Committee commends NIDA for its outreach and work with SAMHSA's
    Center for Substance Abuse Treatment [CSAT] and State substance
    abuse directors, also known as Single State Authorities [SSAs],
    to reduce the current 15- to 20-year lag between the discovery
    of an effective treatment intervention and its availability at
    the community level. In particular, the Committee applauds NIDA
    for working with SAMHSA on a recent RFA designed to strengthen
    State Substance Abuse agencies' capacity to support and engage
    in research that will foster statewide adoption of meritorious
    science-based policies and practices. The Committee also
    encourages NIDA to continue collaborative work with SSAs,
    including its ``blending activities,'' to ensure that research
    findings are relevant and adaptable by State substance abuse
    systems.
        Co-occurring Disorders.--The Committee recognizes that
    addiction is a disorder that can affect the course of other
    diseases, including HIV/AIDS, mental illness, trauma, cancer,
    cardiovascular disease and even obesity. To adequately address
    co-occurring health problems, the Committee encourages the
    Institute to work with other agencies to stimulate new research
    to develop effective strategies and to ensure the timely
    adoption and implementation of evidence-based practices for the
    prevention and treatment of co-occurring disorders.
        Drug Abuse and HIV/AIDS.--The Committee understands that
    one of the most significant causes of HIV virus acquisition and
    transmission is drug taking practices and related risk factors
    in different populations. Drug abuse prevention and treatment
    interventions have been shown to be effective in reducing HIV
    risk. Therefore, the Committee urges NIDA to continue
    supporting research that focuses on developing and testing
    drug-abuse related interventions designed to reduce the spread
    of HIV/AIDS.
        Drug-Induced Liver Injury.--The Committee notes that the
    mechanisms and causes of Drug-Induced Liver Injury [DILI]
    related to over-the-counter and prescription medications is not
    well understood and therefore merits further research. The
    Committee is aware that NIDDK currently funds 5 centers in the
    Drug-Induced Liver Injury Network [DILIN] and encourages
    increased support for the DILIN to help identify the underlying
    mechanisms and patterns in DILI to better obtain data and find
    patterns in DILI. The Committee also encourages NIDA to work
    collaboratively with NIDDK, FDA, industry, and the liver
    research community to address these priorities.
        Drug Treatment in Criminal Justice Settings.--The Committee
    is very concerned about the well-known connections between drug
    use and crime. Research continues to demonstrate that providing
    treatment to individuals involved in the criminal justice
    system decreases future drug use and criminal behavior, while
    improving social functioning. The Committee strongly supports
    NIDA's efforts in this area, particularly the Criminal Justice
    Drug Abuse Treatment Studies.
        Emerging Drug Problems.--The Committee recognizes that drug
    use patterns are constantly changing and is pleased with NIDA's
    efforts to monitor drug use trends and to rapidly inform the
    public of emerging drug problems. The Committee encourages NIDA
    to continue supporting research that provides reliable data on
    emerging drug trends, particularly among youth and in major
    cities across the country.
        Genetics Addiction.--The Committee recognizes that not
    everyone who takes drugs becomes addicted. Research has shown
    that genetics plays a critical role in addiction, and that the
    interplay between genetics and environment is crucial. The
    Institute is urged to further investigate this phenomenon.
        Long-term Consequences of Marijuana Use.--The Committee is
    concerned with the continuing widespread use of marijuana. The
    Committee urges NIDA to continue support for efforts to assess
    the long-term consequences of marijuana use on cognitive
    abilities, achievement, and mental and physical health, as well
    as work with the private sector to develop medications focusing
    on marijuana addiction.
        Medications Development.--The Committee applauds NIDA for
    over a decade of leadership in working with private industry to
    develop anti-addiction medications and is pleased this
    collaboration has resulted in a new medication for opiate
    addiction. The Committee encourages NIDA to continue its work
    with the private sector to develop anti-addiction medications,
    particularly for cocaine, methamphetamine, and marijuana.
        Primary Care Settings and Youth.--The Committee recognizes
    that primary care settings are potential key points of access
    to prevent and treat problem drug use among young people. The
    Committee encourages NIDA to support health services research
    on effective ways to educate primary care providers about drug
    abuse and develop brief behavioral interventions for preventing
    and treating drug use and related health problems; and develop
    methods to integrate drug abuse screening, assessment,
    prevention and treatment into primary health care settings.
        Reducing Health Disparities.--The Committee notes that the
    consequences of drug abuse disproportionately impact
    minorities, especially African American populations. The
    Committee is pleased to learn that NIDA formed a Subgroup of
    its Advisory Council to address this important topic.
    Researchers should be encouraged to conduct more studies in
    this population and to target their studies in geographic areas
    where HIV/AIDS is high and/or growing among African Americans,
    including in criminal justice settings.
        Reducing Inhalant Abuse.--The Committee understands and is
    alarmed that, for the second year in a row, NIDA's Monitoring
    the Future Survey has shown an increase in the use of inhalants
    by 8th graders. The Committee urges the Institute to continue
    its support of research on prevention and treatment of inhalant
    abuse, and to enhance public awareness on this issue.
        Reducing Methamphetamine Abuse.--The Committee is very
    concerned about the continued abuse of methamphetamine across
    the United States. The Committee urges NIDA to continue
    supporting research to address the medical consequences of
    methamphetamine abuse.
        Reducing Prescription Drug Abuse.--The Committee notes the
    recent increases in the numbers of people who use prescription
    drugs for non-medical purposes. Research targeting a reduction
    in prescription drug abuse, particularly among our Nation's
    youth, should continue to be a priority for NIDA.
        Translational Research.--The Committee commends NIDA for
    its broad and varied information dissemination programs. The
    Committee also understands that the Institute is focused on
    stimulating and supporting innovative research to determine the
    components necessary for adopting, adapting, delivering, and
    maintaining effective research-supported policies, programs,
    and practices. As evidence-based strategies are developed, the
    Committee urges NIDA to support research to determine how these
    practices can be best implemented at the community level.

                      NATIONAL INSTITUTE OF MENTAL HEALTH

    Appropriations, 2005....................................  $1,411,933,000
    Budget estimate, 2006...................................   1,417,692,000
    House allowance.........................................   1,417,692,000
    Committee recommendation................................   1,460,393,000

        The Committee recommends an appropriation of $1,460,393,000
    for the National Institute of Mental Health [NIMH]. The budget
    request was $1,417,692,000 and the fiscal year 2005
    appropriation was $1,411,933,000. The comparable amounts for
    the budget estimate include funds to be transferred from the
    Office of AIDS Research.
        Mission.--The National Institute of Mental Health [NIMH]
    supports research on mind, brain, and behavior with the aim of
    reducing the public health burden of mental and behavioral
    disorders. NIMH's ultimate goal is to generate research that
    will lead to the ability to effectively treat mental disorders
    so that individuals can truly recover from them, and,
    ultimately, achieve the ability to predict and prevent them
    from even occurring. A major goal for NIMH is to identify the
    biological basis of mental disorders to more precisely pinpoint
    targets for prevention and treatment. This means understanding
    the neural basis of the illness at all levels, from molecular
    to behavioral.
        Adolescent Depression and Suicide.--Major depressive
    disorder in adolescence--one of the major risk factors for
    suicide--has become increasingly common. Suicide now accounts
    for 13 percent of all adolescent deaths and ranks third as a
    cause of death among teenagers. The Committee notes that NIMH
    has conducted a major trial on adolescent depression which has
    yielded valuable knowledge about effective treatments for
    depression. The Committee strongly encourages NIMH to
    strengthen its investment in understanding the clinical
    epidemiology of suicidal behavior and thinking in children and
    adolescents; improving the criteria for identifying those at
    risk; and examining the outcomes of actions taken to assist
    those found to be at risk.
        Alzheimer's Disease.--Combining imaging with genetics, a
    team of NIMH-funded scientists recently identified a possible
    genetic marker for Alzheimer's disease, a variant of the gene
    that codes for APOE, a protein involved in metabolizing
    cholesterol. PET scans of normal individuals in their fifties
    and sixties who carry this variant showed decreased activity in
    regions of the brain known to be affected by Alzheimer's. PET
    scans of younger individuals who carry this variant found
    lowered metabolism in the same brain areas, suggesting that the
    process at work in Alzheimer's starts decades before memory
    deficits become apparent. The Committee strongly encourages
    NIMH to continue to advance understanding of Alzheimer's
    disease.
        Aging and Mental Health.--The Committee commends the NIMH
    for recently recognizing the need to place a higher priority on
    the mental health needs of older persons through the 2004
    recommendations promulgated by the NIMH Aging Research
    Workgroup and the restructuring of the Adult and Geriatric
    Treatment and Preventive Intervention Research Branch. However,
    the Committee believes it is critical that studies related to
    the elderly keep pace with the rapid growth of this cohort. The
    Committee encourages the NIMH to devote greater resources to
    research on adults over age 65 to reflect the growth in numbers
    of this population. Therefore, the Committee strongly
    encourages NIMH to significantly expand research in this area.
        The Committee is pleased with NIMH's continued emphasis on
    research involving mental disorders in the elderly population,
    especially since the causes of depression in the elderly and
    the factors affecting its course are not well understood. The
    Committee urges NIMH to continue its level of support in this
    area.
        Autism Research.--The Committee commends NIMH for its
    strong leadership of the Interagency Autism Coordinating
    Committee [IACC], and for the institute's continued emphasis on
    autism as an urgent public health problem. Autism continues to
    be a top priority for NIH. The Committee supports continued
    cross-Institute investments in several new centers and
    projects, which have produced recent findings indicating that
    the fundamental pathology may be ``miswiring'' in the brains of
    autistic children, with an excess of local circuits and a
    deficit of long-range circuits. NIMH research is helping to
    develop new tools for detecting autism early, before age 2. In
    a new study on infant siblings of children with autism, early
    findings indicate that siblings later diagnosed with autism
    show social deficits, visual attention impairments, and unusual
    temperament by 12 months of age. This work could greatly
    enhance efforts for early detection and treatment.
        Basic Behavioral Science.--The Committee encourages NIMH to
    continue its commitment to support basic behavioral research
    focused on fundamental psychological domains and factors that
    promote mental health or become disturbed in mental disorders.
    The Committee is concerned that the institute may be
    diminishing its support for some areas of relevant scientific
    inquiry and urges the institute to support a balanced program
    of grant funding and to maintain its support for research on
    the promotion of mental health and the study of psychological,
    social, and legal factors that influence behavior.
        Combat Veterans.--The Committee is concerned about the
    mental health effects of military service in Iraq and
    Afghanistan, particularly since so many of the combatants are
    members of the National Guard or Reserves who will have to
    assimilate quickly back into civilian life after service. The
    Committee urges NIMH to work closely with the Veterans
    Administration and with the Department of Defense in efforts to
    best address this looming problem.
        Demographics.--The Committee is aware that demographics
    will demand a greatly increased focus on mental disorders in
    older persons, and consequently the Committee continues to be
    concerned about funding for late-life mental health research at
    the National Institute of Mental Health [NIMH]. The Committee
    encourages NIMH to expand research in Adult and Geriatric
    Treatment and Preventive.
        Depression in the Workplace.--The Committee notes with
    interest that recent NIMH research has demonstrated the
    importance of recognizing depression in the workplace and the
    cost-effectiveness of treating those affected. Employees with
    depression--even compared to employees with rheumatoid
    arthritis, a chronic illness that can impair job performance--
    were four to five times more likely to become unemployed, to
    have diminished productivity, and to exhibit increased
    absenteeism. However, appropriate treatment for depression
    resulted in positive changes in all three areas. The research
    found that offering appropriate, evidence-based depression
    treatment for employees is a cost-effective strategy for
    American businesses. Further information on cost effectiveness
    will become available at the completion of the ongoing NIMH-
    funded study, ``Outreach and Treatment for Depression in the
    Labor Force,'' which is scheduled for completion in 2006.
        Disease Prevalence.--The Committee is aware that NIMH has
    supported a major study that will provide critical information
    concerning the prevalence of most mental disorders in this
    country, as well as about the availability of quality care.
    When the study is published, the Committee would like to have a
    briefing to summarize the results of that study for interested
    Members of Congress and staff.
        Down Syndrome.--The Committee encourages the NIMH to
    develop new strategies for cataloging, understanding,
    diagnosing and treating behavioral disorders that are common in
    people with Down syndrome. They include autism, pervasive
    developmental disorder, obsessive compulsive disorder,
    depression and psychosis. The Committee urges NIMH to
    coordinate its research on Down syndrome with NICHD, NINDS, NIA
    and other Institutes. The Committee encourages NIMH to continue
    their studies on imaging of the brains of persons with Down
    syndrome broadening their focus to include behavior and motor
    coordination.
        Epilepsy.--Recent evidence of connections between
    depression and epilepsy point to relationships between the two
    disorders that suggest potential common pathogenic mechanisms.
    Research could help improve care for both groups of patients.
    The Committee strongly urges the Institute to make research in
    epilepsy a priority and to coordinate research efforts with
    NINDS.
        Evidence-based Treatments for Recovery and Dissemination.--
    The first of several large, NIMH-funded clinical studies
    testing various treatment options for those with serious mental
    illnesses was completed last summer: a 13-site trial aimed at
    defining the most effective and safe treatment for children and
    adolescents with major depressive disorder. There has been much
    debate about whether a class of antidepressant medications,
    selective serotonin re-uptake inhibitors [SSRIs] can actually
    increase suicidal thinking. Results of the trial revealed that
    a combination of fluoxetine (Prozac) and a type of
    psychotherapy called cognitive behavioral therapy [CBT] was the
    most effective treatment (71 percent responded). Suicidal
    thinking, which was present in 29 percent of the participants
    at the beginning of the study, improved significantly in all
    four treatment groups, with those receiving medication and
    therapy showing the greatest reduction in suicidal thinking.
    The effectiveness of these treatments over a 6-month period
    from treatment initiation will soon be known. It is critical
    for physicians and psychotherapists to closely monitor their
    young patients on antidepressant medications for signs of
    hurtful or suicidal behavior, particularly during the early
    phases of treatment.
        Fragile X.--Fragile X is the most common single-gene
    neuropsychiatric disease known. It causes cognitive impairment,
    mental disorders such as obsessive-compulsive disorder, and
    extreme anxiety. The Committee commends NIMH for spearheading
    three focused research meetings devoted to identifying critical
    research needs, in November 2001, January 2003, and July 2004.
    The Committee urges NIMH to pursue the most critical needs
    identified by the meeting panels. These include controlled
    studies of existing and new pharmacological treatments for
    Fragile X and identification of the key molecular targets which
    are likely candidates for designing drug treatments for Fragile
    X and related disorders such as autism. The Committee also
    urges NIMH to include Fragile X in its studies of related
    neuropsychiatric disorders and to work with other Institutes
    such as NICHD and NINDS to develop cooperative research support
    mechanisms in this area. In addition, the Committee urges the
    NIMH to work with industry and academia to test available
    medications and bring new treatments to market.
        Frontier Mental Health Needs.--The Committee commends NIMH
    on its outreach efforts to determine the differences in mental
    health needs which may exist in remote frontier communities,
    including Alaska. The Committee encourages NIMH to expand its
    research efforts into these communities, which are often
    ignored in research projects, but which continue to suffer from
    high incidences of mental health problems including depression,
    suicide and co-occurring disorders with substance abuse.
        Health Disparities and Clinical Trials.--The Committee is
    aware of the work being done by NIMH and its National Advisory
    Mental Health Council [NAMHC] to address issues involving
    health disparities and inclusion of historically underserved
    minorities in clinical trials sponsored by the Institute. The
    Committee supports these efforts.
        Hepatitis.--The Committee urges the National Institute of
    Mental Health [NIMH] to conduct and/or facilitate research to
    explore the etiology and effective therapeutic management of
    neuropsychiatric symptoms and disorders associated with chronic
    hepatitis C and interferon-based antiviral treatment.
        Learning Disabilities.--The Committee commends NIMH for the
    work conducted to explore the neurological and behavioral
    aspects of learning disabilities. The Committee looks forward
    to learning the results of this work and encourages the
    Institute to continue to coordinate with other Institutes
    working on related activities.
        Morbidity and Mortality.--The burden of mental disorders is
    staggering, in terms of both morbidity and mortality.
    Researchers supported by NIMH have found that half of all
    lifetime cases of mental illness begin by age 14, and that
    despite effective treatments, there are long delays between the
    appearance of the first symptoms of illness and provision of
    even adequate treatment. Unlike most other disabling medical
    diseases, mental illness begins very early in life. Mental
    disorders, then, can very aptly be called the chronic diseases
    of the young. Young people with mental disorders suffer
    disability when they are in the prime of life, when they would
    normally be most productive. The NIMH study also found that
    mental disorders really are quite common--26 percent of the
    general population reported that they had symptoms sufficient
    for diagnosing a mental disorder during the past 12 months.
    Although some of these cases are mild ones that will resolve
    without formal interventions, many more will not. The Committee
    urges NIMH to continue its current efforts to focus on research
    that promises to yield effective results that can be translated
    to the benefit of patients, with the goal of finding new ways
    to intervene early in the development of disease--or even
    prevent its occurrence, and, when prevention is not possible,
    to achieve rational treatments that are tailored to be most
    effective to the individual patient.
        Parkinson's Disease.--The Committee encourages continued
    collaborations including additional intramural activities
    between NINDS, NIMH, and NIA to enhance understanding of
    neurodegenerative diseases, particularly Parkinson's.
        Prevention Research.--The Committee places a high priority
    on prevention research, particularly with respect to mental
    disorders among children and adolescents, in identifying
    protective factors against the negative impacts of stress among
    young adults, and in developing strategies to strengthen the
    family and other relationships that serve as protective
    factors.
        Psoriasis.--Psoriasis is associated with elevated rates of
    mental disability, depression and suicidal ideation. The
    Committee urges NIMH to conduct research into the mental health
    aspects of psoriasis, especially as it relates to quality of
    life and burden of the disease. Furthermore, a 2005 study of 44
    autoimmune diseases found that only psoriasis, when present in
    women around the time of pregnancy, was significantly
    associated with autism, doubling the risk of autism spectrum
    disorder in their children. The Committee urges NIMH to support
    further study of the link between psoriasis and autism.
        Psychological Impacts of Terrorism.--The Committee supports
    NIMH research related to the psychological impact of both acute
    and chronic exposure to threats of violence, including
    terrorism and war, with particular emphasis on vulnerable
    populations, such as trauma survivors, children and older
    adults. The Committee encourages NIMH to expand its research
    portfolio to include research related to factors that promote
    detection or prediction, prevention, and post-exposure recovery
    and resilience.
        Suicide.--In addition to being disabling and chronic,
    mental disorders can be fatal. Depression is an important risk
    factor for suicide, the third leading cause of death among
    adolescents. The Committee notes that there are far more
    suicides each year in this country than there are homicides.
    The Committee supports NIMH efforts to enhance suicide
    awareness and prevention, and encourages the institute to
    continue its ongoing collaborative efforts with other
    institutes and with SAMHSA to address this painful topic.
        Translating Behavioral Research.--The Committee commends
    NIMH for undertaking a reorganization to promote the
    translation of basic behavioral science into treatments for
    those with mental disorders. The Committee strongly supports
    NIMH's efforts to advance the application of behavioral
    research and interventions in clinical settings to address the
    public health burden of mental disorders and develop preventive
    interventions. The Committee strongly supports additional
    clinical trials that examine the effectiveness of behavioral
    interventions in community-based settings. Behavioral
    interventions are especially needed for children and
    adolescents with mental disorders, including post-traumatic
    stress disorder, eating disorders, attention deficit-
    hyperactivity disorder, and the most common forms of
    depression. Translational research in the behavioral and social
    sciences is especially needed to address how basic behavioral
    processes, such as cognition, emotion, motivation, development
    and social interaction, inform the diagnosis, treatment and
    delivery of services for mental disorders.

                    NATIONAL HUMAN GENOME RESEARCH INSTITUTE

    Appropriations, 2005....................................    $488,608,000
    Budget estimate, 2006...................................     490,959,000
    House allowance.........................................     490,959,000
    Committee recommendation................................     502,804,000

        The Committee recommendation includes $502,804,000 for the
    National Human Genome Research Institute [NHGRI]. The budget
    requested $490,959,000 and the fiscal year 2005 appropriation
    was $488,608,000. The comparable amounts for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        Mission.--The Human Genome Project was an effort to
    determine the location and sequence of the estimated 30,000
    genes that constitute the human genome. This historic
    achievement opens the genomic era of medicine. The Committee
    commends the NHGRI for developing this vision for the future of
    genomics.
        The Institute coordinates extramural and intramural
    research, as well as research training, in the areas of
    genomics and genetics. The Division of Extramural Research
    supports research on sequence and function of both human and
    non-human genomes, human genetic variation, technology
    development for genome research, database management and
    analysis, and research on the ethical, legal and social
    implications of human genome research. The Division of
    Intramural Research focuses on applying the tools and
    technologies of the successful Human Genome Project to
    understanding the genetic and environmental basis of disease,
    and developing DNA-based diagnostics and gene-based therapies.
        Basic Behavioral and Social Sciences Research.--The
    Committee encourages NHGRI to participate in trans-institute
    initiatives organized by OBSSR or another institute to
    strengthen basic behavioral research and enhance opportunities
    for behavioral science research training.
        Chromosome Abnormalities.--The Committee commends the NIH
    for its efforts over the past year to encourage new scientific
    work into molecular, genetic, clinical and therapeutic aspects
    of chromosome abnormalities. Because of the multisystemic
    consequences of a chromosome abnormality, multidisciplinary and
    multi-Institute support by NIH will be required in order to
    make progress that will be meaningful to those affected. The
    Committee continues to urge NIH to seek ways to expand and
    intensify such research, especially studies involving the
    syndromes of chromosome 18.
        Molecular Libraries.--The Committee commends NHGRI for
    leadership in the NIH Roadmap Initiative on molecular
    libraries. This includes the founding of the NIH Chemical
    Genomics center, which will provide public sector researchers
    with access to high-throughput screens for small organic
    molecules, enabling development of new tools for exploration of
    health and disease. The Committee recognizes that advances in
    the use of these molecular libraries will enhance NIH's global
    leadership in the future.
        Targeting Disease Prevention.--The Committee commends NHGRI
    for its leadership of the international haplotype mapping
    [HapMap] project. The HapMap will provide a powerful new public
    resource to gain a deeper understanding of human biology, and
    discover the genetic and environmental factors that contribute
    to disease, predict potential disease risk, optimize drug
    prescribing for individuals, and identify and validate critical
    new targets for therapeutic development. These new developments
    also suggest that a large-scale population-based cohort study
    in the United States could provide a critical path toward
    improved genome-based public health and the Committee urges
    NHGRI to explore the feasibility of commencing such a study.

          NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

    Appropriations, 2005....................................    $298,209,000
    Budget estimate, 2006...................................     299,808,000
    House allowance.........................................     299,808,000
    Committee recommendation................................     309,091,000

        The Committee recommends an appropriation of $309,091,000
    for the National Institute of Biomedical Imaging and
    Bioengineering [NIBIB]. The budget requested $299,808,000 and
    the fiscal year 2005 appropriation was $298,209,000. The
    comparable amounts for the budget estimate include funds to be
    transferred from the Office of AIDS Research.
        Mission.--The NIBIB improves health by promoting
    fundamental discoveries, design and development, and
    translation and assessment of technological capabilities in
    biomedical imaging and bioengineering, enabled by relevant
    areas of information science, physics, chemistry, mathematics,
    materials science, and computer sciences. The Institute plans,
    conducts, fosters, and supports an integrated and coordinated
    program of research and research training that can be applied
    to a broad spectrum of biological processes, disorders and
    diseases and across organ systems. The Institute coordinates
    with the biomedical imaging and bioengineering programs of
    other agencies and NIH Institutes to support imaging and
    engineering research with potential medical applications and
    facilitates the transfer of such technologies to medical
    applications.
        Professional Judgment Budget.--The Committee acknowledges
    receipt of the Five-Year Professional Judgment Budget for the
    National Institute of Biomedical Imaging and Bioengineering
    [NIBIB] requested in House Report 108-636. The Committee notes
    the Budget's central conclusion that biomedical imaging and
    bioengineering ``are dynamic and ripe with opportunities for
    major scientific advances'' that could be translated into
    dramatic improvements in health care. The Professional Judgment
    Budget recommends a measured, reasonable rate of growth for the
    NIBIB to achieve the goals of the important research areas
    enumerated in the report. The Committee commends the NIH and
    Department of Health and Human Services for this approach and
    believes that the projected rate of growth is necessary to
    enable the NIBIB to achieve the scientific advances that the
    Congress envisioned when it established the Institute.
        The Professional Judgment Budget recognizes the role of the
    NIBIB with respect to interdisciplinary research, the physical
    sciences, and technology development. The NIBIB has taken a
    leadership role in efforts to examine the scientific questions
    that can be addressed by collaboration between life and
    physical scientists, the barriers to such collaboration, and
    the steps that need to be taken to bridge these disciplines.
        The Committee is pleased with the role of the NIBIB has
    played and will continue to play in the development of
    biomedical technology related to the physical sciences.
        Imaging and Engineering Advances.--The Committee urges
    NIBIB to focus efforts on improving musculoskeletal disease
    detection, monitoring and treatment through focused imaging and
    engineering advances. The Institute also is encouraged to
    develop noninvasive techniques to measure bone quality and bone
    strength in humans.
        Liver Imaging Techniques.--Consistent with NIBIB's mission
    to improve all diagnostic imaging technologies, the Committee
    urges NIBIB to make liver imaging techniques a primary focus,
    speeding the development of new modalities that better capture
    the early stages of various liver diseases, including cancer,
    as well as offering the potential for combinations of diagnosis
    and treatment. This is also necessary to develop less invasive
    diagnostics for liver disease patients. The Committee urges
    NIBIB to participate actively in trans-NIH initiatives that
    address these priorities.
        The Committee is encouraged by the potential of image-
    guided surgery to improve patient outcomes. The Committee
    supports the Institute's plans to hold a conference on image-
    guided surgery and looks forward to learning about the results
    of this conference.
        PET and MicroPET Scans.--The Committee continues to
    encourage the Institute to devote significant resources to
    molecular imaging technologies such as positron emission
    tomography [PET] and microPET to take advantage of the
    capacities of molecular imaging to detect disease process at
    the molecular level and to monitor the effectiveness of
    targeted gene therapies now under development. The Committee
    also encourages the new Institute to develop its research
    agenda in close collaboration with other, disease-specific
    Institutes at NIH, so that new imaging technologies are closely
    tied to the research projects being undertaken by the various
    other Institutes of NIH.

                     NATIONAL CENTER FOR RESEARCH RESOURCES

    Appropriations, 2005....................................  $1,115,090,000
    Budget estimate, 2006...................................   1,100,203,000
    House allowance.........................................   1,100,203,000
    Committee recommendation................................   1,188,079,000

        The Committee recommends an appropriation of $1,188,079,000
    for the National Center for Research Resources [NCRR]. The
    budget request was $1,100,203,000 and the fiscal year 2005
    appropriation was $1,115,090,000. The comparable amounts for
    the budget estimate include funds to be transferred from the
    Office of AIDS Research.
        Mission.--The NCRR develops and supports critical research
    technologies and shared resources that underpin research to
    maintain and improve the health of our Nation. The NCRR
    programs develop a variety of research resources; provide
    biomaterial and resources for complex biotechnologies, clinical
    research, and specialized primate research; develop research
    capacity in minority institutions; and enhance the science
    education of pre-college students and the general public.
        Clinical Research Curriculum Award.--The Clinical Research
    Curriculum Awards or K30, has been extremely effective in
    training successful clinical investigators. Funded programs
    report that over 60 percent of their graduates are active
    researchers who have already secured funding for their
    research. The Committee supports the NIH decision to increase
    the size of these awards from $200,000 to $300,000 but is
    concerned that this was accomplished by reducing the number of
    funded institutions. The Committee would encourage increased
    support in order to expand rather than reduce the number of
    institutions receiving this important award.
        Clinical and Translational Science Awards [CTSA].--In
    September 2003, NIH launched the NIH Roadmap for Medical
    Research, a set of trans-NIH research initiatives designed to
    accelerate the pace of discovery and improve the translation of
    research findings into medical and health interventions for
    public benefit. A critical component of the Roadmap is the
    theme of re-engineering the clinical research enterprise. The
    Committee has encouraged the Director to utilize the NCRR-
    funded General Clinical Research Centers as the foundation of
    NIH Roadmap activities related to clinical research. NIH is now
    poised to capitalize on the revolutionary discoveries emerging
    from basic science, and has developed an innovative proposal to
    address the current difficulty recruiting and retaining
    clinical researchers; the increasing regulatory burden;
    fragmented training programs; and limitations and barriers due
    to NIH funding mechanisms, review and programs structures. The
    Committee supports NIH's efforts to integrate NIH's General
    Clinical Research Centers [GCRCs] and other relevant clinical
    mechanisms into a new and more efficient single application
    that results in awards that combine clinical science support
    with clinical career development and training. This will
    transform clinical and translational sciences for the future.
    The Committee has a long-standing and abiding interest in the
    health of the clinical research system supported under this
    appropriation, and therefore requests that NIH submit a report
    by February 6, 2006. The report should describe NIH's new award
    for clinical and translational sciences, which NIH expects to
    fund in fiscal year 2006, describe the expected costs in fiscal
    year 2006 and fiscal year 2007, and indicate the specific
    components of the program and plans for transition from the
    current funding mechanisms to the new awards. The Committee
    expects that the new award will support the full spectrum of
    clinical research activities, from early translation between
    the laboratory and the patient to epidemiological studies and
    health services research. The report should describe how this
    will be accomplished. The Committee has included $327,000,000
    for clinical research supported by the GCRCs and the CTSAs
    combined. The Committee expects the total number of awards for
    this combined program to remain at 79 in fiscal year 2006.
        Clinical Trials Technology.--The Committee encourages NCRR
    to work with grantees in the Research Centers at Minority
    Institutions [RCMI] program and the General Clinical Research
    Centers [GCRC] program to upgrade their clinical trials data
    management capabilities.
        Extramural Facilities Construction at Minority
    Institutions.--The Committee encourages NCRR to give priority
    consideration to supporting extramural facilities construction
    projects at historically minority institutions which have
    developed a comprehensive plan to address the disproportionate
    impact of cancer in minority communities, and those which have
    developed plans for enhancing their library facilities.
        Extramural Construction.--The Committee has included bill
    language identifying $30,000,000 for extramural biomedical
    facility renovation and construction. This amount is the same
    as the fiscal year 2005 appropriation. The fiscal year 2006
    budget proposed to eliminate funding for the program. These
    funds are to be awarded competitively, consistent with the
    requirements of section 481A of the Public Health Service Act,
    which allocates 25 percent of the total funding to institutions
    of emerging excellence.
        General Clinical Research Centers.--The Committee is
    concerned about the growing gap between the GCRC budgets
    approved by the NCRR Advisory Council and the actual budgets
    awarded. The Committee requests a report comparing the Advisory
    Council-approved budgets and the actual funds awarded to each
    GCRC for fiscal years 2003, 2004, and 2005. The Committee
    requests this same information as soon as possible.
        IDeA Grants.--The Committee has provided $230,000,000 for
    the Institutional Development Award [IDeA] Program authorized
    by section 402(g) of the Public Health Service Act. The
    Committee recognizes the importance of the Centers of
    Biomedical Research Excellence and the IDeA Networks of
    Biomedical Research Excellence programs and expects funding to
    be maintained for both. The focus of IDeA should continue to be
    on improving the necessary infrastructure and strengthening the
    biomedical research capacity and capability of research
    institutions within the IDeA States.
        National Primate Research Centers.--The Committee values
    the critical role played by the eight National Primate Research
    Centers [NPRCs]. These Centers conduct specialized basic and
    applied biomedical research and offer essential and valuable
    services to other researchers. Primates are increasingly
    important to the Nation's public health priorities in areas
    such as biodefense, heart disease, cancer, diabetes, AIDS,
    kidney disease, Alzheimer's, Parkinson's and emerging
    infectious diseases. In fiscal year 2004, the Committee urged
    the NIH to fully commit to the NPRCs' Five Year Federal
    Advancement Initiative in order to address the upgrades and
    program expansions required to meet the demanding research
    needs of the Nation. Nevertheless, NIH has taken only
    incremental steps to increase the NPRCs' base grant funding.
    The Committee strongly urges the NIH to place a higher priority
    on funding these centers adequately.
        Research Centers at Minority Institutions.--The Committee
    continues to recognize the critical role played by minority
    institutions at both the graduate and undergraduate level in
    addressing the health research and training needs of minority
    populations. These programs help facilitate the preparation of
    a new generation of scientists at these institutions. The
    Research Centers in Minority Institutions [RCMI] Program
    continues to impact significantly on these problems. The
    Committee encourages NIH to strengthen participation from
    minority institutions and increase resources available in this
    area. The Committee also encourages NIH to work with minority
    institutions with a track record of producing minority scholars
    in science and technology.

           NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

    Appropriations, 2005....................................    $122,105,000
    Budget estimate, 2006...................................     122,692,000
    House allowance.........................................     122,692,000
    Committee recommendation................................     126,978,000

        The Committee has included $126,978,000 for the National
    Center for Complementary and Alternative Medicine. The budget
    request was $122,692,000 and the fiscal year 2005 appropriation
    was $122,105,000. The comparable amounts for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        The Committee strongly supports the work of the National
    Center for Complementary and Alternative Medicine. The Center
    is charged with assuring that complementary and alternative
    therapies be rigorously reviewed to provide consumers reliable
    information.
        The Committee continues to strongly support the work of
    NCCAM. As more and more Americans are using complementary and
    alternative therapies, there is an increasing need for quality
    research into this area and for sharing research findings and
    other information with health professionals and the general
    public.
        The Committee expects that funding for existing and new
    Centers supported by the office will be maintained. The
    Committee expects NCCAM to renew its support of CDC's field
    investigations program and expand its support of AHRQ's
    literature reviews and data analysis efforts. It also commends
    NCCAM's efforts to develop and disseminate a comprehensive set
    of fact sheets on CAM therapies to inform the public and health
    professionals of the state of scientific knowledge about these
    therapies and expects that to continue and expand.
        Antioxidants.--The Committee is aware that the role of
    antioxidants in maintaining health in a variety of organ
    systems has been attracting attention in recent years. Recent
    evidence suggests that the delicate inner ear structures can be
    protected against the ravages of acoustic trauma produced by
    noise such as that encountered on the battlefield, and may have
    a role to play in preventing or slowing the progression of age-
    related hearing loss in the elderly by routine administration
    of commonly available antioxidant food supplements. Other
    applications may be found for these compounds in the treatment
    or prevention of auditory or vestibular disorders. The
    Committee encourages the institute to collaborate with NIDCD to
    fund research in this very promising area.
        Ameliorating Liver Disease.--The Committee is pleased with
    NCCAM's efforts to conduct clinical trials in collaboration
    with NIDDK regarding the use of milk thistle as a possible
    treatment in slowing the progression of nonalcoholic
    steatohepatitis and to reduce the side effects of hepatitis C
    interferon treatments. The Committee looks forward to the
    development and dissemination of the research results
    associated with the use of milk thistle as a treatment to
    ameliorate liver disease.
        Bone Health.--The Committee encourages NCCAM to conduct
    research on complementary and alternative medical approaches to
    bone health, bone pain and nutrition, including supplements and
    nutraceuticals, for osteoporosis and later life fractures.
        Behavioral Research on Stress.--NCCAM is encouraged to
    continue collaborations with other NIH offices, Institutes and
    centers to identify mechanisms through which various stressors
    produce adverse health effects, and the extent to which stress
    reduction interventions improve health.
        Integrative Medicine Model.--The Committee supports the
    concept of integrative medicine, which reaffirms the importance
    of the relationship between practitioner and patient, focuses
    on the whole person, is informed by evidence, and makes use of
    all appropriate therapeutic approaches, healthcare
    professionals and disciplines to achieve optimal health and
    healing. The Committee encourages NCCAM and other relevant ICs
    to accelerate the infusion of this model throughout their
    research, research training and communication activities.
        Native Hawaiian Healing.--The Committee commends the NCCAM
    for its plans to convene a working group in fiscal year 2005 to
    establish communication and facilitate research collaborations
    among traditional and conventional healing techniques.
        Parkinson's Disease.--The Committee encourages NCCAM to
    continue exploration of aerobic exercise and Chinese exercises
    such as T'ai Chi Chuan in the treatment of Parkinson's. Recent
    studies show exercise may increase neuroprotective chemicals in
    the brain and decrease falls in the elderly. The Committee also
    encourages continued research into magnetic stimulation for
    depression and the phytomedicine Valerian for sleep
    dysfunction, as both symptoms are significant non-motor co-
    morbidities in Parkinson's. Finally, NCCAM is encouraged to
    work the Office of Dietary Supplements in investigating
    supplements which may be neuroprotective, such as berries,
    alpha lipoic acid, N-acetyl-L-cysteine, acetyl-L-carnitine,
    vitamin E, ginko biloba, vitamin D, vitamin B12,
    phosphatidylcholine, and glyconutrients.
        PET.--The Committee continues to urge NCRR to support
    research resource centers for the development and refinement of
    positron emission tomography [PET] as a unique imaging
    technology to diagnose and stage diseases of the brain,
    including Alzheimer's disease.
        Practice-Based Research Network.--One of the major advances
    achieved through the work of NCCAM has been the development of
    CAM or integrative medicine research centers at many of the
    Nation's top medical centers. In order to build upon this
    important new research infrastructure base, the Committee
    expects NCCAM to implement one of the major recommendations of
    the recent Institute of Medicine CAM report--the development
    and utilization of an Integrative Medicine Practice-Based
    Research Network [PBRN]. The Committee concurs with the IOM
    that the PBRN model is very well-suited for the study of CAM
    therapies and would greatly enhance the ability to conduct high
    quality cost-effective clinical trials of CAM therapies and
    treatment modalities. Such a network would also allow for the
    rapid dissemination of data, which would directly affect the
    provision of health care to consumers. Key to the establishment
    of such a network would be funding for a data tracking system
    linking the network practice members and a centralized data
    coordinating center. The Committee considers the PBRN to be one
    of its top priorities for NCCAM this year.

           NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

    Appropriations, 2005....................................    $196,159,000
    Budget estimate, 2006...................................     197,379,000
    House allowance.........................................     197,379,000
    Committee recommendation................................     203,367,000

        The Committee has included $203,367,000 for the National
    Center on Minority Health and Health Disparities. The budget
    request was $197,379,000 and the fiscal year 2005 appropriation
    was $196,159,000. The comparable amounts for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        Mission.--The NCMHD advises the NIH Director and Institute
    and Center [IC] directors on the development of NIH-wide policy
    issues related to minority health disparities research,
    research on other health disparities, and related research
    training. Among other activities, the NCMHD develops, in
    consultation with the NIH Director, IC directors, and the
    advisory council, a comprehensive strategic plan that
    identifies and establishes objectives, priorities, budgets, and
    policy statements governing the conduct and support of all NIH
    minority health disparities research, research on other health
    disparities, and related research training activities. It also
    administers funds for the support of minority health
    disparities research and other health disparities research, by
    awarding grants and leveraging the programs of the ICs.
        Cancer in Minorities.--While the Committee remains
    concerned about the burden of cancer in African-Americans and
    other minorities, it is encouraged by opportunities that exist
    for addressing this devastating toll. The Committee urges the
    NCMHD to collaborate with NCRR and NCI in taking the necessary
    steps to expand comprehensive Cancer Center's with a focus on
    research, treatment, prevention and control of cancer across
    minority and other disadvantaged populations.
        Cancer in Minority Communities.--The Committee commends
    NCMHD for its leadership in addressing the disproportionate
    impact of cancer in minority communities. The Committee
    encourages NCMHD to consider collaborating with the National
    Center for Research Resources and the National Cancer Institute
    in supporting the establishment of a cancer center at a
    historically minority institution focused on research,
    treatment, and prevention of cancer in African-American and
    other minority communities.
        Community-Based Organization Partnership Prevention
    Centers.--The Committee encourages continued expansion of
    community-based prevention initiatives and looks forward to
    hearing the recommendations of the strategic planning
    subcommittee on priority areas for research funding and the
    NCMHD's plans for implementation.
        Glomerular Injury.--The Committee understands that
    glomerular injury, a group of diseases affecting the filtering
    mechanisms of the kidneys, is more prevalent among African-
    Americans than the general population. The Committee urges
    NCMHD to explore collaboration with NIDDK to support research
    activities related to glomerular injury and requests a report
    on progress made in this area.
        Liver Disease.--The Committee notes that many liver
    diseases, such as hepatitis C, hepatitis B and nonalcoholic
    steatohepatitis, are more common in the African-American,
    Hispanic, Asian Pacific Islander and Native American
    populations, than in European Americans. In addition, access to
    and acceptance of care is particularly problematic in these
    populations. The Committee therefore urges the Center to
    initiate and participate with NIDDK, NIDA and NCI in research
    focused on addressing and reducing these disparities.
        Minority Health Disparities.--The Committee commends the
    National Center on Minority Health and Health Disparities for
    its leadership in addressing the long-standing problem of
    health status disparities in minority and medically underserved
    populations. For fiscal year 2006, the Committee continues to
    encourage NCMHD to implement its successful Research Endowment
    program as an ongoing initiative. Moreover, the Committee
    encourages NCMHD to implement the program in a manner that is
    consistent with the authorizing legislation.
        Project EXPORT.--The Committee commends NCMHD for its
    successful ``Project EXPORT'' initiative and urges continued
    support for this important program. Also, the Committee
    encourages the Director of NCMHD to coordinate with the NIH
    Director and the National Center for Research Resources in
    support of extramural facility construction and the development
    of other research and research library infrastructure at
    minority health professions schools.
        Scleroderma.--The Committee encourages NCMHD to support
    research that furthers the understanding of causes and
    consequences of scleroderma, a chronic, degenerative disease of
    collagen production, present among African-Americans, Hispanic
    and Native American men and women. NCMHD is encouraged to
    establish epidemiological studies to address the prevalence of
    scleroderma among these populations, as statistics indicate
    that African-Americans have a slightly higher incidence of
    scleroderma. This population is also likely to be diagnosed at
    a younger age and tends to be diagnosed more often with the
    diffuse form of scleroderma.

     JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH
                                    SCIENCES

    Appropriations, 2005....................................     $66,632,000
    Budget estimate, 2006...................................      67,048,000
    House allowance.........................................      67,048,000
    Committee recommendation................................      68,745,000

        The Committee recommends an appropriation of $68,745,000
    for the Fogarty International Center [FIC]. The budget request
    was $67,048,000 and the fiscal year 2005 appropriation was
    $66,632,000. The comparable amounts for the budget estimate
    include funds to be transferred from the Office of AIDS
    Research.
        Mission.--Adapting research advances in biomedicine to
    populations at home and abroad requires a continuing commitment
    to basic science as well as rigorous clinical and applied
    (epidemiological) studies. Examples are vaccines, anti-
    infective agents, drugs, and more efficient diagnostic tools,
    combinations of interventions, and health policies to reduce
    the risk of disease and its associated human, social, and
    economic consequences. These challenges will benefit from a
    more coordinated and multi-disciplinary approach to global
    health needs. It is the mission of the FIC to address these
    challenges by forging collaborations with a range of domestic
    and global partners in international research and training to
    pursue three core objectives: first, to accelerate the pace of
    discovery and its application by special projects enabling
    scientists worldwide to share conceptual insights, analytic
    methods, data sets, patient cohorts, or special environments;
    second, to engage and assist young as well as more established
    U.S. investigators to address scientific challenges related to
    global health; and third, to help develop a cadre of highly
    capable young foreign investigators positioned to cooperate
    with U.S. scientists in areas of the world that, due to
    geography, genetics, or disease burdens, provide unique
    opportunities to understand disease pathogenesis, anticipate
    disease trends, or develop interventions of relevance and
    priority for both the United States and the collaborating
    country.
        Chronic Obstructive Pulmonary Disease.--The Committee notes
    that Chronic Obstructive Pulmonary Disease [COPD] is the fourth
    leading cause of death worldwide, and encourages the Fogarty
    International Center to expand its COPD research and training
    activities.
        Fragile X.--The Committee encourages the Fogarty
    International Center to consider Fragile X syndrome through all
    appropriate programs, such as the Fogarty International
    Research Collaboration Award and the FIC Brain Disorders in the
    Developing World Program.
        Tuberculosis Training.--The Committee is pleased with the
    Fogarty International Center's efforts to supplement grants in
    AIDS International Training and Research Program [AITRP] or
    International Training and Research Program in Emerging
    Infectious Diseases [ERID], which trains tuberculosis experts
    in the developing world. Given the magnitude of global
    tuberculosis, the Committee encourages FIC to develop a
    specific free-standing TB training program.

                          NATIONAL LIBRARY OF MEDICINE

    Appropriations, 2005....................................    $323,346,000
    Budget estimate, 2006...................................     326,291,000
    House allowance.........................................     326,291,000
    Committee recommendation................................     335,422,000

        The Committee recommends an appropriation of $355,422,000
    for the National Library of Medicine [NLM]. The budget
    requested $326,291,000 and the fiscal year 2005 appropriation
    was $323,346,000. These amounts include $8,200,000 made
    available from program evaluation funds. The recommendation
    includes $4,000,000 for improvement of information systems. The
    comparable amounts for the budget estimate include funds to be
    transferred from the Office of AIDS Research.
        Mission.--The National Library of Medicine is the Federal
    institution that for more than 150 years has collected,
    organized, preserved, and disseminated the world's output of
    biomedical literature in all forms. As a result of this
    activity NLM is the world's largest library of the health
    sciences, its holdings numbering more than 5 million items. The
    NLM has pioneered innovative methods to disseminate
    bibliographic information. Basic to the mission of the NLM is a
    wide-ranging research program to improve how medical
    information is communicated. This responsibility is aided by a
    grants program and by specialized services in toxicology,
    environmental health, and biotechnology.
        Communication of NIH-Supported Research Findings.--One of
    the fundamental charges to NIH is to facilitate the translation
    of research findings into practice, both in terms of the care
    provided by health professionals and behavioral and lifestyle
    changes by the public. The Committee commends the excellent
    work NLM does in this regard. The Committee endorses efforts to
    launch a new magazine aimed at physician offices and their
    patients communicating the latest NIH research findings with
    authoritative content presented in a user-friendly format.
        Disease Management Technology.--The Committee urges NLM to
    conduct outreach activities to all public and private sector
    organizations which have demonstrated capabilities in health
    information technology. The Committee is particularly
    interested in disease management technology as it relates to
    saving health care dollars, and improving care for chronically
    ill individuals and the workforce.
        Health Equity Review.--The Committee congratulates NLM for
    its concern about health disparities and its sensitivity to
    native populations, such as Native Americans, Alaskans, and
    Hawaiians, and other minority communities. The Committee
    encourages NLM to fund projects to map health disparities and
    population profiles in minority communities.
        Native Hawaiian Healing.--The Committee applauds the NLM's
    leadership for conducting ``listening circles'' to discuss the
    need for preservation and documentation of traditional cultural
    healing practices. The Committee encourages the NLM to explore
    the best ways of capturing and documenting this information
    through continued collaboration with Native Hawaiians.
        Outreach.--The Committee encourages NLM to continue its
    outreach activities aimed at educating health care
    professionals and the general public about the Library's
    products and services, in coordination with medical librarians
    and other health information specialists.
        Public Access.--The Committee has noted that the National
    Institutes of Health has begun to implement its public access
    policy which is geared to ensuring that NIH-funded research
    results are made available as soon as possible to the public,
    health care providers, educators, and scientists through the
    National Library of Medicine's PubMed Central [PMC] database.
    The Committee agrees with the need for, and a goal of, issuing
    a balanced policy to help promote increased public access to
    NIH-funded research while maintaining the integrity of the peer
    review system which is essential to ensure the quality and
    accuracy of medical research in the United States. The
    Committee urges NIH to work with all stakeholders as it moves
    forward in implementing this policy. To assist the Congress in
    assessing the degree of success of this new policy, the
    Committee requests a progress report by no later than February
    1, 2006. Specifically, the Committee requests that the report
    contain the following information: (1) the total number of
    peer-reviewed articles deposited in PubMed Central since the
    May 2, 2005 implementation date and the distribution of chosen
    delay periods; (2) an assessment of the extent to which the
    implemented policy has led to improved public access; (3) an
    assessment of the impact of the policy on the peer review
    system; and (4) the cost of operating the database.
        PubChem.--The Committee is aware of the development of
    PubChem, the informatics component of the Molecular Libraries
    project of the NIH Roadmap for Medical Research. The Committee
    understands that the purpose of PubChem is to create a database
    of chemical structures and their biological activities. PubChem
    will house both data from the new NIH molecular libraries
    screening center network and compound information from the
    scientific literature. The Committee expects the NIH to work
    with private sector chemical information providers, with a
    primary goal of maximizing progress in science while avoiding
    unnecessary duplication and competition with private sector
    databases.

                             OFFICE OF THE DIRECTOR

    Appropriations, 2005....................................    $358,047,000
    Budget estimate, 2006...................................     385,195,000
    House allowance.........................................     482,216,000
    Committee recommendation................................     487,434,000

        The Committee recommends an appropriation of $487,434,000
    for the Office of the Director [OD]. The budget request was
    $385,195,000 and the amount appropriated in fiscal year 2005
    was $358,047,000. The comparable amounts for the budget
    estimate include funds to be transferred from the Office of
    AIDS Research.
        The Committee has included within the total, $97,021,000 to
    support specific targeted research activities needed to develop
    radiological/nuclear ($47,021,000) and chemical threat
    ($50,000,000) countermeasures. This funding was originally
    requested in the Office of the Secretary Public health and
    Social Services Emergency Fund.
        Mission.--The Office of the Director provides leadership
    and direction to the NIH research community, and coordinates
    and directs initiatives which crosscut the NIH. The Office of
    the Director is responsible for the development and management
    of intramural and extramural research and research training
    policy, the review of program quality and effectiveness, the
    coordination of selected NIH-wide program activities, and the
    administration of centralized support activities essential to
    operation of the NIH.

    Office of Research on Women's Health

        The Office of Research on Women's Health [ORWH] works in
    collaboration with the Institutes and Center of NIH to promote
    and foster efforts to address gaps in knowledge related to
    women's health through the enhancement and expansion of funded
    research and/or ensuring the inclusion of women in clinical
    research funded by NIH, including the development of a
    computerized tracking system and the implementation of
    guidelines on such inclusion. This office also promotes the
    number of women in biomedical science careers.
        Irritable Bowel Syndrome.--The Committee is pleased with
    the increased focus on irritable bowel syndrome [IBS] at the
    NIH's Office Research on Women's Health. It is estimated that
    between 25 to 45 million Americans, disproportionately women,
    suffer from IBS.

    Office of AIDS Research

        Microbicides to Prevent HIV/AIDS.--Given current scientific
    advancements, an effective microbicide could be developed by
    the end of the decade, and once available, could well change
    the course of the epidemic. According to NIH, ``the U.S.
    Government is firmly committed to accelerating the development
    of safe and effective microbicides to prevent HIV'' because
    microbicides may provide ``one of the most promising prevention
    interventions that could be inexpensive, readily available, and
    widely acceptable'' (U.S. Government Strategic Plan for
    Microbicides). Despite these statements, NIH continues to spend
    barely 2 percent of its HIV/AIDS research budget on
    microbicides. The Committee strongly urges greater funding for
    microbicide research and development at NIH. In addition, this
    Committee has long advocated that NIH establish a dedicated
    microbicide unit with clearly identified leadership to
    accelerate and coordinate federally supported microbicide
    research, and is concerned that no significant progress has
    been made towards this goal. Greater leadership and
    coordination on this issue is especially critical given that
    consideration is being given to the possibility of a
    microbicide-specific clinical trial network. If this evolves,
    the notion of a dedicated microbicide unit at the NIH would be
    essential.
        There is an urgent need to expand the development pipeline
    with more microbicide candidate products, particularly those
    that target HIV in new ways. In addition to candidates that may
    arise from basic research efforts, the best possibilities may
    be found within pharmaceutical companies where there are dozens
    of potential compounds already developed as therapeutics that
    could move into clinical development as microbicides if made
    available. As outlined in the NIH Roadmap, NIH has mechanisms
    in place to encourage partnerships among researchers in
    academia, government and the private sector. The Committee
    strongly urges the leadership at NIH to support the microbicide
    field by encouraging the pharmaceutical industry to allow its
    drug candidates to be developed as microbicides. In the past
    year, the International Partnership for Microbicides has
    entered into innovative agreements with leading pharmaceutical
    companies to jointly test and develop leading AIDS drugs as
    microbicides. More partnerships like these between the
    pharmaceutical industry and the non-profit community will be
    critical, and should receive the active support of NIH
    leadership.
        Pediatric HIV Research.--The Committee recognizes the
    importance of research into the long-term health implications
    of preventive HIV drug regimens in children, the psychological
    and social needs of HIV-infected children and appropriately
    targeted prevention services. The Committee urges the Director
    to provide the resources necessary for domestic and
    international research on the long-term effects of preventive
    drug regimens on HIV-exposed pediatric populations; the long-
    term health, psychosocial, and prevention needs for pediatric
    populations perinatally HIV-infected; the transition to
    adulthood for HIV-infected pediatric populations; and safer and
    more effective treatment options for pediatric populations with
    HIV disease.
        Pediatric HIV Vaccine Testing.--The Committee requests the
    NIH Director to submit a report within 90 days of enactment of
    this bill on the status of activities related to the testing of
    potential HIV vaccine candidates in relevant pediatric
    populations, including infants, preadolescents, and
    adolescents. The report shall include an analysis of regulatory
    or other barriers to developing an HIV vaccine and a
    comprehensive review of current and planned clinical trials in
    relevant pediatric populations. In addition, the Committee
    requests that the NIH fiscal year 2007 Plan for HIV-Related
    Research and future plans include: plans for expanding existing
    capacity for HIV vaccine candidate testing in relevant
    pediatric populations; plans for increasing coordination in
    advancing pediatric HIV vaccine testing across federally funded
    HIV vaccine research programs, including, but not limited to
    the HIV Vaccine Trials Network, the Pediatric AIDS Clinical
    Trials Group, the Food and Drug Administration, the Centers for
    Disease Control and Prevention, and the Partnership for AIDS
    Vaccine Evaluation; opportunities for collaboration with the
    Office of the Global HIV/AIDS Coordinator; appropriate
    principles for initiating HIV vaccine testing in relevant
    pediatric populations, including recommendations for sequencing
    the enrollment of adults and relevant pediatric populations and
    for addressing issues related to human subjects protections for
    children involved in clinical research; and proposed community
    education efforts in support of the inclusion of relevant
    pediatric populations in HIV vaccine clinical trials.

    Office of Research on Women's Health

        Stroke in Women.--As the second leading cause of death
    among women worldwide, stroke is a major health problem. Stroke
    kills more than twice as many women as do breast cancer and
    AIDS combined. Acute care of women stroke victims is often
    delayed, and 61 percent of all stroke-related deaths occur in
    women. Recognizing that women are the single largest group at
    risk for death from stroke, the Committee believes that special
    attention should be focused on better understanding the gender-
    related differences in stroke. Studies suggest that significant
    gender differences occur in the evaluation and treatment of
    stroke patients, with women often receiving fewer diagnostic
    tests and intervention procedures. Increased research is needed
    to understand these differences and provide a means to optimize
    stroke care for all patients. Some aspects of the disease
    unique to women include strokes related to pregnancy and the
    use of oral contraceptives; stroke in younger women requires
    increased attention. Stroke is additionally a leading cause of
    serious disability among women and may contribute to late-life
    cognitive decline. The Committee supports the funding of new
    and continuing NIH studies that investigate the impact of
    postmenopausal hormone replacement therapy on stroke risk.
    Continued support of clinical and basic research on hormone
    physiology in women is necessary to understanding the impact of
    hormones on women's vascular systems. The Committee urges NIH
    to increase research in stroke among women of all ages, with
    specific attention to gender-related differences in stroke
    risk, and to stroke prevention interventions, acute stroke
    management, post-stroke recovery, long-term outcomes, and
    quality of care. The Committee further urges NIH to increase
    research into new therapies for stroke in women as well as into
    ways of enhancing the vascular health of all Americans,
    including: (1) observational research on differences in the way
    men and women present with stroke symptoms, (2) research
    addressing how stroke influences the likelihood and severity of
    cognitive impairment in women, (3) a clinical trial of carotid
    endarterectomy and angioplasty/stenting in women, (4) studies
    of differences in how men and women respond to FDA-approved
    antiplatelet agents for recurrent stroke prevention, and (5)
    basic science research to address unique brain cell death and
    repair mechanisms in females.
        The Committee also encourages and supports NIH's
    initiatives toward advancing the organization of stroke care,
    including post-stroke rehabilitation, and the identification of
    stroke treatment and research centers that would provide rapid,
    early, continuous 24-hour treatment to stroke victims,
    including the use of the clot-buster t-PA, when appropriate.
    Designated areas in medical facilities equipped with the
    resources and personnel for treating stroke would also promote
    the early evaluation of innovative stroke treatments.
        Vulvodynia.--Since fiscal year 1998, the Committee has
    highlighted the need for research on the prevalence, causes and
    treatment of vulvodynia, a painful and often debilitating
    disorder of the female reproductive system. The Committee is
    pleased that some progress has been made since that time. For
    example, the NICHD has supported a major study of the
    prevalence of this disorder. The published results of this
    study found that as many as 6 million women suffer from
    vulvodynia, making it one of the most prevalent chronic pain
    conditions affecting women. The Office of Research on Women's
    Health [ORWH] was crucial in supporting an important 2003
    research conference on vulvodynia. These efforts have both
    clearly demonstrated the need for substantial additional
    research and served to heighten the research community's level
    of interest in studying vulvodynia. The Committee calls upon
    the Director to build upon these initial successes by
    coordinating through the ORWH an expanded and collaborative
    extramural and intramural research effort into the causes of
    and treatments for vulvodynia. This expanded effort should
    involve ORWH, NICHD, NINDS and other relevant ICs as well as
    the NIH Pain Consortium. In addition, the Committee notes that
    as many as 40 percent of women with vulvodynia remain
    undiagnosed after visiting three or more physicians. To address
    this shortcoming, the Committee urges that NIH include
    information about vulvodynia on its website and that it work
    with the National Vulvodynia Association, the American College
    of Obstetricians and Gynecologists and other relevant groups to
    implement a national education program for primary care health
    professionals, patients and the general public on vulvodynia's
    symptoms, diagnosis and treatment options. Finally, the
    Committee encourages the Director to work with the Center for
    Scientific Review and ICs to ensure that experts in vulvodynia
    and related chronic pain and female reproductive system
    conditions are adequately represented on peer review panels.

    Office of Dietary Supplements

        The Committee continues to strongly support the important
    work of this Office. Use of dietary supplements has increased
    significantly among Americans who want to improve their health
    and prevent disease. There is a great need for additional
    research to better inform consumers of the health benefits of
    supplements. Accordingly, the Committee has provided additional
    funds to expand this Office's efforts.
        As in past years, the Committee strongly urges the Office
    to speed up ongoing collaborative efforts to develop, validate
    and disseminate analytical methods and reference materials for
    the most commonly used botanicals and other dietary
    supplements. This effort is a crucial underpinning for
    conducting quality research and assuring quality and
    consistency for consumers of dietary supplements.
        The Committee commends ODS for developing a request for
    proposals for a contract with industry nonprofit associations
    or foundations that currently have and maintain a database of
    dietary supplement labels to develop, create, continually
    update, maintain and make available to Government and research
    entities a database of all supplement labels sold in the United
    States. The creation of this database will allow ODS to have
    access for research purposes of all known supplements
    manufactured in the United States and to allow access by other
    Federal agencies for ensuring safety to consumers who purchase
    supplements manufactured and/or sold in the United States,
    through the mandatory listing of ingredients in these products
    on the label.
        The Committee notes that there is great potential in work
    being done on the relationship between fish oils and other
    dietary supplements in combating anti-inflammatory diseases.
    This also applies to work being done on the potential for
    selected botanicals to reverse the development of insulin
    resistance, the key pathophysiologic feature of metabolic
    syndrome. Given the growing prevalence of obesity, expansion of
    this area of research is clearly warranted.
        A number of recent studies point to the need for an
    expansion of ODS support for research into herb-drug
    interactions. ODS, NCCAM and other ICs at NIH are supporting
    important work in this area, and it should be expanded.
    Improved dissemination of results of this research to the
    public, health professionals and other interested parties is
    also needed.
        The Committee commends ODS for its efforts to seek input
    from consumers, industry, researchers and other stakeholders on
    its future agenda. ODS should continue and expand its outreach
    to industry stakeholders to share information, gather ideas and
    assure better coordination of privately and publicly funded
    research.

    Office of Behavioral and Social Sciences Research

        The Office Behavioral and Social Sciences Research furthers
    the mission of the NIH by emphasizing the role that behavioral
    and social factors and their interaction with biomedical
    variables play in health. The goals of the office are to
    enhance behavioral and social sciences research and training;
    integrate a biobehavioral perspective across the NIH; and
    improve communication among health scientists and with the
    public.

    Office of Rare Disease Research

        The Office of Rare Diseases was established in 1993 to
    address the conditions that affect fewer than 200,000 persons
    in the United States. The goals of the office are to stimulate
    and coordinate research on rare diseases and to support
    research to respond to the needs of patients who suffer from
    the more than 6,000 rare diseases known today.

    Multi-Institute Research Initiatives

        Autism Spectrum Disorders.--The Committee is encouraged by
    the NIH's autism research matrix and urges NIH to devote
    sufficient resources to this research agenda. The Committee
    urges the NIH when implementing the autism research matrix to
    coordinate with autism organizations already funding research
    initiatives to ensure the most efficient use of resources. The
    Committee also notes the promise of particular areas cited in
    the matrix, including genetic and behavioral characterizations
    of the disorder and screening and early diagnosis.
        Autoimmune Diseases.--The Committee commends the NIH
    Autoimmune Diseases Coordinating Committee [ADCC] for fostering
    collaborative, integrated multi-Institute research on issues
    affecting the genetically related family of autoimmune
    diseases. Implementation of autoimmune diseases research by the
    ADCC should focus on high-priority, cross-cutting
    opportunities, including research into the role of
    environmental and infectious agents in the initiation and/or
    exacerbation of autoimmune diseases. The Committee also
    encourages the ADCC to identify and initiate promising areas of
    autoimmune research where collaboration among the NIH
    institutes enhances the potential for major advances in
    understanding the common etiology of, and developing more
    effective diagnostic and treatment tools for, this family of
    debilitating and high-cost diseases.
        Bone Health and Osteoporosis.--The Committee is pleased
    that the Surgeon General has submitted the report on bone
    health requested in the fiscal year 2002 Appropriations bill.
    The Surgeon General calls for a national action plan to achieve
    improved bone health. To this end, the Committee encourages the
    NIH to establish a ``Bone Health Research Blueprint'' to
    achieve the Surgeon General's objectives through enhanced
    cooperation between and among the NIH research institutes. The
    Blueprint should place particular emphasis on osteoporosis,
    osteogenesis imperfecta, Paget's disease, other metabolic bone
    diseases and rare bone disorders such as osteopetrosis. The
    Committee requests a report on the status of the Bone Health
    Blueprint by May 1, 2006.
        Chronic Fatigue Syndrome.--The Committee is deeply
    concerned that NIH has failed to expand research on chronic
    fatigue syndrome [CFS] and that a June 2003 commitment to issue
    a request for applications on CFS has not yet been fulfilled.
    The RFA should emphasize multi-disciplinary studies to
    understand the cause and progression of CFS in adults and
    children, identify diagnostic markers and develop effective
    treatment. The Committee also is troubled that a CFS funding
    report for fiscal years 1999-2003 issued in response to
    congressional requests included amounts for grants unrelated to
    CFS, thus artificially inflating the total dollars awarded for
    CFS research. CFS is just one condition for which this has been
    a problem. The Committee requests that NIH report back to it by
    May 1, 2006, on the number of CFS-specific grant applications
    received and funded since fiscal year 2000.
        Child Abuse and Neglect Research.--The Committee recognizes
    the magnitude and significance of child abuse and neglect as a
    serious public health problem claiming an estimated 896,000
    victims in 2002, according to data reported by the Department
    of Health and Human Services. The Committee applauds NIH for
    developing and implementing a coordinated research agenda for
    child abuse and neglect involving relevant NIH institutes,
    including NIMH, NICHD, NIDA, NINR, and NIAAA, the Office of
    Behavioral Social Science and Research and other appropriate
    agencies. In response to recommendations in the 1993 National
    Research Council report entitled Understanding Child Abuse and
    Neglect, the NIH child abuse and neglect initiative first
    addressed the knowledge gaps in child neglect. The Committee
    encourages NIH to proceed with the research agenda by examining
    current research gaps on the abuse of children, including
    research on treatment interventions with substantiated cases of
    child maltreatment. The Committee requests that the Director be
    prepared to report on current and proposed NIH efforts in this
    area at the fiscal year 2007 hearings.
        Clinical Research and Academic Health Centers.--Past
    breakthroughs in basic biomedical sciences have provided an
    unprecedented supply of information for improving health and
    preventing disease. But in recent years, the Nation's academic
    health centers, which serve as the staging ground that deploys
    the results of research to hospitals and health care providers,
    have encountered obstacles that threaten to slow the pace of
    clinical research, including unfunded mandates. Without a
    robust infrastructure, the translation of basic science into
    tangible public health improvements will be slowed. The
    Committee therefore encourages the Director to take concrete
    steps to address the problems encountered by academic health
    centers.
        Clinical Research Curriculum Award.--The Clinical Research
    Curriculum Award has been extremely effective in training
    successful clinical researchers. The Committee supports the NIH
    decision to increase the size of these awards from $200,000 to
    $300,000 but is concerned that it was accomplished by reducing
    the number of funded institutions. The Committee urges the
    Director to consider an increase in funding from Institutes and
    Centers that support the program in order to expand rather than
    reduce the number of institutions receiving this award. In
    addition, the Committee reiterates its support for
    implementation of the Congressionally authorized Graduate
    Training in Clinical Investigation award to provide tuition and
    stipend support for clinical research training program
    students.
        Clinical Research Workforce Training.--The Committee has
    heard testimony that virtually every medical specialty is
    experiencing a shortage of adequately trained clinical
    investigators capable of translating basic science advances
    into the diagnosis, treatment and prevention of disease. This
    shortage inhibits clinical research productivity and slows the
    rate at which results from basic biomedical research efforts
    can be applied to the problems of patients. Improved clinical
    research will have a positive effect on the quality of health
    care and patient safety, and advance the application of the
    principles of evidenced-based medicine to routine patient care.
    The Committee urges allocation of sufficient resources for
    training of physician-scientists throughout all NIH institutes,
    to support studies of patient outcomes, medical effectiveness,
    and disease- and treatment-specific quality of life.
        Clinical Trials Technology.--The Committee recommends that
    the NIH Director and the Director of the NIH Clinical Center
    explore options for utilization of technology to improve
    efficiency, cost savings, and sharing of information in
    clinical trials being supported intramurally and extramurally.
        Distribution of Resources.--The Committee believes, in
    light of the doubling of the NIH budget and the emergence of
    new medical research challenges such as SARS and threats of
    bioweapons, NIH should encourage funding of large scale
    collaborative efforts to address these and other medical
    challenges. In addition, while the pace of new challenges has
    increased, review time for proposals submitted to the
    Institutes at NIH continues to average about 18 months. The
    Committee strongly encourages the Director to develop means of
    encouraging large scale multi-institution projects to address
    significant areas of medical research and to devise means of
    reducing the time frames between submission of proposals and
    awarding of grants.
        Down Syndrome Research Task Force.--The Committee urges the
    Director of NIH to establish a NIH Down Syndrome Research Task
    Force to develop a strategic plan for genetic and
    neurobiological research relating to the cognitive dysfunction
    and the progressive late-life dementia associated with Down
    syndrome. The purpose of the strategic plan is to provide a
    guide for coordinating Down syndrome research on cognition
    across the NIH and for enhancing the development of new
    research efforts based on identification of areas of greatest
    scientific opportunity, especially as they relate to the
    development of future treatments. The plan should include
    short, intermediate and long-term goals for basic and clinical
    research with strategies for achieving goals and with specified
    timeframes for implementation. The Committee requests the NIH
    to report to Congress by June 1, 2006 on the steps it is taking
    to develop the Down Syndrome Research Task Force on Cognition.
        Duchenne Muscular Dystrophy.--The Committee remains
    concerned with the amount of time taken by the NIH to comply
    with requirements of the MD Care Act, which became law in
    December 2001. The Committee is pleased NIH has funded one
    additional Wellstone Muscular Dystrophy Cooperative Research
    Center and is working to fund two more for a full complement of
    six. The Committee further encourages the Institute to provide
    adequate funding and resources for each center. As the original
    report on the activities being performed pursuant to the MD
    Care Act was both late in coming and insufficient in detail,
    the Committee requests that NIH submit a report to the
    Committee no later than May 1, 2006 stating the current
    research goals and progress made toward each goal; the
    Institute or Center responsible for each goal; the total amount
    of money invested toward each goal as well as projected
    spending for the present and future fiscal year; opportunities
    for external partnerships; and a timeline for establishing a
    Duchenne/Muscular Dystrophy translational research initiative,
    modeled on the lines of the spinal muscular atrophy project.
    The Committee recognizes that several promising treatments and
    therapies for Duchenne and Becker Muscular Dystrophy are in
    development, and urges NIH to invest additional resources,
    including a coordinating mechanism, necessary to expedite their
    translation into practice. Furthermore, the Committee urges NIH
    to work with leading stakeholders to convene a consensus
    conference on translational research opportunities in early
    2006, and report back to the Committee, by September 2006, with
    a strategic plan for launching a translational research
    initiative.
        Dystonia.--The Committee is very pleased with progress
    demonstrated by the NIH intramural research program in the
    treatment and understanding of dystonia. NIH intramural
    researchers have successfully utilized injections of Botox to
    treat many patients who otherwise would be severely debilitated
    by dystonia. The Committee urges continued work in this
    important area of study and treatment.
        Epilepsy.--While NINDS is the primary Institute for
    addressing epilepsy research, several other Institutes are also
    involved in related research. The Committee urges the Director
    to intensify coordination of cross-cutting research on epilepsy
    in all Institutes.
        Fragile X.--The Committee notes the impressive progress
    made by Fragile X researchers in understanding the basic neural
    defects that cause this developmental disorder. NIH Institutes,
    units, and its National Center for Research Resources provided
    75 grants in fiscal year 2004 to find a treatment and cure for
    Fragile X. The success of these translational research efforts
    has made treatment of Fragile X a near-term possibility.
    However, further efforts are required to translate these basic
    science findings into viable treatments. Specifically,
    collaborative efforts between industry, academia and NIH
    Institutes are likely to be necessary to develop promising
    therapeutic options for this orphan indication. The Committee
    further notes that while Fragile X is a relatively common
    genetic disease, the treatments being developed for Fragile X
    may also be effective for a much larger number of people with
    related autism spectrum disorders. Research has shown many
    possible treatment strategies which merit human Fragile X
    clinical trials, including--but not limited to--mGluR5
    antagonists, Ampakines, aripiprazole, and lithium. The
    Committee strongly urges the Director to facilitate and fund
    public/private partnerships which will enable these vital
    studies to proceed. In addition, privately-funded Fragile X
    research is rapidly expanding, often in partnership with NIH
    grants. The Committee commends the growing breadth and
    diversity of this research but strongly urges the Director to
    establish a coordinating mechanism to direct and coordinate
    these efforts in regularly-scheduled meetings. To achieve this
    mandate, the NIH is urged to convene a yearly workshop with the
    research community to develop priorities for basic, clinical
    and translational research as they relate to Fragile X. The
    Committee also encourages the Director to increase the number
    and size of institutional training grants to institutions
    supporting pediatric training and the number of grants for
    career development clinical research as they relate to Fragile
    X.
        Gene Therapy Research.--While the promise of gene therapy
    has not yet been realized, the Committee is encouraged by some
    promising research done in the area of thalassemia, or Cooley's
    anemia. It is concerned, however, that the most innovative gene
    therapy research is currently being done in Europe rather than
    in the United States. The Committee urges the Director to
    assess the prospects for the most promising areas for
    breakthroughs in this field and to develop an aggressive
    program to focus resources on it. The assessment should also
    include the prospects for successes in additional
    hemoglobinopathies and in an even broader range of diseases.
    The goal of this effort should be nothing less than to cure a
    disease in the shortest possible time utilizing gene therapy
    techniques.
        Heart Disease Research and Prevention Action Plan.--
    Advances have been made in the identification and treatment of
    risk factors for heart disease. The Committee encourages the
    NIH to convene a transagency national conference on heart
    disease to assess progress and opportunities and to develop a
    comprehensive, long range research and prevention action plan.
    Participants should include representatives from all Federal
    agencies involved in heart disease research and prevention,
    including the NIH and all relevant institutes and centers, CDC,
    AHRQ, DOD, and pertinent voluntary nonprofit organizations,
    foundations, and experts in the field. The Committee encourages
    the Director to develop a long-range, strategic Heart Disease
    Research and Prevention Action Plan and submit a report to the
    Committee by May 1, 2006. The plan should include quantifiable
    goals and benchmarks to measure progress in the battle against
    heart disease, and a professional judgment budget for each year
    as well as for the entire plan.
        Hereditary Hemorrhagic Telangiectasia.--Hereditary
    Hemorrhagic Telangiectasia [HHT], also known as Osler-Weber-
    Rendu Syndrome, is a multi-system vascular genetic disorder
    producing blood vessel malformations in the brain and lung
    which may result in stroke, hemorrhage, aneurysm and death.
    Sudden death or disability occurs in 20 percent of children and
    adults but is largely preventable with proper intervention.
    Because this is a multi-system disorder, the Committee
    encourages the Director to formulate an NIH-wide research
    agenda with the participation of the NHLBI, NINDS and NIDDK
    Institutes.
        Hepatitis B.--Although there has been tremendous success in
    the prevention and treatment of hepatitis B, this disease
    remains a serious concern. The Committee proposes that the
    success of past research be built upon with new program
    development and the potential for new funding. The large number
    of immigrants to the United States from parts of the world
    where hepatitis B is endemic will keep this disease in the
    forefront of public health for years to come. For example, the
    more than 8 million people who are estimated to have immigrated
    from Asia to the United States in the past 10 years, alone,
    will significantly add as many as 600,000 people to the more
    than 1.2 million people already believed to be chronically
    infected, in the United States. The Committee urges the
    Director of NIH to report to Congress the amount of funding
    necessary to develop programs which would stimulate new
    research to find: (1) complements for the current therapies for
    hepatitis B, (2) improvements in the detection and treatment of
    hepatitis and liver cancer associated with hepatitis B, (3)
    improvements in the prevention of the disease by development of
    new vaccines, new outreach and population studies. Initiatives
    that promote truly innovative approaches and stimulate and
    excite new investigation in these areas is specifically
    encouraged.
        Human Tissue Supply.--The Committee remains interested in
    matching the increased needs of NIH grantees, intramural, and
    university-based researchers who rely upon human tissues and
    organs to study human diseases and search for cures, including
    for those researchers dedicated to the study and cure of rare
    diseases. The Committee is aware that one of the leaders in
    this competitive field, the National Disease Research
    Interchange [NDRI], is uniquely positioned to obtain this
    valuable and effective alternative research resource. More than
    500 peer-reviewed research advances made by NDRI-dependent
    researchers have been published during the past 4 years
    contributing to the research community's fund of knowledge. The
    Committee is encouraged by NDRI's role in these research
    advances and applauds the Director's expanded support for NDRI
    by bringing NEI, NIDDK, NIAID, NIAMS, and the Office of Rare
    Diseases into the multi-Institute initiative. While this is
    promising, more needs to be done to match the demand for the
    use of human tissue in research. The Committee, therefore,
    expects the Director to increase the core support NDRI receives
    from NCRR, and to broaden the scope of the multi-Institute
    initiative by strongly urging the Institute Directors of NCI,
    NHGRI, NHLBI, NICHD, NIMH, and NINDS to identify and implement
    program-specific initiatives to expand support for NDRI.
        Islet Transplantation.--The Committee commends the NIDDK
    and NIAID for the establishment of the Clinical Islet
    Transplantation Consortium and the islet transplantation
    clinical trial that will include Medicare-eligible individuals
    whose transplant and related costs will be covered by Medicare.
    The Committee encourages cooperation between the NIDDK and
    NIAID and members of the Consortium to ensure the timely launch
    of these clinical trials.
        Kidney Disease.--The Committee is aware that kidney disease
    is a major health problem in the United States, and according
    to a recent CDC study is one of the fastest growing causes of
    death in the United States. It is estimated that at least 15
    million people have lost 50 percent of their kidney function
    and another 20 million more are at increased risk of developing
    kidney disease due to diabetes, cardiovascular disease and
    hypertension. Of these individuals, a disproportionate share
    are minorities. The Committee encourages the Director to ensure
    that the NIDDK and NHBLI work closely and collaboratively to
    maximize the output of our national investment in kidney
    disease.
        Lupus.--The Committee recognizes lupus is a serious,
    complex, debilitating chronic autoimmune disease that can cause
    inflammation and tissue damage to virtually any organ system in
    the body. The Committee strongly urges the Director of the
    National Institutes of Health to expand, intensify and
    coordinate research and related activities with respect to
    lupus across all relevant institutes, centers and offices,
    especially the National Institute of Arthritis and
    Musculoskeletal and Skin Diseases, and the National Institute
    of Allergy and Infectious Diseases.
        The Committee is disappointed with the pace of research
    regarding lupus and strongly urges that the Director of the
    National Institutes of Health conduct or support research to
    expand the understanding of lupus, including: basic research to
    discover the pathogenesis and pathophysiology of the disease;
    research to determine the reasons underlying the
    disproportionate prevalence of lupus in African American,
    Hispanic, Native American, and Asian women; epidemiological
    studies to address the frequency and natural history of the
    disease and the differences between the sexes and among racial
    and ethnic groups with respect to the disease; clinical
    research for the development and evaluation of new treatments,
    including new biological agents; and research to validate lupus
    biomarkers; and research to develop improved diagnostic tests.
    The Committee strongly urges the Institute to increase funding
    for lupus research by actively soliciting grant applications
    for lupus and taking aggressive steps to assure that a vigorous
    research program is established.
        Lymphangioleiomyomatosis [LAM].--The Committee remains very
    interested in efforts to find a cure and treatments for LAM, a
    progressive and fatal lung disease that strikes women, usually
    in their childbearing years. Currently, there are no effective
    treatments. The Committee understands that recent scientific
    findings have presented new treatment approaches for clinical
    testing, and that experimental trials with the drug sirolimus
    have begun. The Committee urges the NHLBI, as well as the NCI,
    the Office of Rare Diseases, and the NINDS to fund clinical
    treatment trials through both intramural and extramural means
    and to use all available mechanisms as appropriate, including
    support of state-of-the-science symposia, request for
    applications, and facilitating access to human tissues to
    stimulate a broad range of clinical and basic LAM research. The
    Committee also commends the NCRR and ORD for their roles in
    supporting the Rare Lung Disease Consortium.
        Lymphatic Research.--The lymphatic system is central to the
    progression of disease and the maintenance of health, yet
    scientific and medical knowledge of this important system is
    woefully deficient. While the Committee is pleased that a
    Trans-NIH Coordinating Committee on the Lymphatic System exists
    to ensure that scientific knowledge and understanding about
    this neglected body system will be advanced and coordinated,
    adequate efforts and funding are lacking. ICs are urged to
    include relevant language addressing basic and clinical
    lymphatic system research in all existing and future funding
    mechanisms, where such grant applications could be responsive.
    The Trans-NIH Coordinating Committee should be informed of
    relevant lymphatic language included within such funding
    initiatives.
        The Committee is encouraged to learn that the Trans-NIH
    Coordinating Committee on the Lymphatic System, and in
    particular the NHBLI, is working with patient advocates to
    address the needs of the lymphatic disease and lymphedema
    patient communities. Initiatives such as a national lymphatic
    disease patient registry/tissue bank; an NIH lymphatic disease
    working group and national guidelines for clinical care; an NIH
    partnership funding program; intramural longitudinal studies;
    and multidisciplinary centers for research, clinical care, and
    medical training are strongly encouraged.
        Nanosystems Biology.--The Committee encourages the
    Director, along with NCI, to support a collaborative effort to
    bring nanotechnology, systems biology and molecular imaging
    together to examine the molecular basis of cancer, consistent
    with the Director's Roadmap Initiative. Initial efforts have
    shown that cancers such as breast cancer are not a single
    disease, but may encompass many different diseases, when
    examined at the molecular level. Many clinical trials of new
    drugs are now considered to fail if only 10 percent of patients
    benefit, yet that 10 percent may represent a specific type of
    the disease, where the drug in question may be 100 percent
    effective. Bringing these three disciplines together may allow
    researchers to identify specific sub-types of cancer and to
    better target new interventions. Successful results of such an
    effort could lead to a molecular classification of many types
    of cancer and to targeted molecular treatments for molecular-
    specific disease.
        Parkinson's Disease.--The Committee understands that the
    Director, in accordance with the Udall Act, convened a research
    conference in June 2005. The Committee strongly urges the
    Director to report back to the Committee by May 1, 2006 to
    address current and ongoing Parkinson's disease research
    including the final analysis of the Parkinson's Disease
    Research Agenda that expired this year, the goals and
    conclusions from the summit held in June 2005, a thorough
    examination of the existing Parkinson's research portfolio,
    identification of shortcomings and opportunities for more
    effective treatments and a cure for Parkinson's, and
    recommendations of research goals for the next 3 years to help
    scientists better understand the causes, more quickly diagnose,
    and develop better treatments and a cure for Parkinson's
    disease.
        The Committee strongly urges the NIH to work in conjunction
    with the Centers for Disease Control and Prevention to
    investigate and report on geographic population clusters of
    incidence of Parkinson's disease. It is estimated that more
    than 1 million Americans are fighting Parkinson's disease and
    60,000 cases are newly diagnosed each year. However, these
    figures are only estimates. Further, it is believed that there
    are increasing numbers of Americans who are diagnosed with
    young onset Parkinson's disease. With a stronger understanding
    of who is impacted by this devastating disease, the NIH will be
    better able to better target critical research funds that will
    find treatments or cures for the more than 1 million Americans
    who have this progressive, neurodegenerative disease.
        Peer Review of Patient-Focused Research.--In 1998, the NIH
    Director's Panel on Clinical Research identified problems with
    NIH peer review of clinical research grant applications and
    recommended the organization of study sections capable also of
    reviewing patient-oriented research and the implementation of a
    system for tracking the review of these clinical research
    applications. Nevertheless, a 2002 General Accounting Office
    report to Congress indicated that the NIH did not have reliable
    methods for identifying and tracking patient-oriented research
    applications or reviewers. More recent analysis by the Center
    for Scientific Review has confirmed previous studies
    demonstrating that grant applications focused on patient-
    oriented research are less likely to receive funding than
    laboratory research grant proposals. The Committee believes it
    is critically important that the Director take action to
    address this disparity and requests a report regarding efforts
    that are being undertaken to recruit clinical investigators to
    participate in the peer review process, to assure that patient-
    oriented research applications are assigned to knowledgeable
    review groups, and to improve the system for tracking the
    review of clinical research grants to assure that shortcomings
    of the review process are identified and corrected.
        Pioneer Awards.--The Committee is pleased with the
    establishment of the NIH Director's Pioneer Award, an
    innovative program designed to encourage investigators to
    pursue high-risk research avenues of research with the
    potential to result in truly groundbreaking discoveries. The
    Committee is especially pleased that this program has attracted
    a large number of interested, high-quality applicants, but is
    concerned that relatively few awards have been made so far.
        Population-Based Prevention Research.--The Committee
    commends NIH for its efforts to support research in humans that
    examines factors associated with preventing disease and
    promoting health. The Committee urges the NIH to seek ways to
    remove barriers that prevent research findings from being
    translated into population-wide health improvements and to
    expand its support for studies that include examination in
    human populations of biological, behavioral and environmental
    factors associated with disease and means to ameliorate them.
        The Committee urges the Director to support additional
    genetic research to identify the genes responsible for
    psoriasis susceptibility, basic research to understand the
    mechanism of disease and clinical research to identify new safe
    and effective therapies for these diseases.
        Rehabilitation Services.--The Committee recognizes the
    burgeoning growth in rehabilitation services provided to
    patients, especially the elderly, with musculoskeletal problems
    and the urgent need to establish a solid scientific basis for
    clinical practice in this area. The Committee urges the
    Director to establish a research program in the National Center
    for Medical Rehabilitation Research to: (1) evaluate the
    efficacy and establish optimal schedules and settings for
    movement based rehabilitation interventions, such as
    therapeutic exercise, to improve physical function in
    individuals with musculoskeletal conditions, including
    arthritis, back pain, hip fracture and major joint
    replacements, and (2) further knowledge of the underlying
    mechanisms of repair, regeneration and recovery of these
    interventions. The NCMRR is still a relatively new agency with
    a small budget and its research portfolio needs to be expanded
    particularly in the area of medical and physical rehabilitation
    and musculoskeletal conditions. The Committee urges the
    National Institute on Aging, the National Institute on
    Arthritis and Musculoskeletal and Skin Diseases, and the
    National Institute on Biomedical Imaging and Bioengineering to
    collaborate on these initiatives.
        Reproductive Health Research.--The Committee is concerned
    that the NIH does not have trans-NIH information regarding the
    amount of infertility and reproductive health research that is
    conducted in many Institutes including NICHD, NCI, NIDDK,
    NIAID, and NIEHS. The Committee is concerned that until NIH has
    accurate trans-NIH information, it is not possible to lead and
    coordinate this area of research to help ensure scientific and
    research progress. The Committee therefore urges that the
    Office of the Director ensure that such information is
    available in order to permit a vigorous scientific leadership
    with regard to this category of diseases that has devastating
    physical, social, financial and psychological consequences.
        Research Centers at Minority Health Institutions.--The
    Committee continues to be pleased with the NIH Director's
    implementation of various programs focused on developing
    research infrastructure at minority health professions
    institutions, including Research Centers at Minority
    Institutions, Extramural Biomedical Research Facilities, and
    the National Center on Minority Health and Health Disparities.
    The Committee encourages that the NIH Director work closely
    with the Director of the National Center on Minority Health and
    Health Disparities to establish a program of coordination among
    these various mechanisms to partner with minority health
    professions schools to address their infrastructure needs.
        Spinal Muscular Atrophy.--The Committee strongly urges the
    OD to ensure the success of the SMA Project by providing active
    and ongoing support from the OD as well as from other related
    Institute Directors. While the Committee commends the active
    work and progress of NINDS on the SMA Project, the Committee
    remains concerned that other Institutes, to date, has made no
    commitment to SMA research. The Committee reiterates its
    request of last year that the OD take all necessary steps to
    ensure that relevant Institutes are fully engaged by devoting
    attention and resources to SMA and specifically to the SMA
    Project.
        Temporomandibular Joint Disorders [TMJ].--The Committee
    continues its strong support of research into TMJ disorders.
    The Committee agrees with and is encouraged by recent public
    statements by NIH officials that because of past and current
    investments in research and patient registries, the field is
    now ready to support a substantial new research investment in
    this complex set of disorders. The Committee therefore strongly
    urges that this path be followed and that a substantially
    expanded TMJ research effort be undertaken to speed up
    completion of the research needs and opportunities agenda
    outlined in the June 2005 NIH TMJ Report to Congress. As noted
    previously, the multifaceted nature of TMJ disorders requires
    an approach that coordinates the work of many interested
    parties at NIH. Therefore, this expanded effort should include
    increased efforts from all relevant ICs and should give
    priority to collaborative, cross-cutting research.
        In addition, the Committee strongly encourages the
    Director, through the NIDCR and ORWH, to undertake an effort to
    improve awareness among dentists and other relevant health
    professionals such as internists, rheumatologists,
    otolaryngologists, neurologists and other primary care
    professionals about TMJ disorders. Such an effort should
    include the development of a model symposium on this topic and
    the presentation of this symposium at relevant major medical
    society conferences.
        Trans-NIH Research Initiatives.--The Committee commends NIH
    for continuing to expand trans-NIH research initiatives that
    foster scientific collaboration and advancement. The Committee
    is particularly interested in programs like the Blueprint for
    Neuroscience Research, which pools the resources and expertise
    of 15 NIH institutes and centers to focus on disorders of the
    nervous system. The multidimensional roots of the obesity
    epidemic--encompassing behavioral, biological, and
    environmental factors--call for research efforts across
    Institutes and Centers, and the Committee commends the
    activities undertaken through the trans-NIH Strategic Plan for
    Obesity Research. The Committee urges that funds allocated to
    the NIH Institutes and Centers be used for increased support of
    the Neurosciences Blueprint and increased research in obesity.
        Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or
    TSC, is a genetic disorder that triggers uncontrollable tumor
    growth in multiple organs of the body, including the brain,
    heart, kidneys, lungs, liver, eyes or skin. Its victims--many
    of whom are infants and young children--face a lifetime of
    suffering with kidney failure, seizures, behavioral disorders,
    autism and mental retardation. Because of the effects of TSC on
    multiple organ systems, the Committee in 2003 called upon the
    NIH Director to formulate an NIH-wide research agenda. The
    Committee is encouraged by recent steps taken by the Office of
    the Director to establish a Trans-NIH Tuberous Sclerosis
    Coordinating Committee. The Committee encourages the Office to
    continue its support of this Committee and expand it to include
    other Institutes such as the NEI, NIGMS and NICHD.

                            OFFICE OF AIDS RESEARCH

        The Committee recommendation does not include a direct
    appropriation for the Office of AIDS Research [OAR]. Instead,
    funding for AIDS research is included within the appropriation
    for each Institute, Center, and Division of the NIH. The
    recommendation also includes a general provision which directs
    that the funding for AIDS research, as determined by the
    Director of the National Institutes of Health and the OAR, be
    allocated directly to the OAR for distribution to the
    Institutes consistent with the AIDS research plan. The
    recommendation also includes a general provision permitting the
    Director of the NIH and the OAR to shift up to 3 percent of
    AIDS research funding among Institutes and Centers throughout
    the year if needs change or unanticipated opportunities arise.
    The Committee requests that the Director provide notification
    to the Committee in the event the Directors exercise the 3
    percent transfer authority.
        The NIH Office of AIDS Research [OAR] coordinates the
    scientific, budgetary, legislative, and policy elements of the
    NIH AIDS research program. Congress provided new authorities to
    the OAR to fulfill these responsibilities in the NIH
    Revitalization Act Amendments of 1993. The law mandates the OAR
    to develop an annual comprehensive plan and budget for all NIH
    AIDS research and to prepare a Presidential bypass budget.

                            BUILDINGS AND FACILITIES

    Appropriations, 2005....................................    $110,288,000
    Budget estimate, 2006...................................      81,900,000
    House allowance.........................................      81,900,000
    Committee recommendation................................     113,626,000

        The Committee recommends an appropriation of $113,626,000
    for buildings and facilities [B&F]. The budget requested
    $81,900,000 and the fiscal year 2005 appropriation was
    $110,288,000.
        Mission.--The buildings and facilities appropriation
    provides for the NIH construction programs including design,
    construction, and repair and improvement of the clinical and
    laboratory buildings and supporting facilities necessary to the
    mission of the NIH. This program maintains physical plants at
    Bethesda, Poolesville, Baltimore, and Frederick, MD; Research
    Triangle Park, NC; Hamilton, MT; Perrine, FL; New Iberia, LA;
    and Sabana Seca, PR.
        The Committee has included full-scope bill language within
    this appropriation to give flexibility to the NIH to continue
    work on the John E. Porter Neuroscience Research Center for
    which $15,000,000 has been included. Funds have also been
    included for the Animal Research Center, the Rocky Mountain
    Laboratories Buffer Replacement Facility, asbestos abatement,
    fire protection and health and safety compliance, air quality
    improvement programs and to eliminate barriers to persons with
    disabilities.

           Substance Abuse and Mental Health Services Administration

    Appropriations, 2005....................................  $3,391,769,000
    Budget estimate, 2006...................................   3,336,023,000
    House allowance.........................................   3,352,047,000
    Committee recommendation................................   3,385,086,000

        The Committee recommends $3,385,086,000 for the Substance
    Abuse and Mental Health Services Administration [SAMHSA] for
    fiscal year 2006. This amount is $6,683,000 below the
    comparable fiscal year 2005 level and $49,063,000 above the
    administration request. The recommendation includes
    $123,303,000 in transfers available under section 241 of the
    Public Health Service Act. SAMHSA is responsible for supporting
    mental health programs and alcohol and other drug abuse
    prevention and treatment services throughout the country,
    primarily through categorical grants and block grants to
    States.
        The Committee has provided funding for programs of regional
    and national significance under each of the three SAMHSA
    centers: mental health services, substance abuse treatment and
    substance abuse prevention. Separate funding is available for
    the children's mental health services program, projects for
    assistance in transition from homelessness, the protection and
    advocacy program, data collection activities undertaken by the
    Office of Applied Studies and the two block grant programs: the
    community mental health services block grant and the substance
    abuse prevention and treatment block grant.
        The Committee strongly supports SAMHSA's Federal leadership
    role to improve the quality and availability of empirically-
    based prevention and treatment services in the areas of mental
    health and substance abuse. To further the translation of
    research knowledge into practice, the Committee supports the
    ongoing collaboration between SAMHSA and the National
    Institutes of Health (specifically with the National Institute
    of Mental Health, the National Institute on Drug Abuse, and the
    National Institute on Alcohol Abuse and Alcoholism). Through
    this partnership, services research conducted by NIH will
    identify effective treatment and prevention strategies, the
    findings of which will be promoted by SAMHSA through its
    knowledge dissemination programs to improve the quality of
    services rendered. Furthermore, outcomes from program
    evaluation research conducted by SAMHSA will be communicated as
    critical implementation feedback to NIH, and may ultimately
    lead to further improvements in the delivery of effective
    mental health and substance abuse services in community
    programs nationwide.
        The Committee expects that no less than the amounts
    allocated in fiscal year 2005 will be spent in fiscal year 2006
    on activities throughout SAMHSA addressing the needs of the
    homeless. Specifically, the Committee has provided funding at
    last year's level for programs directed at chronic homelessness
    and for programs directed at providing mental health and
    substance abuse treatment services to homeless.
        The Committee notes that, according to a study released by
    the New England Journal of Medicine, as many as one in four
    veterans of Afghanistan and Iraq treated at Veterans Affairs
    hospitals in the past 16 months have been diagnosed with mental
    disorders. While many at-risk veterans will take advantage of
    mental health services available through the Departments of
    Defense and Veterans Affairs, concern about possible
    stigmatization may lead some veterans to avoid treatment
    through these sources. The Committee believes that community
    outreach, early intervention and treatment for veterans will be
    a significant need in the coming years and encourages SAMHSA,
    through CMHS and CSAT, to develop opportunities for communities
    to prepare and coordinate mental health and addiction services
    for returning combat veterans and their families.
        Greater availability of a rapid HIV test can increase
    overall HIV testing and reduce the number of people, an
    estimated 225,000 Americans, who are unaware of their HIV
    infection. The Committee acknowledges that treatment services
    provided by mental and behavioral health care providers for
    individuals testing positive are a necessary component of rapid
    HIV testing. The Committee commends SAMHSA for developing the
    Rapid HIV Testing Initiative [RHTI] to train substance abuse
    and mental health service providers on rapid HIV testing and
    encourages SAMHSA to expand the program.
        The Committee remains concerned by the disproportionate
    presence of substance abuse in rural and native communities,
    particularly for American Indian, Alaska Native and Native
    Hawaiian communities. The Committee reiterates its belief that
    funds for prevention and treatment programs should be targeted
    to those persons and communities most in need of service.
    Therefore, the Committee has provided sufficient funds to fund
    projects to increase knowledge about effective ways to deliver
    services to rural and native communities.

                       CENTER FOR MENTAL HEALTH SERVICES

    Appropriations, 2005....................................    $901,317,000
    Budget estimate, 2006...................................     837,250,000
    House allowance.........................................     880,294,000
    Committee recommendation................................     901,334,000

        The Committee recommends $901,334,000 for mental health
    services. This amount is $17,000 above the comparable level for
    fiscal year 2005 and $64,084,000 above the administration
    request. The recommendation includes $21,803,000 in transfers
    available under section 241 of the Public Health Service Act.
    Included in the recommendation is funding for programs of
    regional and national significance, the mental health
    performance partnership block grant to the States, children's
    mental health services, projects for assistance in transition
    from homelessness, and protection and advocacy services for
    individuals with mental illnesses.

    Programs of Regional and National Significance

        The Committee recommends $274,297,000 for programs of
    regional and national significance. This amount is the same as
    the comparable level for fiscal year 2005 and $64,084,000 above
    the administration request. Programs of regional and national
    significance address priority mental health needs through
    developing and applying best practices, offering training and
    technical assistance, providing targeted capacity expansion
    grants, and changing the delivery system through family,
    client-oriented and consumer-run activities.
        The Committee remains deeply concerned that suicide is the
    third leading cause of death among adolescents. Consistent with
    the recommendations of the President's New Freedom Commission
    on Mental Health, the Committee in fiscal year 2005 called upon
    SAMHSA to award grants to local educational systems or non-
    profit entities in conjunction with local educational systems
    to test the use of screening mechanisms and to identify
    evidence-based practices for facilitating treatment for youth
    at risk. The Committee has provided funding at last year's
    level for SAMHSA to continue this effort in fiscal year 2006.
        In addition, the Committee has provided $11,000,000 for
    State and campus-based programs that address youth suicide
    prevention. This is an increase of $2,556,000 above the
    comparable level for fiscal year 2005 and the administration
    request. The Committee has included funding at last year's
    level to continue supporting the National Suicide Prevention
    Resource Center. This important initiative supports technical
    assistance in developing, implementing and evaluating effective
    suicide prevention programs. The Resource Center serves as a
    training and field support and acts as a clearinghouse for all
    pertinent best practices information regarding suicide
    prevention, and it promotes evaluation of suicide prevention
    programs to ensure that effective techniques, strategies, and
    recommended best practices are made available to users. The
    Committee also continues funding at last year's level for the
    Suicide Prevention Hotline program.
        The Committee notes that the National Strategy for Suicide
    Prevention calls for the establishment of public/private
    partnerships for the purpose of advancing and coordinating the
    implementation of the National Strategy. While much progress
    has been made, many of the objectives included in the National
    Strategy have not been completed. The Committee commends SAMHSA
    for its work on examining the National Strategy objectives with
    the goal of developing a priority work plan and encourages
    SAMHSA to establish a coordinating body aimed at advancing the
    objectives of the National Strategy.
        The Committee continues to strongly support funding for
    prevention of youth violence. The Committee intends that no
    less than last year's level of funding be used for this
    initiative, which includes the Safe Schools/Healthy Students
    interdepartmental program. The administration proposed cutting
    this program by $27,427,000. The Committee believes that
    enhanced school and community-based services can strengthen
    healthy child development, thus reducing violent behavior and
    substance use. Since 1999, over 180 communities have received
    and benefited from these grants. The Committee therefore is
    providing funding at last year's level to assist schools in
    that effort. It is again expected that SAMHSA will collaborate
    with the Departments of Education and Justice to continue a
    coordinated approach.
        The Committee provides funding at last year's level for the
    consumer and consumer-supporter national technical assistance
    centers. The Committee directs CMHS to support multi-year
    grants to five such national technical assistance centers.
        The Committee recommendation restores funding to the State
    Infrastructure Planning Grants activity. The administration
    request proposed to shift the funding source for this program
    to the CMHS block grant setaside. State Infrastructure Planning
    Grants are a critical initiative that informs both States and
    SAMHSA on practical implementation issues and mechanics related
    to the new performance and outcome data reporting requirements
    included in SAMHSA's Data Strategy.
        The Committee recommendation includes funding at last
    year's level for the elderly treatment and outreach program.
    The Committee notes that while many older Americans experience
    depression, dementia, anxiety and substance abuse disorders,
    far too often these conditions are not recognized or treated.
    Outreach to elderly persons conducted in places frequented by
    seniors, such as senior centers, meal sites, primary care
    settings and other locations, is needed. The elderly treatment
    and outreach program helps local communities establish the
    infrastructure necessary to better serve the mental health
    needs of older adults.
        The Committee recommendation fully funds the administration
    request for the State Incentive Grants for Transformation
    program. The Committee directs SAMHSA to ensure that State
    mental health planning and advisory councils play a significant
    role in the development of comprehensive State plans under this
    new program, because the councils represent the consumer and
    family voice in States across the country.
        The Committee believes that research-based prevention and
    wellness promotion efforts that strengthen parenting and
    enhance child resilience in the face of adversity can have a
    significant impact on the mental health of children and youth.
    While some programs that use such a strengths-based approach
    exist for families already in contact with the juvenile justice
    system or immediate risk for dissolution, evidence suggests
    that they may be particularly effective for families that have
    one or more risk factors but are not yet in crisis and may not
    have had contact with child protective services or other
    government agencies. The Committee requests CMHS to provide it
    with a report by May 1, 2006 that reviews the effectiveness of
    such programs and the best ways to implement them so they reach
    families in need, and offers recommendations for future
    preventive efforts in this area.

    Community Mental Health Services Block Grant

        The Committee recommends $432,756,000 for the community
    mental health services block grant, which is the same as the
    comparable fiscal year 2005 amount and the administration
    request. The recommendation includes $21,803,000 in transfers
    available under section 241 of the Public Health Service Act.
        States use these funds to support the development and
    implementation of innovative community-based services and
    maintain continuity of community programs. Funds are allocated
    to 59 eligible States and Territories through a formula based
    upon specified economic and demographic factors. Applications
    must include an annual plan for providing comprehensive
    community mental health services to adults with a serious
    mental illness and children with a serious emotional
    disturbance. Because the mental health needs of our Nation's
    elderly population are often not met by existing programs and
    because the need for such services is dramatically and rapidly
    increasing, the Committee encourages SAMHSA to require that
    States' plans include specific provisions for mental health
    services for older adults.

    Children's Mental Health Services

        The Committee recommends $105,129,000 for the children's
    mental health services program. This amount is $17,000 above
    the comparable fiscal year 2005 level and the same as the
    administration request. This program provides grants and
    technical assistance to support community-based services for
    children and adolescents with serious emotional, behavioral or
    mental disorders. Grantees must provide matching funds, and
    services must involve the educational, juvenile justice, and
    health systems.

    Projects for Assistance in Transition From Homelessness [PATH]

        The Committee recommends $54,809,000 for the PATH Program.
    This amount is the same as the comparable fiscal year 2005
    level and the administration request.
        PATH provides outreach, mental health, and case management
    services and other community support services to individuals
    with serious mental illness who are homeless or at risk of
    becoming homeless. The PATH program makes a significant
    difference in the lives of homeless persons with mental
    illnesses. PATH services eliminate the revolving door of
    episodic inpatient and outpatient hospital care.
    Multidisciplinary teams address client needs within a continuum
    of services, providing needed stabilization so that mental
    illnesses and co-occurring substance abuse and medical issues
    can be addressed. Assistance is provided to enhance access to
    housing, rehabilitation and training, and other needed
    supports, assisting homeless people in returning to secure and
    stable lives.

    Protection and Advocacy

        The Committee recommends $34,343,000 for the protection and
    advocacy program, which is the same as the comparable fiscal
    year 2005 level and the administration request. This program
    helps ensure that the rights of mentally ill individuals are
    protected while they are patients in treatment facilities, or
    while they are living in the community, including their own
    homes. Funds are allocated to States according to a formula
    based on population and relative per capita incomes.

                      CENTER FOR SUBSTANCE ABUSE TREATMENT

    Appropriations, 2005....................................  $2,197,921,000
    Budget estimate, 2006...................................   2,222,607,000
    House allowance.........................................   2,184,986,000
    Committee recommendation................................   2,187,646,000

        The Committee recommends $2,187,646,000 for substance abuse
    treatment programs. This amount is $10,275,000 below the
    comparable fiscal year 2005 funding level and $34,961,000 below
    the administration request. The recommendation includes
    $83,500,000 in transfers available under section 241 of the
    Public Health Service Act. This amount funds substance abuse
    treatment programs of regional and national significance and
    the substance abuse prevention and treatment block grant to the
    States.
        The Committee commends the Center for Substance Treatment
    [CSAT] for its ongoing collaboration with the National
    Institute on Drug Abuse [NIDA]. The Committee continues to be
    pleased that the CSAT/NIDA collaboration with State substance
    abuse directors, also known as Single State Authorities [SSAs]
    for Substance Abuse, is improving the manner in which evidence-
    based practices are used in our publicly funded system. The
    Committee encourages CSAT to continue its Blending Initiative
    with NIDA and SSAs to ensure that research findings are
    relevant and adaptable by State substance abuse systems.

    Programs of Regional and National Significance

        The Committee recommends $412,091,000 for programs of
    regional and national significance [PRNS]. The recommendation
    includes $4,300,000 in transfers available under section 241 of
    the Public Health Service Act. The recommendation is
    $10,275,000 below the comparable fiscal year 2005 level and
    $34,961,000 below the administration request.
        Programs of regional and national significance include
    three primary activities: best practice programs are used to
    develop more information on how best to serve those most in
    need; training and technical assistance supports dissemination
    of information through knowledge development; and targeted
    capacity expansion programs enable the agency to respond to
    service needs in local communities.
        The Committee recommendation includes $100,000,000 for the
    Access to Recovery program. The Committee expects that
    addictive disorder clinical treatment providers participating
    in the Access to Recovery program, as well as their respective
    staff, shall meet the certification, accreditation, and/or
    licensing standards recognized in their respective States.
        The Committee recommends funding at no less than last
    year's level for the Addiction Technology Transfer Centers
    [ATTCs]. The ATTC Network operates as 14 regional centers and
    one national office to translate the latest science of
    addiction, including evidence-based addiction treatment. The
    ATTCs are also an important component of the CSAT/NIDA Blending
    Initiative that seeks to improve the manner in which research
    findings are moved into every day practice.
        The Committee continues to be concerned about the incidence
    of drug addiction among pregnant and parenting women. The
    unavailability of family-based treatment is manifested in the
    overrepresentation of substance-abusing mothers in the child
    welfare system. Up to 80 percent of the families who come to
    the attention of child welfare agencies are substance abusing.
    The absence of treatment opportunities for families has also
    extended to the criminal justice system. Nearly 70 percent of
    the women behind bars are suffering from untreated addiction.
    Most of these women offenders are mothers: approximately 65
    percent of women in State prisons, and 59 percent of women in
    Federal prisons have young children.
        SAMHSA's evaluation of both the Residential Women and
    Children [RWC] and Pregnant and Postpartum Women [PPW] programs
    showed significantly reduced alcohol and drug use, as well as
    decreased criminal behavior. Rates of premature delivery, low
    birth weight, and infant mortality were improved for
    participating women. In addition, treatment costs were offset
    three to four times by savings from reduced costs of crime,
    foster care, Temporary Assistance to Needy Families [TANF], and
    adverse birth outcomes. The Committee believes that increased
    capacity for family-based treatment programs is imperative.
    Within the funds appropriated for CSAT, the Committee
    recommends $11,000,000 for treatment programs for pregnant,
    postpartum, and residential women and their children. This
    amount is $1,080,000 above the comparable level for fiscal year
    2005 and the administration request. No less than last year's
    funding shall be used for the Residential Treatment Program for
    Pregnant and Postpartum Women [PPW], authorized under section
    508 of the Public Health Service Act. In addition, the
    Committee strongly urges SAMHSA to explore ways to increase
    family treatment capacity.

    Substance Abuse Prevention and Treatment Block Grant

        The Committee recommends $1,775,555,000 for the substance
    abuse prevention and treatment block grant. The recommendation
    includes $79,200,000 in transfers available under section 241
    of the Public Health Service Act. The recommendation is the
    same as the comparable level for fiscal year 2005 and the
    administration request. The block grant provides funds to
    States to support alcohol and drug abuse prevention, treatment,
    and rehabilitation services. Funds are allocated to the States
    according to formula. State plans must be submitted and
    approved annually.
        The Committee wishes to express its strong support for
    increased funding for the Substance Abuse Prevention and
    Treatment [SAPT] Block Grant, an effective and efficient
    funding stream that flows to every State and territory. The
    Committee is aware that the SAPT Block Grant funds critical
    prevention and treatment services for our Nation's most
    vulnerable citizens, including those with HIV/AIDS, pregnant
    women, and others who can not afford these lifesaving services.
    The Committee continues to believe that the most effective and
    efficient way to support substance abuse programs in every
    State and territory is to direct the bulk of available new
    resources into the SAPT Block Grant.
        The Committee is aware of SAMHSA's efforts to improve the
    quality of substance abuse prevention and treatment data by
    seeking information on a core set of National Outcome Measures
    [NOMS] across all SAMHSA funding mechanisms, including services
    funded by the SAPT Block Grant. The Committee is also aware of
    SAMHSA's work to implement a State Outcomes Measurement and
    Management System [SOMMS] as the mechanism to achieve this
    initiative. The Committee commends SAMHSA for working with
    States and territories to streamline data reporting
    requirements and reduce reporting burden while improving
    accountability. The Committee strongly encourages SAMHSA to
    continue to work with States and territories to reach consensus
    on all aspects of SOMMS planning, implementation and
    evaluation.
        The Committee recognizes that States receiving the HIV set-
    aside within their Substance Abuse Prevention and Treatment
    Block Grant are well positioned to offer hepatitis prevention
    services to high risk clients, and encourages set-aside dollars
    to be used to support hepatitis prevention. The Committee
    recognizes that the majority of new hepatitis C virus
    infections are related to drug use, and asks SAMHSA to
    encourage all grantees to incorporate hepatitis prevention
    services, such as hepatitis C screening, into existing drug
    treatment programs.

                     CENTER FOR SUBSTANCE ABUSE PREVENTION

    Appropriations, 2005....................................    $198,725,000
    Budget estimate, 2006...................................     184,349,000
    House allowance.........................................     194,950,000
    Committee recommendation................................     202,289,000

        The Committee recommends $202,289,000 for programs to
    prevent substance abuse, which is $3,564,000 above the
    comparable fiscal year 2005 level and $17,940,000 above the
    administration request.
        The Committee recognizes the important role played by the
    20 percent prevention services set-aside within the Substance
    Abuse Prevention and Treatment [SAPT] Block Grant. This vital
    substance abuse prevention funding helped contribute to the
    fact that 600,000 fewer teens used drugs in 2004 compared to
    2001, according to the Monitoring the Future survey. The
    Committee also supports the need to recognize substance abuse
    prevention as a unique, separate and distinct field and
    encourages SAMHSA to promote programming consistent with this
    finding, including a strong role for CSAP as the Federal
    Government's lead agency for substance abuse prevention.
        The Committee is concerned about the intersection of
    methamphetamine abuse and the transmission of infectious
    diseases such as HIV and Hepatitis C. Both SAMHSA and the
    Centers for Disease Control and Prevention [CDC] have funded
    crucial programs targeting methamphetamine abuse and infectious
    disease prevention. However, the intersection of
    methamphetamine abuse and infectious disease has not been
    adequately addressed. Recognizing that the two agencies have
    different responsibilities in responding to the damage caused
    by the drug abuse epidemic, the Committee requests that SAMHSA
    and CDC draft a list of priorities to address the intersections
    of these two epidemics and provide a collaborative written
    report by April 1, 2006, designating a coordinating plan
    between SAMSHA and CDC. The plan should include a proposed
    infrastructure, needed resources, mechanisms of communication,
    and community involvement representing populations at high-risk
    to coordinate prevention, community outreach, professional
    training, treatment and new and existing grant programs to
    effectively address the intersection of the crystal
    methamphetamine epidemic and rising HIV rates.

    Programs of Regional and National Significance

        The Committee has provided $202,289,000 for programs of
    regional and national significance [PRNS]. The recommendation
    is $3,564,000 above the comparable fiscal year 2005 level and
    $17,940,000 above the administration request. The Center for
    Substance Abuse Prevention is the sole Federal organization
    with responsibility for improving accessibility and quality of
    substance abuse prevention services. Through the programs of
    regional and national significance activity, CSAP supports:
    development of new practice knowledge on substance abuse
    prevention; identification of proven effective models;
    dissemination of science-based intervention information; State
    and community capacity-building for implementation of proven
    effective substance abuse prevention programs; and programs
    addressing new needs in the prevention system.
        The Committee recommendation includes $93,488,000 for the
    Strategic Prevention Framework State Incentive Grant [SPFSIG]
    program, which is designed to promote, bolster and sustain
    prevention infrastructure for every State in the country. The
    Committee recognizes that a linchpin of this program is State
    flexibility so that each State may tailor initiatives and
    direct resources in ways that are most appropriate for its own
    jurisdiction. The Committee encourages SAMHSA to promote
    maximum State flexibility in managing the SPFSIG program and
    the 20 percent prevention set-aside within the Substance Abuse
    Prevention and Treatment [SAPT] Block Grant so that each State
    may employ a range of effective prevention strategies to meet
    their own unique needs and local circumstances.
        The Committee expects SAMHSA to ensure that SPFSIG grantees
    do not fund duplicative sub-state anti-drug coalition
    infrastructures, but utilize those already functioning and
    funded by programs such as the Drug Free Communities program.
        The Committee remains very concerned about the prevalence
    of methamphetamine use. According to the National Survey on
    Drug Use and Health [NSDUH], approximately 12.3 million
    Americans ages 12 or over tried methamphetamine in 2003. In
    more than three-quarters of Western States, methamphetamine and
    amphetamine-related treatment admissions rates are higher than
    those for cocaine or heroin. While methamphetamine is a serious
    problem on the West Coast, in the Mountain States and in parts
    of the Midwest, recent data suggest that the problem may be
    spreading eastward. Since fiscal year 2003 the Committee has
    provided $14,000,000 to twelve States for grants aimed at
    expanding the capacity of health care and community
    organizations to address methamphetamine abuse. The Committee
    is disturbed that the administration did not request funding
    for this program in fiscal year 2006. The Committee's
    recommendation includes $4,000,000 to continue this program.
        With the consolidation of the contracts for the National
    Clearinghouse for Alcohol and Other Drug Information and the
    Mental Health Clearinghouse, the Committee expects SAMHSA to
    ensure that the funding and materials available for substance
    abuse prevention be maintained at no less than current levels.
        The Committee recommendation includes $850,000 for the
    third year of the Ad Council's parent-oriented media campaign
    to combat underage drinking. Previous funding for the campaign
    was provided through the Office of the Secretary.

                               PROGRAM MANAGEMENT

        The Committee recommends $93,817,000 for program management
    activities of the agency. The recommendation includes
    $18,000,000 in transfers available under section 241 of the
    Public Health Service Act. The recommendation is $11,000 above
    the comparable level for fiscal year 2005 and $2,000,000 above
    the budget request.
        The program management activity includes resources for
    coordinating, directing, and managing the agency's programs.
    Program management funds support salaries, benefits, space,
    supplies, equipment, travel, and departmental overhead required
    to plan, supervise, and administer SAMHSA's programs.
        Last year the Committee included funds for SAMHSA to
    ``establish surveillance measures to address the mental and
    behavioral health needs of the population of the United
    States.'' The Committee is pleased that SAMHSA decided to work
    with the Centers for Disease Control and Prevention [CDC] to
    include questions on mental health in a CDC survey known as the
    Behavioral Risk Factor Surveillance System. The funds are being
    used to test appropriate questions and to help defray the cost
    of including them in the survey. Funds are also being provided
    to help States respond to the surveys. The Committee
    recommendation for fiscal year 2006 includes $2,000,000 to
    expand on the collaborative effort by SAMHSA and CDC to
    establish a population-based source of data on the mental and
    behavioral health needs in this country. These data will help
    policymakers implement the recommendations of the President's
    New Freedom Commission on Mental Health report ``Achieving the
    Promise: Transforming Mental Health Care in America.''
        The Committee recognizes the benefits of client level data
    reporting in order to build a more accurate picture of
    Americans in need of prevention and treatment services. The
    Committee strongly encourages SAMHSA to reach out to the
    Department of Justice, Department of Education, Health
    Resources and Services Administration [HRSA] and other Federal
    agencies to ensure that all Federal grants seek client level
    data reporting in order to complement and coordinate with
    SAMHSA's National Outcomes Measurement [NOMS] and State
    Outcomes Measurement and Management Initiative [SOMMS]
    initiatives.

                   Agency for Healthcare Research and Quality

    Appropriations, 2005....................................    $318,695,000
    Budget estimate, 2006...................................     318,695,000
    House allowance.........................................     318,695,000
    Committee recommendation................................     323,695,000

        The Committee recommends $323,695,000 for the Agency for
    Healthcare Research and Quality [AHRQ]. This amount is
    $5,000,000 above both the administration request and the
    comparable funding level for fiscal year 2005. The Committee
    has funded AHRQ through transfers available under section 241
    of the Public Health Service Act.
        The Agency for Healthcare Research and Quality was
    established in 1990 to promote improvements in clinical
    practice and patient outcomes, promote improvements in the
    financing, organization, and delivery of health care services,
    and increase access to quality care. AHRQ is the Federal agency
    charged to produce and disseminate scientific and policy-
    relevant information about the cost, quality, access, and
    medical effectiveness of health care. AHRQ provides
    policymakers, health care professionals, and the public with
    the information necessary to improve cost effectiveness and
    appropriateness of health care and to reduce the costs of
    health care.

                      HEALTH COSTS, QUALITY, AND OUTCOMES

        The Committee provides $265,695,000 for research on health
    costs, quality and outcomes [HCQO]. This amount is $5,000,000
    above both the administration request and the comparable amount
    for fiscal year 2005. HCQO research activity is focused upon
    improving clinical practice, improving the health care system's
    capacity to deliver quality care, and tracking progress toward
    health goals through monitoring and evaluation.
        For fiscal year 2006, the Committee directs AHRQ to devote
    $84,000,000 of the total amount provided for HCQO to
    determining ways to reduce medical errors. Of this amount,
    $50,000,000 will support the Department's initiative to promote
    the development, adoption and diffusion of information
    technology in health care.
        The Committee recognizes the work that AHRQ has done
    regarding comparative effectiveness research. Comparative
    effectiveness research has the potential to lower health care
    costs while improving quality of care. The Committee directs
    AHRQ to devote $20,000,000 of the total amount provided to
    research authorized under Section 1013 of the Medicare
    Prescription Drug, Improvement and Modernization Act of 2003.
    The Committee's recommendation is $5,000,0000 more than the
    amount provided last year. The increased funding will allow
    AHRQ to continue and build upon the priority list of conditions
    identified in fiscal year 2005.
        Autoimmune Disease.--In order to support continued HHS-wide
    implementation of the HHS Autoimmune Diseases Research Plan,
    the Committee encourages AHRQ to estimate the annual treatment
    and societal costs of autoimmune diseases in the United States,
    in order to project their future impact and burden on the
    healthcare system.
        Duchenne Muscular Dystrophy.--The Committee is pleased AHRQ
    is studying standards of care issues associated with patients
    diagnosed with Duchenne Muscular Dystrophy. The Committee urges
    AHRQ to build on this work by partnering with CDC to convene a
    consensus conference to develop these standards.
        Elderly Mental Health.--The Committee is seriously
    concerned about the prevalence of undiagnosed and untreated
    mental illness among older Americans. Affective disorders,
    including depression, anxiety, dementia, and substance abuse
    and dependence, are often misdiagnosed or not recognized at all
    by primary and specialty care physicians in their elderly
    patients. While effective treatments for these conditions are
    available, there is an urgent need to translate advancements
    from biomedical and behavioral research to clinical practice.
    The Committee urges AHRQ to support evidence-based research
    projects focused on the diagnosis and treatment of mental
    illnesses in the geriatric population, and to disseminate
    evidence-based reports to physicians and other health care
    professionals.
        Health Disparities.--The Committee remains disturbed by the
    March 2002 Institute of Medicine report regarding the
    disparities of medical care delivery to minorities. The
    Committee encourages AHRQ to carefully evaluate the analysis,
    findings, and recommendations of this study in order to pursue
    creative ways to improve health care delivery for all minority
    populations, including African-Americans, those of Hispanic and
    Asian origin, Native Americans, Alaskans and Native Hawaiians.
        Hospital-based Initiative.--The Committee urges AHRQ to
    work with multi-site academic medical centers to identify and
    implement programs to improve patient safety in a hospital
    setting. The Committee is interested in patient safety
    improvements that are designed for rapid turnaround and for
    developing practical and replicable projects in the future.
        Investigator-initiated Research.--The Committee notes that
    the Department reallocated $11,518,000 from AHRQ in fiscal year
    2005 to fund the Department's health information technology
    initiative. While the Committee strongly supports this
    initiative, it notes that this reallocation delayed the start
    of several non-patient safety grant programs. Research outside
    of targeted areas such as patient safety, health IT and
    comparative effectiveness is a critical part of AHRQ's mission
    yet these grants are a diminishing portion of the agency's
    research portfolio. The Committee notes that important
    initiatives like the patient safety program were based on
    investigator-initiated research. The Committee strongly urges
    AHRQ to maximixe investigator-initiated research.
        Nurse-Managed Health Centers.--The Committee encourages
    AHRQ to include nurse managed health centers and advanced
    practice nurses in research and demonstration projects
    conducted by the agency.

                       MEDICAL EXPENDITURES PANEL SURVEYS

        The Committee provides $55,300,000 for health insurance and
    medical expenditures panel surveys [MEPS], which is the same as
    the administration request and the comparable fiscal year 2004
    level. MEPS is intended to obtain timely national estimates of
    health care use and expenditures, private and public health
    insurance coverage, and the availability, costs and scope of
    private health insurance benefits. It also develops cost and
    savings estimates of proposed changes in policy and identifies
    impact of policy changes on payers, providers, and patients.

    Program Support

        The Committee recommends $2,700,000 for program support.
    This amount is the same as the administration request and the
    comparable fiscal year 2005 level. This activity supports the
    overall management of the Agency.

                   Centers for Medicare and Medicaid Services

                         GRANTS TO STATES FOR MEDICAID

    Appropriations, 2005

                                                            $123,779,019,000

    Budget estimate, 2006

                                                             156,954,419,000

    House allowance

                                                             156,954,419,000
    Committee recommendation
                                                             156,954,419,000

        The Committee recommends $156,954,419,000 for Grants to
    States for Medicaid. This amount is $33,175,400,000 more than
    the fiscal year 2005 appropriation and the same as the
    administration's request and House allowance. This amount
    excludes $58,517,290,000 in fiscal year 2005 advance
    appropriations for fiscal year 2006. In addition,
    $62,783,825,000 is provided for the first quarter of fiscal
    year 2007, as requested by the administration. Fiscal year 2006
    funding increases by $22,910,109,000 to fund obligations
    incurred but not reported in fiscal year 2005, thus reflecting
    the shift in the program from a cash basis of accounting to
    accrual-based accounting. The Medicaid program provides medical
    care for eligible low-income individuals and families. It is
    administered by each of the 50 States, the District of
    Columbia, Puerto Rico, and the territories. Federal funds for
    medical assistance are made available to the States according
    to a formula, which determines the appropriate Federal matching
    rate for State program costs. This matching rate is based upon
    the State's average per capita income relative to the national
    average, and shall be no less than 50 percent and no more than
    83 percent.

                      PAYMENTS TO HEALTH CARE TRUST FUNDS

    Appropriations, 2005

                                                            $114,608,900,000

    Budget estimate, 2006

                                                             177,822,200,000

    House allowance

                                                             177,742,200,000
    Committee recommendation
                                                             177,822,200,000

        The Committee recommends $177,822,200,000 for Federal
    payments to health care trust funds. This amount is the same as
    the administration's request, $80,000,000 more than the House
    allowance, and is an increase of $63,213,300,000 from the
    fiscal year 2005 appropriation. The significant funding
    increase is largely due to the cost of the new prescription
    drug benefit. This entitlement account includes the general
    fund subsidy to the Federal Supplementary Medical Insurance
    Trust Fund for Medicare Part B benefits and for Medicare Part D
    drug benefits and administration, plus other reimbursements to
    the Federal Hospital Insurance Trust Fund for Part A benefits
    and related administrative costs that have not been financed by
    payroll taxes or premium contributions. The Committee has
    provided $128,015,000,000 for the Federal payment to the
    Supplementary Medical Insurance Trust Fund. This payment
    provides matching funds for premiums paid by Medicare Part B
    enrollees. This amount is the same as the administration's
    request and is $14,013,000,000 more than the fiscal year 2005
    amount. The Committee further provides $53,596,000,000 for the
    general fund share of benefits paid under Public Law 108-173,
    the Medicare Prescription Drug, Improvement and Modernization
    Act of 2003. The Committee includes bill language requested by
    the administration providing indefinite authority for paying
    the General Revenue portion of the Part B premium match and
    provides resources for the Part D drug benefit program in the
    event that the annual appropriation is insufficient. The
    recommendation also includes $202,000,000 for hospital
    insurance for the uninsured. This amount is the same as the
    administration's request and is $115,000,000 more than the
    fiscal year 2005 amount. The Committee also recommends
    $206,000,000 for Federal uninsured benefit payment. This
    payment reimburses the Hospital Insurance Trust Fund for the
    cost of benefits provided to Federal annuitants who are
    eligible for Medicare. This amount is the same as the
    administration's request and an increase of $7,000,000 over the
    fiscal year 2005 level, reflecting an increase on the number of
    covered individuals who are currently enrolled. The Committee
    recommendation includes $164,000,000 to be transferred to the
    Hospital Insurance Trust Fund as the general fund share of CMS
    Program Management administrative expenses. This amount is the
    same as the administration's request and is $51,000,000 less
    than the fiscal year 2005 amount. The Committee recommendation
    also includes $677,000,000 to be transferred to the
    Supplementary Insurance Trust Fund as the general fund share of
    Part D administrative expenses. This amount is the same as the
    administration's request. The recommendation also provides
    $99,100,000 for State low-income determination activities
    through the prescription drug account. This amount is the same
    as the administration's request and is $6,800,000 less than the
    2005 amount. The Committee recommends $80,000,000 as
    reimbursement to the Health Care Fraud and Abuse Control
    [HCFAC] fund, described in a separate account, for new program
    integrity activities to be funded as discretionary spending.
    The House did not fund this account.

                      HEALTH CARE FRAUD AND ABUSE CONTROL

    Appropriations, 2005....................................................
    Budget estimate, 2006...................................     $80,000,000
    House allowance.........................................................
    Committee recommendation................................      80,000,000

        The Committee recommends $80,000,000 for program integrity
    activities to be funded in fiscal year 2006 through a
    discretionary cap adjustment. These funds will be reimbursed
    from the Payment to the Health Care Trust Funds appropriation.
    Of this total, $75,000,000 is for program integrity activities
    related to the new Part D prescription drug benefit and
    $5,000,000 for enhanced Medicaid financial management. The
    House did not fund this account.
        The Committee notes that mandatory funding for program
    integrity activities has not increased since fiscal year 2003
    and that the Part D prescription drug legislation did not
    include resources for program oversight. The Committee
    recommends $75,000,000 to be used to initiate program integrity
    efforts related to the new prescription drug benefit in the
    Medicare Integrity Program. The Committee recommends $5,000,000
    to augment the role of the CMS in financial management and
    oversight of program integrity efforts in the Medicaid and
    SCHIP grant programs.
        The Committee encourages CMS to consider implementing a
    Medicare analysis and detection system, aimed at reducing
    fraud, waste, and abuse through use of supercomputing
    technology.

                               PROGRAM MANAGEMENT

    Appropriations, 2005....................................  $2,664,911,000
    Budget estimate, 2006...................................   3,177,478,000
    House allowance.........................................   3,180,284,000
    Committee recommendation................................   3,203,418,000

        The Committee recommends $3,203,418,000 for CMS program
    management, which is $25,940,000 more than the amount requested
    by the administration $23,134,000 more than the House
    allowance, and $538,507,000 more than the fiscal year 2005
    enacted level. Fiscal year 2006 marks the first year that
    funding for ongoing Medicare Modernization Act [MMA] activities
    is included in the CMS Program Management appropriation. The
    Committee recommends the budget request of $560,000,000 for
    ongoing MMA activities in fiscal year 2006.

    Research, Demonstrations, and Evaluations

        The Committee recommends $78,494,000 for research,
    demonstrations, and evaluation activities. This amount is
    $33,300,000 more than the budget request, and $1,000,000 more
    than the 2005 level.
        CMS research and demonstration activities facilitate
    informed, rational Medicare and Medicaid policy choices and
    decision making. These studies and evaluations include projects
    to measure the impact of Medicare and Medicaid policy analysis
    and decision making, projects to measure the impact of Medicare
    and Medicaid on health care costs, projects to measure patient
    outcomes in a variety of treatment settings, and projects to
    develop alternative strategies for reimbursement, coverage, and
    program management.
        The Committee has included $40,000,000 for Real Choice
    Systems Change Grants for Community Living to States to fund
    initiatives that establish enduring and systemic improvements
    in long-term services and supports. Given the progress to date,
    the Committee recommends the issuance of a grant solicitation
    designed to provide a greater level of support to grantees to
    effectively identify and target requisite components of a
    coherent and integrated system of long-term care supports. The
    Secretary shall also allocate a portion of funding to: provide
    technical assistance to grantees on the development of a
    strategic plan to achieve systems transformation; maintain an
    information system that facilitates acquisition of data and
    information necessary to assess the progress of states in
    transforming their long-term care systems; and conduct an
    evaluation that would provide specific, measurable indicators
    of whether systems transformation has been achieved.
        The Committee commends CMS for implementing section 1860d-
    4(c)(2) of the Medicare Modernization Act requiring Part D
    prescription drug sponsors to provide medication therapy
    management services [MTMP] to targeted Medicare Part D
    enrollees. MTMP are critical to improving health outcomes and
    to reducing medication errors for targeted Medicare
    beneficiaries with chronic conditions and high drug costs. The
    Committee encourages CMS to conduct a demonstration project to
    identify effective MTMP models for targeted Medicare Part D
    enrollees, capable of implementation on a large scale. This
    demonstration project should include approaches that emphasize
    evidence-based prescribing, prospective medication management,
    technological innovation, and outcomes reporting.

    Medicare Operations

        The Committee recommends $2,184,984,000 for Medicare
    operations, which is $5,003,000 less than the amount requested
    by the administration. In addition, $720,000,000 is available
    for the Medicare Integrity Program within the mandatory budget
    as well as $80,000,000 recommended in this bill for a new
    Health Care Fraud and Abuse Control account.
        The Medicare operations line item covers a broad range of
    activities including claims processing and program safeguard
    activities performed by Medicare contractors. These contractors
    also provide information, guidance, and technical support to
    both providers and beneficiaries. In addition, this line item
    includes a variety of projects that extend beyond the
    traditional fee-for-service arena.
        The Committee recommends that not less than $31,700,000 be
    made available for the State Health Insurance Counseling
    Program. SHIPs provide one-on-one counseling to beneficiaries
    on complex Medicare-related topics, including Medicare
    entitlement and enrollment, health plan options, prescription
    drug benefits, Medigap and long-term care insurance, and
    Medicaid.
        The Committee recommends that $79,934,000 be made available
    for obligation over a 2-year period ending September 30, 2007,
    for contract costs pursuant to the development of the
    Healthcare Integrated General Ledger Accounting System
    [HIGLAS].
        CMS is encouraged to explore alternative approaches for
    recruiting, training and employing the severely disabled for 1-
    800-MEDICARE. The outcome will identify work activities
    performed by severely disabled individuals that fully support
    the needs of the 1-800-MEDICARE program and promote the
    employment of people with disabilities. CMS is encouraged to
    work directly with the National Industries for the Severely
    Handicapped [NISH] organization to develop the approach and to
    subsequently implement within the 1-800-MEDICARE program.
        Medicare contractors partner with Federal Government to
    administer the Medicare fee-for-service program. Contractors
    pay over 1 billion Medicare fee-for-service claims annually,
    are the first line of defense against Medicare fraud, and are
    the primary contact for Medicare providers and beneficiaries.
    Without adequate funding, contractors are not able to pay
    claims, respond to beneficiary and provider inquiries timely,
    and effectively combat fraud and abuse. The Committee is
    pleased CMS eliminated the 5 percent cap on transferring funds
    among Medicare functions so that contractors have greater
    flexibility to manage their budgets in a manner that best
    matches program requirements. Budget flexibility is important
    to Medicare contractors, particularly in a tight funding
    environment. The Committee understands an existing statute
    capped Medicare Integrity Program [MIP] funding at $720,000,000
    in fiscal year 2003. The Committee believes that Medicare
    contractors must be given greater flexibility to effectively
    manage their MIP resources given the continuing increases in
    claims volume. In fact claims have risen by more than 16
    percent since MIP was last increased. The Committee strongly
    recommends CMS give Medicare Contractors and Program Safeguard
    Contractors greater flexibility to manage their Medicare
    Integrity Program [MIP] funding in a manner that best matches
    program requirements including increases in workload. The
    Committee expects CMS to report on its plans to provide this
    flexibility to contractors in its fiscal year 2007
    congressional justification.

    State Survey and Certification

        The Committee recommends $260,735,000, the budget estimate
    and House allowance, for Medicare State survey and
    certification activities, which is $2,000,000 more than the
    fiscal year 2005 level.
        Survey and certification activities ensure that
    institutions and agencies providing care to Medicare and
    Medicaid beneficiaries meet Federal health, safety, and program
    standards. On-site surveys are conducted by State survey
    agencies, with a pool of Federal surveyors performing random
    monitoring surveys.

    Federal Administration

        The Committee recommends $655,000,000 for Federal
    administration costs, which is an increase of $73,507,000, over
    the fiscal year 2005 level. This funding level allows for fixed
    cost increases associated with the current staffing level of
    4,398 full-time equivalent positions. Savings from the request
    level of $657,357,000 are expected to be made in travel
    expenses and such administrative costs as printing and postage.
        The Committee recommends continuing the Healthy Start, Grow
    Smart program, which disseminates informational brochures to
    new Medicaid-eligible mothers. These brochures are distributed
    at the time of birth, then monthly over the first year of each
    child's life. Each publication focuses on activities that
    stimulate infant brain development and build the skills these
    children need to be successful in school. In addition to these
    educational suggestions, Healthy Start pamphlets include vital
    health and safety information for new parents.
        During last year's consideration of the Omnibus
    Appropriations Act, the Committee expressed its concerns with
    the lack of adequate funding for section 508 of the Medicare
    Modernization Act. The Committee directed CMS to report back on
    the number of hospitals that qualified for reclassification
    under section 508; the number of hospitals that qualified but
    received no funding; and a cost estimate, by year, of the
    amounts needed to fully fund these hospitals over 3 years. The
    Committee recently received the required report from CMS,
    several months late and well into this year's appropriations
    process. The report finds the cost to fully fund section 508
    reclassification for hospitals that qualified for funding but
    received no funds to be approximately $1,050,000,000 to
    $1,080,000,000 for 3 years or $350,000,000 to $360,000,000 for
    1 year. The Committee believes that it is important to find
    resources to expand section 508 reclassifications to as many
    unfunded hospitals as possible as a necessary first step in
    addressing the inequities caused by the existing wage index
    determinations, while a long-term solution is developed.
        The Committee expects that programs funded under the
    authority of the Ryan White Act (title XXVI of the Public
    Health Service Act) continue to be considered as payors of last
    resort in any Federal or State health benefits program. The
    Committee expects CMS to conform its program guidance to
    preserve the status of Ryan White funds as the payor of last
    resort. The Committee further requests that the Government
    Accountability Office study the legislative intent regarding
    the interaction of Ryan White and Medicare Part D spending, and
    report its findings by October 1, 2005. The report should
    examine whether Ryan White spending should be able to provide
    ``wrap around'' coverage which counts toward true out-of-pocket
    costs and thus catastrophic coverage under Part D of the
    Medicare Modernization Act.
        The Committee commends CMS for its outreach efforts to help
    dually eligible beneficiaries transfer from Medicaid
    prescription drug coverage to the new Medicare Part D program.
    However, the Committee believes that low-income dual eligible
    persons with mental disabilities will need additional
    assistance with Part D enrollment decisions and both
    pharmaceutical and formulary changes. The Committee urges CMS
    to support one-on-one pharmaceutical benefits counseling
    through community-based organizations and safety net mental
    health providers in order to address this need.
        The Committee is very pleased with the demonstration
    project at participating sites licensed by the Program for
    Reversing Heart Disease and encourages its continuation. The
    Committee further urges CMS to continue with the demonstration
    project being conducted at the Mind Body Institute of Boston,
    Massachusetts.
        The Committee is very pleased with the efforts of CMS to
    address the extraordinary adverse health status of Native
    Hawaiians in Waimanalo, Hawaii. The Committee continues to urge
    additional focus upon American Samoan residents in that
    geographical area utilizing the expertise of the Waimanalo
    Health Center.
        The Committee urges the Centers for Medicare and Medicaid
    Services to consider waivers for rural or isolated area
    demonstration projects when calculating such requirements as
    population density in the State of Hawaii.
        The Committee urges CMS to provide for reimbursement for
    services rendered to Native Hawaiians in federally qualified
    health centers in the same manner that it currently does for
    American Indians and Alaskan Natives. Further, the Committee
    requests a report on this matter by next year's budget
    hearings.
        The Committee is aware that legislation authorizing direct
    Medicare reimbursement to nurse practitioners providing
    reimbursable Medicare Services, was passed by Congress and
    signed into law, effective January 1, 1998. Since that time
    nurse practitioners have been providing reimbursable care to
    patients as Part B providers. Despite their ability to provide
    and bill for services rendered in all of these areas, they are
    still unable to refer patients to home health or hospice care.
    The apparent reason is that an expanded interpretation of the
    word ``physician'' is needed in Part A, Section 1814, of the
    Medicare law in order for home health agencies and hospice
    centers to accept these referrals.
        The Committee is very aware that nurse practitioners have
    been demonstrated to provide safe and responsible care to the
    patients they serve. They have expert knowledge that allows
    them to provide high level assessments of patients needs and
    recognize when additional care, such as home health and hospice
    care is needed or not needed by their patients. The Committee
    urges CMS to reinterpret the statute that will authorize home
    health agencies and hospices to accept orders from nurse
    practitioners.
        The Committee recognizes that rural residents account for
    25 percent of the general population in the United States with
    a disproportionate number of them being seniors. Additionally,
    67 percent of the country's primary care health professional
    shortage areas are located in rural areas and access to
    specialized care is limited for seniors. The Committee urges
    CMS to consider funding projects with a focus on rural
    healthcare, specifically those serving minority populations
    such as Native Hawaiians, Native Alaskans, and Native
    Americans.
        The Committee expects CMS to promulgate regulations
    providing the option of direct access to licensed audiologists
    under similar terms and conditions used by the Department of
    Veterans Affairs and the Office of Personnel Management. The
    Department of Veterans Affairs reports that direct access
    provides high-quality, efficient, and cost-effective hearing
    care.
        The Secretary of HHS is encouraged to include, in
    negotiating Prime contracts supporting the Medicare
    Prescription Drug Plan Program Part D, small business and small
    disadvantaged business subcontracting plan requirements. These
    subcontract plans should achieve a participation rate of not
    less than 5 percent of the total value of prime contract award
    for each fiscal year.
        The Committee expects CMS to conduct a demonstration to
    develop a pilot program to assist patients with expensive
    chronic illnesses, including hepatitis, in securing private
    health insurance. Non-profit organizations such as Patient
    Services, Inc. have had success on a State level in assisting
    families burdened by chronic illness in retaining or obtaining
    insurance coverage. This transitional support has saved State
    dollars by reducing reliance on Medicaid and keeping patients
    with expensive chronic illnesses insured. The Committee is
    hopeful that this model can be expanded to achieve savings on a
    national level.
        Those State Pharmaceutical Assistance Programs (SPAPs)
    whose outreach plans have been approved and awarded outreach
    grants by CMS may rollover any unspent fiscal year 2005 grant
    monies into the next Federal fiscal year to be used to bring
    the initiative to completion (section 221).
        A qualified pharmacy workforce is necessary to fully
    implement efforts to improve the quality of care received by
    our Nation's seniors, particularly high-risk seniors who have
    multiple chronic conditions and are taking multiple
    medications. The committee therefore urges CMS to carefully
    review its decision to cut Medicare funding for second-year,
    specialized pharmacy residency programs, which provide
    specialized training to medication use experts in areas like
    geriatrics, oncology, and critical care, taking into account
    new data submitted by national pharmacist associations, and
    provide a full report back to the Committee within 3 months
    with the Agency's rationale for any decision that results in
    these programs remaining un-funded.
        Deep-vein thrombosis affects more than 2 million Americans
    each year and its complications also take a toll on our
    Nation's hospital systems, costing approximately $860,000,000
    annually. It has been brought to the Committee's attention that
    there is a large gap between knowledge and practice where deep-
    vein thrombosis and associated morbidity and mortality
    including Pulmonary Embolus and Post Thrombotic Syndrome are
    concerned. In order to identify ways to reduce the burden of
    deep-vein thrombosis and associated complications including
    death in the inpatient setting, the Center for Medicare and
    Medicaid Services is encouraged to develop a demonstration
    project, with from experts in the field to: analyze ongoing
    practices to appropriately assess and prophylax ``at risk''
    surgical and medical patients; implement a process within
    demonstration study sites to improve appropriate prophylaxis;
    and, create a follow-up report on steps of implementation and
    an outcomes report, to define the impact of the program.
        The Committee supports programs that can demonstrate the
    feasibility of achieving quality improvement as well as cost
    savings to the Medicare program through improved quality of
    care. In this regard, the Committee encourages CMS to consider
    a quality-focused cost containment in cardiac surgery for
    Medicare beneficiaries pilot program to demonstrate and
    quantify cost savings possible through quality improvement
    efforts.

    Revitalization Plan

        The Committee recommends the budget request and House
    allowance of $24,205,000 in 2-year budget authority, as the
    third-year investment in CMS's efforts to make significant
    improvements to key aspects of managing the Agency and the
    Medicare program. First-year funding in fiscal year 2004 was
    $29,619,000 and second-year funding was $24,205,000 for fiscal
    year 2005. Funding in fiscal year 2006 will target system-
    related improvements, and continue addressing long-term
    information technology issues, including Medicare claims
    processing redesign activities. The Committee urges CMS to
    augment information technology activities utilizing resources
    available under the Quality Improvement Organization program.

    HMO Loan and Loan Guarantee Fund

        The Committee concurs with requested bill language making
    receipts of this fund available for payment of obligations, but
    prohibiting the issuance of additional direct loans or loan
    guarantees to health maintenance organizations from this fund.

                    Administration for Children and Families

      PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
                                    PROGRAMS

    Appropriations, 2005....................................  $2,873,802,000
    Budget estimate, 2006...................................   2,071,943,000
    House allowance.........................................   2,121,643,000
    Committee recommendation................................   2,121,643,000

        The Committee recommends $2,121,643,000 be made available
    in fiscal year 2006 for payments to States for child support
    enforcement and family support programs. The comparable funding
    level for fiscal year 2005 is $2,873,802,000 and the budget
    request includes $2,071,943,000 for this program. The Committee
    recommendation provides the full amount requested under current
    law. The budget request includes net savings of $49,700,000
    based on proposed legislation.
        These payments support the States' efforts to promote the
    self-sufficiency and economic security of low-income families.
    These funds also support efforts to locate non-custodial
    parents, determine paternity when necessary, and establish and
    enforce orders of support. The appropriation, when combined
    with the $1,200,000,000 in advance funding provided in last
    year's bill, an estimated $208,000,000 from offsetting
    collections, and an estimated carryover of $740,173,000,
    supports a program level of $4,269,816,000.
        The Committee also has provided $1,200,000,000 in advance
    funding for the first quarter of fiscal year 2007 for the child
    support enforcement program, the same as the budget request.

                   LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

    Appropriations, 2005....................................  $2,182,399,000
    Budget estimate, 2006...................................   2,000,000,000
    House allowance.........................................   2,006,799,000
    Committee recommendation................................   2,183,000,000

        The Committee recommends $2,183,000,000 for fiscal year
    2006 for LIHEAP. The comparable funding level for fiscal year
    2005 is $2,182,399,000 and the budget request includes
    $2,000,000,000 for this program. LIHEAP is made up of two
    components: the State grant program and the contingency fund.
        The Committee recommendation includes $1,883,000,000 for
    fiscal year 2006 for the State grant program. The comparable
    funding level for fiscal year 2005 is $1,884,799,000 and the
    budget request includes $1,800,000,000 for this program. Within
    the funds provided, the Committee recommends $500,000 for a
    feasibility study, as requested by the administration. LIHEAP
    grants are awarded to States, territories, Indian tribes, and
    tribal organizations to assist low-income households in meeting
    the costs of home energy. States receive great flexibility in
    how they provide assistance, including direct payments to
    individuals and vendors and direct provision of fuel. These
    resources are distributed by formula to these entities as
    defined by statute, based in part on each State's share of home
    energy expenditures by low-income households.
        The Committee recommendation includes $300,000,000 for
    fiscal year 2006 for an emergency fund to meet the additional
    home energy assistance needs arising from a natural disaster or
    other emergencies. The comparable funding level for fiscal year
    2005 is $297,600,000 and the budget request does not include
    funds designated as emergency for this program, but did request
    $200,000,000 for the contingency fund.
        The Committee intends that up to $27,500,000 of the amount
    recommended for LIHEAP for fiscal year 2006 be used for the
    leveraging incentive fund. The fund will provide a percentage
    match to States for private or non-Federal public resources
    allocated to low-income home energy benefits.

                         REFUGEE AND ENTRANT ASSISTANCE

    Appropriations, 2005....................................    $484,394,000
    Budget estimate, 2006...................................     552,040,000
    House allowance.........................................     560,919,000
    Committee recommendation................................     571,140,000

        The Committee recommends $571,140,000 for fiscal year 2006
    for refugee and entrant assistance. The comparable funding
    level for fiscal year 2005 is $484,394,000 and the budget
    request includes $552,040,000 for this program.
        The Refugee and Entrant Assistance Program is designed to
    assist States in their efforts to assimilate refugees, asylees,
    Cuban and Haitian entrants, and adults and minors who are
    trafficking victims, into American society as quickly and
    effectively as possible. The program funds State-administered
    transitional and medical assistance, the voluntary agency
    matching grant program, programs for victims of trafficking and
    torture, employment and social services, targeted assistance,
    and preventive health. Based on an estimated refugee admission
    ceiling of 70,000, this appropriation enables States to provide
    at least 8 months of cash and medical assistance to eligible
    refugees and entrants, a variety of social and educational
    services, as well as foster care for refugee and entrant
    unaccompanied minors.
        In order to carry out the refugee and entrant assistance
    program, the Committee recommends $268,229,000 for transitional
    and medical assistance including State administration and the
    voluntary agency program, of which $4,100,000 is from emergency
    funds; $9,915,000 for victims of trafficking; $151,121,000 for
    social services; $4,796,000 for preventive health; and
    $49,081,000 for targeted assistance.
        For unaccompanied children, pursuant to section 462 of the
    Homeland Security Act of 2002, the Committee recommends
    $78,083,000, of which $15,000,000 is from emergency funds.
    Funds are provided for the care and placement of unaccompanied
    alien minors in the Office of Refugee Resettlement. In fiscal
    year 2006 there will be approximately 9,600 placements for
    unaccompanied alien children apprehended in the United States
    by INS/Homeland Security agents, Border Patrol officers, or
    other law enforcement agencies. These children are then taken
    into care pending resolution of their claims for relief under
    U.S. immigration law, released to an adult family member, or
    released to a responsible adult guardian.
        The Committee also recommends $9,915,000 to treat and
    assist victims of torture. These funds may also be used to
    provide training to healthcare providers to enable them to
    treat the physical and psychological effects of torture. The
    Committee acknowledges that well-established treatment centers,
    such as the Center for Victims of Torture, have developed the
    knowledge base that has fostered growth of treatment facilities
    around the country and strengthened treatment services
    generally. This positive trend may continue if leading centers
    are able to expand their staffs to create more trainers and
    improve evaluation and research needed to guide and develop new
    programs. The Committee recommends ORR support core funding of
    strong regional programs that invest carefully in building
    their rehabilitation programs that produce research and
    knowledge in this new field. Those organizations can then be
    expected to organize training for mainstream health care
    providers.
        The Committee bill includes $19,100,000 in emergency funds
    for the unanticipated and significantly increased demand for
    services to individuals eligible for assistance, of which
    $4,100,000 is for transitional and medical services and
    $15,000,000 is for unaccompanied alien children programs. An
    increasing share of refugee admissions are coming from Africa
    and Thailand and these refugees have far more costly medical
    needs than previous arrivals from Russia and Southeast Asian
    countries due in part to increased health screening tests and
    lab cultures, increased medical treatment for parasites, HIV,
    and multiple drug-resistant TB, and increased prostheses and
    rehabilitation for machete victims. These refugees also tend to
    stay on refugee cash assistance longer because they require
    more intensive services for reading and writing in their native
    language, English as a Second Language, and job placement.
    There also has been a much higher than anticipated increase in
    unaccompanied alien children entering the United States and
    being placed in the care of ORR. While the fiscal year 2005
    appropriation assumed an increase of 20 percent in this
    program, the actual increases are close to 30 percent. These
    additional funds are needed to address these unanticipated
    situations.
        The Committee is deeply concerned that accompanied
    children, even as young as nursing infants, who are apprehended
    by the Department of Homeland Security [DHS] are being
    separated from their parents and being placed in the
    unaccompanied alien children program while their parents are
    held in separate adult facilities. The Committee is pleased
    that ORR has taken the initiative to work with DHS to correct
    this problem and anticipates a prompt resolution.
        The Committee is aware that at times ORR allows individual
    abused, abandoned, or neglected children in its custody to
    access State dependency proceedings for ultimate care and
    placement in State foster care or under legal guardianship. The
    Committee urges ORR to continue this practice in such cases as
    it is appropriate.
        The Committee is pleased with the steps the ORR has taken
    to improve access to legal representation for children served
    through this program. ORR has participated in roundtables, and
    met with various groups to better understand the issue. They
    have also put together a comprehensive list of pro bono
    attorneys and guardians to ensure that the children's needs are
    being served and are currently working on a program that would
    ensure that resources are available to unaccompanied alien
    children. The Committee commends ORR for their commitment to
    providing unaccompanied alien children in its care access to a
    comprehensive range of services, from legal representatives to
    access to necessary unique medical care.
        The Committee directs that not later than 1 year after the
    date of enactment of this Act the Secretary of Health and Human
    Services shall submit a report on progress made by ORR to
    deinstitutionalize the care provided to unaccompanied children
    in its custody, including the utilization of community-based,
    child welfare centered services.
        The Committee is pleased that the majority of the 15,000
    Hmong refugees that were admitted will have arrived by the end
    of fiscal year 2005. The Committee was concerned that unlike
    prior groups of Hmong refugees, which were made up of military
    and political leaders with the means and education to succeed
    in America, these immigrants had spent their lives in a refugee
    camp. Few, if any, spoke English. Most are under 18 and have
    little schooling. Even with the greater level of education and
    skills possessed by prior refugees, statistics indicated that
    about 38 percent of current Hmong-Americans live in poverty.
        Section 412(a)(7) of title IV of the Immigration and
    Nationality Act authorizes the use of funds appropriated under
    this account to be used to carry out monitoring, evaluation,
    and data collection activities to determine the effectiveness
    of funded programs and to monitor the performance of States and
    other grantees.

                     CHILD CARE AND DEVELOPMENT BLOCK GRANT

    Appropriations, 2005....................................  $2,082,921,000
    Budget estimate, 2006...................................   2,082,910,000
    House allowance.........................................   2,082,910,000
    Committee recommendation................................   2,082,910,000

        The Committee recommends $2,082,910,000 for fiscal year
    2006 for the child care and development block grant. The
    comparable funding level for fiscal year 2005 is $2,082,921,000
    and the budget request includes $2,082,910,000 for this
    program.
        The child care and development block grant supports grants
    to States to provide low-income families with financial
    assistance for child care; for improving the quality and
    availability of child care; and for establishing or expanding
    child development programs. The funds are used to both expand
    the services provided to individuals who need child care in
    order to work, or attend job training or education, and to
    allow States to continue funding the activities previously
    provided under the consolidated programs.
        The Committee recommendation continues specific earmarks in
    appropriations language, also included in the budget request,
    that provide targeted resources to specific policy priorities
    including $19,120,000 for the purposes of supporting before and
    afterschool services, as well as resource and referral
    programs. This represents the Federal commitment to the
    activities previously funded under the dependent care block
    grant. The Committee expects that these funds will not supplant
    current funding dedicated to resource and referral and school
    age activities provided by the child care and development block
    grant. The Committee strongly encourages States to continue to
    address the matters of before and afterschool care and the
    establishment of resource and referral programs with the funds
    provided in this program.
        The Committee recommendation includes an additional
    $272,672,000 for child care quality activities, and sets aside
    $100,000,000 specifically for an infant care quality
    initiative. These funds are recommended in addition to the 4
    percent quality earmark established in the authorizing
    legislation. The Committee has provided these additional
    quality funds because of the considerable research that
    demonstrates the importance of serving children in high quality
    child care settings which include nurturing providers who are
    educated in child development and adequately compensated. While
    considerable progress has been made, the Committee believes
    States should continue to invest in education and training
    linked to compensation of the child care workforce in order to
    improve the overall quality of child care.
        The Committee recommendation also provides $10,000,000 for
    child care research, demonstration and evaluation activities.
        The Committee recommendation for resource and referral
    activities also includes $1,000,000 to continue support for the
    National Association of Child Care Resource and Referral
    Agencies' information service, Child Care Aware, and the
    national toll-free information hotline which links families to
    local child care services and programs.

                          SOCIAL SERVICES BLOCK GRANT

    Appropriations, 2005....................................  $1,700,000,000
    Budget estimate, 2006...................................   1,700,000,000
    House allowance.........................................   1,700,000,000
    Committee recommendation................................   1,700,000,000

        The Committee recommends $1,700,000,000 for fiscal year
    2006 for the social services block grant. The comparable
    funding level for fiscal year 2005 is $1,700,000,000 and the
    budget request includes $1,700,000,000 for this program. The
    Committee has included bill language that allows States to
    transfer up to 10 percent of their TANF allotment to the social
    services block grant.

                    CHILDREN AND FAMILIES SERVICES PROGRAMS

    Appropriations, 2005....................................  $9,007,770,000
    Budget estimate, 2006...................................   8,386,293,000
    House allowance.........................................   8,688,707,000
    Committee recommendation................................   9,000,832,000

        The Committee recommends $9,000,832,000 for fiscal year
    2006 for children and families services programs. The
    comparable funding level for fiscal year 2005 is $9,007,770,000
    and the budget request includes $8,386,293,000 for this
    program. In addition, $10,500,000 in transfers are available
    under section 241 of the Public Health Service Act.
        This appropriation provides funding for programs for
    children, youth, and families, the developmentally disabled,
    and Native Americans, as well as Federal administrative costs.

    Head Start

        The Committee recommends $6,874,314,000 for fiscal year
    2006 for Head Start. The comparable funding level for fiscal
    year 2005 is $6,843,114,000 and the budget request includes
    $6,899,336,000 for this program. The Committee recommendation
    includes $1,388,800,000 in advance funding that will become
    available on October 1, 2007. The Committee recommendation does
    not include the $45,000,000 requested in the budget for a State
    pilot project that would allow States to directly administer
    the Head Start program.
        Head Start provides comprehensive development services for
    low-income children and families, emphasizing cognitive and
    language development, socioemotional development, physical and
    mental health, and parent involvement to enable each child to
    develop and function at his or her highest potential. At least
    10 percent of enrollment opportunities in each State are made
    available to children with disabilities.
        The Committee is aware that studies on early childhood that
    provide clear evidence that the brain undergoes its most
    dramatic development during the first 3 years of life, when
    children acquire the ability to think, speak, learn, and
    reason. Disparities in children's cognitive and social
    abilities become evident well before they enter Head Start or
    pre-kindergarten programs at age 4. Early Head Start minimizes
    these disparities so that children are ready to enter school
    and learn. The National Evaluation of Early Head Start
    concluded that Early Head Start is making a positive difference
    in areas associated with children's success in school, family
    self-sufficiency, and parental support of child development.
    Currently only 3 percent of estimated eligible infants and
    toddlers are enrolled in Early Head Start. Over the past 5
    years, the Committee has significantly increased funding for
    Early Head Start, to provide more low-income infants and
    toddlers with the positive experiences they need for later
    school and life successes. The Committee intends to continue
    this important investment.
        The Committee understands the serious need for additional
    and expanded Head Start facilities among Native American
    populations and in rural areas. The Committee believes that the
    Department could help serve these needy communities by
    providing minor construction funding, as authorized, in remote
    Native American communities.
        The Committee strongly supports the effort to strengthen
    the qualifications of Head Start teachers. While the Committee
    is pleased that the percentage of teachers with an associate,
    baccalaureate, or advanced degree in early childhood education,
    or a degree in a related field with experience in teaching
    preschool children has reached 65 percent, the Committee
    encourages Head Start to continue to work toward the goal of
    100 percent. The Committee expects the Department to focus
    staff development efforts on increasing the educational level
    of Head Start teachers in order to meet this goal.
        The Committee is aware that in May 2005, the Secretary made
    $35,000,000 in additional fiscal year 2005 funds available to
    Migrant and Seasonal Head Start programs and that these funds,
    which will be awarded on competitive basis, will allow for at
    least 4,000 additional children to access Migrant and Seasonal
    Head Start. The Committee acknowledges that these expansion
    funds will increase access to this important program, however
    additional funding may be necessary to adequately serve this
    population. The Committee requests that the Secretary submit a
    report on the Bureau's ongoing plans to ensure that Migrant and
    Seasonal Head Start programs are able to serve a larger
    percentage of the children eligible for services. The Committee
    continues to point to the 2001 study published by the U.S.
    Department of Health and Human Services which documented that
    only 19 percent of eligible children were able to access
    Migrant and Seasonal Head Start.
        The Head Start Bureau shall continue to provide the
    Committee with the number and cost of buses purchased, by
    region with Head Start in the annual congressional budget
    justification.
        The Committee is conscious of efforts currently being
    undertaken to improve pre-literacy skills in Head Start
    children and lauds the administration for its commitment to
    this effort. However, the Committee continues to caution
    against anything that would detract from the comprehensive
    nature of the program in delivering early childhood development
    and family services. While school readiness is front and center
    in the goals of Head Start, the elements necessary to achieve
    that readiness range from adequate nutrition and health
    screening, to social and emotional development and family
    building, as well as the cognitive growth of young children.
        The Committee is aware that the Government Accountability
    Office came out on May 17 with the report, ``Head Start:
    Further Development Could Allow Results of New Test to be Used
    for Decision Making,'' on the National Reporting System [NRS]
    test. The report stated that analysis was currently incomplete
    to support its use for the purposes of accountability and
    targeting training and technical assistance, that grantees have
    not yet shown that the NRS provides the scope and quality of
    assessment information needed for holding grantees accountable,
    and that language experts raised serious concerns about whether
    the Spanish version of the NRS adequately measures the skills
    of Spanish-speaking children and whether results from the
    English and Spanish. Therefore, the Committee directs the
    Secretary to submit a report to House and Senate Committees on
    Appropriations, not later than 90 days after enactment of this
    Act, addressing: (1) a detailed justification to Congress
    regarding the planned uses of the NRS results and data in terms
    of program evaluation, professional development, technical
    assistance, and other activities; (2) an itemization of the
    costs of development, implementation, and analysis of the NRS,
    detailing by name, amount, and description of activities each
    contract or grant to persons or entities involved in its
    design, development, implementation, or analysis; and (3) the
    recommendations made by the Technical Working Group established
    by the Secretary, including an explanation of how the Secretary
    has addressed or plans to address the Working Group's and the
    GAO's recommendations.

    Consolidated Runaway and Homeless Youth Program

        The Committee recommends $88,724,000 for fiscal year 2006
    for the consolidated runaway and homeless youth program. The
    comparable funding level for fiscal year 2005 is $88,724,000
    and the budget request includes $88,728,000 for this program.
    This program was reauthorized under the Runaway, Homeless, and
    Missing Children Protection Act of 2003. In this
    reauthorization a statutory formula was established to
    distribute funds between the Basic Center Program and the
    Transitional Living Program.
        This program addresses the crisis needs of runaway and
    homeless youth and their families through support to local and
    State governments and private agencies. Basic centers and
    transitional living programs help address the needs of some of
    the estimated 500,000 to 1.5 million and homeless youth, many
    of whom are running away from unsafe or unhealthy living
    environments. These programs have been proven effective at
    supporting positive youth development, securing stable and safe
    living arrangements and providing the skills required to engage
    in positive relationships with caring adults and contribute to
    society.
        The Committee also recognizes the need for and value of
    expanding transitional living opportunities for all homeless
    youth. Therefore, the Committee seeks to preserve the
    flexibility afforded in current law to respond to the needs of
    the young people who are most at-risk and in greatest need of
    transitional living opportunities in their communities by
    providing additional resources to the existing portfolio of
    consolidated Runaway and Homeless Youth Act programs.
        It is the Committee's expectation that current and future
    TLP grantees will continue to provide transitional living
    opportunities and support to pregnant and parenting homeless
    youth, as is their current practice. To further ensure that
    pregnant and parenting homeless youth are able to access
    transitional living opportunities and support in their
    communities, the Committee encourages the Secretary, acting
    through the network of federally-funded runaway and homeless
    youth training and technical assistance providers, to offer
    guidance to grantees and others on the programmatic
    modifications required to address the unique needs of pregnant
    and parenting youth and on the various sources of funding
    available for residential services to this population.

    Maternity Group Homes

        The Committee recommendation does not include the
    $10,000,000 requested in the budget for the maternity group
    homes program. Under this proposed program, the ACF would
    provide targeted funding for community-based, adult-supervised
    group homes for young mothers and their children. These homes
    would provide safe, stable, nurturing environments for mothers
    who cannot live safely with their own families and assist them
    in moving forward with their lives by providing support so they
    can finish school, acquire job skills, and learn to be good
    parents.
        The Committee expects the Family and Youth Services Bureau
    to continue to provide the technical assistance needed to
    enable TLP grantees and their community partners to address the
    unique needs of young mothers and their children, as well as
    helping interested entities in identifying sources of funding
    currently available to provide residential services to this
    population.

    Runaway Youth Prevention Program

        The Committee recommends $15,179,000 for fiscal year 2006
    for the runaway youth prevention program. The comparable
    funding level for fiscal year 2005 is $15,178,000 and the
    budget request includes $15,179,000 for this program. This is a
    discretionary grant program open to private nonprofit agencies
    for the provision of services to runaway, homeless, and street
    youth. Funds may be used for street-based outreach and
    education, including treatment, counseling, provision of
    information, and referrals for these youths, many of whom have
    been subjected to, or are at risk of being subjected to, sexual
    abuse. The goal of this program is to help young people leave
    the streets.

    Child Abuse Programs

        The Committee recommends $101,779,000 for fiscal year 2006
    for child abuse programs. The comparable funding level for
    fiscal year 2005 is $101,778,000 and the budget request
    includes $101,784,000 for this program. The recommendation
    includes $27,280,000 for State grants, $31,640,000 for
    discretionary activities, and $42,859,000 for community based
    child abuse prevention.
        These programs seek to improve and increase activities at
    all levels of government which identify, prevent, and treat
    child abuse and neglect through State grants, technical
    assistance, research, demonstration, and service improvement.

    Abandoned Infants Assistance

        The Committee recommends $11,955,000 for fiscal year 2006
    for abandoned infants assistance. The comparable funding level
    for fiscal year 2005 is $11,955,000 and the budget request
    includes $11,955,000 for this program.
        This program provides grants to public and private non-
    profit agencies, State and county child welfare agencies,
    universities, and community-based organizations to develop,
    implement, and operate demonstration projects that will prevent
    the abandonment of infants and young children, especially those
    impacted by substance abuse and HIV and who are at-risk of
    being or are currently abandoned. By providing respite care for
    families and care givers and assisting abandoned infants and
    children to reside with their natural families or in foster
    care. The Committee recognizes that the rates of prenatal
    substance abuse and maternal HIV/AIDS have increased, that the
    related problem of infants abandoned or boarding in hospitals
    has grown, and that existing grantees have experienced a large
    increase in demand for services nationwide.

    Child Welfare Services

        The Committee recommends $289,650,000 for fiscal year 2006
    for child welfare services. The comparable funding level for
    fiscal year 2005 is $289,650,000 and the budget request
    includes $289,650,000 for this program.
        This program helps State public welfare agencies improve
    their child welfare services with the goal of keeping families
    together. State services include: preventive intervention, so
    that, if possible, children will not have to be removed from
    their homes; reunification so that children can return home;
    and development of alternative placements like foster care or
    adoption if children cannot remain at home. These services are
    provided without regard to income.

    Child Welfare Training

        The Committee recommends $7,409,000 for fiscal year 2006
    for child welfare training. The comparable funding level for
    fiscal year 2005 is $7,409,000 and the budget request includes
    $7,409,000 for this program.
        Under section 426, title IV-B of the Social Security Act,
    discretionary grants are awarded to public and private
    nonprofit institutions of higher learning to develop and
    improve education/training programs and resources for child
    welfare service providers. These grants upgrade the skills and
    qualifications of child welfare workers.
        Given research on failings in the Child and Family Services
    Reviews [CFSRs] and the States' continuing challenges in
    recruiting and retaining qualified child welfare personnel,
    particularly those who hold a degree in social work, the
    Committee encourages ACF to continue to provide grants to
    schools of social work and traineeships to social work students
    being trained in the specialty of child welfare. The Committee
    also encourages ACF to provide funding for research into how
    specially trained social work personnel affect outcomes for
    children and families.

    Adoption Opportunities

        The Committee recommends $27,119,000 for fiscal year 2006
    for adoption opportunities. The comparable funding level for
    fiscal year 2005 is $27,116,000 and the budget request includes
    $27,119,000 for this program.
        This program eliminates barriers to adoption and helps find
    permanent homes for children who would benefit by adoption,
    particularly children with special needs.

    Adoption Incentives

        The Committee recommends $22,846,000 for fiscal year 2006
    for adoption incentives. The comparable funding level for
    fiscal year 2005 is $31,846,000 and the budget request includes
    $31,846,000 for this program. Fewer resources were needed in
    fiscal year 2005 to make bonus payments to States for the full
    amount for which they were eligible under this program, so the
    reduction recommended by the Committee will not have any impact
    on this program, unused funds will supplement the fiscal year
    2006 appropriation in order to maintain a robust incentives
    program.
        The purpose of this program is to provide incentive funds
    to States to encourage an increase in the number of adoptions
    of children from the public foster care system. These funds are
    used to pay States bonuses for increasing their number of
    adoptions. The appropriation allows incentive payments to be
    made for adoptions completed prior to September 30, 2007.

    Adoption Awareness

        The Committee recommends $12,802,000 for fiscal year 2006
    for adoption awareness. The comparable funding level for fiscal
    year 2005 is $12,802,000 and the budget request includes
    $12,802,000 for this program.
        This program was authorized in the Children's Health Act of
    2000. The program consists of two activities: the Infant
    Adoption Awareness Training Program and the Special Needs
    Awareness Campaign. The Infant Adoption Awareness Training
    Program provides grants to support adoption organizations in
    the training of designated health staff, in eligible health
    centers that provide health services to pregnant women, to
    inform them about adoption and make referrals on request on an
    equal basis with all other courses of action. Within the
    Committee recommendation, $9,826,000 is available for this
    purpose.
        The Special Needs Adoption Campaign supports grants to
    carry out a national campaign to inform the public about the
    adoption of children with special needs. The Committee
    recommendation includes $2,976,000 to continue this important
    activity.

    Compassion Capital Fund

        The Committee recommends $95,000,000 for fiscal year 2006
    for the compassion capital fund. The comparable funding level
    for fiscal year 2005 is $54,549,000 and the budget request
    includes $100,000,000 for this program.
        The Committee expects funds made available through this
    program to supplement and not supplant private resources and
    encourages the Secretary to require private resources to match
    grant funding provided to public/private partnerships.
        Funds available will support grants to charitable
    organizations to emulate model social service programs and to
    encourage research on the best practices of social service
    organizations.
        Of the funds provided, $45,000,000 is for a new anti-gang
    initiative. Competitive grants will be awarded to community and
    faith-based organizations that will foster supportive
    relationships with youths ages 8-17 through targeted street
    outreach, direct youths to social services, and present
    alternatives to gang involvement. These grants will be
    especially helpful in urban areas such as Philadelphia that
    have experienced alarming increases in youth gang violence.

    Social Services Research

        The Committee recommends $32,012,000 for fiscal year 2006
    for the social services research. The comparable funding level
    for fiscal year 2005 is $32,012,000 and the budget request
    includes $6,000,000 for this program.
        The Committee has funded $6,000,000 of this program through
    transfers available under section 241 of the Public Health
    Service Act. These funds support cutting-edge research and
    evaluation projects in areas of critical national interest.
    Research includes determining services that are more cost-
    effective and alternative ways to increase the economic
    independence of American families.
        The Committee notes ACF's efforts to assist States with
    meeting the extensive record-keeping, reporting and tracking
    requirements of the TANF program. Working through the State
    information technology consortium, ACF is providing States with
    the tools necessary to strengthen and improve the complex IT
    systems required to support TANF. Plans are now underway to
    pilot test a data exchange program that will offer States a
    faster, less expensive means of validating, accessing,
    modifying and recording TANF data elements. Similarly, on
    behalf of Child Support Enforcement, the consortium is helping
    to expand data exchange capabilities between the courts and
    State child support enforcement agencies as well as increase
    collection efficiency in States and tribal organizations. Next
    steps include accessing existing databases used as primary
    sources for collection-related data of non-custodial parents,
    and enhancing data-matching capabilities to ensure the
    integrity of the information being collected. The Committee
    recommends that both collaborative efforts with the State
    information technology consortium be continued at their current
    levels.

    Abstinence Education

        The Committee recommends $105,500,000 for fiscal year 2006
    for community based abstinence education. The comparable
    funding level for fiscal year 2005 is $103,698,000 and the
    budget request includes $142,545,000 for this program. Within
    the Committee recommendation, $101,000,000 is provided for
    community-based abstinence education, $4,500,000 is provided
    through an evaluation set-aside, as requested by the
    administration. In addition, $50,000,000 is available from pre-
    appropriated mandatory funds.
        This program provides support for the development and
    implementation of abstinence education programs for
    adolescents, ages 12 through 18. These programs are unique in
    that their entire focus is to educate young people and create
    an environment within communities that supports teen decisions
    to postpone sexual activity until marriage.
        Of the funds provided up to $10,000,000 may be available
    for a national abstinence media campaign. The Committee
    understands that a portion of fiscal year 2005 funds will be
    used for evaluation purposes. The Committee intends that ACF
    use available funds to continue support for an independent
    group to conduct a thorough and rigorous evaluation of this
    campaign.

    Developmental Disabilities

        The Committee recommends $171,561,000 for fiscal year 2006
    for programs administered by the Administration on
    Developmental Disabilities. The comparable funding level for
    fiscal year 2005 is $168,575,000 and the budget request
    includes $168,561,000 for these programs. Within the funds
    provided, $156,682,000 is for carrying out the Developmental
    Disability Act, and $14,879,000 is for carrying out the Help
    America Vote Act of 2002.
        The Administration on Developmental Disabilities supports
    community-based delivery of services which promote the rights
    of persons of all ages with developmental disabilities.
    Developmental disability is defined as severe, chronic
    disability attributed to mental or physical impairments
    manifested before age 22, which causes substantial limitations
    in major life activities. The ADD also administers monies for
    election assistance for individuals with disabilities. This
    program is for individuals with any type of disability.
        Of the funds provided, the Committee recommends $72,496,000
    for State councils. These councils assist each State in
    promoting the development of a comprehensive, statewide,
    consumer and family-centered system which provides a
    coordinated array of culturally-competent services, and other
    assistance for individuals with development disabilities. State
    councils undertake a range of activities including
    demonstration of new approaches, program and policy analysis,
    interagency collaboration and coordination, outreach and
    training.
        The Committee recommends $39,109,000 for protection and
    advocacy grants. This formula grant program provides funds to
    States to establish protection and advocacy systems to protect
    the legal and human rights of persons with developmental
    disabilities who are receiving treatment, services, or
    rehabilitation within the State.
        The Committee recommends $14,879,000 for disabled voter
    services. Of these funds, $10,000,000 is to promote disabled
    voter access, and the remaining $4,879,000 is for disabled
    voters protection and advocacy systems. The election assistance
    for individuals with disabilities program was authorized in the
    Help America Vote Act of 2002. The program enables an applicant
    to establish, expand, and improve access to, and participation
    by, any individual with a disability in the election process.
        The Committee recommends $11,529,000 for projects of
    national significance to assist persons with developmental
    disabilities. This program funds grants and contracts providing
    nationwide impact by developing new technologies and applying
    and demonstrating innovative methods to support the
    independence, productivity, and integration into the community
    of persons with developmental disabilities. The Committee
    recognizes the potential benefits that assistive technology can
    have for individuals with developmental disabilities. Of these
    funds, $4,000,000 is available to expand activities of the
    Family Support Program. The Committee's placement of funds for
    family support within the Projects of National Significance
    account does not provide ACF with discretion on this definition
    of family support as defined in Title II of the Developmental
    Disability Act. The Committee makes a crucial distinction
    between support services designed for families of children with
    disabilities and support services designed for an individual
    with a disability. The Committee intends that these funds be
    used for the support and assistance of families of children
    with disabilities, in accordance with the statute.
        The Committee recommends $33,548,000 for the University
    Centers for Excellence in Developmental Disabilities [UCEDDs]
    which is a network of 61 centers that are interdisciplinary
    education, research and public service units of a university
    system or are public or non-profit entities associated with
    universities. UCEDDs conduct research, develop evidence based
    practices and teach thousands of parents, professionals,
    students and people with disabilities about critical disability
    areas such as early intervention, health care, community-based
    services, inclusive and meaningful education, transition from
    school to work, employment, housing, assistive technology,
    aging with a disability and transportation. The Centers serve
    as the major vehicle to translate disability related research
    into community practice and service systems and to train the
    next cohort of future professionals who will provide services
    and supports to an increasingly diverse population of people
    with disabilities.
        The increase provided in the bill will allow funding for
    the three new Centers established in fiscal year 2005 to be
    increased to the same grant award level as the existing 61
    Centers, as well as to establish additional Center grants in
    the States that currently have unserved and underserved
    populations, and support additional training initiatives.

    Native American Programs

        The Committee recommends $44,780,000 for fiscal year 2006
    for Native American programs. The comparable funding level for
    fiscal year 2005 is $44,786,000 and the budget request includes
    $44,780,000 for this program.
        The Administration for Native Americans [ANA] assists
    Indian tribes and Native American organizations in planning and
    implementing long-term strategies for social and economic
    development through the funding of direct grants for individual
    projects, training and technical assistance, and research and
    demonstration programs.

    Community Services

        The Committee recommends $708,895,000 for fiscal year 2006
    for the community services programs. The comparable funding
    level for fiscal year 2005 is $726,506,000 and the budget
    request includes $24,699,000 for this program.
        Within the funds provided, the Committee recommends
    $636,793,000 for the community services block grant [CSBG].
    These funds are used to make formula grants to States and
    Indian tribes to provide a wide range of services and
    activities to alleviate causes of poverty in communities and to
    assist low-income individuals in becoming self-sufficient.
        The Committee rejects the administration's recommendation
    to eliminate the community services block grant funding.
    Although a restrictive Committee allocation prevented CSBG
    funding from being increased this year, the Committee continues
    to recognize the importance of CSBG and the Community Action
    Agencies it funds in helping meet the extraordinary challenges
    facing low-income communities.
        The Nation's Community Action Agency network relies on CSBG
    funding to help initiate and administer programs designed to
    alleviate poverty. The universal characteristic of these CSBG-
    funded programs is that they provide people with the resources
    and the tools to become self-sufficient. The Committee
    understands that the Department of Health and Human Services,
    and its Office of Community Services in particular, could
    better use this network in developing future policy
    initiatives. The Committee notes that in a number of States,
    including Iowa and Pennsylvania, CAA-initiated family
    development and self-sufficiency programs are a integral
    component of welfare reform efforts. The administration is
    encouraged to look for further nationwide linkages between
    those individuals seeking to leave the welfare system and
    become self-sufficient and the many family development and
    self-sufficiency strategies operated by Community Action
    Agencies.
        The Committee expects the Office of Community Services
    [OCS] to release funding to States in the most timely manner
    and also expects States to make funds available promptly. The
    Committee is aware that the Office of Community Services and
    some States have been extraordinarily delinquent in providing
    funds to local eligible entities.
        In addition, the Committee again expects the Office of
    Community Services to inform the State CSBG grantees of any
    policy changes affecting carryover CSBG funds within a
    reasonable time after the beginning of the Federal fiscal year.
        Several other discretionary programs are funded from this
    account. Funding for these programs is recommended at the
    following levels for fiscal year 2006: community economic
    development, $32,731,000; individual development accounts,
    $24,699,000; rural community facilities, $7,492,000; and
    community food and nutrition, $7,180,000. The Committee did not
    provide funds for the national youth sports program.
        The Committee continues to support strongly the Community
    Economic Development program because of the substantial record
    of achievement that Community Development Corporations have
    complied in working in distressed urban and rural communities.
    The Committee, in particular, notes that Federal funds leverage
    substantial non-Federal resources in meeting the objectives of
    this program. Therefore, it is the Committee's intent that
    appropriated funds should be allocated to the maximum extent
    possible in the form of grants to qualified Community
    Development Corporations in order to maximize the leveraging
    power of the Federal investment and the number and amount of
    set-asides should be reduced to the most minimal levels. The
    Committee requests an operation plan for how OCS plans to use
    appropriated funds consistent with the Committee's
    expectations. This plan should include a detailed breakdown of
    planned expenditures for program support, technical assistance,
    contracts, and research and grants.
        Community economic development grants are made to private,
    nonprofit community development corporations, which in turn
    provide technical and financial assistance to business and
    economic development projects that target job and business
    opportunities for low income citizens. The Committee has
    included bill language clarifying that Federal funds made
    available through this program may be used for financing for
    construction and rehabilitation and loans or investments in
    private business enterprises owned by Community Development
    Corporations.
        Of the total provided, the Committee has included
    $5,436,000 for the Job Opportunities for Low-Income Individuals
    [JOLI] program authorized under the Family Support Act to
    target community development activities to create jobs for
    people on public assistance. This demonstration program
    provides grants on a competitive basis to non-profit
    organizations to create new employment and business
    opportunities for TANF recipients and other low-income
    individuals. Funding also supports technical and financial
    assistance for private employers that will result in the
    creation of full-time permanent jobs for eligible individuals.
    The Committee recognizes that continued funding of this program
    would provide opportunities for more low-income individuals.
    The Committee expects that experienced community development
    corporations be given appropriate consideration for grants
    under this program.
        Most of the drinking water and wastewater systems in the
    country that are not in compliance with Federal standards are
    in communities of 3,000 or fewer. Rural Community Assistance
    Programs [RCAPs] use funds available from the Rural Community
    Facilities Program to assist a number of communities in gaining
    access to adequate community facilities, gaining financing for
    new or improved water and wastewater systems and in complying
    with Federal standards.
        The Committee has included bill language allocating funding
    to the Office of Community Services for Rural Community
    Facilities Technical Assistance as authorized under section
    680(3)(B) of the Community Services Block Grant Act. In
    providing this funding, the Committee expects that it be used
    solely for the purpose of improving water and wastewater
    facilities in poor, rural communities. The Committee intends
    that funds provided above the request shall be made available
    to the six regional RCAPs.
        The Committee is concerned that many small and very small
    community water and wastewater treatment systems might be most
    vulnerable to terrorist attack, and yet least prepared to deal
    with the issue. The Committee urges OCS to continue to support
    RCAP Small Community Infrastructure Safety and Security
    Training and Technical Assistance project, which provides
    State, regional and national infrastructure safety and security
    training workshops and on-site technical assistance targeted to
    small and very small community water and wastewater treatment
    systems. The goal of the project is to improve the capacity of
    small systems to better prepare for emergencies, develop
    emergency preparedness training manuals for small water
    systems, identify appropriate technologies to secure such
    systems, and provide technical assistance to small communities
    struggling to deal with these issues.

    Domestic Violence Hotline

        The Committee recommends $3,000,000 for fiscal year 2006
    for the national domestic violence hotline. The comparable
    funding level for fiscal year 2005 is $3,224,000 and the budget
    request includes $3,000,000 for this program.
        This is a cooperative agreement which funds the operation
    of a national, toll-free, 24-hours-a-day telephone hotline to
    provide information and assistance to victims of domestic
    violence.

    Battered Women's Shelters

        The Committee recommends $125,991,000 for fiscal year 2006
    for battered women's shelters program. The comparable funding
    level for fiscal year 2005 is $125,630,000 and the budget
    request includes $125,991,000 for this program.
        This is a formula grant program to support community-based
    projects which operate shelters and provide related assistance
    for victims of domestic violence and their dependents. Emphasis
    is given to projects which provide counseling, advocacy, and
    self-help services to victims and their children.

    Early Learning Opportunities Program

        The Committee does not include funds for fiscal year 2006
    for the early learning opportunities program. The comparable
    funding level for fiscal year 2005 is $35,712,000 and the
    budget request did not include funds for this program.
        This program supports grants to local community councils
    comprised of representatives from agencies involved in early
    learning programs, parent organizations and key community
    leaders. Funds are used to increase the capacity of local
    organizations to facilitate development of cognitive skills,
    language comprehension and learning readiness; enhance
    childhood literacy; improve the quality of early learning
    programs through professional development and training; and
    remove barriers to early learning programs.

    Faith-Based Center

        The Committee recommends $1,400,000 for fiscal year 2006
    for the operation of the Department's Center for Faith-Based
    and Community Initiatives. The comparable funding level for
    fiscal year 2005 is $1,375,000 and the budget request includes
    $1,400,000 for this program.

    Mentoring Children of Prisoners

        The Committee recommends $49,993,000 for fiscal year 2006
    for mentoring children of prisoners. The comparable funding
    level for fiscal year 2005 is $49,598,000 and the budget
    request includes $49,993,000 for this program.
        The mentoring children of prisoners program was authorized
    in 2001 under section 439 of the Social Security Act. The
    purpose of this program is to help children while their parents
    are imprisoned and includes activities that keep children
    connected to a parent in prison in order to increase the
    chances that the family will come together successfully when
    the parent is released. As a group, children of prisoners are
    less likely than their peers to succeed in school and more
    likely to become engaged in delinquent behavior.

    Independent Living Training Vouchers

        The Committee recommends $46,623,000 for fiscal year 2006
    for independent living training vouchers. The comparable
    funding level for fiscal year 2005 is $46,623,000 and the
    budget request includes $59,999,000 for this program.
        These funds will support vouchers of up to $5,000 for
    college tuition, or vocational training for individuals who age
    out of the foster care system so they can be better prepared to
    live independently and contribute productively to society.
    Studies have shown that 25,000 youth leave foster care each
    year at age 18 and just 50 percent will have graduated high
    school, 52 percent will be unemployed and 25 percent will be
    homeless for one or more nights.

    Program Administration

        The Committee recommends $186,000,000 for fiscal year 2006
    for program administration. The comparable funding level for
    fiscal year 2005 is $185,210,000 and the budget request
    includes $185,217,000 for this program.
        The Committee continues its interest in the Department's
    Child and Family Services reviews. These reviews are an
    effective method for monitoring the progress States are making
    in assuring the safety, health, and permanency for children in
    child welfare and foster care as required in the Adoption and
    Safe Families Act. The Committee encourages the Department to
    make available sufficient resources to ensure full
    implementation of the new collaborative monitoring system. The
    Committee directs ACF to continue to provide information on the
    progress of the reviews in the annual congressional
    justification.

                       PROMOTING SAFE AND STABLE FAMILIES

    Appropriations, 2005....................................    $403,586,000
    Budget estimate, 2006...................................     410,000,000
    House allowance.........................................     404,000,000
    Committee recommendation................................     395,000,000

        The Committee recommends $395,000,000 for fiscal year 2006
    for promoting safe and stable families. The comparable funding
    level for fiscal year 2005 is $403,586,000 and the budget
    request includes $410,000,000 for this program.
        Funding available provides grants to States in support of:
    (1) family preservation services; (2) time-limited family
    reunification services; (3) community-based family support
    services; and (4) adoption promotion and support services. The
    Committee notes that most of the Federal funding related to
    child welfare is provided for the removal and placement of
    children outside of their own homes. Funds available through
    the Promoting Safe and Stable Families program are focused on
    supporting those activities that can prevent family crises from
    emerging which might require the temporary or permanent removal
    of a child from his or her own home.
        The Promoting Safe and Stable Families program is comprised
    of $305,000,000 in capped entitlement funds authorized by the
    Social Security Act and $90,000,000 in discretionary
    appropriations.

           PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

    Appropriations, 2005....................................  $5,037,900,000
    Budget estimate, 2006...................................   4,852,800,000
    House allowance.........................................   4,852,800,000
    Committee recommendation................................   4,852,800,000

        The Committee recommends $4,852,800,000 for fiscal year
    2006 for payments to States for foster care and adoption
    assistance. The comparable funding level for fiscal year 2005
    is $5,037,900,000 and the budget request includes
    $4,852,800,000 for this program. In addition, the Committee
    recommendation concurs with the administration's request of
    $1,730,000 for an advance appropriation for the first quarter
    of fiscal year 2007.
        The Foster Care Program provides Federal reimbursement to
    States for: maintenance payments to families and institutions
    caring for eligible foster children, matched at the Federal
    medical assistance percentage [FMAP] rate for each State; and
    administration and training costs to pay for the efficient
    administration of the Foster Care Program, and for training of
    foster care workers and parents.
        The Adoption Assistance Program provides funds to States
    for maintenance costs and the nonrecurring costs of adoption
    for children with special needs. The goal of this program is to
    facilitate the placement of hard-to-place children in permanent
    adoptive homes, and thus prevent long, inappropriate stays in
    foster care. As in the Foster Care Program, State
    administrative and training costs are reimbursed under this
    program.
        The Independent Living Program provides services to foster
    children under 18 and foster youth ages 18-21 to help them make
    the transition to independent living by engaging in a variety
    of services including educational assistance, life skills
    training, health services and room and board. States are
    awarded grants from the annual appropriation proportionate to
    their share of the number of children in foster care, subject
    to a matching requirement.

                            Administration on Aging

    Appropriations, 2005....................................  $1,393,342,000
    Budget estimate, 2006...................................   1,369,028,000
    House allowance.........................................   1,376,217,000
    Committee recommendation................................   1,391,699,000

        The Committee recommends an appropriation of $1,391,699,000
    for aging programs. This amount is $1,643,000 below the
    comparable fiscal year 2005 level and $22,671,000 above the
    administration request.

    Supportive Services and Senior Centers

        The Committee recommends an appropriation of $354,136,000
    for supportive services and senior centers, which is the same
    as the comparable fiscal year 2005 level and the administration
    request. This State formula grant program funds a wide range of
    social services for the elderly, including multipurpose senior
    centers, adult day care, and ombudsman activities. State
    agencies on aging award funds to designated area agencies on
    aging who in turn make awards to local services providers. All
    individuals age 60 and over are eligible for services,
    although, by law, priority is given to serving those who are in
    the greatest economic and social need, with particular
    attention to low-income minority older individuals and those
    residing in rural areas. Under the basic law, States have the
    option to transfer up to 30 percent of funds appropriated
    between the senior centers program and the nutrition programs,
    which allows the State to determine where the resources are
    most needed.

    Preventive Health Services

        The Committee recommends $21,616,000 for preventive health
    services, which is the same as the comparable fiscal year 2005
    level and the administration request. Funds appropriated for
    this activity are part of the comprehensive and coordinated
    service systems targeted to those elderly most in need.
    Preventive health services include nutritional counseling and
    education, exercise programs, health screening and assessments,
    and prevention of depression.

    Protection of Vulnerable Older Americans

        The Committee recommends $20,360,000 for grants to States
    for protection of vulnerable older Americans. This is
    $1,072,000 above the comparable fiscal year 2005 level and
    $1,000,000 above the administration request. Within the
    Committee recommendation, $15,162,000 is for the ombudsman
    services program and $5,198,000 is for the prevention of elder
    abuse program. Both programs provide formula grants to States
    to prevent the abuse, neglect, and exploitation of older
    individuals. The ombudsman program focuses on the needs of
    residents of nursing homes and board and care facilities, while
    elder abuse prevention targets its message to the elderly
    community at large.

    National Family Caregiver Support Program

        The Committee recommends $160,744,000 for the national
    family caregiver support program, which is $5,000,000 above the
    comparable fiscal year 2005 level and the administration
    request. Funds appropriated for this activity established a
    multifaceted support system in each State for family
    caregivers. All States are expected to implement the following
    five components into their program: individualized referral
    information services; assistance to caregivers in locating
    services from a variety of private and voluntary agencies;
    caregiver counseling, training and peer support; respite care
    provided in the home, an adult day care center or other
    residential setting located in an assisted living facility; and
    limited supplemental services that fill remaining service gaps.

    Native American Caregiver Support Program

        The Committee recommendation includes $6,304,000 to carry
    out the Native American Caregiver Support Program, which is the
    same as the comparable fiscal year 2005 level and the
    administration request. The program will assist tribes in
    providing multifaceted systems of support services for family
    caregivers and for grandparents or older individuals who are
    relative caregivers.

    Congregate and Home-delivered Nutrition Services

        For congregate nutrition services, the Committee recommends
    an appropriation of $387,274,000, which is the same as the
    comparable fiscal year 2005 level and the administration
    request. For home-delivered meals, the Committee recommends
    $182,827,000, which is the same as the comparable fiscal year
    2005 level and $1,000 above the administration request. These
    programs address the nutritional need of older individuals.
    Projects funded must make home-delivered and congregate meals
    available at least once a day, 5 days a week, and each meal
    must meet one-third of the minimum daily dietary requirements.
    While States receive separate allotments of funds for
    congregate and home-delivered nutrition services and support
    services, they are permitted to transfer up to 40 percent of
    funds between these programs.

    Nutrition Services Incentives Program

        The Committee recommendation includes $148,596,000 for the
    nutrition services incentives program [NSIP], the same as the
    comparable fiscal year 2005 funding level and the
    administration request. This program augments funding for
    congregate and home-delivered meals provided to older adults.
    Funds provided under this program are dedicated exclusively to
    the provision of meals. NSIP rewards effective performance by
    States and Tribal organizations in the efficient delivery of
    nutritious meals to older individuals through the use of cash
    or commodities.

    Aging Grants to Indian Tribes and Native Hawaiian Organizations

        The Committee recommends $26,398,000 for grants to Native
    Americans, which is the same as the comparable fiscal year 2005
    funding level and the administration request. Under this
    program awards are made to tribal and Alaskan Native
    organizations and to public or nonprofit private organizations
    serving native Hawaiians which represent at least 50 percent
    Indians or Alaskan Natives 60 years of age or older to provide
    a broad range of supportive services and assure that nutrition
    services and information and assistance are available.
        The Committee recognizes that this program is the primary
    vehicle for providing nutrition and other supportive services
    to Indian, Alaska Native, and Native Hawaiian elders. The
    Committee urges the Administration on Aging to devote its
    attention toward this purpose.

    Training, Research, and Discretionary Projects

        The Committee recommends $40,513,000 for training,
    research, and discretionary projects, which is $2,773,000 below
    the comparable fiscal year 2005 level and $16,670,000 above the
    administration request. These funds support activities designed
    to expand public understanding of aging and the aging process,
    apply social research and analysis to improve access to and
    delivery of services for older individuals, test innovative
    ideas and programs to serve older individuals, and provide
    technical assistance to agencies that administer the Older
    Americans Act. Given the enormous demands on Alzheimer's family
    caregivers, the Committee has included $1,000,000 to support an
    Alzheimer's family contact center for round-the-clock help to
    Alzheimer's families in crisis.
        The Committee continues to support funding at no less than
    last year's level for national programs scheduled to be
    refunded in fiscal year 2006 that address a variety of issues,
    including elder abuse, Native American issues, and legal
    services.
        The Committee encourages the Administration on Aging to
    facilitate the expansion of demonstration projects gauging the
    efficiency of nurse-managed Geriatric Wellness Centers.
        The Committee expects the Administration on Aging to
    continue to fund the national program of statewide senior legal
    services hotlines (also called legal helplines) at their
    current levels and ideally to provide an increase in the number
    of States served by these legal hotlines.
        The Committee is aware of innovative program models aimed
    at mobilizing older Americans, particularly the 77 million baby
    boomers, to serve their communities. The Committee encourages
    the agency to develop partnerships with organizations that
    enable older Americans to help meet critical social needs
    effectively.

    Aging Network Support Activities

        The Committee recommends $13,266,000 for aging network
    support activities, the same as the comparable amount for
    fiscal year 2005 and the administration request. The Committee
    recommendation includes funding at the administration request
    level for the Eldercare Locator and for the Pension Information
    and Counseling Program.
        The Eldercare Locator, a toll-free, nationwide directory
    assistance service for older Americans and their caregivers, is
    operated by the National Association of Area Agencies on Aging.
    Since 1991, the service has linked more than 700,000 callers to
    an extensive network of resources for aging Americans and their
    caregivers.
        Pension counseling projects provide information, advice,
    and assistance to workers and retirees about pension plans,
    benefits, and how to pursue claims when pension problems arise.
    The information dissemination and outreach activities of the
    pension counseling projects have served over 25,000 people and
    has helped obtain more than $50,000,000 in retirement benefits
    for older individuals.
        The Committee has provided funding at the administration
    request level for the National Long Term Care Ombudsman
    Resource Center, the National Center on Elder Abuse and the
    Health Care Anti-Fraud, Waste and Abuse Program.

    Alzheimer's Disease Demonstration Grants to States

        As a result of the aging of the baby boom generation, the
    number of individuals affected by Alzheimer's disease will
    double in the next 20 years. The Committee recommends a funding
    level of $11,786,000 for Alzheimer's disease demonstration
    grants to States. This is the same as the comparable fiscal
    year 2005 funding level and the administration request.
        Currently, an estimated 70 percent of individuals with
    Alzheimer's disease live at home, where families provide the
    preponderance of care. For these families, caregiving comes at
    enormous physical, emotional, and financial sacrifice. The
    Alzheimer's disease demonstration grant program currently
    provides matching grants to 38 States to stimulate and better
    coordinate services for families coping with Alzheimer's. With
    a relatively small amount of Federal support to provide the
    stimulus, States have found innovative ways to adapt existing
    health, long-term care, and community services to reach
    previously underserved populations, particularly minorities and
    those living in rural communities.

    White House Conference on Aging

        The Committee recommendation does not include funding for
    the White House Conference on Aging. This conference will be
    held in December 2005 and is required by the Older Americans
    Act Amendments of 2000. White House Conferences on Aging are
    decennial events held to develop recommendations for the
    President and Congress on issues, policy, and research in the
    field of aging.

    Program Administration

        The Committee recommends $17,879,000 for program
    administration, which is $422,000 below the comparable fiscal
    year 2005 funding level and the same as the administration
    request. These funds support salaries and related expenses for
    program management and oversight activities.

                            Office of the Secretary

                        GENERAL DEPARTMENTAL MANAGEMENT

    Appropriations, 2005....................................    $369,931,000
    Budget estimate, 2006...................................     359,176,000
    House allowance.........................................     344,546,000
    Committee recommendation................................     359,465,000

        The Committee recommends $359,465,000 for general
    departmental management [GDM]. This amount is $10,466,000 below
    the comparable level for fiscal year 2005 and $289,000 above
    the administration request. The Committee recommendation
    includes the transfer of $5,851,000 from Medicare trust funds,
    which is the same as the administration request. In addition,
    for policy evaluation activities the Committee recommends
    $39,552,000 in transfers available under section 241 of the
    Public Health Service Act.
        The Committee directs that specific information requests
    from the chairman and ranking member of the Subcommittee on
    Labor, Health and Human Services, and Education, and Related
    Agencies, on scientific research or any other matter, shall be
    transmitted to the Committee on Appropriations in a prompt
    professional manner and within the time frame specified in the
    request. The Committee further directs that scientific
    information requested by the Committees on Appropriations and
    prepared by Government researchers and scientists be
    transmitted to the Committee on Appropriations, uncensored and
    without delay.
        This appropriation supports those activities that are
    associated with the Secretary's role as policy officer and
    general manager of the Department. It supports certain health
    activities performed by the Office of Public Health and
    Science, including the Office of the Surgeon General. GDM funds
    also support the Department's centralized services carried out
    by several Office of the Secretary staff divisions, including
    personnel management, administrative and management services,
    information resources management, intergovernmental relations,
    legal services, planning and evaluation, finance and
    accounting, and external affairs.
        The Office of the Surgeon General, in addition to its other
    responsibilities, provides leadership and management oversight
    for the PHS Commissioned Corps, including the involvement of
    the Corps in departmental emergency preparedness and response
    activities.
        The Committee recommendation includes $3,000,000 for the
    Citizens' Health Care Working Group which was authorized by the
    Medicare Prescription Drug, Improvement, and Modernization Act
    of 2003. These funds are available for all activities of the
    Working Group, including preparation and distribution of
    reports.
        Advance Directives.--The Committee believes that through
    the execution of advance directives, including living wills and
    durable powers of attorney for health care according to the
    laws of the State in which they reside, individuals can better
    protect their right to express their wishes about end-of-life
    care and have those wishes respected. The Committee directs the
    Secretary to conduct a study to determine the best way to
    promote the use of advance directives among competent adults as
    a means of specifying their wishes about end of life care, and
    provide recommendations to Congress on changes to Federal law
    needed to ensure appropriate use of advance directives. As part
    of that study, the Department shall consider that decisions
    relating to advance directives are often made without adequate
    information about what it is like to live with a significant
    disability. The Committee intends that the study directly
    involve persons with disabilities, family members, disability
    experts and organizations in assessing this reality and
    identifying what information and support is necessary. This
    study should also review options related to those individuals
    whose significant cognitive disabilities limit or prohibit them
    from making decisions about directing their care and treatment.
        Childhood Drinking.--In April 2004 the Secretary created,
    at the request of Congress, an Interagency Coordinating
    Committee on the Prevention of Underage Drinking [ICCPUD],
    chaired by the Administrator of SAMHSA. Since then the ICCPUD
    has developed a draft plan for combating underage drinking
    which contained a complete listing of Federal programs related
    to underage drinking prevention. However, the Committee is
    concerned that the ICCPUD has not made more progress; it has
    not produced meaningful coordination among Federal agencies,
    identified effective and underperforming programs, or created a
    plan for improving Federal data collection. In addition, the
    ICCPUD has not identified the resources currently available for
    programs targeting underage drinking or made recommendations on
    the allocation of additional resources. Finally, the interim
    plan lacks measurable goals or benchmarks which would serve to
    monitor the progress and accountability of the ICCPUD's
    efforts. The Committee looks forward to the ICCPUD's final plan
    to be issued later this year and hopes that it will address
    these issues.
        Chiropractic Care.--The Committee notes that chiropractic
    health care services are now available to beneficiaries within
    the Department of Veterans' Affairs health care system, the
    Department of Defense health care program for active duty
    military personnel and, through a demonstration, within the
    Medicare health program. Despite this broad integration of
    chiropractic care into the mainstream of Federal and private
    sector health care systems, the Committee notes that there are
    not Doctors of Chiropractic Medicine commissioned to serve
    within the U.S. Public Service Commissioned Corps. The
    Committee notes that authority for the Surgeon General to
    appoint such commissioned officers exists under current law,
    but that none have been appointed. The Committee encourages the
    Surgeon General to begin to develop a plan to commission
    Doctors of Chiropractic into the U.S. Public Health Service
    Commissioned Corps and directs the Surgeon General to update
    the Committee on its progress within 6 months after enactment
    of this Act.
        Chronic Fatigue.--The Committee is pleased that the
    Department's Chronic Fatigue Syndrome Advisory Committee
    [CFSAC] has been meeting quarterly. This advisory committee
    serves an important role in setting priorities for Federal
    research and education programs related to chronic fatigue
    syndrome [CFS] and in keeping the Department abreast of the
    needs of persons with CFS. The Committee awaits the Secretary's
    written response to the CFSAC's recommendations dated August
    23, 2004.
        Health Disparities.--The Committee is committed to ensuring
    the overall improved health of the American people, and
    strongly urges the Secretary to intensify efforts to implement
    recommendations developed by the Institute of Medicine's
    Unequal Treatment: Confronting Racial and Ethnic Disparities in
    Health Care study. The recommendations offer significant
    guidelines and opportunities for eliminating health disparities
    and improving health across all populations. The Committee
    expects the Secretary to report on the progress of this action
    during next year's appropriations hearings.
        Hepatitis C-HIV Co-infection.--The Committee is concerned
    with the growing co-infection of individuals with both HIV and
    hepatitis C and notes that the largest single cause of death of
    individuals with HIV infection is now liver disease. The
    Committee is pleased that, in response to this high co-
    infection rate, approximately 20 of the State AIDS Drug
    Assistance Programs [ADAP] have now included Hepatitis C
    pharmaceuticals on their formularies. The Committee notes that
    the Ryan White Care Act requires the Secretary to issue
    guidelines regarding appropriate treatments under the program
    and requests that the Secretary review and re-issue these
    treatment guidelines to address the treatment issues and
    formulary requirements associated with the significant co-
    infection rate of HIV and hepatitis C.
        HIV1-2 Rapid Testing.--The Committee is aware that wide-
    scale deployment of new oral fluid testing for AIDS is a
    significant step towards helping citizens, throughout the
    United States and around the world, to know their HIV status.
    The Committee urges the Secretary to significantly increase the
    use of bulk purchasing and wide-scale deployment of FDA-
    approved oral fluid HIV1-2 rapid tests for domestic and
    international programs.
        Parental Website.--It has come to the Committee's attention
    that an independent study reviewed 4parents.gov, the
    Department's website created to help parents counsel their
    teenagers about risky health behaviors. While noting positive
    aspects about the website, the study found numerous examples of
    inaccurate information. The Committee is aware that this web
    site was designed by outside contractors, not by the
    Department's public health experts. The Committee directs the
    Department to review the findings of the study, undertake a
    review of the website by Departmental public health and
    scientific experts, and make any necessary changes to conform
    with scientific evidence. The Committee also directs the
    Department to include scientifically accurate information about
    underage drinking and tobacco use.
        Sleep Disorders.--At the National Institutes of Health's
    Frontiers of Knowledge in Sleep and Sleep Disorders conference
    in March of 2004, the U.S. Surgeon General reported on the
    profound impact that chronic sleep loss and untreated sleep
    disorders have on Americans of all ages and that the public
    health model is well suited to translate these essential health
    messages to society. The Committee urges the Surgeon General to
    consider development of a Surgeon General's Report on Sleep and
    Sleep Disorders.

    Adolescent Family Life

        The Committee has provided $30,742,000 for the Adolescent
    Family Life Program [AFL], which is the same as the
    administration request. This is $158,000 below the comparable
    fiscal year 2005 level.
        AFL is the only Federal program focused directly on the
    issue of adolescent sexuality, pregnancy, and parenting.
    Through demonstration grants and contracts, AFL focuses on a
    comprehensive range of health, educational, and social services
    needed to improve the health of adolescents, including the
    complex issues of early adolescent sexuality, pregnancy, and
    parenting.

    Minority Health

        The Committee recommends $50,980,000 for the Office of
    Minority Health, which is $462,000 above the comparable level
    for fiscal year 2005 and $3,744,000 above the administration
    request.
        The Office of Minority Health [OMH] focuses on strategies
    designed to decrease the disparities and to improve the health
    status of racial and ethnic minority populations in the United
    States. OMH establishes goals, and coordinates all departmental
    activity related to improving health outcomes for disadvantaged
    and minority individuals. OMH supports several demonstration
    projects, including the Minority Community Health Coalition,
    the Bilingual/Bicultural Service, the Center for Linguistic and
    Cultural Competency in Health Care, and the Family and
    Community Violence Prevention Program.
        The Committee expects OMH and the National Center for
    Minority Health and Health Disparities at the National
    Institutes of Health to play a joint role in coordinating and
    monitoring the implementation of the Department's elimination
    of health disparities initiatives and strategic plans. The
    Committee expects the Secretary to report on the progress and
    implementation of the strategic plans during next year's
    appropriations hearings, and to include a progress update in
    the Department's Budget Justification.

    Office on Women's Health

        The Committee recommends $28,715,000 for the Office on
    Women's Health. This is $103,000 below the comparable level for
    fiscal year 2005 and the same as the administration request.
        The PHS Office on Women's Health [OWH] develops,
    stimulates, and coordinates women's health research, health
    care services, and public and health professional education and
    training across HHS agencies. It advances important
    crosscutting initiatives and develops public-private
    partnerships, providing leadership and policy direction, and
    initiating and synthesizing program activities to redress the
    disparities in women's health.
        Bodywise.--The Committee is impressed with the efforts of
    the OWH to address the growing problem of negative body image
    and eating disorders through the Bodywise Project. This has
    been a widely successful project and the Committee urges the
    Secretary to continue this educational initiative and broaden
    the efforts by collaborating with the Department of Education
    to disperse the educational materials resulting from Bodywise
    and expand the educational project to target all levels of
    education from elementary to high school.
        Lupus.--The Committee understands that Lupus is a serious,
    complex, debilitating chronic autoimmune disease that can cause
    inflammation and tissue damage to virtually any organ system in
    the body and impacts an estimated 1.5 and 2 million
    individuals. The Committee is aware that public and
    professional recognition and understanding of lupus is
    extremely low, contributing to misdiagnoses or late diagnoses
    that can result in disability or death. The Committee strongly
    urges OWH to develop and implement a sustained lupus awareness
    and education campaign aimed at reaching health care
    professionals and the general public, with an emphasis on
    reaching women at greatest risk for developing Lupus.
        Offices of Women's Health.--The Committee has great
    interest in women's health and wants to encourage further
    health research, education, and services for women. The
    Committee also recognizes that the Offices of Women's Health
    within the Department, the Food and Drug Administration, the
    Centers for Disease Control and Prevention, the Health
    Resources and Services Administration, and the Agency for
    Healthcare Research and Quality provide critical services in
    support of these needs. The Committee strongly encourages the
    Secretary to see that these offices continue to receive
    sufficient funding to assure their ability to continue to meet
    their missions.

    Afghanistan

        The Committee recommendation includes $5,952,000 for the
    Secretary's Afghanistan health initiative. This amount is the
    same as the comparable fiscal year 2005 funding level and the
    administration request. Funds will be used in partnership with
    the Department of Defense for medical training activities at
    the Rabia Balkhi Women's Hospital in Kabul, and for support of
    maternal and child health throughout Afghanistan.

    Embryo Adoption

        The Committee continues to believe that increasing public
    awareness of embryo donation and adoption remains an important
    goal. The Committee has provided $2,000,000 for the
    Department's embryo adoption awareness campaign, which is
    $1,008,000 more than the comparable fiscal year 2005 funding
    level and the administration request.

    HIV/AIDS in Minority Communities

        To address high-priority HIV prevention and treatment needs
    of minority communities heavily impacted by HIV/AIDS, the
    Committee recommends $52,415,000. This amount is the same as
    the comparable fiscal year 2005 level and the administration
    request. These funds are available to key operating divisions
    of the Department with capability and expertise in HIV/AIDS
    services to assist minority communities with education,
    community linkages, and technical assistance.

    Information Technology Security and Innovation Fund

        The Committee recommendation does not include funding for
    the Information Technology Security and Innovation Fund, which
    is $14,695,000 below the comparable fiscal year 2005 level and
    $14,630,000 below the administration request. This activity
    funds investments such as information technology services,
    security and infrastructure that enable common administrative
    systems throughout the Department.

                    OFFICE OF MEDICARE HEARINGS AND APPEALS

    Appropriations, 2005....................................     $57,536,000
    Budget estimate, 2006...................................      80,000,000
    House allowance.........................................      60,000,000
    Committee recommendation................................      75,000,000

        The Committee provides $75,000,000 for the Office of
    Medicare Hearings and Appeals, which is $17,464,000 above the
    comparable fiscal year 2005 level and $5,000,000 below the
    administration request.
        The Office of Medicare Hearings and Appeals is responsible
    for hearing Medicare appeals at the administrative law judge
    level, which is the third level of Medicare claims appeals.
    Since fiscal year 1995 these appeals have been processed by the
    Social Security Administration under an interagency agreement
    with the Centers for Medicare and Medicaid Services. This
    function was transferred to the Office of the Secretary by the
    Medicare Prescription Drug, Improvement and Modernization Act
    of 2003.

      OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

    Appropriations, 2005....................................     $24,011,000
    Budget estimate, 2006...................................      77,750,000
    House allowance.........................................      75,000,000
    Committee recommendation................................      45,150,000

        The Committee provides $45,150,000 to the Office of the
    National Coordinator for Health Information Technology
    [ONCHIT]. This amount is $21,139,000 above the comparable
    fiscal year 2005 level and $32,600,000 below the administration
    request. The Committee recommendation includes $12,350,000 in
    transfers available under section 241 of the Public Health
    Service Act. In addition, the Committee has provided
    $50,000,000 for health information technology to the Agency for
    Healthcare Research and Quality.
        The Office of The National Coordinator for Health
    Information Technology is responsible for promoting the use of
    electronic health records in clinical practice, coordinating
    Federal health information systems and collaborating with the
    private sector to develop standards for a nationwide
    interoperable health information technology infrastructure.
        The Committee urges the Coordinator for the ONCHIT to
    conduct outreach activities to all public and private sector
    organizations which have demonstrated capabilities in health
    information technology. The Committee is particularly
    interested in disease management technology as it relates to
    saving health care dollars, and improving care for chronically
    ill individuals and the workforce.
        Interoperability.--The Committee commends the efforts by
    the Secretary to increase interoperability within healthcare.
    Through the Consolidated Health Informatics [CHI] Project, 24
    electronic standards have been identified to allow sharing of
    clinical information. The Committee urges the Secretary to
    implement procedures to enable the Department to accept the
    optional submission of data derived from health care reporting
    requirements for the purposes of quality, surveillance,
    epidemiology, adverse event reporting, or research using the
    electronic standards identified under the CHI project.

                          OFFICE OF INSPECTOR GENERAL

    Appropriations, 2005....................................     $39,930,000
    Budget estimate, 2006...................................      39,813,000
    House allowance.........................................      39,813,000
    Committee recommendation................................      39,813,000

        The Committee recommends an appropriation of $39,813,000
    for the Office of Inspector General, which is the same as the
    administration request. The fiscal year 2005 comparable level
    was $39,930,000. In addition to discretionary funds, the Health
    Insurance Portability and Accountability Act of 1996 provides
    $160,000,000 in mandatory funds for the Office of Inspector
    General in fiscal year 2006; the total funds provided to the
    Office by this bill and the authorizing bill would be
    $199,813,000 in fiscal year 2006.
        The Office of Inspector General conducts audits,
    investigations, inspections, and evaluations of the operating
    divisions within the Department of Health and Human Services.
    The OIG functions with the goal of reducing the incidence of
    waste, abuse, and fraud. It also pursues examples of
    mismanagement toward the goal of promoting economy and
    efficiency throughout the Department.

                            OFFICE FOR CIVIL RIGHTS

    Appropriations, 2005....................................     $35,013,000
    Budget estimate, 2006...................................      34,996,000
    House allowance.........................................      34,996,000
    Committee recommendation................................      34,996,000

        The Committee recommends $34,996,000 for the Office for
    Civil Rights [OCR]. This is the same as the administration
    request. The comparable fiscal year 2005 level was $35,013,000.
    The recommendation includes the transfer of $3,314,000 from the
    Medicare trust funds.
        The Office for Civil Rights is responsible for enforcing
    civil rights-related statutes in health care and human services
    programs. To enforce these statutes, OCR investigates
    complaints of discrimination, conducts program reviews to
    correct discriminatory practices, and implements programs to
    generate voluntary compliance among providers and constituency
    groups of health and human services.

         RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

    Appropriations, 2005....................................    $330,636,000
    Budget estimate, 2006...................................     328,552,000
    House allowance.........................................     328,552,000
    Committee recommendation................................     328,552,000

        The Committee provides an estimated $328,552,000 for
    retirement pay and medical benefits for commissioned officers
    of the U.S. Public Health Service, the same as the
    administration request. The comparable level for fiscal year
    2005 was $330,636,000.
        This account provides for: retirement payments to U.S.
    Public Health Service officers who are retired for age,
    disability, or length of service; payments to survivors of
    deceased officers; medical care to active duty and retired
    members and dependents and beneficiaries; and for payments to
    the Social Security Administration for military service
    credits.

                PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

    Appropriations, 2005....................................  $2,407,415,000
    Budget estimate, 2006...................................   2,427,833,000
    House allowance.........................................     183,589,000
    Committee recommendation................................     183,589,000

        The Committee provides $183,589,000 to the Public Health
    and Social Services Emergency Fund. This is $2,223,826,000
    below the comparable fiscal year 2005 level and $2,244,244,000
    below the administration request. The Committee's
    recommendation for fiscal year 2006 includes $63,589,000 for
    bioterrorism preparedness within the Office of the Secretary
    and $120,000,000 for pandemic flu activities.
        The Committee has provided funding for bioterrorism
    preparedness directly to other agencies within the Department
    instead of to this account as it has done in the past. When
    these funding levels are included, the Committee has provided a
    total of $2,357,581,000 for bioterrorism preparedness, which is
    $49,834,000 less than the comparable fiscal year 2005 level and
    $70,252,000 less than the administration request.
        The Committee is aware that a recent study projected that
    over half a million Americans could die and over 2.3 million
    could be hospitalized if a moderately severe strain of a
    pandemic flu virus hits the United States. Given the potential
    for such a scenario, the Committee urges the Department to
    finalize its August 2004 draft Pandemic Influenza Preparedness
    and Response Plan and make it publicly available. In addition,
    the Committee urges the Department to examine the study's key
    recommendations, including those relating to stockpiling
    medical supplies, and developing emergency communications
    plans; stockpiling additional antivirals and developing surge
    capacity plans for hospitals and health care providers; and
    increasing vaccine production and the development of new
    technologies for vaccines.

          General Provisions, Department of Health and Human Services

        The Committee recommendation continues a provision placing
    a $50,000 ceiling on official representation expenses (sec.
    201).
        The Committee recommendation continues a provision which
    limits the assignment of certain public health personnel (sec.
    202).
        The Committee recommendation retains language regarding
    set-asides in the authorizing statute of the National
    Institutes of Health (sec. 203).
        The Committee recommendation continues a provision limiting
    the use of grant funds to pay individuals no more than an
    annual rate of Executive Level I (sec. 204).
        The Committee recommendation continues a provision
    restricting the Secretary's use of taps for program evaluation
    activities unless a report is submitted to the Appropriations
    Committees on the proposed use of funds (sec. 205).
        The Committee recommendation includes language authorizing
    the transfer of up to 2.5 percent of Public Health Service
    funds for evaluation activities (sec. 206).
        The Committee modifies a provision restricting transfers of
    appropriated funds and requires a 15 day notification to both
    the House and Senate Appropriations Committees (sec. 207).
        The Committee recommendation continues a provision
    permitting the transfer of up to 3 percent of AIDS funds among
    Institutes and Centers by the Director of NIH and the Director
    of the Office of AIDS Research at NIH (sec. 208).
        The Committee recommendation retains language which
    requires that the use of AIDS research funds be determined
    jointly by the Director of the National Institutes of Health
    and the Director of the Office of AIDS Research and that those
    funds be allocated directly to the Office of AIDS Research for
    distribution to the Institutes and Centers consistent with the
    AIDS research plan (sec. 209).
        The Committee recommendation continues a provision
    regarding requirements for family planning applicants (sec.
    210).
        The Committee recommendation retains language which
    restricts the use of funds to carry out the Medicare Advantage
    Program if the Secretary denies participation to an otherwise
    eligible entity (sec. 211).
        The Committee recommendation retains language which States
    that no provider services under Title X of the PHS Act may be
    exempt from State laws regarding child abuse (sec. 212).
        The Committee recommendation retains language which
    prohibits the Secretary from withholding substance abuse
    treatment funds (sec. 213).
        The Committee recommendation continues a provision which
    facilitates the expenditure of funds for international AIDS
    activities (sec. 214).
        The Committee recommendation includes a provision allowing
    the Division of Federal Occupational Health to use personal
    services contracting to employ professional, administrative,
    and occupational health professionals (sec. 215).
        The Committee recommendation retains a provision
    authorizing the Director of the National Institutes of Health
    to enter into certain transactions to carry out research in
    support of the NIH Roadmap Initiative of the Director (sec.
    216).
        The Committee includes a provision that permits the Centers
    for Disease Control and Prevention and the Agency for Toxic
    Substances and Disease Registry to transfer funds that are
    available for Individual Learning Accounts to ``Disease
    Control, Research, and Training'' (sec. 217).
        The Committee recommendation includes bill language
    allowing use of funds to continue operating the Council on
    Graduate Medical Education (sec. 218).
        The Committee recommendation includes a general provision,
    which rescinds $10,000,000 in unobligated balances from amounts
    appropriated in Public Law 108-11 under the heading ``Public
    Health and Social Services Emergency Fund'', the smallpox
    compensation program (sec. 219).
        The Committee recommendation rescinds $15,912,000 of
    unobligated balances in the Health Professions Student Loan
    Program (sec. 220).
        The Committee recommendation extends availability of funds
    for the State Pharmaceutical Assistance Programs (sec. 221).

                       TITLE III--DEPARTMENT OF EDUCATION

                        Education for the Disadvantaged

    Appropriations, 2005.................................... $14,843,974,000
    Budget estimate, 2006...................................  16,431,473,000
    House allowance.........................................  14,728,735,000
    Committee recommendation................................  14,525,135,000

        The Committee recommends an appropriation of
    $14,525,135,000 for education for the disadvantaged. The
    comparable funding level for fiscal year 2005 is
    $14,843,974,000 and the budget request includes $16,431,473,000
    for this account.
        The programs in the education for the disadvantaged account
    help ensure that poor and low-achieving children are not left
    behind in the Nation's effort to raise the academic performance
    of all children and youth. That goal is more pressing than ever
    since the passage of the No Child Left Behind Act, which
    incorporates numerous accountability measures into Title I
    programs, especially part A grants to local educational
    agencies--the largest Federal elementary and secondary
    education program.
        In particular, the law strengthens Title I accountability
    by requiring States to implement statewide accountability
    systems covering all public schools and students. These systems
    must be based on challenging State standards in reading and
    mathematics, annual statewide progress objectives ensuring that
    all groups of students reach proficiency in reading and math by
    the end of the 2013-2014 school year, and annual testing for
    all students in grades 3-8. State progress objectives and
    assessment results must be broken out by poverty, race and
    ethnicity, disability, and limited English proficiency. States,
    school districts, and schools must report annually on their
    progress toward statewide proficiency goals. Districts and
    schools that fail to make adequate yearly progress [AYP] toward
    these goals will, over time, be subject to increasingly
    rigorous improvement, corrective action, and restructuring
    measures aimed at getting them back on course to meet State
    standards. Students attending schools that fail to meet annual
    State AYP objectives for 2 consecutive years will be permitted
    to transfer to a better public school or, if the school
    continues to fail to meet AYP for 3 years or more, to use Title
    I funds to obtain educational services from a public- or
    private-sector provider selected by their parents.
        Funds appropriated in this account primarily support
    activities in the 2006-2007 school year.

    Grants to Local Educational Agencies

        Title I Grants to Local Educational Agencies [LEAs] provide
    supplemental education funding, especially in high-poverty
    areas, for local programs that provide extra academic support
    to help raise the achievement of eligible students or, in the
    case of schoolwide programs, help all students in high-poverty
    schools to meet challenging State academic standards. The
    program serves more than 15 million students in nearly all
    school districts and more than half of all public schools--
    including two-thirds of the Nation's elementary schools.
        Title I schools help students reach challenging State
    standards through one of two models: ``targeted assistance''
    that supplements the regular education program of individual
    children deemed most in need of special assistance, or a
    ``schoolwide'' approach that allows schools to use Title I
    funds--in combination with other Federal, State, and local
    funds--to improve the overall instructional program for all
    children in a school.
        Starting with the fiscal year 2004 appropriation, States
    are required to reserve 4 percent of their allocation under
    this program for school improvement activities, unless such
    action would require a State to reduce the grant award of a
    local educational agency to an amount below the preceding year.
    At the funding level recommended by the Committee for fiscal
    year 2006, this set-aside could generate up to $504,000,000 for
    this purpose. States must distribute 95 percent of these
    reserved funds to local educational agencies for schools
    identified for improvement, corrective action, or
    restructuring. The Committee is concerned about the effect of
    the authorizing language, which in some States is requiring
    high-poverty districts to receive much less funding than they
    would otherwise receive, in order for States to ``hold
    harmless'' other districts and redistribute the required amount
    of school improvement funds. As a result, districts with the
    most eligible children in those States are not receiving the
    funds needed to serve their students adequately. In addition,
    some States are not able to set aside the full 4 percent, which
    means fewer resources to help struggling schools implement
    school improvement plans, support public school choice or offer
    supplemental education services.
        More than any other Federal program, Title I grants to LEAs
    are critical to the success of the No Child Left Behind Act.
    The Committee recommends $12,839,571,000 for this program. The
    comparable funding level for fiscal year 2005 is
    $12,739,571,000 and the budget request includes $13,342,309,000
    for Title I grants to LEAs. The Committee recommendation
    proposes an increase of 46.5 percent over the amount provided
    prior to passage of the No Child Left Behind Act. These Federal
    resources represent the significant commitment this Committee
    has made to provide the resources necessary to help all
    children succeed in school.
        The appropriation for Title I grants to LEAs primarily
    supports activities associated with the 2006-2007 academic
    year. Of the funds available for this program, up to $3,472,000
    shall be available on October 1, 2005, not less than
    $5,452,798,000 will become available on July 1, 2006 and
    $7,383,301,000 will become available on October 1, 2006. The
    funds that become available on July 1, 2006 and October 1, 2006
    will remain available for obligation until September 30, 2007.
        Title I grants are distributed through four formulas:
    basic, concentration, targeted, and education finance incentive
    grant [EFIG].
        For Title I basic grants, including up to $3,472,000
    transferred to the Census Bureau for poverty updates, the
    Committee recommends an appropriation of $6,934,854,000. The
    comparable funding level for fiscal year 2005 and the budget
    request are both $6,934,854,000 for the basic grants funding
    stream. Basic grants are awarded to school districts with at
    least 10 poor children who make up more than 2 percent of
    enrollment.
        For concentration grants, the Committee recommends an
    appropriation of $1,365,031,000. The comparable funding level
    for fiscal year 2005 and the budget request are both
    $1,365,031,000. Funds under this program are distributed
    according to the basic grants formula, except that they go only
    to LEAs where the number of poor children exceeds 6,500 or 15
    percent of the total school-aged population.
        Last year, Congress provided all of the additional funding
    for Title I grants to LEAs above the fiscal year 2004 level
    through the EFIG and targeted formulas. The Committee
    recommends allocating all of the increase proposed this year in
    a similar manner. The Committee notes that analysis conducted
    by the Congressional Research Service has demonstrated that
    these formulas deliver a larger share of Title I funds to high-
    poverty school districts than any other Title I formula. In
    addition, the EFIG formula uses State-level ``equity'' and
    ``effort'' factors to make allocations to States that are
    intended to encourage States to spend more on education and to
    improve the equity of State funding systems. Once State
    allocations are determined, suballocations to the LEA level are
    based on a modified version of the targeted grants formula,
    described below.
        The targeted grants formula weights child counts to make
    higher payments to school districts with high numbers or
    percentages of poor students. For these grants, the Committee
    recommends an appropriation of $2,269,843,000. The comparable
    funding level for fiscal year 2005 is $2,219,843,000 and the
    budget request includes $2,822,581,000 for this funding stream.
        The Committee recommends an appropriation of $2,269,843,000
    for education finance incentive grants. The comparable funding
    level for fiscal year 2005 and the budget request both are
    $2,219,843,000 for the EFIG funding stream.

    William F. Goodling Even Start Family Literacy Program

        The Committee does not recommend additional funds for the
    Even Start program. The comparable funding level for fiscal
    year 2005 is $225,095,000 and the budget request does not
    include any funds for this program.
        The Even Start program provides grants for family literacy
    programs that serve disadvantaged families with children under
    8 years of age and adults eligible for services under the Adult
    Education and Family Literacy Act. Programs combine early
    childhood education, adult literacy, and parenting education.
    Funding is provided to States based on their relative share of
    Title I, Part A funds and States use these resources to make
    competitive subgrants to partnerships comprised of local
    educational agencies and other organizations serving families
    in high-poverty areas.

    Reading First State Grants

        The Committee recommends $1,041,600,000 for the Reading
    First State Grants program, the same amount as the comparable
    funding level for fiscal year 2005 and the budget request.
        Reading First is a comprehensive effort to provide States
    and LEAs with funds to implement comprehensive reading
    instruction for children in grades K-3. The purpose of the
    program is to help ensure that every child can read by the end
    of third grade. LEAs and schools that receive funds under this
    program should use the money to provide professional
    development in reading instruction for teachers and
    administrators, adopt and use reading diagnostics for students
    in grades K-3 to determine where they need help, implement
    reading curricula that are based on scientific research, and
    provide reading interventions for children who are not reading
    at grade level.
        The Committee intends for funds available under the Reading
    First program to encourage and support the use of reading
    programs with the strongest possible scientific evidence of
    effectiveness. The Committee urges the Department to provide
    clear guidance to its technical assistance centers and the
    States to: fully consider scientific evidence of effectiveness
    in rating programs for use under Reading First; contemplate
    expanded lists of allowable programs that include innovative
    programs with scientific evidence of effectiveness; when
    awarding new grants, consider giving preference to those
    schools that select programs with strong, scientific evidence
    of effectiveness; emphasize that the Department has not
    established a predetermined approved list of reading materials;
    and allow comprehensive reading programs that have scientific
    evidence of effectiveness to be implemented in full, as they
    have been researched, without modification to conform to other
    models of instruction. The Committee also is concerned that
    certain practices under the Reading First program may unduly
    interfere with local control of curriculum. The Committee notes
    that Reading First materials decisions are to be made at the
    school level, subject to the approval of the State.

    Early Reading First

        The Committee recommends $104,160,000 for the Early Reading
    First program, the same amount as the comparable funding level
    for fiscal year 2005 and the budget request.
        Early Reading First complements Reading First State Grants
    by providing competitive grants to school districts and
    nonprofit groups to support activities in existing preschool
    programs that are designed to enhance the verbal skills,
    phonological awareness, letter knowledge, pre-reading skills,
    and early language development of children ages 3 through 5.
    Funds are targeted to communities with high numbers of low-
    income families.

    Striving Readers

        The Committee recommends $35,000,000 for the Striving
    Readers initiative. The comparable fiscal year 2005 funding
    level is $24,800,000 and the budget request includes
    $200,000,000 for the Striving Readers program. This program
    supports grants to develop, implement, and evaluate reading
    interventions for middle- or high-school students reading
    significantly below grade level. Under this program, awards
    will be made to local educational agencies eligible to receive
    funds under Part A of Title I with one or more high schools or
    middle schools serving a significant number of students reading
    below grade level. Awards also may be made to partnerships
    including institutions of higher education and eligible
    nonprofit or for-profit organizations. The Committee intends
    that funds provided in this bill be utilized in accordance with
    the priorities established in the statement of the managers
    accompanying the fiscal year 2005 appropriations Act that
    relate to a rigorous evaluation requirement and parity in
    funding for middle schools and high schools.

    Improving Literacy Through School Libraries

        The Committee recommends $19,683,000 for the Improving
    Literacy Through School Libraries program, the same amount as
    the comparable funding level for fiscal year 2005 and the
    budget request.
        This program provides funds for urgently needed, up-to-date
    school library books and training for school library media
    specialists in order to support the scientifically based
    reading programs authorized by the Reading First initiative.
    LEAs with a child-poverty rate of at least 20 percent are
    eligible for the competitive awards. Funds may be used to
    acquire school library media resources, including books and
    advanced technology; facilitate resource-sharing networks among
    schools and school libraries; provide professional development
    for school library media specialists; and provide students with
    access to school libraries during non-school hours.
        The Committee is concerned that funds provided under this
    program are not reaching those schools that are most in need of
    financial assistance for updating their school libraries,
    either because they are not applying for funds or are
    unsuccessful in writing their grant applications. The Committee
    encourages the Department to work with the Institute of Museum
    and Library Services and other relevant organizations to
    improve awareness, among the most needy schools, of the
    availability of this financial assistance, and to help them
    increase their success rates in competing for available funds.
    The Committee requests that the Department explain in its
    fiscal year 2007 congressional budget justification the actions
    it has taken or will take to address this issue with respect to
    the 2006 and future grant competitions.

    High School Intervention

        The Committee recommendation does not include any funding
    for the new High School Intervention initiative. The budget
    proposed $1,240,000,000 for this new initiative. Funds would
    have been used to develop, implement and evaluate interventions
    that increase the achievement of all high school students,
    particularly those at risk of failing to meet challenging State
    academic content standards; eliminate achievement gaps between
    student from different socioeconomic backgrounds; and help all
    students graduate with the education, skills, and knowledge to
    succeed in postsecondary education and a high-technology
    economy. The proposed initiative would have provided funds to
    States based on a formula and SEAs would then make competitive
    grants to LEAs using 95 percent of appropriated funds.
        The budget request proposes bill language that would
    authorize this new high school initiative and require each
    State to participate in 12th grade State National Assessment of
    Educational Progress reading and math assessments. The
    Committee bill does not include the requested language.
        The Committee is supportive of the administration's goal of
    preparing all students for postsecondary education and the
    high-technology economy. However, the Committee notes that this
    initiative has not been acted on by the appropriate authorizing
    committees of Congress and would have been funded by the
    elimination of GEAR-UP, certain TRIO activities and the Perkins
    Vocational and Technical Education program, each of which have
    been restored to their fiscal year 2005 funding levels.

    Migrant Education Program

        The Committee recommends $390,428,000 for the Migrant
    Education program, the same amount as the comparable fiscal
    year 2005 funding level and the budget request.
        The Title I Migrant Education program authorizes grants to
    State educational agencies for programs to meet the special
    educational needs of the children of migrant agricultural
    workers and fishermen. Funds are allocated to the States
    through a statutory formula based on each State's average per-
    pupil expenditure for education and actual counts of migratory
    children ages 3 through 21 residing within the States in the
    previous year. Only migratory children who have moved within
    the last 3 years are generally eligible to be counted and
    served by the program.
        This appropriation also supports activities to improve
    interstate and intrastate coordination of migrant education
    programs, as well as identifying and improving services to the
    migrant student population.

    Neglected and Delinquent

        The Committee recommends $51,000,000 for the Title I
    neglected and delinquent program. The comparable funding level
    for fiscal year 2005 and the budget request both are
    $49,600,000 for the neglected and delinquent program.
        This program provides financial assistance to State
    educational agencies for education services to neglected and
    delinquent children and youth in State-run institutions and for
    juveniles in adult correctional institutions. Funds are
    allocated to individual States through a formula based on the
    number of children in State-operated institutions and per-pupil
    education expenditures for the State.
        States are authorized to set aside at least 15 percent, but
    not more than 30 percent, of their neglected and delinquent
    funds to help students in State-operated institutions make the
    transition into locally operated programs and to support the
    successful reentry of youth offenders, who are age 20 or
    younger and have received a secondary school diploma or its
    recognized equivalent. Reentry activities may include
    strategies designed to expose the youth to, and prepare the
    youth for, postsecondary education, or vocational and technical
    training programs.
        Under the No Child Left Behind Act, the Congress provided
    the Secretary with the authority to reserve up to 2.5 percent
    of the appropriation for national activities. The Committee
    continues to urge the Secretary to fully utilize this authority
    to support capacity building in and dissemination of best
    practices to State agency programs and to develop a uniform
    model for evaluating State performance under this program.

    Evaluation

        The Committee recommends $9,424,000 for evaluation of Title
    I programs, the same amount as the comparable funding level for
    fiscal year 2005 and the budget request.
        Evaluation funds are used to support large-scale national
    surveys that examine how the Title I programs are contributing
    to student academic achievement. Funds also are used to
    evaluate State assessment and accountability systems and
    analyze the effectiveness of educational programs supported
    with Title I funds.

    Comprehensive School Reform Demonstration

        The Committee does not recommend additional funds for the
    comprehensive school reform demonstration program. The
    comparable funding level for fiscal year 2005 is $205,344,000
    and the budget request did not include any funds for the
    comprehensive school reform program.
        This program provided schools with funding to develop or
    adopt, and implement, comprehensive school reforms that will
    enable children in participating schools to meet State
    standards. The Department allocated funds to States based on
    their relative shares of the previous year's Title I basic
    grants funds.

    High School Equivalency Program

        The Committee recommends $18,737,000 for the high school
    equivalency program [HEP], the same amount as the comparable
    funding level for fiscal year 2005 and the budget request.
        This program provides 5-year grants to institutions of
    higher education and other nonprofit organizations to recruit
    migrant students ages 16 and over and provide the academic and
    support services needed to help them obtain a high school
    equivalency certificate and subsequently gain employment, win
    admission to a postsecondary institution or a job-training
    program, or join the military. Projects provide counseling,
    health services, stipends, and placement assistance. At the
    funding level recommended by the Committee, HEP will serve
    roughly 7,000 migrants.

    College Assistance Migrant Program

        For the College Assistance Migrant Program [CAMP], the
    Committee recommends $15,532,000, the same amount as the
    comparable funding level for fiscal year 2005 and the budget
    request.
        Funds provide 5-year grants to institutions of higher
    education and nonprofit organizations for projects that provide
    tutoring, counseling, and financial assistance to migrant
    students during their first year of postsecondary education.
    Projects also may use up to 10 percent of their grants for
    follow-up services after students have completed their first
    year of college, including assistance in obtaining student
    financial aid.
        The Committee encourages the Department to consider
    efficient and effective means for collecting performance
    outcome data related to postsecondary persistence and
    completion rates of CAMP program participants beyond those
    measures currently employed. The Committee notes that the
    follow-up services set aside may be used to monitor and report
    on the progress of students participating in projects during
    such students' subsequent years in college.

                                   Impact Aid

    Appropriations, 2005....................................  $1,243,862,000
    Budget estimate, 2006...................................   1,240,862,000
    House allowance.........................................   1,240,862,000
    Committee recommendation................................   1,240,862,000

        The Committee recommends an appropriation of $1,240,862,000
    for impact aid for the Department of Education. The comparable
    funding level for fiscal year 2005 is $1,243,862,000 and the
    budget request proposes $1,240,862,000 for this purpose.
        Impact aid provides financial assistance to school
    districts for the costs of educating children when enrollments
    and the availability of revenues from local sources have been
    adversely affected by the presence of Federal activities.
    Children who reside on Federal or Indian lands generally
    constitute a financial burden on local school systems because
    these lands do not generate property taxes--a major revenue
    source for elementary and secondary education in most
    communities. In addition, realignments of U.S. military forces
    at bases across the country often lead to influxes of children
    into school districts without producing the new revenues
    required to maintain an appropriate level of education.
        The Committee bill includes language that provides for
    continued eligibility for students affected by the deployment
    or death of their military parent, as long as these children
    still attend the same school district. This language was
    included in the budget request and last year's appropriation
    bill.
        Basic Support Payments.--The Committee recommends
    $1,102,896,000 for basic support payments. The comparable
    funding level for fiscal year 2005 and the budget request both
    are $1,075,018,000. Under this statutory formula, payments are
    made on behalf of all categories of federally connected
    children, with a priority placed on making payments first to
    heavily impacted school districts and providing any remaining
    funds for regular Basic Support Payments.
        Payments for Children with Disabilities.--The Committee
    bill includes $49,966,000 for this purpose, the same amount as
    the comparable funding level for fiscal year 2005 and the
    budget request. Under this program, additional payments are
    made for certain federally connected children eligible for
    services under the Individuals with Disabilities Education Act.
        Facilities Maintenance.--The Committee recommends
    $5,000,000 for facilities maintenance. The comparable funding
    level for fiscal year 2005 and the budget request both are
    $7,838,000 for this purpose. This activity provides funding for
    emergency repairs and comprehensive capital improvements to
    certain school facilities owned by the Department of Education
    and used by local educational agencies to serve federally
    connected military dependent students. Funds appropriated for
    this purpose are available until expended.
        Construction.--The Committee recommends $18,000,000 for
    this program. The comparable fiscal year 2005 funding level is
    $48,544,000 and the budget request includes $45,544,000 for
    this purpose. Formula and competitive grants are awarded to
    eligible LEAs for emergency repairs and modernization of school
    facilities. Funds appropriated for the construction activity
    are available for obligation for a period of 2 years.
        While the Committee recommendation is less than last year,
    formula and competitive grant funds will still be made
    available under this appropriation for those districts in need
    of and eligible for additional financial assistance to improve
    their school facilities. In addition, funds are still remaining
    from the fiscal year 2005 appropriation for competitive grants
    under this program.
        Payments for Federal Property.--The Committee recommends
    $65,000,000 for this activity. The comparable funding level for
    fiscal year 2005 and the budget request both are $62,496,000
    for this program. These payments compensate local educational
    agencies in part for revenue lost due to the removal of Federal
    property from local tax rolls. Payments are made to LEAs that
    have a loss of tax base of at least 10 percent of assessed
    value due to the acquisition since 1938 of real property by the
    U.S. Government.

                          School Improvement Programs

    Appropriations, 2005....................................  $5,619,657,000
    Budget estimate, 2006...................................   5,332,219,000
    House allowance.........................................   5,393,765,000
    Committee recommendation................................   5,457,953,000

        The Committee recommends an appropriation of $5,457,953,000
    for school improvement programs. The comparable funding level
    in fiscal year 2005 for this account is $5,619,657,000 and the
    budget request includes $5,332,219,000.

    State Grants for Improving Teacher Quality

        The No Child Left Behind Act requires States to ensure that
    all teachers teaching in core academic subjects are ``highly
    qualified'' by the end of the 2005-2006 school year. The
    Committee recommends $2,916,605,000 for State grants for
    improving teacher quality, the same as both the comparable
    funding level for fiscal year 2005 and the budget request.
        The appropriation for this program primarily supports
    activities associated with the 2006-2007 academic year. Of the
    funds provided, $1,481,605,000 will become available on July 1,
    2006 and $1,435,000,000 will become available on October 1,
    2006. These funds will remain available for obligation until
    September 30, 2007.
        Under the Committee recommendation, funding for programs
    that specifically support high-quality professional development
    for teachers and school leadership will have increased by 40
    percent since passage of the No Child Left Behind Act. The
    Committee recommendation for fiscal year 2006 includes nearly
    $3,600,000,000 for such activities in recognition of the
    critical role that these individuals occupy in educating the
    Nation's children and the significant academic benefit that
    students may derive from the presence of a highly qualified
    teacher in their classroom. In addition, State and local
    educational agencies have considerable flexibility to use funds
    from their Title I grants to LEAs allocations, as well as other
    State grant program dollars in support of high-quality
    professional development opportunities.
        States and LEAs may use the funds for a range of activities
    related to the certification, recruitment, professional
    development, and support of teachers and administrators.
    Activities may include reforming teacher certification and
    licensure requirements, addressing alternative routes to State
    certification of teachers, recruiting teachers and principals,
    and implementing teacher mentoring systems, teacher testing,
    merit pay, and merit-based performance systems.
        These funds may also be used by districts to hire teachers
    to reduce class sizes. The Committee recognizes that smaller
    classes, particularly in the early grades, can have a positive
    impact on students by improving classroom discipline, providing
    students with more individualized attention, and allowing
    parents and teachers to work more closely together. Funds
    within the teacher quality State grants program may be used to
    continue this commitment to our Nation's students, parents, and
    teachers, without taking away from other efforts to invest in
    professional development.

    Early Childhood Educator Professional Development

        The Committee recommends $14,696,000 to support
    professional development activities for early childhood
    educators and caregivers in high-poverty communities. The
    comparable funding level for fiscal year 2005 and the budget
    request are both $14,696,000 for this program. From this
    appropriation, the Secretary makes competitive grants to
    partnerships of early childhood and family literacy caregivers
    and educators in order to provide high quality, sustained and
    intensive professional development for early childhood
    educators to help them provide developmentally appropriate
    school-readiness services for preschool-age children.

    Mathematics and Science Partnerships

        The Committee recommends $178,560,000 for the mathematics
    and science partnerships program. The comparable funding level
    for fiscal year 2005 is $178,560,000 and the budget request
    includes $269,000,000 for this purpose. These funds will be
    used to improve the performance of students in the areas of
    math and science by bringing math and science teachers in
    elementary and secondary schools together with scientists,
    mathematicians, and engineers to increase the teachers'
    subject-matter knowledge and improve their teaching skills.
    When the appropriation for this program is $100,000,000 or
    greater, the Secretary is authorized to award grants to States
    by a formula which includes consideration of the number of
    children aged 5 to 17 below the poverty line. States then are
    required to make grants competitively to eligible partnerships
    to enable the entities to pay the Federal share of the costs of
    developing or redesigning more rigorous mathematics and science
    curricula that are aligned with State and local standards;
    creating opportunities for enhanced professional development
    that improves the subject-matter knowledge of math and science
    teachers; recruiting math and science majors; and improving and
    expanding training of math and science teachers, including the
    effective integration of technology into curricula and
    instruction.
        The budget request includes legislative language that would
    allow the Secretary to use $120,000,000 in appropriated funds
    to make competitive awards to projects designed to improve the
    mathematics learning of secondary students. The Committee has
    not provided this requested authority.

    Innovative Education Program Strategies State Grants

        The Committee recommends $100,000,000 for innovative
    education program strategies State grants. The comparable
    funding level for fiscal year 2005 is $198,400,000 and the
    budget request is $100,000,000 for this purpose.
        The innovative education program is a flexible source of
    Federal funds that provides support to States and LEAs for
    developing education reform initiatives that will improve the
    performance of students, schools, and teachers.

    Educational Technology State Grants

        The Committee recommends $425,000,000 for educational
    technology State grants. The comparable funding level for
    fiscal year 2005 is $496,000,000 and the budget request did not
    include any funds for this program.
        The educational technology State grants program supports
    efforts to integrate technology into curricula to improve
    student learning. Funds flow by formula to States and may be
    used for the purchase of hardware and software, teacher
    training on integrating technology into the curriculum, and
    efforts to use technology to improve communication with
    parents, among other related purposes. An LEA must use at least
    25 percent of its formula allocation for professional
    development in the integration of technology into the curricula
    unless it can demonstrate that it already provides such high-
    quality professional development.

    Supplemental Education Grants

        The Committee recommendation includes $18,183,000 for the
    supplemental education grants program, the same as both the
    comparable funding level for fiscal year 2005 and the budget
    request. This grant program was authorized by the Compact of
    Free Association Amendments Act of 2003. The Act discontinued
    the eligibility of Republic of Marshall Islands [RMI] and the
    Federated States of Micronesia [FSM] for funding available from
    Adult, Dislocated Worker and Youth Workforce Investment Act
    programs, Head Start, Title I Grants to LEAs, Adult and
    Vocational Education State Grants, Federal Work-Study and
    Federal Supplemental Educational Opportunities Grants. In place
    of funding from these sources, the Act provided a separate
    supplemental education grant program that provides these
    entities with a more flexible source of funds that can be
    tailored to local needs. These funds will be transferred from
    the Department of Education to the Secretary of Interior for
    grants to these entities. The Committee bill includes language
    that allows up to 5 percent to be used by the FSM and RMI to
    purchase oversight and technical assistance, which may include
    reimbursement of the Departments of Labor, Health and Human
    Services and Education for such services. Of the funds
    appropriated, $12,132,000 is for the Federated States of
    Micronesia and $6,051,000 is for the Republic of the Marshall
    Islands.

    21st Century Community Learning Centers

        The Committee recommends an appropriation of $991,077,000
    for the 21st Century Community Learning Centers program, the
    same as both the comparable level for fiscal year 2005 and the
    budget request.
        Funds are allocated to States by formula, which in turn,
    award at least 95 percent of their allocations to local
    educational agencies, community-based organizations and other
    public and private entities. Grantees use these resources to
    establish or expand community learning centers that provide
    activities offering significant extended learning
    opportunities, such as before- and after-school programs,
    recreational activities, drug and violence prevention and
    family literacy programs for students and related services to
    their families. Centers must target their services on students
    who attend schools that are eligible to operate a schoolwide
    program under Title I of the Elementary and Secondary Education
    Act or serve high percentages of students from low-income
    families.

    State Assessments and Enhanced Assessment Instruments

        The Committee recommends $411,680,000 for State
    assessments, the same as both the comparable funding level for
    fiscal year 2005 and the budget request.
        A key accountability measure in the No Child Left Behind
    Act requires annual State assessments in reading and
    mathematics for all students in grades 3-8 beginning in the
    2005-2006 school year. The new assessments will be used to
    determine whether States, LEAs, and schools are making adequate
    yearly progress toward the goal of helping all students attain
    proficiency within 12 years of the 2001-2002 school year.
        This program has two components. The first provides formula
    grants to States to pay the cost of developing standards and
    assessments required by the new law. The statute includes
    funding ``trigger amounts'' for fiscal years 2002-2007; States
    may defer the new assessments for each year the appropriation
    falls below the trigger level. The trigger for fiscal year 2006
    is $400,000,000. The Committee recommendation includes
    $400,000,000 for this purpose.
        Under the second component of State assessments--Grants for
    Enhanced Assessment Instruments--appropriations in excess of
    the trigger level are used for a competitive grant program
    designed to support efforts by States to improve the quality
    and fairness of their assessment systems. The Committee
    recommendation for the second component is $11,680,000, the
    same as both the comparable funding level for fiscal year 2005
    and the budget request.
        The Committee continues to be concerned that many schools
    are unable to properly assess the performance of students with
    disabilities and students with limited English proficiency.
    Therefore, the Committee urges the Department to place a high
    priority on grant applications that aim to improve the quality
    of State assessments for these two groups of students and to
    ensure the most accurate means of measuring their performance
    on these assessments.

    High School Assessments

        The Committee recommendation does not include funds for the
    proposed High School Assessments program. The budget request
    includes $250,000,000 for this new activity. This proposed
    program was designed to complement the administration's High
    School Reform initiative. Funds requested under this program
    would be used to provide grants to States to pay for the
    reading and math assessments that would be required in two
    additional grades during high school by school year 2009-2010.
    The budget request includes legislative language which would
    authorize this program. As noted earlier, the High School
    Reform proposal has not been considered by the appropriate
    authorizing committees of Congress, so the Committee has not
    included the legislative language or provided the requested
    funds.

    Javits Gifted and Talented Education

        The Committee recommends $11,022,000 for the Javits Gifted
    and Talented Students Education Program, the same as the
    comparable fiscal year 2005 funding level. The President's
    budget proposes to eliminate funding for this program. Funds
    are used for awards to State and local education agencies,
    institutions of higher education, and other public and private
    agencies for research, demonstration, and training activities
    designed to enhance the capability of elementary and secondary
    schools to meet the special educational needs of gifted and
    talented students.

    Foreign Language Assistance

        The Committee recommends $25,000,000 for the Foreign
    Language Assistance program. The comparable funding level for
    fiscal year 2005 is $17,856,000 and the budget request proposes
    eliminating funds for foreign language assistance activities.
        The Committee recommendation provides funds above what is
    needed for continuation costs for current activities. These
    additional funds shall be used for a new grant competition to
    school districts with poverty rates of 15 percent or more, to
    help the highest-need elementary schools within such districts
    establish foreign language instruction programs.
        Funds from this program support competitive grants to
    increase the quality and quantity of foreign language
    instruction. At least 75 percent of the appropriation must be
    used to expand foreign language education in the elementary
    grades. The Committee has included bill language that prohibits
    Foreign Language Assistance program funds from being be used
    for the Foreign Language Incentive program.
        The Committee is concerned that this program, which is the
    only Federal program designed to help schools meet the need for
    foreign language instruction, is unavailable to the poorest
    schools because grant recipients must provide a 50 percent
    match from non-Federal sources. The Committee, therefore,
    strongly urges the Secretary to use her ability to waive the
    matching requirement for qualifying schools and to increase
    awareness of this accommodation among the affected school
    population. The Committee also believes that the sustainability
    preference established in the authorizing legislation should
    not prohibit the highest-need applicants from receiving one or
    more grants under this program or from being eligible to have
    the matching requirement waived during their initial or
    subsequent grants.

    Education for Homeless Children and Youth

        For carrying out education activities authorized by Title
    VII, subtitle B of the Stewart B. McKinney Homeless Assistance
    Act, the Committee recommends $62,496,000. The comparable
    fiscal year 2005 funding level and the budget request both are
    $62,496,000.
        This program provides assistance to each State to support
    an office of the coordinator of education for homeless children
    and youth, to develop and implement State plans for educating
    homeless children, and to make subgrants to LEAs to support the
    education of those children. Grants are made to States based on
    the total that each State receives in Title I grants to LEAs.
        Under the McKinney-Vento Homeless Children and Youths
    Program, State educational agencies [SEAs] must ensure that
    homeless children and youth have equal access to the same free
    public education, including a public preschool education, as is
    provided to other children and youth. States must review and
    undertake steps to revise any laws, regulations, practices, or
    policies that may act as barriers to the enrollment,
    attendance, or success in school of homeless children and
    youth.

    Training and Advisory Services

        For training and advisory services authorized by Title IV
    of the Civil Rights Act, the Committee recommends $7,185,000.
    The comparable fiscal year 2005 funding level and the budget
    request both are $7,185,000 for these services.
        The funds provided will support awards to operate the 10
    regional equity assistance centers [EACs]. Each EAC provides
    services to school districts upon request. Activities include
    disseminating information on successful practices and legal
    requirements related to nondiscrimination on the basis of race,
    color, sex, or national origin in education programs.

    Education for Native Hawaiians

        For programs for the education of Native Hawaiians, the
    Committee recommends $34,500,000. The comparable fiscal year
    2005 funding level is $34,224,000 and the budget request is
    $32,624,000 for these programs.
        The Committee bill includes language allowing $1,250,000 of
    the funds recommended to be used for construction and
    renovation of Native Hawaiian educational facilities.
        Education for Native Hawaiians.--The Committee recognizes
    the Department's continuing support in working with the Native
    Hawaiian Education Council as a vehicle for assessing,
    evaluating, and coordinating all education programs for Native
    Hawaiians. The Committee urges the Secretary to work with the
    Executive Director of the Council to ensure adequate funds are
    set aside to perform the tasks assigned to the Council in title
    VII of the No Child Left Behind Act. In addition, the Committee
    requests that the Department provide the Council with the
    grantee reports on a timely basis to allow the Council to fully
    undertake the assessment, evaluation and issuance of
    recommendations, as required by law.
        Native Hawaiian Law Center of Excellence.--The Committee
    commends the Department's support in establishing a Center of
    Excellence in Native Hawaiian Law at the University of Hawaii.
    This Center will provide a forum for the examination and
    preservation of law with respect to the Native Hawaiian culture
    and spirit. The Committee bill includes language stipulating
    that $1,250,000 shall be used for a grant to the Center of
    Excellence at the University of Hawaii School of Law.

    Alaska Native Educational Equity

        The Committee recommends $34,500,000 for the Alaska Native
    educational equity assistance program. The comparable fiscal
    year 2005 funding level is $34,224,000 and the budget request
    includes $31,224,000 for this purpose.
        These funds address the severe educational handicaps of
    Alaska Native schoolchildren. Funds are used for the
    development of supplemental educational programs to benefit
    Alaska Natives. The Committee bill includes language which
    allows funding provided by this program to be used for
    construction. The Committee expects the Department to use some
    of these funds to address the construction needs of rural
    schools.

    Rural Education

        The Committee recommends $170,624,000 for rural education
    programs, the same as both the comparable fiscal year 2005
    funding level and the budget request.
        The Committee strongly supports the continued use of
    Federal funding specifically for rural education. Rural schools
    face difficult challenges in meeting the mandates in the No
    Child Left Behind Act, particularly in the areas of attracting
    highly qualified teachers and adapting to new assessment
    requirements and reporting expectations. The rural education
    programs are intended to help level the playing field for small
    and high-poverty rural school systems that typically receive
    less Federal formula funding than their urban and suburban
    counterparts, and are frequently unable to compete for
    competitive grants. In addition to providing more total funding
    for such districts, the program also allows these districts to
    combine funds from four categorical programs and use the money
    to address their highest priorities, such as recruiting
    teachers, purchasing technology, or upgrading curricula.
        The Committee expects that rural education funding will be
    equally divided between the Small, Rural Schools Achievement
    Program, which provides funds to LEAs that serve a small number
    of students, and the Rural and Low-Income Schools Program,
    which provides funds to LEAs that serve concentrations of poor
    students, regardless of the number of students served.

    Comprehensive Centers

        The Committee recommends $56,825,000 for the comprehensive
    centers program, the same as both the comparable fiscal year
    2005 funding level and the budget request.
        These funds will provide continued support to 10-20
    comprehensive centers expected to be established before
    September 2005. At least one center will operate in each of the
    10 regions of the United States. The centers, which would be
    operated by research organizations, agencies, institutions of
    higher education or partnerships thereof, would provide
    training and technical assistance on various issues to States,
    LEAs, and schools as identified through needs assessments
    undertaken in each region. Grantees will develop 5-year plans
    for undertaking authorized activities that address the needs of
    States in a region and develop an advisory board to advise the
    center on allocation of resources, maintaining a high standard
    of quality in services delivery and ensuring that activities
    promote progress toward improving student achievement. The
    National Center for Education Evaluation and Regional
    Assistance will provide for ongoing independent evaluation of
    each center to assess whether each is meeting its objectives.

                                Indian Education

    Appropriations, 2005....................................    $119,889,000
    Budget estimate, 2006...................................     119,889,000
    House allowance.........................................     119,889,000
    Committee recommendation................................     119,889,000

        The Committee recommends $119,889,000 for Indian Education
    programs. The comparable fiscal year 2005 funding level and the
    budget request both are $119,889,000 for such activities.

    Grants to Local Education Agencies

        For grants to local education agencies, the Committee
    recommends $96,294,000. The comparable fiscal year 2005 funding
    level is $95,165,000 and the budget request includes
    $96,294,000 for authorized activities.
        These funds provide financial support to elementary and
    secondary school programs that serve Indian students, including
    preschool children. Funds are awarded on a formula basis to
    local educational agencies, schools supported and operated by
    the Bureau of Indian Affairs, and in some cases directly to
    Indian Tribes.

    Special Programs for Indian Children

        The Committee recommends $19,595,000 for special programs
    for Indian children, the same as the comparable fiscal year
    2005 funding level and the budget request.
        Funds are used for demonstration grants to improve Indian
    student achievement through early childhood education and
    college preparation programs, and for professional development
    grants for training Indians who are preparing to begin careers
    in teaching and school administration.

    National Activities

        The Committee recommends $4,000,000 for national
    activities. The comparable fiscal year 2005 amount is
    $5,129,000 and the budget request is $4,000,000 for authorized
    activities. Funds will be used to expand efforts to improve
    research, evaluation, and data collection on the status and
    effectiveness of Indian education programs.

                           Innovation and Improvement

    Appropriations, 2005....................................  $1,092,642,000
    Budget estimate, 2006...................................   1,307,871,000
    House allowance.........................................     708,522,000
    Committee recommendation................................   1,057,385,000

        The Committee recommends an appropriation of $1,057,385,000
    for programs within the innovation and improvement account. The
    comparable fiscal year 2005 funding level for these programs is
    $1,092,642,000 and the budget request includes $1,307,871,000
    for this account.

    Troops-to-Teachers

        The Committee recommends an appropriation of $14,793,000
    for the Troops-to-Teachers program, the same as both the
    comparable funding level for fiscal year 2005 and the budget
    request.
        This program supports the Defense Department's Troops to
    Teachers program, which helps recruit and prepare retiring and
    former military personnel to become highly qualified teachers
    serving in high-poverty school districts. The Secretary of
    Education transfers program funds to the Department of Defense
    for the Defense Activity for Non-Traditional Education Support
    to provide assistance, including stipends of up to $5,000 and
    bonuses of up to $10,000, to eligible members of the Armed
    Forces so that they can obtain teacher certification or
    licensing. In addition, the program helps these individuals
    find employment in a school.
        The Committee notes that the GAO and Department are
    required to report to Congress on the effectiveness of this
    program in placing highly-qualified teachers in high-need
    districts. The Committee looks forward to receiving a copy of
    the report and urges the Department to utilize the findings in
    implementing this program.

    Transition to Teaching

        The Committee recommends $44,933,000 for the transition to
    teaching program, the same as both the comparable fiscal year
    2005 funding level and the budget request.
        This program provides grants to help support efforts to
    recruit, train, and place nontraditional teaching candidates
    into teaching positions and to support them during their first
    years in the classroom. In particular, this program is intended
    to attract mid-career professionals and recent college
    graduates. Program participants are placed in high-need schools
    in high-need LEAs.
        The Committee encourages the Department to continue to work
    with grantees to ensure that appropriated funds are used
    effectively to recruit highly qualified teachers to and retain
    them in employment in high need schools. The Committee looks
    forward to receiving more performance outcome information
    regarding this program, and, in particular, the results of the
    ongoing evaluation of grantee progress toward their goals and
    objectives.

    National Writing Project

        The Committee recommends $23,000,000 for the National
    Writing Project. The comparable funding level for fiscal year
    2005 is $20,336,000 and the budget request proposes to
    eliminate Federal funding for this program.
        These funds are awarded to the National Writing Project, a
    nonprofit organization that supports and promotes K-16 teacher
    training programs in the effective teaching of writing. From
    the funds provided by the fiscal year 2006 appropriation, the
    Committee intends that $500,000 shall be used to continue
    support for the pilot program on the integration of technology
    training in the NWP program.

    Teaching of Traditional American History

        The Committee recommends $121,000,000 for the teaching of
    traditional American history program. The comparable fiscal
    year 2005 funding level is $119,040,000 and the budget request
    is $119,040,000 for this activity. This program supports
    competitive grants to LEAs, and funds may be used only to
    undertake activities that are related to American history, and
    cannot be used for social studies coursework. Grant awards are
    designed to augment the quality of American history instruction
    and to provide professional development activities and teacher
    education in the area of American history. The Committee
    directs the Department to continue its current policy of
    awarding 3-year grants.
        The budget request includes bill language that would allow
    the Department to reserve up to 3 percent of funds appropriated
    for this program for national activities. The Committee bill
    includes the requested language. The Committee requests that
    the Department prepare and submit an operating plan to the
    House and Senate Committees on Appropriations, within 30 days
    of enactment of this Act, on how these reserved funds will be
    used to support the intent of this program.

    School Leadership

        The Committee recommends $15,000,000 for the school
    leadership program. The comparable fiscal year 2005 funding
    level is $14,880,000 and the budget request proposes to
    eliminate funding for this program. This program provides
    competitive grants to assist high-need LEAs to recruit and
    train principals and assistant principals through activities
    such as professional development and training programs. The
    Committee continues to recognize the critical role that
    principals and assistant principals play in creating an
    environment that fosters effective teaching and high academic
    achievement for students.

    Advanced Credentialing

        The Committee recommends $10,000,000 for the advanced
    credentialing program. The comparable fiscal year 2005 funding
    level is $16,864,000 and the budget request includes $8,000,000
    for one component of the authorized program.
        The Committee recommendation includes $10,000,000 for the
    National Board for Professional Teaching Standards [NBPTS]. The
    comparable fiscal year 2005 funding level is $9,920,000 and the
    budget request proposes to eliminate funding for the National
    Board. Funds available assist the Board's work in providing
    financial support to States for teachers applying for
    certification, increasing the number of minority teachers
    seeking certification and developing outreach programs about
    the advanced certification program. The fiscal year 2006
    appropriation will support continuation of an award to the
    National Board for Professional Teaching Standards.
        The Committee continues its strong support of the National
    Board for Professional Teaching Standards, based on the
    significant body of rigorous research that has demonstrated the
    benefits to students from being taught by a Board-certified
    educator. The Committee notes that the National Board has
    developed standards that describe the knowledge and skills
    characterizing effective teaching in 24 different areas,
    including school counseling. The accomplished educators who
    achieve certification in these standards do so by demonstrating
    their understanding through actual teaching, as well as through
    a written exam and teaching portfolio. The Committee believes
    that these activities are consistent with the mission of the
    National Board, which is to advance the quality of teaching and
    learning in the United States.

    Charter Schools Grants

        The Committee recommends $216,952,000 for the support of
    charter schools. The comparable fiscal year 2005 funding level
    is $216,952,000 and the budget request is $218,702,000 for this
    program.
        This program supports the planning, development, and
    initial implementation of charter schools, which are public
    schools that receive exemption from many statutory and
    regulatory requirements in exchange for promising to meet
    agreed-upon accountability measures. State educational agencies
    that have the authority under State law to approve charter
    schools are eligible to compete for grants. If an eligible SEA
    does not participate, charter schools from the State may apply
    directly to the Secretary. The authorizing statute requires
    that amounts appropriated in excess of $200,000,000 and less
    than $300,000,000 be used for 5-year competitive grants to
    States that operate per-pupil facilities aid programs for
    charters schools. Federal funds are used to match State funded
    programs in order to provide charter schools with additional
    resources for charter school facilities financing. At the
    Committee recommendation, almost $17,000,000 will be available
    to continue support for per-pupil facilities aid grants.
        The Committee notes that the Department plans to use
    $8,000,000 in appropriated funds for national activities, which
    may include support for a rigorous evaluation of charter
    schools and the expansion of State capacity to administer their
    charter schools. The Committee encourages the Department to
    support such efforts and requests that additional information
    on these activities be included in the fiscal year 2007
    congressional budget justification.

    Credit Enhancement for Charter School Facilities

        The Committee does not recommend additional for this
    program. The comparable funding level for fiscal year 2005 and
    the budget request both are $36,981,000 for this purpose. The
    Committee notes that the authorization for this program expired
    in fiscal year 2005, and due to limited resources, does not
    fund this unauthorized activity. The budget request includes
    bill language that would continue to authorize this activity in
    fiscal year 2006.
        This program provides assistance to help charter schools
    meet their facility needs. Funds are provided on a competitive
    basis to public and non-profit entitities, to leverage non-
    Federal funds that help charter schools obtain school
    facilities through purchase, lease, renovation and
    construction.

    Voluntary Public School Choice

        The Committee recommends $26,543,000 for the voluntary
    public school choice program, the same as both the comparable
    funding level for fiscal year 2005 and the budget request.
        This program supports efforts by States and school
    districts to establish or expand State- or district-wide public
    school choice programs, especially for parents whose children
    attend low-performing public schools.

    Magnet Schools Assistance

        The Committee recommends $107,771,000 for the magnet
    schools assistance program, the same as both the comparable
    fiscal year 2005 funding level and the budget request.
        This program supports grants to local educational agencies
    to establish and operate magnet schools that are part of a
    court-ordered or federally approved voluntary desegregation
    plan. Magnet schools are designed to attract substantial
    numbers of students from different social, economic, ethnic,
    and racial backgrounds. Grantees may use funds for planning and
    promotional materials, teacher salaries, purchase of computers,
    and other educational materials and equipment.

    Choice Incentive Fund

        The Committee does not recommend any funding for this
    proposed program, which is not specifically authorized. The
    budget request includes $50,000,000 for this purpose. Through
    this proposed program, funds would be used to award competitive
    grants to establish or expand public or private school choice
    opportunities.

    Fund for the Improvement of Education

        The Committee recommends an appropriation of $417,924,000
    for the Fund for the Improvement of Education [FIE]. The
    comparable funding level for fiscal year 2005 is $414,078,000
    and the budget request includes $106,296,000 for comparable
    activities.
        The Committee recommendation includes $700,000 for the
    National Institute of Building Sciences to continue operation
    of the National Clearinghouse for Educational Facilities, the
    Nation's sole source for comprehensive information about school
    planning, design, financing, construction and maintenance. The
    Committee recommends an additional $300,000 for this purpose
    within Safe and Drug-Free Schools and Communities National
    Programs to address issues related to school safety and healthy
    school buildings.
        The Committee recommends $25,296,000 to award a contract to
    Reading Is Fundamental, Inc. [RIF] to provide reading-
    motivation activities. The comparable funding level for fiscal
    year 2005 and the budget request both are $25,296,000 for this
    purpose. RIF, a private nonprofit organization, helps prepare
    young children and motivate older children to read, through
    activities including the distribution of books. Federal funds
    provide up to 75 percent of the costs of books, except for
    migrant and seasonal farmworker programs which may receive up
    to 100 percent of the costs of books.
        The administration proposes $40,000,000 for a new adjunct
    teacher corps initiative. Through this new categorical grant
    program, the Department of Education would make competitive
    grants to partnerships of school districts and public and
    private institutions to create opportunities for professionals
    to teach secondary-school courses in the core academic
    subjects, particularly math and science. Due to budget
    constraints, the Committee recommendation does not include
    funds for this purpose.
        The Committee recommendation does not include any funds for
    State scholars capacity building. The comparable funding level
    for fiscal year 2005 is $2,500,000 and the budget request
    includes $12,000,000 for this program. This program supports
    State-level business and education partnerships that encourage
    high school students to complete a rigorous curriculum in core
    academic subjects.
        The administration recommended eliminating funding for
    activities listed below.
        The Committee recommends $21,000,000 for the Star Schools
    program. The comparable funding level for fiscal year 2005 is
    $20,832,000. The Star Schools program is designed to improve
    instruction in math, science, foreign languages, and other
    areas such as vocational education, to underserved populations
    by means of telecommunications technologies.
        The Committee recommends $11,000,000 for the Ready to Teach
    program. The comparable funding level for fiscal year 2005 is
    $14,291,000. Ready to Teach is the successor to the Public
    Broadcasting Service's Mathline program, which was one of the
    first to provide online professional development and continuing
    education for teachers. Ready to Teach was reauthorized by the
    No Child Left Behind Act of 2001 and continues to evolve to
    enhance teacher quality and meet the goals of that Act. Ready
    to Teach encompasses funding for PBS TeacherLine and one or
    more nonprofit entities, for the purpose of continuing to
    develop telecommunications-based programs to improve teacher
    quality in core areas. It also includes digital educational
    programming grants, which encourages community partnerships
    among local public television stations, State and local
    educational agencies, and other institutions to develop and
    distribute digital instructional content based on State and
    local standards.
        The Committee recommendation includes $10,000,000 for the
    Education through Cultural and Historical Organizations [ECHO]
    Act of 2001, as authorized by the No Child Left Behind Act. The
    comparable funding level for fiscal year 2005 is $8,631,000 and
    the budget request did not include any funds for this purpose.
    Programs authorized under ECHO provide a broad range of
    educational, cultural, and job training opportunities for
    students from communities across the Nation, including Alaska,
    Hawaii and Massachusetts. Funds also are available to support a
    range of services to the Mississippi Band of Choctaw Indians.
        The Committee has included $35,700,000 for arts in
    education. The comparable funding level for fiscal year 2005 is
    $35,633,000. Within the total, $6,369,000 is for the John F.
    Kennedy Center for the Performing Arts; $7,440,000 is for VSA
    arts; $13,455,000 is for the competitive art education model
    grant program for the development of model projects that
    effectively strengthen and integrate arts and cultural
    partnerships into the core curriculum; $7,936,000 is for grants
    for professional development for music, dance, drama, and
    visual arts educators to be administered by the U.S. Department
    of Education; $500,000 is to continue the evaluation and
    national dissemination of information regarding model programs
    and professional development projects funded through the Arts
    in Education section, including dissemination promising
    practices from funded projects and technical assistance for
    self-evaluation.
        The Committee recommends $42,000,000 for Parental
    Information and Resource Centers, which provide training,
    information, and support to parents, State and local education
    agencies, and other organizations that carry out parent
    education and family involvement programs. The comparable
    funding level for fiscal year 2005 is $41,886,000. The
    Committee notes that research overwhelmingly demonstrates that
    parent involvement in children's learning is positively related
    to student achievement.
        The Committee also notes that the No Child Left Behind Act
    requires grantees to use at least 30 percent of their awards to
    establish, expand, or operate Parents as Teachers, Home
    Instruction Program for Preschool Youngsters, or other early
    childhood parent education programs.
        The Committee recommends $5,000,000 to continue support for
    the Mental Health Integration in School program. The comparable
    funding level for fiscal year 2005 is $4,960,000. This program
    supports grants to or contracts with State educational
    agencies, local educational agencies or Indian tribes to
    increases student access to mental health care by linking
    schools with their local mental health systems. The Committee
    expects this program to continue to be carried out by the
    Office of Safe and Drug-Free Schools.
        The Committee includes $3,000,000 for the women's
    educational equity program. The comparable funding level for
    fiscal year 2005 is $2,956,000. This program supports projects
    that assist in the local implementation of gender equity
    policies and practices.
        The Committee recommendation includes $1,500,000 for
    activities authorized by the Excellence in Economics Education
    Act. The comparable fiscal year 2005 funding is $1,488,000.
    These funds will support a grant to a non profit educational
    organization to promote economic and financial literacy among
    kindergarten through 12th grade students.
        The Committee is pleased that, according to a nationwide
    survey of more than 4,000 high school seniors conducted by the
    Jump$tart Coalition, the level of financial literacy among 12th
    grade students has increased. However, with an average score of
    just 52.3 percent on the national exam, there is still much
    room for improvement. The Committee urges the Department to
    continue funding programs that improve the money management
    skills of young people through the inclusion of financial
    literacy materials, standards and assessments in high school
    math, economics and business courses.
        The Committee recommendation includes $10,000,000 to carry
    out the American History and Civics Education Act of 2004. From
    the amount available, $5,000,000 shall be used to establish
    Presidential Academies for Teaching of American History and
    Civics. These Presidential Academies will strengthen the
    knowledge and teaching capacity of K-12 teachers of American
    history and civics. The remaining $5,000,000 will support the
    establishment of Congressional Academies for Students of
    American History and Civics. These Congressional Academies will
    help outstanding students of American history and civics
    develop a broader and deeper understanding of these subject
    matters.
        The Committee expects funds to be awarded on a competitive
    basis to institutions of higher education, non-profit
    educational institutions, and consortia thereof, to establish
    and operate such Academies. The Committee further intends grant
    awards to last for a period of 2 years. The Committee urges the
    Secretary to give considerable weight to sustainability plans,
    which shall be required of applicants to show how they plan to
    sustain their project after their grant expires, when
    considering awards under this program.
        The Committee recommendation also includes resources for
    the following activities: teacher quality initiatives;
    evaluation and data quality initiatives designed to improve the
    quality of data collected from, and evaluations conducted by,
    grantees under elementary and secondary education programs;
    Reach Out and Read; and peer review.

    Teacher Incentive Fund

        The Committee recommendation does not include any funds for
    this new program. The budget request includes $500,000,000 for
    this new activity.
        Under the budget request, $450,000,000 would be available
    for formula grants to States for monetary awards to teachers
    who raise student achievement or reduce the achievement gap,
    and to ``highly qualified'' teachers who teach in high-need
    schools. Under the proposed program, States would be required
    to spend at least 25 percent of their funds for each of these
    two activities. The remaining $50,000,000 proposed in the
    budget request would be available for competitive grants from
    the U.S. Department of Education to partnerships of State
    educational agencies, local educational agencies and non-profit
    organizations for the development and implementation of
    performance-based teacher compensation systems in States and
    school districts.
        The budget request includes bill language that would
    authorize this new program. However, the Committee notes that
    this program was not specifically authorized under the No Child
    Left Behind Act, so it is not included in the Committee bill.

    Ready to Learn Television

        The Committee recommends an appropriation of $25,000,000
    for the Ready to Learn Television program. The comparable
    funding level for fiscal year 2005 and the budget request both
    are $23,312,000 for this purpose.
        Ready to Learn Television supports the development and
    distribution of educational television programming designed to
    improve the readiness of preschool children to enter
    kindergarten and elementary school. The program also supports
    the development, production, and dissemination of educational
    materials designed to help parents, children, and caregivers
    obtain the maximum advantage from educational programming.
        The original objective of RTL was to place educational
    programming within the reach of every American child,
    especially those in culturally disadvantaged households or
    communities.
        The Committee commends the research collaboration of WGBH
    Between the Lions, Sesame Workshop, and the National Center for
    Rural Early Childhood Education regarding Ready to Learn
    television shows and outreach programming. This new research
    for the first time shows the unique learning that occurs in
    rural areas and how they can be best addressed with
    technologically accessible enhancing programming coupled with
    regular public broadcasting of a variety of RTL television
    shows.
        The Committee notes that awards have yet to be made with
    fiscal year 2005 funds available for this program. The
    Committee understands that the competition placed a priority on
    reading programming, but does not intend to restrict program
    content to that subject only. The Committee appreciates the
    Department's commitment to creating high-quality learning
    environments for children through this program and intends that
    funds provided in last year's bill and this Act will support
    the Department's broad view of the educational value of this
    program. While successful reading is clearly an important
    foundation that will allow children to achieve at grade level
    in future years, it is not the only factor that will help them
    reach that goal.
        The Committee appreciates and continues to support the
    community outreach efforts that support programming developed
    and delivered through the Ready to Learn partnership during
    prior funding cycles. While not all of the local outreach
    activities achieved their goal of adequately supporting Ready
    to Learn programming, many leveraged significant local
    resources, fostered broad community collaboration with a small
    amount of Federal funding, and led to more frequent and longer
    periods of reading and other learning activities by those
    adults who attended local training workshops. The Committee
    notes that this small investment in local community outreach
    greatly extended the scope and educational value of this
    program, not only through the services offered to parents but
    also because of the incentive that it created for local
    stations to air Ready to Learn programming. The Committee
    believes this framework should continue to be supported and
    strongly urges the Department to utilize funds appropriated in
    fiscal year 2005 and continued in fiscal year 2006 for this
    purpose.

    Dropout Prevention

        The Committee does not recommend additional funds for the
    dropout prevention program. The comparable funding level for
    fiscal year 2005 is $4,930,000 and the budget request did not
    include any funding for the dropout prevention program. These
    funds are used to help schools implement effective school
    dropout prevention and re-entry programs.
        In addition, the Committee notes that in fiscal year 2005,
    States reserved more than $105,000,000 from their Title I, Part
    A allocations to operate State-administered projects in LEAs
    with the highest dropout rates and in areas serving a large
    number of children in local correctional facilities, as is
    required by law.

    Close Up Fellowships

        The Committee recommendation includes $1,469,000 for Close
    Up Fellowships. The comparable funding level for fiscal year
    2005 is $1,469,000 and the budget request did not include any
    funds for this purpose. The Close Up Fellowships, formerly
    called Ellender Fellowships, which is administered by the Close
    Up Foundation of Washington, DC, provides fellowships to
    students from low-income families and their teachers to enable
    them to spend 1 week in Washington attending seminars and
    meeting with representatives of the three branches of the
    Federal Government.
        The Committee notes that the Close Up Foundation, in
    collaboration with the Secretary of Education, is required to
    develop and implement procedures for measuring the efficacy of
    the Foundation's authorized programs, including the extent to
    which the programs are providing young people with an increased
    understanding of the Federal Government; heightening a sense of
    civic responsibility among young people; and enhancing the
    skills of educators in teaching young people about civic
    responsibility, the Federal Government, and attaining
    citizenship competencies. The Committee requests a more
    complete discussion of the actions taken to meet this statutory
    requirement, as well as program performance information, in the
    fiscal year 2007 Congressional Budget Justification.

    Advanced Placement Program

        The Committee recommends $33,000,000 for Advanced
    Placement. The comparable funding level for fiscal year 2005 is
    $29,760,000 and the budget request includes $51,500,000 for the
    Advanced Placement program.
        The first priority of the program is to subsidize test fees
    for low-income students who are enrolled in an Advanced
    Placement class and plan to take an Advanced Placement test.
    The balance of the funds are allocated for Advanced Placement
    Incentive Program grants, which are used to expand access for
    low-income individuals to Advanced Placement programs. Eligible
    activities include teacher training and participation in online
    Advanced Placement courses, among other related purposes.

                     Safe Schools and Citizenship Education

    Appropriations, 2005....................................    $833,987,000
    Budget estimate, 2006...................................     396,767,000
    House allowance.........................................     763,870,000
    Committee recommendation................................     697,300,000

    Safe and Drug-Free Schools and Communities

        The Committee recommends a total of $697,300,000 for
    activities to promote Safe Schools and Citizenship Education.
    The comparable fiscal year 2005 funding level is $833,987,000
    and the budget request includes $396,767,000 for these
    activities.
        State Grant Program.--The Committee recommends $300,000,000
    for the safe and drug-free schools and communities State grant
    program. The comparable fiscal year 2005 funding level is
    $437,381,000 and the budget request did not include any funds
    for this purpose. The State grant program is the backbone of
    youth drug prevention efforts in the United States. This
    formula-based State grant program provides resources to
    Governors, State educational agencies and local educational
    agencies for developing and implementing activities that help
    create and maintain safe and drug-free learning environments in
    and around schools.
        National Programs.--The Committee has included $150,000,000
    for the national programs portion of the safe and drug-free
    schools and communities program. The comparable funding level
    for fiscal year 2005 is $152,537,000 and the budget request
    includes $267,967,000 for these programs. The Committee does
    not recommend additional funding for Project SERV (School
    Emergency Response to Violence), which provides education-
    related services to LEAs in which the learning environment has
    been disrupted due to a violent or traumatic crisis. The budget
    request includes $5,000,000 for Project SERV. However, the
    Committee notes that the Department currently has roughly
    $8,000,000 available for this purpose. These funds are
    available until expended. The Committee will monitor the
    availability of funding and consider action in subsequent
    appropriations bills.
        The Committee continues to be concerned about the
    increasing problem of alcohol and drug abuse on college
    campuses. The Committee has included bill language requiring
    the Department to spend $850,000 on a program under the
    guidelines in section 120(f) of Public Law 105-244. This
    program identifies and provides models of alcohol and drug
    abuse prevention and education programs in higher education.
    The Committee includes these funds within the requested
    $10,000,000 for post-secondary alcohol prevention efforts
    proposed in the budget request.
        The Committee expects that the Department will provide
    $300,000 for the continued operation of the National
    Clearinghouse for Educational Facilities. These funds will be
    used to address issues related to school safety and healthy
    school buildings. The Committee has included additional funds
    for the Clearinghouse through the Fund for the Improvement of
    Education.
        The Committee recommendation does not include $87,500,000
    as requested by the Department for a new grant program for
    local educational agencies. This program was proposed to
    replace the State grant program, a proposal rejected by the
    Commmittee.
        The Committee recommendation includes $30,000,000 to
    continue the school safety initiative. The budget request
    includes $30,000,000 to support grants and technical assistance
    to elementary and secondary schools for responding to emergency
    response challenges identified in the Department of Homeland
    Security's Critical Infrastructure plan. The Committee notes
    that not all districts in need of planning funds previously
    provided have received them, so the Department is encouraged to
    consider running an additional planning grant competition to
    ensure that the most at-risk districts receive planning grants
    before moving to this next phase. The Committee expects to
    receive a letter report on the plan for fiscal year 2006 funds,
    prior to the announcement of the next grant competition under
    this program.
        The Committee recommendation includes $7,492,000 for
    school-based drug testing programs for students. The comparable
    fiscal year 2005 funding level is $9,920,000 and the budget
    request includes $25,000,000. The Committee expects that this
    funding will be used to continue and evaluate current drug
    testing grants.
        The Committee recommendation also includes $9,372,000 to
    continue data management improvement grants and related
    technical assistance; $82,336,000 for safe schools healthy
    students; $2,000,000 for the required impact evaluation;
    $2,000,000 for information and materials; $2,000,000 for data
    collection and analysis; $1,500,000 for other joint project
    with Federal agencies; and $3,000,000 for other program
    improvement activities.
        Research studies have found that mental health greatly
    affects academic achievement and educational outcomes. The
    Committee recognizes the negative impact that depression,
    anxiety, substance abuse, and other mental disorders can have
    on a youth's academic performance and urges the Office of Safe
    and Drug Free Schools to join the Substance Abuse and Mental
    Health Services Administration, the Centers for Disease
    Control, and other Federal agency efforts to take concrete
    steps to improve the mental health of America's youth through
    the early identification of mental health problems, including
    the use of voluntary, evidence-based mental health screening of
    adolescents. The Committee urges the Department to continue to
    promote school-wide mental health strategies, provide training
    to school personnel to recognize early warning signs of mental
    illness, and increase access to high-quality mental health
    services. In addition, the Department is encouraged to include
    an evaluation component to determine the most effective
    programs and practices for the early identification of youth
    mental illness.

    Alcohol Abuse Reduction

        The Committee recommends $33,500,000 for grants to LEAs to
    develop and implement programs to reduce underage drinking in
    secondary schools. The comparable funding level for fiscal year
    2005 is $32,736,000 and the budget request did not include any
    funds for this purpose. The Committee directs the Department
    and the Substance Abuse and Mental Health Services
    Administration [SAMHSA] in the Department of Health and Human
    Services to work together on this effort.

    Mentoring

        The Committee recommends $49,307,000 to support mentoring
    programs and activities for children who are at risk of failing
    academically, dropping out of school, getting involved in
    criminal or delinquent activities, or who lack strong positive
    role models. The comparable fiscal year 2005 funding level and
    the budget request both are $49,307,000 for this purpose.

    Character Education

        The Committee recommends $24,493,000 to provide support for
    the design and implementation of character education programs.
    The comparable funding level for fiscal year 2005 and the
    budget request both are $24,493,000 for this purpose.

    Elementary and Secondary School Counseling

        The Committee recommends $36,000,000 to establish or expand
    counseling programs in elementary schools. The comparable
    fiscal year 2005 funding level is $34,720,000 and the
    President's budget proposes to eliminate funding for this
    program. As authorized by the No Child Left Behind Act, all
    amounts appropriated up to $40,000,000 are used only for
    elementary school counseling programs.

    Carol M. White Physical Education for Progress Program

        The Committee recommends $74,000,000 to help LEAs and
    community-based organizations initiate, expand and improve
    physical education programs for students in grades K-12, as
    authorized by Public Law 107-110. The comparable funding level
    for fiscal year 2005 is $73,408,000 and the budget request
    includes $55,000,000 for this program. Provision of this
    funding will help schools and communities nationwide improve
    their structured physical education programs for students and
    help children develop healthy lifestyles to combat the epidemic
    of obesity in the Nation. The Committee does not agree with the
    administration's proposal to phase-out and eventually eliminate
    funding for this program.
        The Committee notes that in the past 15 years, obesity has
    increased by over 50 percent among adults and in the past 20
    years, obesity has increased by 100 percent among children and
    adolescents. The National Institute of Child Health and Human
    Development [NICHD] Study of Early Child Care and Youth
    Development found that third grade children in the study
    received an average of 25 minutes per week in school of
    moderate to vigorous activity, while experts in the United
    States have recommended that young people should participate in
    physical activity of at least moderate intensity for 30 to 60
    minutes each day. While not nationally represented, this
    information is consistent with the 2002 Youth Risk Behavior
    Surveillance System which found that only roughly one-half of
    all students report attending a physical education class one or
    more times a week. The Committee believes Federal funding is
    critical to the effort to reducing these trends and helping
    improve the health of the American public.

    Civic Education

        The Committee recommends $30,000,000 for grants to improve
    the quality of civics and government education, to foster civic
    competence and responsibility, and to improve the quality of
    civic and economic education through exchange programs with
    emerging democracies. The comparable fiscal year 2005 funding
    level is $29,405,000 and the budget request proposed to
    eliminate funding for this purpose.
        Civic Education program funds support both the We the
    People programs and the Cooperative Education Exchange. The
    Committee recommends $17,560,000 for the nonprofit Center for
    Civic Education to support the We the People programs. We the
    People has two primary components: the Citizen and the
    Constitution program, which provides teacher training,
    curriculum materials, and classroom instruction for upper
    elementary, middle, and high school students; and Project
    Citizen, a program for middle school students that focuses on
    the role of State and local governments in the American Federal
    system.
        Within the amount for the We the People program, the
    Committee recommends the following: that $3,087,000 be reserved
    to continue the comprehensive program to improve public
    knowledge, understanding, and support of American democratic
    institutions which is a cooperative project among the Center
    for Civic Education, the Center on Congress at Indiana
    University, and the Trust for Representative Democracy at the
    National Conference of State Legislatures; and that $1,543,000
    be used for continuation and expansion of the school violence
    prevention demonstration program including the Native American
    program.
        The Committee recommends $12,440,000 for the Cooperative
    Education Exchange program. Within this amount, the Committee
    has included $4,665,000 for the Center for Civic Education and
    $4,665,000 for the National Council on Economic Education. The
    remaining $3,110,000 should be used for a competitive grant
    program for civics and government education, and for economic
    education.

                          English Language Acquisition

    Appropriations, 2005....................................    $675,765,000
    Budget estimate, 2006...................................     675,765,000
    House allowance.........................................     675,765,000
    Committee recommendation................................     675,765,000

        The Committee recommends an appropriation of $675,765,000
    for English language acquisition. The comparable funding level
    for fiscal year 2005 and the budget request both are
    $675,765,000 for authorized activities.
        The Department makes formula grants to States based on each
    State's share of the Nation's limited-English-proficient and
    recent immigrant student population. The program is designed to
    increase the capacity of States and school districts to address
    the needs of these students. The No Child Left Behind Act also
    requires that 6.5 percent of the appropriation, an amount equal
    to $43,925,000 at the Committee recommendation funding level,
    be used to support national activities, which include
    professional development activities designed to increase the
    number of highly qualified teachers serving limited English
    proficient students; a National Clearinghouse for English
    Language Acquisition and Language Instructional Programs; and
    evaluation activities. The budget request includes language
    that would allow national activities funds to be available for
    2 years. The Committee bill includes the requested language.
        At the level of the Committee recommendation, the State
    grant portion of this account will increase by more than
    $44,000,000, as funding for expiring projects under the prior
    law are redirected to the State grant program. These additional
    funds will help States improve the educational outcomes for
    limited English proficient students.

                               Special Education

    Appropriations, 2005.................................... $11,673,606,000
    Budget estimate, 2006...................................  12,126,130,000
    House allowance.........................................  11,813,783,000
    Committee recommendation................................  11,774,107,000

        The Committee recommends $11,774,107,000 for special
    education programs authorized by the Individuals with
    Disabilities Education Act [IDEA]. The comparable fiscal year
    2005 funding level is $11,673,606,000 and the budget request
    includes $12,126,130,000 for such programs.

    Office of Special Education and Rehabilitative Services [OSERS]

        No Child Left Behind [NCLB].--The Committee notes that the
    Department recently announced changes in NCLB policy regarding
    students with disabilities who have shown academic
    difficulties. The Department estimates that 2 percent of
    students with academic disabilities can make progress toward
    grade-level standards when they receive high-quality
    instruction and when their assessments are based on modified
    academic achievement standards assessments. The Committee is
    concerned that States do not yet have the tools and resources
    to appropriately implement the new policy in the 2005-2006
    school year. To help States prepare for future implementation
    based on the promulgation of final regulations, the Committee
    strongly urges OSERS to provide support guidance to States, and
    LEAs, and parents that will define how students are identified
    for this category and ensure that eligible students have every
    possible opportunity for full and consistent participation in
    the general education curriculum and be on track to graduate
    with a regular diploma.

    Office of Special Education Programs [OSEP]

        Specific Learning Disabilities [SLD].--The Committee urges
    OSEP to ensure that the National Research Center on Learning
    Disabilities [NRCLD] continues to conduct and synthesize
    research on how to best implement and take to scale
    identification methods that rely on students' responses to
    scientific research-based instruction. OSEP, through the NRCLD,
    should assist States and LEAs in identifying the criteria for
    determining an SLD and ensuring the consistency and integrity
    of the classification system across the States, and provide
    guidance and technical assistance systems for the improvement
    of SLD identification and eligibility. The NRCLD should
    disseminate to and assist both States and LEAs with replicable
    models that produce measurable positive improvements in student
    learning. The NRCLD should coordinate with the PTIs, the
    National Dissemination Center for Children with Disabilities
    and other national partners to disseminate information about
    accurate identification of SLDs to parents. The Committee
    encourages OSEP to coordinate efforts within the Department of
    Education, NIH, NSF and other Federal agencies working on
    related activities.
        No Child Left Behind [NCLB] and the Individuals with
    Disabilities Education Improvement Act of 2004.--The Committee
    urges OSEP to educate parents of students with learning
    disabilities with the critical information they need to
    understand the impact of decisions made by the IEP team
    regarding assessments required by NCLB, school choice,
    supplemental education services, and other provisions of NCLB.

    Grants to States

        The Committee recommends $10,689,746,000 for special
    education grants to States, as authorized under part B of the
    IDEA. The comparable fiscal year 2005 funding level is
    $10,589,746,000 and the budget request includes
    $11,097,746,000. This program provides formula grants to assist
    States, Outlying Areas, and other entities in meeting the costs
    of providing special education and related services for
    children with disabilities. States pass along most of these
    funds to local educational agencies, but may reserve some for
    program monitoring, enforcement, technical assistance and other
    activities.
        The appropriation for this program primarily supports
    activities associated with the 2006-2007 academic year. Of the
    funds available for this program, $5,265,546,000 will become
    available on July 1, 2006 and $5,424,200,000 will become
    available on October 1, 2006. These funds will remain available
    for obligation until September 30, 2007.
        The reauthorization established a new activity under this
    program, which allows funds to be used by the Secretary for
    grants to and contracts with States that improve their capacity
    to collect data required under the Act. The reauthorization
    also established a separate program for IDEA studies and
    evaluations, which is now funded as a separate program under
    the Institute of Education Sciences. Studies and evaluations
    were funded previously under this program, in accordance with
    the former law.
        The Committee's recommended funding level represents
    approximately 18 percent of the average per-pupil expenditure,
    an increase of 50 percent from the level in fiscal year 2000
    when the Federal share of average per-pupil expenditure was 12
    percent.
        The budget request includes language capping the Department
    of Interior set-aside at the prior year level, adjusted by the
    increase in inflation. The Committee bill includes this
    language.

    Preschool Grants

        The Committee recommends $384,597,000 for preschool grants.
    The comparable fiscal year 2005 funding level and the budget
    request both are $384,597,000. The preschool grants program
    provides formula grants to States to make available special
    education and related services for children with disabilities
    aged 3 through 5. States are eligible for funds, which they in
    turn pass on to local educational agencies, if they serve all
    eligible children with disabilities aged 3 through 5 and have
    an approved application under the Individuals with Disabilities
    Education Act.

    Grants for Infants and Families

        The Committee recommends $444,308,000 for grants for the
    infants and families program under part C of the IDEA. The
    comparable fiscal year 2005 funding level and the budget
    request both are $440,808,000. This program provides formula
    grants to States, Outlying Areas and other entities to
    implement statewide systems of coordinated, comprehensive,
    multidisciplinary interagency programs to make available early
    intervention services to all children with disabilities, ages 2
    and under, and their families.
        The Individuals with Disabilities Education Improvement Act
    of 2004 created a new State Incentive Grant program, triggered
    when the appropriation for this program exceeds $460,000,000.
    Under this new authority, 15 percent of the appropriation is
    reserved by the Secretary for grants to States that have chosen
    to extend Part C services to 3-year-old children through their
    enrollment in kindergarten or elementary school who otherwise
    would be eligible for services under the Preschool Grants
    program.

    State Personnel Development

        The Committee recommends $50,653,000 for the State
    personnel development program. The comparable fiscal year 2005
    funding level is $50,653,000 and the budget request does not
    include any funds for this program. The program formerly was
    known as the State improvement grant program, until it was
    changed by the Individuals with Disabilities Education
    Improvement Act of 2004. Under the reauthorization, this
    program focuses on the professional development needs in States
    by requiring that 90 percent of funds be used for professional
    development activities. The program supports grants to State
    educational agencies to help them reform and improve their
    personnel preparation and professional development related to
    early intervention, educational and transition services that
    improve outcomes for students with disabilities.
        Under this program, competitive grants are made when the
    appropriation is less than $100,000,000, but are made by
    formula to States when the appropriation exceeds this amount
    and $100,000,000 is remaining after covering continuation
    costs.

    Transition Initiative

        The Committee recommendation does not include any funds for
    this new program. The budget request includes $5,000,000 for
    this new initiative. Funds would be used to help States improve
    high school graduation rates, transition activities, and post-
    school outcomes, establish better data collection systems, and
    analyze and use student information. Grants would be made to
    State educational agencies on a competitive basis.
        The Committee notes that the budget request includes
    $2,000,000 under the demonstration and training program in the
    Rehabilitation Services and Disability Research account to
    support this initiative. Funds are available under that program
    for this initiative, but the Committee is unable to provide the
    additional special education funds requested for the new
    program given budgetary constraints.

    Technical Assistance and Dissemination

        The Committee recommends $49,397,000 for technical
    assistance and dissemination. The comparable fiscal year 2005
    funding level is $52,396,000 and the budget request is
    $49,397,000 for these activities. This program supports awards
    for technical assistance, model demonstration projects, the
    dissemination of useful information and other activities.
    Funding supports activities that are designed to improve the
    services provided under IDEA.

    Personnel Preparation

        The Committee recommends $90,626,000 for the personnel
    preparation program. The comparable fiscal year 2005 funding
    level and the budget request both are $90,626,000 for this
    program. Funds support competitive awards to help address
    State-identified needs for personnel who are qualified to work
    with children with disabilities, including special education
    teachers and related services personnel.
        The Committee is particularly concerned about the shortage
    of qualified occupational therapists available to work in
    school systems, to assist children with disabilities, and with
    the shortage of leadership-level faculty to train such
    professionals. The Committee intends that funds be used to
    address these shortages.

    Parent Information Centers

        The Committee recommends $25,964,000 for parent information
    centers. The comparable fiscal year 2005 funding level and the
    budget request both are $25,964,000 for authorized activities.
    This program makes awards to parent organizations to support
    parent training and information centers, including community
    parent resource centers. These centers provide training and
    information to meet the needs of parents of children with
    disabilities living in the areas served by the centers,
    particularly underserved parents, and parents of children who
    may be inappropriately identified.

    Technology and Media Services

        The Committee recommends $38,816,000 for technology and
    media services. The comparable fiscal year 2005 funding level
    is $38,816,000 and the budget request includes $31,992,000 for
    such activities. This program makes competitive awards to
    support the development, demonstration, and use of technology,
    and educational media activities of value to children with
    disabilities.
        The Committee recommendation includes $12,000,000 for
    Recording for the Blind and Dyslexic, Inc. [RFB&D]. These funds
    support the continued production and circulation of recorded
    textbooks, increased outreach activities to print-disabled
    students and their teachers, and accelerated use of digital
    technology. The administration proposed eliminating support of
    RFB&D for these activities.
        The Committee also recommends $1,500,000 to continue
    support of the Reading Rockets program. Last year, this program
    received $1,488,000. The administration proposed eliminating
    support for this program.
        This activity is authorized by section 687(b)(2)(G) of the
    Individuals with Disabilities Education Act, as amended. The
    Committee recognizes the progress of the Reading Rockets
    program, which is developing a wide range of media resources to
    disseminate research conducted by the National Institutes of
    Health, as well as other research concerning effective teaching
    strategies, early diagnosis of, and intervention for, young
    children with reading disabilities. These resources include an
    extensive web site, videos, and programming for television and
    radio broadcast. The Committee includes funding for the
    continued development and distribution of media resources to
    reach the parents and teachers of children with reading
    disabilities.
        The Committee notes that, within the budget request, funds
    are available to provide better access to educational media and
    materials for individuals with disabilities, including
    activities related to the National Instructional Materials
    Accessibility Standard. The Committee supports these efforts,
    and encourages the Department to provide sufficient funds to
    fulfill the requirements related to this standard established
    by the Individuals with Disabilities Education Improvement Act
    of 2004.

                Rehabilitation Services and Disability Research

    Appropriations, 2005....................................  $3,074,574,000
    Budget estimate, 2006...................................   3,059,298,000
    House allowance.........................................   3,128,638,000
    Committee recommendation................................   3,133,638,000

        The Committee recommends $3,133,638,000 for rehabilitation
    services and disability research. The comparable fiscal year
    2005 funding level is $3,074,574,000 and the budget request
    includes $3,059,298,000 for programs in this account.
        The authorizing statute for programs funded in this
    account, except for those authorized under the Assistive
    Technology Act, expired September 30, 2004. The program
    descriptions provided below assume the continuation of current
    law.
        The Committee recognizes the importance, efficiency, and
    return on the taxpayer dollar of community rehabilitation
    programs and other nonprofit organizations in providing support
    for people with disabilities. The Committee urges the
    Rehabilitation Services Administration to support the
    utilization of community rehabilitation programs to the maximum
    extent possible in the delivery of employment and other support
    services to people with disabilities.

    Vocational Rehabilitation State Grants

        The Committee provides $2,720,192,000 for vocational
    rehabilitation grants to States. The Committee recommendation
    provides the full amount authorized by the Rehabilitation Act
    of 1973. The comparable funding level for fiscal year 2005 is
    $2,635,845,000.
        Basic State grant funds assist States in providing a range
    of services to help persons with physical and mental
    disabilities prepare for and engage in meaningful employment.
    Authorizing legislation requires States to give priority to
    persons with the most significant disabilities. Funds are
    allotted to States based on a formula that takes into account
    population and per capita income. States must provide a 21.3
    percent match of Federal funds, except the State's share is 50
    percent for the cost of construction of a facility for
    community rehabilitation program purposes.
        The Rehabilitation Act requires that no less than 1 percent
    and not more than 1.5 percent of the appropriation in fiscal
    year 2006 for vocational rehabilitation State grants be set
    aside for grants for Indians. Service grants are awarded to
    Indian tribes on a competitive basis to help tribes develop the
    capacity to provide vocational rehabilitation services to
    American Indians with disabilities living on or near
    reservations.

    Client Assistance

        The Committee recommends $11,901,000 for the client
    assistance program. The comparable fiscal year 2005 funding
    level and the budget request both are $11,901,000 for
    authorized activities.
        The client assistance program funds State formula grants to
    assist vocational rehabilitation clients or client applicants
    in understanding the benefits available to them and in their
    relationships with service providers. Funds are distributed to
    States according to a population-based formula, except that
    increases in minimum grants are guaranteed to each of the 50
    States, the District of Columbia, and Puerto Rico, and
    guaranteed to each of the outlying areas, by a percentage not
    to exceed the percentage increase in the appropriation. States
    must operate client assistance programs in order to receive
    vocational rehabilitation State grant funds.

    Training

        The Committee recommends $38,826,000 for training
    rehabilitation personnel. The comparable fiscal year 2005
    funding level and the budget request both are $38,826,000 for
    training activities.
        The purpose of this program is to ensure that skilled
    personnel are available to serve the rehabilitation needs of
    individuals with disabilities. It supports training,
    traineeships, and related activities designed to increase the
    numbers of qualified personnel providing rehabilitation
    services. The program awards grants and contracts to States and
    public or nonprofit agencies and organizations, including
    institutions of higher education, to pay all or part of the
    cost of conducting training programs. Long-term, in-service,
    short-term, experimental and innovative, and continuing
    education programs are funded, as well as special training
    programs and programs to train interpreters for persons who are
    deaf, hard of hearing and deaf-blind.

    Demonstration and Training Programs

        The Committee bill includes $6,577,000 for demonstration
    and training programs for persons with disabilities. The
    comparable fiscal year 2005 funding level is $25,607,000 and
    the budget request includes $6,577,000 for authorized
    activities. This program awards grants to States and nonprofit
    agencies and organizations to develop innovative methods and
    comprehensive services to help individuals with disabilities
    achieve satisfactory vocational outcomes. Demonstration
    programs support projects for individuals with a wide array of
    disabilities.
        The Committee is pleased with the partnership between RSA
    and the American Academy of Orthotists and Prosthetists to
    support and improve the quality of applied orthotic and
    prosthetic research and help meet the increasing demand for
    provider services. The Committee has provided sufficient funds
    to support this partnership at its current level. Funds are to
    be used to further develop the orthotic and prosthetic
    awareness campaign, which includes an educational outreach
    initiative designed to recruit and retain professionals. Funds
    also will continue to support a series of consensus conferences
    and the dissemination of best practices to the field.

    Migrant and Seasonal Farmworkers

        The Committee recommends $2,302,000 for migrant and
    seasonal farmworkers, the same amount as the comparable fiscal
    year 2005 funding level. The Department proposes eliminating
    separate funding for this program.
        This program provides grants limited to 90 percent of the
    costs of the projects providing comprehensive rehabilitation
    services to migrant and seasonal farm workers with disabilities
    and their families. Projects also develop innovative methods
    for reaching and serving this population. The program
    emphasizes outreach, specialized bilingual rehabilitation
    counseling, and coordination of vocational rehabilitation
    services with services from other sources.

    Recreational Programs

        The Committee provides $2,543,000 for recreational
    programs, the same amount as the comparable fiscal year 2005
    funding level. The budget request does not include funding for
    this program.
        Recreational programs help finance activities such as
    sports, music, dancing, handicrafts, and art to aid in the
    employment, mobility, and socialization of individuals with
    disabilities. Grants are awarded to States, public agencies,
    and nonprofit private organizations, including institutions of
    higher education. Grants are awarded for a 3-year period with
    the Federal share at 100 percent for the first year, 75 percent
    for the second year, and 50 percent for the third year.
    Programs must maintain the same level of services over the 3-
    year period.

    Protection and Advocacy of Individual Rights

        The Committee recommends $16,656,000 for protection and
    advocacy of individual rights. The comparable fiscal year 2005
    funding level and the budget request both are $16,656,000.
        This program provides grants to agencies to protect and
    advocate for the legal and human rights of persons with
    disabilities who are not eligible for protection and advocacy
    services available through the Developmental Disabilities
    Assistance and Bill of Rights Act or the Protection and
    Advocacy for Individuals with Mental Illness Act.

    Projects with Industry

        The Committee recommends $19,735,000 for projects with
    industry. The comparable fiscal year 2005 funding level is
    $21,625,000 and the administration proposes eliminating
    separate funding for this program.
        The projects with industry [PWI] program promotes greater
    participation of business and industry in the rehabilitation
    process. PWI provides training and experience in realistic work
    settings to prepare individuals with disabilities for
    employment in the competitive job market. Postemployment
    support services are also provided. The program supports grants
    to a variety of agencies and organizations, including
    corporations, community rehabilitation programs, labor and
    trade associations, and foundations.

    Supported Employment State Grants

        The Committee's bill includes $30,000,000 for the supported
    employment State grant program. The comparable fiscal year 2005
    funding level is $37,379,000 and the administration proposes
    eliminating separate funding for this program.
        This program assists the most severely disabled individuals
    by providing the ongoing support needed to obtain competitive
    employment. Short-term vocational rehabilitation services are
    augmented with extended services provided by State and local
    organizations. Federal funds are distributed on the basis of
    population.

    Independent Living State Grants

        The Committee recommends $22,816,000 for independent living
    State grants. The comparable funding level for fiscal year 2005
    and the budget request both are $22,816,000 for authorized
    activities.
        The independent living State formula grants program
    provides funding to improve independent living services,
    support the operation of centers for independent living,
    conduct studies and analysis, and provide training and
    outreach.

    Independent Living Centers

        The Committee recommends $75,392,000 for independent living
    centers. The comparable fiscal year 2005 funding level and the
    budget request both are $75,392,000 for the centers.
        These funds support consumer-controlled, cross-disability,
    nonresidential, community-based centers that are designed and
    operated within local communities by individuals with
    disabilities. These centers provide an array of independent
    living services.

    Independent Living Services for Older Blind Individuals

        The Committee provides $33,227,000 for independent living
    services to older blind individuals. The comparable fiscal year
    2005 funding level and the budget request both are $33,227,000
    for these activities. Through this program, assistance is
    provided to persons aged 55 or older to adjust to their
    blindness, continue living independently and avoid societal
    costs associated with dependent care. Services may include the
    provision of eyeglasses and other visual aids, mobility
    training, braille instruction and other communication services,
    community integration, and information and referral. These
    services help older individuals age with dignity, continue to
    live independently and avoid significant societal costs
    associated with dependent care. The services most commonly
    provided by this program are daily living skills training,
    counseling, the provision of low-vision devices community
    integration, information and referral, communication devices,
    and low-vision screening.
        The Committee notes that there are 5 million Americans in
    this country age 55 and older who are experiencing vision loss
    and that the number of Americans in this category is expected
    to double in the next 30 years. The Committee recognizes the
    very important and cost-effective work carried out through this
    program. By allowing older individuals to remain in their homes
    and communities, substantial savings are achieved.

    Program Improvement Activities

        The Committee recommends $843,000 for program improvement
    activities. The comparable fiscal year 2005 funding level and
    the budget request both are $843,000 for authorized activities.
    In fiscal year 2006, funds for these activities will continue
    to support technical assistance efforts to improve the
    efficiency and effectiveness of the vocational rehabilitation
    program and improve accountability efforts. The funds provided
    are sufficient to support technical assistance and other
    ongoing program improvement activities, such as improved
    program performance measurement.

    Evaluation

        The Committee recommends $1,488,000 for evaluation
    activities. The comparable fiscal year 2005 funding level and
    the budget request both are $1,488,000 for such activities.
        These funds support evaluations of the impact and
    effectiveness of programs authorized by the Rehabilitation Act.
    The Committee recommendation continues to support a new multi-
    year study of the State Vocational Rehabilitation Services
    program. The Department awards competitive contracts for
    studies to be conducted by persons not directly involved with
    the administration of Rehabilitation Act programs.

    Helen Keller National Center

        The Committee recommends $8,597,000 for the Helen Keller
    National Center for Deaf-Blind Youth and Adults. The comparable
    fiscal year 2005 funding level is $10,581,000 and the budget
    request includes $8,597,000 for this purpose. The difference
    between fiscal year 2005 funding and the Committee
    recommendation relates to earmarked funds provided in the
    Consolidated Appropriations Act, 2005. These funds are still
    available for expenditure and it is estimated it could take
    another 2 years before they are exhausted.
        The Helen Keller National Center consists of a national
    headquarters in Sands Point, NY, with a residential training
    and rehabilitation facility where deaf-blind persons receive
    intensive specialized services; a network of 10 regional field
    offices which provide referral and counseling assistance to
    deaf-blind persons; and an affiliate network of agencies. At
    the recommended level, the center would serve more than 110
    persons with deaf-blindness at its headquarters facility and
    provide field services to approximately 2,500 individuals and
    families and approximately 1,100 organizations.

    National Institute on Disability and Rehabilitation Research

        The Committee recommends $107,783,000 for the National
    Institute on Disability and Rehabilitation Research [NIDRR].
    The comparable fiscal year 2005 funding level and the budget
    request both are $107,783,000 for authorized activities.
        NIDRR develops and implements a comprehensive and
    coordinated approach to the conduct of research, demonstration
    projects, and related activities that enable persons with
    disabilities to better function at work and in the community,
    including the training of persons who provide rehabilitation
    services or who conduct rehabilitation research. The Institute
    awards competitive grants to support research in federally
    designated priority areas, including rehabilitation research
    and training centers, rehabilitation engineering research
    centers, research and demonstration projects, and dissemination
    and utilization projects. NIDRR also supports field-initiated
    research projects, research training, and fellowships.
        The Committee recommendation includes $11,863,000, as
    proposed in the budget request, for NIDRR's spinal cord injury
    model systems projects. The Committee intends that these funds
    should be used to support investments that would facilitate
    multi-center research and encourages NIDRR to continue its
    collaboration with other Federal agencies in order to leverage
    Federal investments in this area.

    Assistive Technology

        The Committee recommends $34,760,000 for assistive
    technology. The comparable fiscal year 2005 funding level is
    $29,760,000. The budget request includes $15,000,000 solely for
    the alternative financing program.
        The Assistive Technology program is designed to improve
    occupational and educational opportunities and the quality of
    life for people of all ages with disabilities through increased
    access to assistive technology services and devices. The
    program support various activities that help States to develop
    comprehensive, consumer-responsive statewide programs that
    increase access to, and the availability of, assistive
    technology devices and services. Under the recent
    reauthorization, the administration of this program was moved
    to the Rehabilitation Services Administration from the National
    Institute on Disability and Rehabilitation Research. The
    reauthorization also requires that an annual report be
    submitted to Congress by December 31 of each year.
        The Committee recommendation includes $25,300,000 for State
    grant activities authorized under section 4, $4,500,000 for
    protection and advocacy systems authorized by section 5, and
    $1,200,000 for technical assistance activities authorized under
    section 6.
        The Committee recommendation also includes $3,760,000 for
    the alternative financing program. The Committee recommendation
    includes bill language requested by the administration designed
    to encourage States to support alternative financing programs.
    These changes allow States to receive less than $500,000 for an
    award, require a match of 25 percent and enable States to
    receive more than one grant. The Committee urges the Department
    to ensure that grantees design and operate their programs in a
    consumer-directed fashion. The Committee also urges the
    Department to utilize these funds to expand the number of
    States operating alternative financing programs.

               Special Institutions for Persons With Disabilities

                     AMERICAN PRINTING HOUSE FOR THE BLIND

    Appropriations, 2005....................................     $16,864,000
    Budget estimate, 2006...................................      16,864,000
    House allowance.........................................      17,000,000
    Committee recommendation................................      18,500,000

        The Committee recommends $18,500,000 for the American
    Printing House for the Blind [APH]. The comparable fiscal year
    2005 funding level is $16,864,000 and the budget request
    includes $16,864,000 for this purpose.
        This appropriation helps support the American Printing
    House for the Blind, which provides educational materials to
    students who are legally blind and enrolled in programs below
    the college level. The Federal subsidy provides almost 60
    percent of APH's total sales income. Materials are distributed
    free of charge to schools and States through per capita
    allotments based on the total number of students who are blind.
    Materials provided include textbooks and other educational aids
    in braille, large type, and recorded form and microcomputer
    applications. Appropriated funds may be used for staff salaries
    and expenses, as well as equipment purchases and other
    acquisitions consistent with the purpose of the Act to Promote
    the Education of the Blind.
        In addition to its ongoing activities, the Individuals with
    Disabilities Education Improvement Act assigned to the American
    Printing House for the Blind the responsibility of establishing
    and maintaining a National Instructional Materials Access
    Center. The Center will serve as a national clearinghouse,
    maintaining a repository of textbook files provided in the
    National Instructional Materials Accessibility Standard format
    by textbook publishers. The Center will manage the transfer of
    these files to State Education Agencies for production in media
    that are readily accessible to the blind, visually impaired,
    and print disabled. The Committee supports this effort, and
    encourages the Department to provide sufficient funds to
    fulfill the requirements of the law.

                   NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

    Appropriations, 2005....................................     $55,344,000
    Budget estimate, 2006...................................      54,472,000
    House allowance.........................................      56,137,000
    Committee recommendation................................      57,279,000

        The Committee recommends $57,279,000 for the National
    Technical Institute for the Deaf [NTID]. The comparable fiscal
    year 2005 funding level is $55,344,000 and the budget request
    includes $54,472,000 for this purpose.
        The Institute, located on the campus of the Rochester
    Institute of Technology, was created by Congress in 1965 to
    provide a residential facility for postsecondary technical
    training and education for persons who are deaf. NTID also
    provides support services for students who are deaf, trains
    professionals in the field of deafness, and conducts applied
    research. Within the amount provided, $800,000 is for
    construction. At the discretion of the Institute, funds may be
    used for the Endowment Grant program.

                              GALLAUDET UNIVERSITY

    Appropriations, 2005....................................    $104,557,000
    Budget estimate, 2006...................................     104,557,000
    House allowance.........................................     107,657,000
    Committee recommendation................................     108,500,000

        The Committee recommends $108,500,000 for Gallaudet
    University. The comparable fiscal year 2005 funding level and
    the budget request both are $104,557,000 for the university.
        Gallaudet University is a private, nonprofit institution
    offering undergraduate, and continuing education programs for
    students who are deaf, as well as graduate programs in fields
    related to deafness for students who are hearing-impaired and
    who are deaf. The University conducts basic and applied
    research related to hearing impairments and provides public
    service programs for the deaf community.
        The Model Secondary School for the Deaf serves as a
    laboratory for educational experimentation and development,
    disseminates models of instruction for students who are deaf,
    and prepares adolescents who are deaf for postsecondary
    academic or vocational education. The Kendall Demonstration
    Elementary School develops and provides instruction for
    children from infancy through age 15.
        The Committee recommendation includes funding to enable
    Gallaudet University to continue to offer competitive pay
    increases for faculty and staff, support investments in
    information technology and address other cost increases and
    program improvements. Funds also are available, at the
    discretion of the University, for the Endowment Grant program.

                         Vocational and Adult Education

    Appropriations, 2005....................................  $2,037,733,000
    Budget estimate, 2006...................................     215,734,000
    House allowance.........................................   1,991,782,000
    Committee recommendation................................   1,923,766,000

        The Committee recommendation includes a total of
    $1,923,766,000 for vocational and adult education, consisting
    of $1,309,400,000 for vocational education, $585,406,000 for
    adult education and $28,960,000 for other activities. The
    comparable funding level in fiscal year 2005 is $2,037,733,000
    and the budget request includes $215,734,000 for this account.
        The authorizing statute for vocational and adult education
    programs and the State grants for incarcerated youth offenders
    program funded in this account expired September 30, 2004.
    Descriptions for these programs provided below assume the
    continuation of current law.

                              VOCATIONAL EDUCATION

        The Committee recommends $1,309,400,000 for vocational
    education. The comparable fiscal year 2005 funding level is
    $1,326,107,000 and the budget request does not include any
    funds for these activities. The administration proposed to
    redirect the funds currently allocated for vocational education
    to a new High School initiative. The Committee notes that this
    initiative has not been acted on by the appropriate authorizing
    committees of Congress.
        Basic Grants.--The Committee recommends $1,194,331,000 for
    basic grants, the same amount as the comparable fiscal year
    2005 funding level. The budget request does not include any
    funds for this purpose. Funds provided under the State grant
    program assist States, localities, and outlying areas to expand
    and improve their programs of vocational education and provide
    equal access to vocational education for populations with
    special needs. Persons assisted range from secondary students
    in prevocational courses through adults who need retraining to
    adapt to changing technological and labor market conditions.
    Funds are distributed according to a formula based on State
    population and State per capita income.
        Under the Indian and Hawaiian Natives programs, competitive
    grants are awarded to federally recognized Indian tribes or
    tribal organizations and to organizations primarily serving and
    representing Hawaiian Natives for services that are in addition
    to services such groups are eligible to receive under other
    provisions of the Perkins Act.
        Of the funds available for this program, $403,331,000 will
    become available on July 1, 2006 and $791,000,000 will become
    available on October 1, 2006. These funds will remain available
    for obligation until September 30, 2007.
        Tech-Prep Education.--The Committee recommends $105,812,000
    for tech-prep programs. The comparable fiscal year 2005 funding
    level is $105,812,000 and the budget request proposes to
    eliminate funding for this program. This program is designed to
    link academic and vocational learning and to provide a
    structured link between secondary schools and postsecondary
    education institutions. Funds are distributed to the States
    through the same formula as the basic State grant program.
    States then make planning and demonstration grants to consortia
    of local educational agencies and postsecondary institutions to
    develop and operate model 4-year programs that begin in high
    school and provide students with the mathematical, science,
    communication, and technological skills needed to earn a 2-year
    associate degree or 2-year certificate in a given occupational
    field.
        National Programs, Research.--The Committee recommends
    $9,257,000 for national research programs and other national
    activities. The comparable fiscal year 2005 funding level is
    $11,757,000 and the budget request proposes to eliminate
    separate funding for this program. The Committee recommendation
    maintains the current spending on national programs because
    $2,500,000 has been utilized under this appropriation for the
    State Scholars program. Funding for State Scholars was
    requested under the Fund for the Improvement of Education.
        Funds provided under this program support research,
    development, dissemination, evaluation and assessment designed
    to improve the quality and effectiveness of vocational and
    technical education. Funds have been provided to the National
    Research Center for Career and Technical Education and the
    National Dissemination Center for Career and Technical
    Education to conduct research and provide technical assistance
    to vocational educators. The results of the applied research
    done by these Centers inform technical assistance to reform and
    improve vocational education instruction in schools and
    colleges. Resources made available through this program also
    are used to support a variety of activities to identify and
    promote effective research-based programs and practice in
    vocational education.
        Tech-Prep Education Demonstration Program.--The Committee
    recommendation does not include additional funding for this
    program. The comparable fiscal year 2005 funding level is
    $4,900,000 and the budget request proposes to eliminate funding
    for this program. Under this demonstration authority, the
    Secretary has awarded grants competitively to consortia that
    involve a business as a member, locate a secondary school on
    the site of a community college, and seek voluntary
    participation of secondary school students enrolled such a high
    school. The purpose of the demonstration program is to support
    development of the ``middle college'' model of high school,
    which promotes higher student achievement and postsecondary
    enrollment. Funds have been used for curriculum, professional
    development, equipment, and other start-up and operational
    costs.
        The Committee notes that evaluations for the first round of
    funded grantees will be available this year. The Committee
    urges the Department to identify effective programs from these
    projects that have positive findings, based on rigorous
    evaluations, and disseminate them to States, so they can
    further benefit from the investment made in this program.
        Occupational and Employment Information Program.--The
    Committee does not recommend additional funds for activities
    authorized by section 118 of the Carl Perkins Act. The
    comparable fiscal year 2005 funding level is $9,307,000, and
    the budget request proposes to eliminate this program. The Act
    requires that at least 85 percent of the amount appropriated be
    provided directly to State entities to develop and deliver
    occupational and career information to students, job seekers,
    employers, education, employment and training programs.

                                ADULT EDUCATION

        The Committee recommends $585,406,000 for adult education,
    the same amount as the comparable fiscal year 2005 funding
    level. The budget request includes $215,734,000 for this
    purpose.
        Adult Education State Programs.--For adult education State
    programs, the Committee recommends $569,672,000, the same
    amount as the comparable fiscal year 2005 funding level. The
    budget request includes $200,000,000 for authorized activities.
    These funds are used by States for programs to enable
    economically disadvantaged adults to acquire basic literacy
    skills, to enable those who so desire to complete a secondary
    education, and to make available to adults the means to become
    more employable, productive, and responsible citizens.
        The Committee recommendation continues the English literacy
    and civics education State grants set aside within the Adult
    Education State grant appropriation. Within the total,
    $68,582,000 is available to help States or localities affected
    significantly by immigration and large limited-English
    populations to implement programs that help immigrants acquire
    English literacy skills, gain knowledge about the rights and
    responsibilities of citizenship and develop skills that will
    enable them to navigate key institutions of American life.
        The Committee is pleased with the progress States are
    making in reporting on and improving performance outcomes
    generated by this program and urges the Department to continue
    to work with States to assist them in these efforts. The
    Commmittee recognizes the diverse population eligible for
    services under this program, ranging from adults striving to
    complete their secondary education to workers requiring better
    English skills to benefit from employer-provided job training
    and to grandparents desiring the skills necessary to help
    grandchildren to learn to read. The Committee also notes that
    while some participants cite employment as their reason for
    enrolling in an adult education program, many program
    participants do not establish this as a goal. Furthermore, even
    if employment is a goal, increased earnings might not be
    associated with the career goals of the more than one-third of
    adult education participants currently employed. Therefore, the
    Committee has recommended level funding for this program, and
    urges the Department to consider these facts when assessing
    program performance under the Adult Education program and the
    appropriateness of including this education program under the
    Administration's initiative to identify common measures for job
    training and employment programs.
        National Activities.--The Committee recommends $9,096,000
    for national leadership activities. The comparable funding
    level for fiscal year 2005 and the budget request both are
    $9,096,000 for this purpose. Under this program, the Department
    supports applied research, development, dissemination,
    evaluation and program improvement activities to assist States
    in their efforts to improve the quality of adult education
    programs.
        National Institute for Literacy.--The Committee recommends
    $6,638,000 for the National Institute for Literacy, authorized
    under section 242 of the Adult Education and Family Literacy
    Act. The comparable fiscal year 2005 funding level and the
    budget request both are $6,638,000 for this purpose. The
    Institute provides leadership and coordination for national
    literacy efforts by conducting research and demonstrations on
    literacy, establishing and maintaining a national center for
    adult literacy and learning disabilities, and awarding
    fellowships to outstanding individuals in the field to conduct
    research activities under the auspices of the Institute.

    Smaller Learning Communities

        The Committee does not recommend additional funds for this
    program. The comparable fiscal year 2005 funding level is
    $94,476,000 and the budget request does not include any funds
    for this purpose. This program has supported competitive grants
    to local educational agencies to enable them to create smaller
    learning communities in large schools. Funds have been used to
    study, research, develop and implement strategies for creating
    smaller learning communities, as well as professional
    development for staff. Two types of grants were made under this
    program: 1-year planning grants, which help LEAs plan smaller
    learning communities and 3-year implementation grants, which
    help create or expand such learning environments.
        The Committee notes that the fiscal year 2004 and 2005
    appropriations are still available for obligation and the
    Department lapsed more than $26,000,000 from the fiscal year
    2003 appropriation because of a lack of fundable applications.

    Community Technology Centers

        The Committee recommends $4,960,000 for community
    technology centers, the same amount as the comparable funding
    level for fiscal year 2005. The budget request proposes to
    eliminate funding for this program. Community technology
    centers provide disadvantaged residents of economically
    distressed urban and rural communities with access to
    information technology and related training. They can provide,
    among other things, preschool and after-school programs, adult
    education and literacy, and workforce development and training.

    State Grants for Incarcerated Youth Offenders

        The Committee has included $24,000,000 for education and
    training for incarcerated youth offenders. The comparable
    funding level for fiscal year 2005 is $21,824,000. The
    Administration proposes to eliminate funding for these
    activities. This program provides grants to State correctional
    education agencies to assist and encourage incarcerated youth
    to acquire functional literacy, life and job skills, through
    the pursuit of a postsecondary education certificate or an
    associate of arts or bachelor's degree. Grants also assist
    correction agencies in providing employment counseling and
    other related services that start during incarceration and
    continue through prerelease and while on parole. Under current
    law, each student is eligible for a grant of not more than
    $1,500 annually for tuition, books, and essential materials,
    and not more than $300 annually for related services such as
    career development, substance abuse counseling, parenting
    skills training, and health education. In order to participate
    in a program, a student must be no more than 25 years of age
    and be eligible to be released from prison within 5 years.
    Youth offender grants are for a period not to exceed 5 years, 1
    year of which may be devoted to study in remedial or graduate
    education.
        The Committee expects the Department to administer this
    program through the Office of Correctional Education within the
    Office of Vocational and Adult Education. The Committee notes
    that this would be consistent with the Department's recent
    reorganization, which designated the Under Secretary with the
    authority to coordinate the efforts of postsecondary programs
    and initiatives.

    Literacy Programs for Prisoners

        The Committee recommendation does not include funds for
    this program. The comparable funding level for fiscal year 2005
    is $4,960,000 and the budget request does not include any funds
    for this purpose. Under this program, grants have been made to
    State and local correctional education agencies and
    correctional education agencies to establish and operate
    programs that develop and improve the life skills of prisoners
    so they may more effectively reintegrate into society.

                          Student Financial Assistance

    Appropriations, 2005.................................... $14,265,749,000
    Budget estimate, 2006...................................  15,050,977,000
    House allowance.........................................  15,283,752,000
    Committee recommendation................................  15,103,795,000

        The Committee recommends an appropriation of
    $15,103,795,000 for student financial assistance. The
    comparable fiscal year 2005 funding level is $14,265,749,000
    and the budget request includes $15,050,977,000 for this
    purpose.
        Programs in this account are authorized through September
    30, 2005. Program authorities and descriptions assume the
    continuation of current law.

    Federal Pell Grant Program

        For Pell grant awards in the 2006-2007 academic year, the
    Committee recommends $13,177,000,000 to maintain the record
    maximum Pell Grant award level of $4,050. The Committee is very
    supportive of the President's proposal to increase the Pell
    Grant maximum award using mandatory funds. This proposal would
    have guaranteed $100 increases in the Pell Grant maximum award
    for each of the next 5 years. Unfortunately, the Budget
    Resolution rejected this proposal and proposed that an increase
    in the maximum award should compete against funding for other
    student aid programs, vocational and technical education and
    other activities funded in this bill. The Committee encourages
    the Administration to make this worthwhile proposal again next
    year and take necessary action to ensure its adoption.
        Pell grants provide need-based financial assistance that
    helps low- and middle-income undergraduate students and their
    families defray a portion of the costs of postsecondary
    education and vocational training. Awards are determined
    according to a statutory need analysis formula that takes into
    account a student's family income and assets, household size,
    and the number of family members, excluding parents, attending
    postsecondary institutions. Pell grants are considered the
    foundation of Federal postsecondary student aid.
        The Committee has deferred action on the proposed enhanced
    Pell grants for State scholars program. This program is not
    currently authorized. The budget request includes $33,000,000
    to provide additional Pell grant support to students completing
    specific challenging coursework while in secondary school.
        The Committee bill also includes language in section 305 of
    the general provisions to pay off the estimated $4,300,000,000
    accumulated shortfall in the Pell Grant program. The
    administration provided mandatory funds within its budget
    request for this purpose. These funds are provided pursuant to
    section 303 of the Concurrent Resolution on the Budget for
    fiscal year 2006 (H. Con. Res. 95, House Report 109-62) and are
    not reflected in the totals for this program or account.

    Federal Supplemental Educational Opportunity Grants

        The Committee recommends $804,763,000 for Federal
    supplemental educational opportunity grants [SEOG]. The
    comparable fiscal year 2005 funding level and the budget
    request both are $778,720,000 for this purpose. This program
    provides funds to postsecondary institutions for need-based
    grants to undergraduate students. Institutions must contribute
    25 percent towards SEOG awards, which are subject to a maximum
    grant level of $4,000. School financial aid officers have
    flexibility to determine student awards, though they must give
    priority to Pell grant recipients.

    Federal Work-Study Programs

        The Committee bill provides $990,257,000 for the Federal
    work-study program, the same amount as both the comparable
    fiscal year 2005 funding level and the budget request.
        This program provides grants to more than 3,300
    institutions to help an estimated 800,000 undergraduate,
    graduate, and professional students meet the costs of
    postsecondary education through part-time employment. Work-
    study jobs must pay at least the Federal minimum wage and
    institutions must provide at least 25 percent of student
    earnings. Institutions also must use at least 7 percent of
    their grants for community-service jobs.
        The Committee strongly supports continued funding for the
    work colleges program authorized in section 448 of the Higher
    Education Act of 1965. These funds help support comprehensive
    work-service learning programs at seven work colleges, and
    cooperative efforts among the work colleges to expose other
    institutions of higher education to the work college concept.
    Of the amount recommended by the Committee, $6,000,000 is
    available for this program.

    Federal Perkins Loans

        The Committee bill does not include additional funds for
    Federal Perkins loans capital contributions. The comparable
    fiscal year 2005 funding level did not include such funds and
    the budget request does not provide any funds for this purpose.
        The Federal Perkins loan program supports student loan
    revolving funds built up with capital contributions to nearly
    1,900 participating institutions. Institutions use these
    revolving funds, which also include Federal capital
    contributions [FCC], institutional contributions equal to one-
    third of the FCC, and student repayments, to provide low-
    interest (5 percent) loans that help financially needy students
    pay the costs of postsecondary education.
        The Committee recommends $66,132,000 for loan
    cancellations, the same amount as the comparable funding level
    for fiscal year 2005. The budget request did not include any
    funds for this purpose. These funds reimburse institutional
    revolving funds on behalf of borrowers whose loans are
    cancelled in exchange for statutorily specified types of public
    or military service, such as teaching in a qualified low-income
    school, working in a Head Start Program, serving in the Peace
    Corps or VISTA, or nurses and medical technicians providing
    health care services.
        The Committee recommendation will maintain a robust loan
    program that will support more than $1,100,000,000 in loans to
    more than 550,000 individuals.

    Presidential Math and Science Scholars

        The Committee recommendation does not include funds for
    this new program. The budget request includes $50,000,000 for
    this purpose, based on proposed legislation.
        This proposed program would support a public-private
    partnership designed to provide grant aid to low-income math
    and science students. Grants of up to $5,000 for each eligible
    student would be available through this proposed partnership.

    Leveraging Educational Assistance Partnership Program

        For the leveraging educational assistance partnership
    [LEAP] program, the Committee recommends $65,643,000, the same
    amount as the comparable funding level for fiscal year 2005.
    The budget proposes to eliminate funding for this program.
        The leveraging educational assistance partnership program
    provides a Federal match to States as an incentive for
    providing need-based grant and work-study assistance to
    eligible postsecondary students. When the appropriation exceeds
    $30,000,000, amounts above this threshold must be matched by
    States on a 2:1 basis. Federally supported grants and job
    earnings are limited to $5,000 per award year for full-time
    students.

                           Student Aid Administration

    Appropriations, 2005....................................    $119,084,000
    Budget estimate, 2006...................................     939,285,000
    House allowance.........................................     124,084,000
    Committee recommendation................................     120,000,000

        The Committee recommends $120,000,000 in discretionary
    resources for the Student Aid Administration account. The
    comparable fiscal year 2005 discretionary funding level is
    $119,084,000 and the budget request includes $939,285,000 in
    such funding. However, the budget request assumes enactment of
    a proposal to rescind mandatory budget authority available in
    Section 458 of the Higher Education Act and to provide these
    funds through discretionary appropriations. The Committee does
    not agree with the administration's legislative proposal to
    fund this new account solely through annual appropriations.
        Funds appropriated for the Student Aid Administration
    account, in addition to mandatory funding available through
    Section 458 of the Higher Education Act, will support the
    Department's student aid management expenses. The Office of
    Federal Student Aid and Office of Postsecondary Education have
    primary responsibility for administering Federal student
    financial assistance programs.

                         Loans for Short-Term Training

    Appropriations, 2005....................................................
    Budget estimate, 2006...................................     $11,000,000
    House allowance.........................................................
    Committee recommendation................................................

        The Committee defers action on this program, which is to be
    established by proposed legislation. The budget request
    includes $11,000,000 for this new activity. Under this proposed
    program, dislocated workers, the unemployed, transitioning and
    older workers, and students would be eligible to borrow funds
    to engage in training needed to acquire new or upgraded skills
    through short-term training programs. Such training programs
    must lead to an industry credential, certificate, or employer-
    endorsed technical or occupational skill.

                                Higher Education

    Appropriations, 2005....................................  $2,116,698,000
    Budget estimate, 2006...................................   1,202,315,000
    House allowance.........................................   1,936,936,000
    Committee recommendation................................   2,104,508,000

        The Committee recommends an appropriation of $2,104,508,000
    for higher education programs. The comparable fiscal year 2005
    funding level is $2,116,698,000 and the budget request includes
    $1,202,315,000 for such activities.
        Except for the activities authorized by the Mutual
    Educational and Cultural Exchange Act of 1961, programs in this
    account are authorized through September 30, 2005. Program
    authorities and descriptions assume the continuation of current
    law.

    Aid for Institutional Development

        The Committee recommends $510,923,000 for aid for
    institutional development authorized by titles III and V of the
    Higher Education Act. The comparable funding level for fiscal
    year 2005 is $507,764,000 and the budget request includes
    $505,519,000 for authorized activities.
        Strengthening Institutions.--The Committee bill includes
    $80,338,000 for the part A strengthening institutions program.
    The comparable fiscal year 2005 funding level and the budget
    request both are $80,338,000 for this activity. The part A
    program supports competitive, 1-year planning and 5-year
    development grants for institutions with a significant
    percentage of financially needy students and low educational
    and general expenditures per student in comparison with similar
    institutions. Applicants may use part A funds to develop
    faculty, strengthen academic programs, improve institutional
    management, and expand student services. Institutions awarded
    funding under this program are not eligible to receive grants
    under other sections of part A or part B.
        Hispanic-Serving Institutions [HSI].--The Committee
    recommends $95,873,000 for institutions at which Hispanic
    students make up at least 25 percent of enrollment. The
    comparable fiscal year 2005 funding level is $95,106,000 and
    the budget request includes $95,873,000 for these institutions.
    Institutions applying for title V funds must meet the regular
    part A requirements and show that at least one-half of their
    Hispanic students are low-income college students. Funds may be
    used for acquisition, rental or lease of scientific or
    laboratory equipment, renovation of instructional facilities,
    development of faculty, support for academic programs,
    institutional management, and purchase of educational
    materials. Title V recipients are not eligible for other awards
    provided under title III, parts A and B.
        Strengthening Historically Black Colleges and
    Universities.--The Committee recommends $240,500,000 for part B
    grants. The comparable fiscal year 2005 funding level is
    $238,576,000 and the budget request includes $240,500,000 for
    authorized activities. The part B strengthening historically
    black colleges and universities [HBCU] program makes formula
    grants to HBCUs that may be used to purchase equipment,
    construct and renovate facilities, develop faculty, support
    academic programs, strengthen institutional management, enhance
    fundraising activities, provide tutoring and counseling
    services to students, and conduct outreach to elementary and
    secondary school students. The minimum allotment is $500,000
    for each eligible institution. Part B recipients are not
    eligible for awards under part A.
        Strengthening Historically Black Graduate Institutions.--
    The Committee recommends $58,500,000 for the part B, section
    326 program. The comparable fiscal year 2005 funding level is
    $58,032,000 and the budget request includes $58,500,000 for
    such activities. The section 326 program provides 5-year grants
    to strengthen historically black graduate institutions [HBGIs].
    The Higher Education Amendments of 1998 increased the number of
    recipients to 18 named institutions, but reserved the first
    $26,600,000 appropriated each year to the 16 institutions
    included in the previous authorization. Grants may be used for
    any part B purpose and to establish an endowment.
        Strengthening Alaska Native and Native Hawaiian-Serving
    Institutions.--The Committee recommends $11,904,000 for this
    program, the same amount as last year. The budget request
    includes $6,500,000 for authorized activities. The purpose of
    this program is to improve and expand the capacity of
    institutions serving Alaska Native and Native Hawaiian
    students. Funds may be used to plan, develop, and implement
    activities that encourage: faculty and curriculum development;
    better fund and administrative management; renovation and
    improvement of educational facilities; student services; and
    the purchase of library and other educational materials. As
    initial funding cycles expire, the Committee encourages the
    Department to use simplified application forms to permit
    participating institutions to obtain continuation funding for
    successful programs funded under this program.
        Strengthening Tribally Controlled Colleges and
    Universities.--The Committee recommends $23,808,000 for
    strengthening tribal colleges and universities [TCUs]. The
    comparable funding level for fiscal year 2005 and the budget
    request both are $23,808,000 for this program. Tribal colleges
    and universities rely on a portion of the funds provided to
    address developmental needs, including faculty development,
    curriculum and student services.

    International Education and Foreign Language Studies

        The bill includes a total of $106,819,000 for international
    education and foreign language programs. The comparable fiscal
    year 2005 funding level is $106,818,000 and the budget request
    includes $106,819,000 for such activities.
        The Committee bill includes language allowing funds to be
    used to support visits and study in foreign countries by
    individuals who plan to utilize their language skills in world
    areas vital to the United States national security in the
    fields of government, international development and the
    professions. Bill language also allows up to 1 percent of the
    funds provided to be used for program evaluation, national
    outreach and information dissemination activities. This
    language is continued from last year's bill.
        Domestic Programs.--The Committee recommends $92,466,000
    for domestic program activities related to international
    education and foreign language studies, including international
    business education, under title VI of the HEA. The comparable
    fiscal year 2005 funding level is $92,465,000 and the budget
    request includes $92,466,000 for authorized activities.
    Domestic programs include national resource centers,
    undergraduate international studies and foreign language
    programs, international research and studies projects,
    international business education projects and centers, American
    overseas research centers, language resource centers, foreign
    language and area studies fellowships, and technological
    innovation and cooperation for foreign information access.
        Overseas Programs.--The bill includes $12,737,000 for
    overseas programs authorized under the Mutual Educational and
    Cultural Exchange Act of 1961, popularly known as the
    Fulbright-Hays Act. The comparable fiscal year 2005 funding
    level and the budget request both are $12,737,000 for these
    programs. Under these overseas programs, grants are provided
    for group and faculty research projects abroad, doctoral
    dissertation research abroad, and special bilateral projects.
    Unlike other programs authorized by the Fulbright-Hays Act and
    administered by the Department of State, these Department of
    Education programs focus on training American instructors and
    students in order to improve foreign language and area studies
    education in the United States.
        Institute for International Public Policy.--The Committee
    bill recommends $1,616,000 for the Institute for International
    Public Policy. The comparable funding level for fiscal year
    2005 and the budget request both are $1,616,000 for authorized
    activities. This program is designed to increase the number of
    minority individuals in foreign service and related careers by
    providing a grant to a consortium of institutions for
    undergraduate and graduate level foreign language and
    international studies. An institutional match of 50 percent is
    required.

    Fund for the Improvement of Postsecondary Education

        The Committee recommends $162,211,000 for the Fund for the
    Improvement of Postsecondary Education [FIPSE]. The comparable
    fiscal year 2005 funding level is $162,108,000 and the budget
    request includes $22,211,000 for this purpose. FIPSE stimulates
    improvements in education beyond high school by supporting
    exemplary, locally developed projects that have potential for
    addressing problems and recommending improvements in
    postsecondary education. The Fund is administered by the
    Department with advice from an independent board and provides
    small, competitive grants and contracts to a variety of
    postsecondary institutions and agencies, including 2- and 4-
    year colleges and universities, State education agencies,
    community-based organizations, and other non-profit
    institutions and organizations concerned with education beyond
    high school.
        The Committee recommendation includes $17,423,000, the full
    amount requested for the comprehensive program, as well as
    funds for international consortia programs.

    Minority Science and Engineering Improvement

        The Committee recommends $8,818,000 for the Minority
    Science and Engineering Improvement program [MSEIP]. The
    comparable fiscal year 2005 funding level and the budget
    request both are $8,818,000 for this program. Funds are used to
    provide discretionary grants to institutions with minority
    enrollments greater than 50 percent to purchase equipment,
    develop curricula, and support advanced faculty training.
    Grants are intended to improve science and engineering
    education programs and increase the number of minority students
    in the fields of science, mathematics, and engineering.

    Interest Subsidy Grants

        The Committee does not recommend additional funds for
    interest subsidy grants. The comparable fiscal year 2005
    funding level is $1,488,000 and the budget request does not
    include funds for these grants. Unobligated balances from prior
    year appropriations are available to meet the Federal
    commitment to pay interest subsidies on 13 loans made in past
    years for constructing, renovating, and equipping postsecondary
    academic facilities. No new interest subsidy commitments have
    been entered into since 1973 but subsidy payments on existing
    loans are expected to continue until the year 2013.

    Tribally Controlled Postsecondary Vocational Institutions

        The Committee recommends $7,440,000 on a current-funded
    basis for tribally controlled postsecondary vocational
    institutions. The comparable fiscal year 2005 funding level and
    the budget request both are $7,440,000 for this purpose. This
    program provides grants for the operation and improvement of
    two tribally controlled postsecondary vocational institutions
    to ensure continued and expanding opportunities for Indian
    students: United Tribes Technical College in Bismarck, North
    Dakota, and Crownpoint Institute of Technology in Crownpoint,
    New Mexico.
        The Committee bill includes language carried over from last
    year's bill that allows grantees to charge the regular indirect
    cost rate to their grants.

    Federal TRIO Programs

        The Committee recommends $836,543,000 for Federal TRIO
    Programs. The comparable fiscal year 2005 funding level is
    $836,543,000 and the budget request includes $369,390,000 for
    authorized activities. The budget request redirects the savings
    from the reduction proposed for TRIO programs to provide
    support for a proposed High School initiative.
        TRIO programs provide a variety of services to improve
    postsecondary education opportunities for low-income
    individuals and first-generation college students: Upward Bound
    offers disadvantaged high school students academic services to
    develop the skills and motivation needed to continue their
    education; Student Support Services provides remedial
    instruction, counseling, summer programs and grant aid to
    disadvantaged college students to help them complete their
    postsecondary education; Talent Search identifies and counsels
    individuals between ages 11 and 27 regarding opportunities for
    completing high school and enrolling in postsecondary
    education; Educational Opportunity Centers provide information
    and counseling on available financial and academic assistance
    to low-income adults who are first-generation college students;
    and the Ronald E. McNair Postbaccalaureate Achievement Program
    supports research internships, seminars, tutoring, and other
    activities to encourage disadvantaged college students to
    enroll in graduate programs.

    Gaining Early Awareness and Readiness for Undergraduate Programs
            [GEARUP]

        The Committee recommends $306,488,000 for GEARUP. The
    comparable fiscal year 2005 funding level is $306,488,000 and
    the budget request does not include any funds for this purpose.
    The budget proposes to redirect these funds to provide support
    for a proposed High School intiative.
        Under this program funds are used by States and
    partnerships of colleges, middle and high schools, and
    community organizations to assist middle and high schools
    serving a high percentage of low-income students. Services
    provided help students prepare for and pursue a postsecondary
    education.

    Byrd Honors Scholarships

        The Committee recommends $41,000,000 for the Byrd honors
    scholarship program. The comparable fiscal year 2005 funding
    level is $40,672,000 and the budget request does not include
    any funds for this program.
        The Byrd honors scholarship program is designed to promote
    student excellence and achievement and to recognize
    exceptionally able students who show promise of continued
    excellence. Funds are allocated to State education agencies
    based on each State's school-aged population. The State
    education agencies select the recipients of the scholarships in
    consultation with school administrators, teachers, counselors,
    and parents. The funds provided will support a new cohort of
    first-year students in 2006, and continue support for the 2003,
    2004, and 2005 cohorts of students in their fourth, third and
    second years of study, respectively. The amount recommended
    will provide scholarships of $1,500 to 27,333 students.

    Javits Fellowships

        The Committee recommends $9,797,000 for the Javits
    Fellowships program. The comparable fiscal year 2005 funding
    level and the budget request both are $9,797,000 for this
    program.
        The Javits Fellowships program provides fellowships of up
    to 4 years to students of superior ability who are pursuing
    doctoral degrees in the arts, humanities, and social sciences
    at any institution of their choice. Each fellowship consists of
    a student stipend to cover living costs, and an institutional
    payment to cover each fellow's tuition and other expenses.
    Funds provided in the fiscal year 2006 appropriation support
    fellowships for the 2007-2008 academic year.

    Graduate Assistance in Areas of National Need [GAANN]

        The Committee recommends $30,371,000 for graduate
    assistance in areas of national need. The comparable fiscal
    year 2005 funding level and the budget request both are
    $30,371,000 for GAANN. This program awards competitive grants
    to graduate academic departments and programs for fellowship
    support in areas of national need as determined by the
    Secretary. In fiscal year 2004, the Secretary designated the
    following areas of national need: biology, chemistry, computer
    and information sciences, engineering, geological and related
    sciences, mathematics and physics. Recipients must demonstrate
    financial need and academic excellence, and seek the highest
    degree in their fields.

    Teacher Quality Enhancement Grants

        The Committee recommends $58,000,000 for the teacher
    quality enhancement grants program. The comparable fiscal year
    2005 funding level is $68,337,000 and the budget request
    proposes to eliminate funding for this program.
        The program was established to support initiatives that
    best meet specific teacher preparation and recruitment needs.
    Further, the Act provides and designates funding for the
    program in three focus areas: 45 percent of resources support a
    State grant program, 45 percent of funds are used for a
    partnership program, and 10 percent are designated for a
    recruitment grant program.
        The Committee bill includes language that would allow the
    Department to fund awards under the three program areas at the
    discretion of the Department, instead of as mandated by the
    Higher Education Act. The Committee continues this language
    from last year's bill in order to prevent funds available under
    this program from going unused.
        Under the State grant program, funds may be used for a
    variety of State-level reforms, including more rigorous teacher
    certification and licensure requirements; provision of high-
    quality alternative routes to certification; development of
    systems to reward high-performing teachers and principals; and
    development of efforts to reduce the shortage of qualified
    teachers in high-poverty areas.
        Teacher training partnership grants, which are awarded to
    local partnerships comprised of at least one school of arts and
    science, one school or program of education, a local education
    agency, and a K-12 school, may be used for a variety of
    activities designed to improve teacher preparation and
    performance, including efforts to provide increased academic
    study in a proposed teaching specialty area; to prepare
    teachers to use technology effectively in the classroom; to
    provide preservice clinical experiences; and to integrate
    reliable research-based teaching methods into the curriculum.
    Partnerships may work with other entities, with those involving
    businesses receiving priority consideration. Partnerships are
    eligible to receive a one-time-only grant to encourage reform
    and improvement at the local level.
        The recruitment grant program supports efforts to reduce
    shortages of qualified teachers in high-need school districts
    as well as provide assistance for high-quality teacher
    preparation and induction programs to meet the specific
    educational needs of the local area.

    Child Care Access Means Parents in Schools

        The Committee recommends an appropriation of $15,970,000
    for the Child Care Access Means Parents in School [CCAMPIS]
    program. The comparable fiscal year 2005 funding level and the
    budget request both are $15,970,000 for this program. CCAMPIS
    was established in the Higher Education Amendments of 1998 to
    support the efforts of a growing number of non-traditional
    students who are struggling to complete their college degrees
    at the same time that they take care of their children.
    Discretionary grants of up to 4 years are made to institutions
    of higher education to support or establish a campus-based
    childcare program primarily serving the needs of low-income
    students enrolled at the institution.

    Community College Access

        The Committee recommendation does not include any resources
    for this proposed program. The budget request includes
    $125,000,000 for this purpose.
        Under this proposed program, funds would support
    competitive awards that serve as an incentive for States and
    partnerships to increases access, particularly for low-income
    and minority students, to a college education. Two main
    activities would be supported under this proposed program,
    community college access grants and state consortia
    initiatives. Community college access grants would create
    incentives for community colleges to create dual enrollment
    programs. Grants under the state consortia initiative would
    provide incentives to States to establish credit transfer
    programs across State lines.

    Demonstration Projects to Ensure Quality Higher Education for Students
            With Disabilities

        The Committee recommends $6,944,000 for this program, the
    same amount as the comparable fiscal year 2005 funding level.
    The budget proposes no funding for this program. This program's
    purpose is to ensure that students with disabilities receive a
    high-quality postsecondary education. Grants are made to
    support model demonstration projects that provide technical
    assistance and professional development activities for faculty
    and administrators in institutions of higher education.
        The Committee recognizes that the Department has made
    limited efforts to work with grantees to collect the type of
    outcome data that would demonstrate the value of this program.
    The Committee is aware of the significant progress that
    grantees have made in developing standards for information
    dissemination, faculty and staff awareness, policies and
    procedures, and program administration and evaluation that
    institutions of higher education can adopt to more effectively
    support students with disabilities. The Committee urges the
    Department to utilize resources available under the GPRA/data
    collection program to support a rigorous evaluation of outcomes
    achieved by grantees funded under this program and to identify
    the impact that these funds are having on improving
    opportunities for students with disabilities at institutions of
    higher education throughout the United States.

    Underground Railroad Program

        The Committee recommendation includes $2,204,000 for the
    Underground Railroad program, the same amount as the comparable
    fiscal year 2005 funding level. The budget request does not
    include any funds for this activity. The program was authorized
    by the Higher Education Amendments of 1998 and was funded for
    the first time in fiscal year 1999. Grants are provided to
    research, display, interpret, and collect artifacts relating to
    the history of the underground railroad. Educational
    organizations receiving funds must demonstrate substantial
    private support through a public-private partnership, create an
    endowment fund that provides for ongoing operation of the
    facility, and establish a network of satellite centers
    throughout the United States to share information and teach
    people about the significance of the Underground Railroad in
    American history.

    GPRA/Higher Education Act Program Evaluation

        The Committee recommends $980,000 for data collection
    associated with the Government Performance and Results Act data
    collection and to evaluate programs authorized by the Higher
    Education Act. The comparable fiscal year 2005 funding level
    and the budget request both are $980,000 for these activities.
    These funds are used to comply with the Government Performance
    and Results Act, which requires the collection of data and
    evaluation of Higher Education programs and the performance of
    recipients of Higher Education funds.

    B.J. Stupak Olympic Scholarships

        The Committee recommendation does not include funding for
    this program. The comparable fiscal year 2005 funding level is
    $980,000 and the budget request did not include funds for this
    activity. Funds appropriated in fiscal year 2005 will be used
    to provide financial assistance to athletes who are training at
    the United States Olympic Education Center or one of the United
    States Olympic Training Centers and who are pursuing a
    postsecondary education at an institution of higher education.
    Unlike most other Federal student aid programs, scholarships
    are provided without consideration of expected family
    contributions.

    Thurgood Marshall Legal Educational Opportunity Program

        The Committee recommendation does not include any funds for
    the Thurgood Marshall Legal Educational Opportunity Program.
    The comparable funding level for fiscal year 2005 is $2,976,000
    and the budget request does not include any funds for this
    purpose.
        Under this program, funds help low-income, minority or
    disadvantaged college students with the information,
    preparation and financial assistance to enter and complete law
    school study. The Higher Education Act stipulates that the
    Secretary make an award to or contract with the Council on
    Legal Education Opportunity to carry out authorized activities.

                               Howard University

    Appropriations, 2005....................................    $238,790,000
    Budget estimate, 2006...................................     238,789,000
    House allowance.........................................     240,790,000
    Committee recommendation................................     238,789,000

        The Committee recommends an appropriation of $238,789,000
    for Howard University. The comparable fiscal year 2005 funding
    level is $238,790,000 and the budget request includes
    $238,789,000 for this purpose. Howard University is located in
    the District of Columbia and offers undergraduate, graduate,
    and professional degrees through 12 schools and colleges. The
    university also administers the Howard University Hospital,
    which provides both inpatient and outpatient care, as well as
    training in the health professions. Federal funds from this
    account support more than 50 percent of the university's
    projected educational and general expenditures, excluding the
    hospital. The Committee recommends, within the funds provided,
    not less than $3,600,000 shall be for the endowment program.
        Howard University Hospital.--Within the funds provided, the
    Committee recommends $29,759,000 for the Howard University
    Hospital. The comparable fiscal year 2005 funding level and the
    budget request both are $29,759,000 for this purpose. The
    hospital serves as a major acute and ambulatory care center for
    the District of Columbia and functions as a major teaching
    facility attached to the university. The Federal appropriation
    provides partial funding for the hospital's operations.

                 College Housing and Academic Facilities Loans

    Appropriations, 2005....................................        $573,000
    Budget estimate, 2006...................................         573,000
    House allowance.........................................         573,000
    Committee recommendation................................         573,000

        Federal Administration.--The Committee bill includes
    $573,000 for Federal administration of the CHAFL program. The
    comparable fiscal year 2005 funding level and the budget
    request both are $573,000 for such expenses.
        These funds will be used to reimburse the Department for
    expenses incurred in managing the existing CHAFL loan portfolio
    during fiscal year 2006. These expenses include salaries and
    benefits, travel, printing, contracts (including contracted
    loan servicing activities), and other expenses directly related
    to the administration of the CHAFL Program.

      Historically Black College and University Capital Financing Program

    Appropriations, 2005....................................        $210,000
    Budget estimate, 2006...................................         210,000
    House allowance.........................................         210,000
    Committee recommendation................................         210,000

        Federal Administration.--The Committee recommends $210,000
    for Federal administration of the Historically Black College
    and University [HBCU] Capital Financing Program. The comparable
    fiscal year 2005 funding level and the budget request both are
    $210,000 for this activity.
        The HBCU Capital Financing Program makes capital available
    to HBCUs for construction, renovation, and repair of academic
    facilities by providing a Federal guarantee for private sector
    construction bonds. Construction loans will be made from the
    proceeds of the sale of the bonds.

                         Institute of Education Science

    Appropriations, 2005....................................    $523,234,000
    Budget estimate, 2006...................................     479,064,000
    House allowance.........................................     522,696,000
    Committee recommendation................................     522,695,000

        The bill includes $522,695,000 for the Institute of
    Education Sciences. The comparable fiscal year 2005 funding
    level is $523,234,000 and the budget request includes
    $479,064,000 for comparable activities. This account supports
    education research, data collection and analysis activities,
    and the assessment of student progress.

    Research, Development and Dissemination

        The Committee recommends $164,194,000 for education
    research, development and national dissemination activities.
    The comparable fiscal year 2005 amount and the budget request
    both are $164,194,000 for these activities. Funds are available
    for obligation for 2 fiscal years. These funds support
    research, development, and dissemination activities that are
    aimed at expanding fundamental knowledge of education and
    promoting the use of research and development findings in the
    design of efforts to improve education.
        The Committee strongly supports the premise that
    developing, identifying and implementing scientifically based
    research is critical to the success of the No Child Left Behind
    Act [NCLB] and to the increased effectiveness generally of
    education programs and interventions. The Committee recognizes
    the current scarcity of educational interventions that have
    been proven effective in research that meets the rigorous
    standards set out in the NCLB. In particular, the Committee
    believes that a greater focus must be placed on the use of
    randomized controlled trials, longitudinal studies, and other
    research that meets the standards set by the National Research
    Council. The Committee commends the Department for its efforts
    in this area.
        The Committee strongly supports the Department's efforts to
    carry out authorized evaluations of Federal education programs
    using rigorous methodologies, particularly random assignment,
    that are capable of producing scientifically valid knowledge
    regarding which program activities are effective. To ensure
    that such evaluations have sufficient participation required to
    make them scientifically valid, the Committee urges the
    Department, wherever feasible and not specifically prohibited
    by the authorizing legislation, to take appropriate action to
    secure grantee involvement, which may include requests to be
    randomly assigned to intervention and control groups. The
    Committee notes that the National Board for Education Sciences
    recently recommended such a policy.
        The Committee recognizes the critical role that IES plays
    in achieving the important goals set by the No Child Left
    Behind Act and encourages IES to continue its progress in
    translating scientifically based research findings into
    classroom practice. The Committee would like to see increased
    support for programs that bring advances in cognitive,
    developmental, educational and neuroscience research into the
    classroom by informing curriculum development in schools and in
    graduate schools of education. Research that focuses on the key
    processes of attention, memory, reasoning, and cognitive styles
    are essential for learning and are likely to produce
    substantial gains in academic achievement.

    Statistics

        The Committee recommends $90,931,000 for data-gathering and
    statistical-analysis activities of the National Center for
    Education Statistics [NCES]. The comparable fiscal year 2005
    funding level and the budget request both are $90,931,000 for
    this purpose.
        The NCES collects, analyzes, and reports statistics on
    education in the United States. Activities are carried out
    directly and through grants and contracts. The Center collects
    data on educational institutions at all levels, longitudinal
    data on student progress, and data relevant to public policy.
    The NCES also provides technical assistance to State and local
    education agencies and postsecondary institutions.

    Regional Educational Laboratories

        The Committee recommends $66,131,000 to continue support
    for the regional educational laboratories. The comparable
    fiscal year 2005 funding level is $66,132,000 and the budget
    request proposes to eliminate funding for this purpose. Program
    funds support a network of 10 laboratories that are responsible
    for promoting the use of broad-based systemic strategies to
    improve student achievement.
        Fiscal year 2006 funding will support a new competition
    under this program. The Committee believes it is important that
    the research, development, dissemination, and technical
    assistance activities carried out by the regional educational
    laboratories be consistent with the standards for
    scientifically based research prescribed in the Education
    Sciences Reform Act of 2002. The Committee therefore urges IES
    to ensure, through its competitive selection and evaluation of
    the laboratories and system of peer review of laboratory
    activities, that the laboratories adhere to these rigorous
    research standards. The Committee believes that the
    laboratories have an important role to play in helping parents,
    States and school districts improve student achievement as
    called for in No Child Left Behind.

    Research and Innovation in Special Education

        The Committee recommends $72,566,000 for research and
    innovation in special education. The comparable funding level
    for fiscal year 2005 is $83,104,000 and the budget request
    includes $72,566,000 for this purpose. The reauthorization of
    the Individuals with Disabilities Education Act created a new
    National Center for Special Education Research. This new center
    will address gaps in scientific knowledge in order to improve
    special education and early intervention services and outcomes
    for infants, toddlers, and children with disabilities. Funds
    provided to the center will be available for obligation for 2
    fiscal years.
        Similarly, the Committee recognizes the new role IES will
    play in special education research with the enactment and
    implementation of the Individuals with Disabilities Education
    Improvement Act of 2004. The Committee encourages IES to
    investigate alternative assessment models for determining
    learning disabilities for the purposes of special education
    placement in the absence of the discrepancy criterion
    requirement and the effectiveness of behavioral interventions
    and early intervening services. The Committee encourages IES to
    commit funding for research focusing on pupil services and
    related services providers.

    Special Education Studies and Evaluations

        The Committee recommends $10,000,000 for special education
    studies and evaluations. Funding for this activity was made
    available previously as a set-aside from the Special Education
    State Grants program until this new authority was created by
    the Individuals with Disabilities Education Improvement Act of
    2004. The budget request includes $10,000,000 for this purpose.
        This program will support competitive grants, contracts and
    cooperative agreements to assess the implementation of the
    Individuals with Disabilities Education Act. Funds also will be
    used to evaluate the effectiveness of State and local efforts
    to deliver special education services and early intervention
    programs. Funds are available for obligation for 2 fiscal
    years.
        The Committee is concerned that school districts across the
    country are inadequately prepared to provide appropriate
    educational services to students with intellectual disabilities
    (mental retardation and related disabilities). This lack of
    preparedness is particularly acute as it relates to the
    universal design of standards, curriculum, instructional
    strategies and materials, and assessments. This too often
    results in a lack of access to the general education curriculum
    and families and teachers developing curricula, instructional
    materials and assessments on an ad hoc basis. The Committee
    urges the Department to prepare a comprehensive plan to address
    this matter that would be sufficiently detailed to serve as an
    outline for proposals for K-12 projects to meet the needs of
    intellectual disabilities. Consideration should be given to
    research, model demonstration, technical assistance and
    dissemination, technology innovations, personnel preparation
    and other means to develop and apply universally designed
    standards, curriculum instructional strategies and materials,
    and assessments. The plan also shall include proposed funding
    levels and timelines for implementing the various research,
    development and dissemination activities and other components
    of the plan. The Department is urged to consult with experts in
    the field, including the several national organizations
    representing the interests of children with intellectual
    disabilities in the development of this plan. Finally, the
    Committee requests the Department to submit a report to the
    House and Senate Committees on Appropriations not later than
    April 15, 2006 on this issue.

    Statewide Data Systems

        The Committee recommendation includes $24,800,000 for
    Statewide Data Systems. The comparable funding level for fiscal
    year 2005 and the budget request both are $24,800,000.
        Under this program, the Department awards grants
    competitively to State Educational Agencies to enable such
    agencies to design, develop, and implement statewide,
    longitudinal data systems to manage, analyze, disaggregate, and
    use individual student data. Funds are available for obligation
    for 2 fiscal years. The Committee believes these funds are
    necessary to help States measure individual student
    performance, particularly as it relates to adequate yearly
    progress goals, more efficiently and accurately. The Committee
    urges the Department to continue to support those States that
    currently have the most limited ability to collect, analyze and
    report student achievement data when considering applications
    for funds available through this program.

    Assessment

        The Committee recommends $94,073,000 for assessment. The
    comparable fiscal year 2005 funding level is $94,073,000 and
    the budget request includes $116,573,000 for authorized
    activities.
        These funds provide support for the National Assessment of
    Educational Progress [NAEP], a congressionally mandated
    assessment created to measure the educational achievement of
    American students. The primary goal of NAEP is to determine and
    report the status and trends over time in educational
    achievement, subject by subject. Beginning in 2002, the
    Department began paying for State participation in biennial
    reading and mathematics assessments in grades 4 and 8.
        The budget request includes an increase of $22,500,000 to
    expand the State NAEP to reading and mathematics in the 12th
    grade. The Committee recommendation does not include these
    funds.
        Within the funds appropriated, the Committee recommends
    $5,088,000 for the National Assessment Governing Board [NAGB],
    which is responsible for formulating policy for NAEP. The
    comparable fiscal year 2005 amount and the budget request both
    are $5,088,000 for NAGB.

                            Departmental Management

                             PROGRAM ADMINISTRATION

    Appropriations, 2005....................................    $419,280,000
    Budget estimate, 2006...................................     418,992,000
    House allowance.........................................     410,612,000
    Committee recommendation................................     418,992,000

        The Committee recommends $418,992,000, for program
    administration. The comparable fiscal year 2005 funding level
    is $419,280,000 and the budget request includes $418,992,000
    for this purpose.
        Funds support personnel compensation and benefits, travel,
    rent, communications, utilities, printing, equipment and
    supplies, automated data processing, and other services
    required to award, administer, and monitor approximately 180
    Federal education programs. Support for program evaluation and
    studies and advisory councils is also provided under this
    activity.
        The Committee is concerned that the Department, in
    implementing Reading First and other programs authorized by the
    No Child Left Behind Act which are required to implement
    activities that are backed by scientifically based research,
    may not be effectively helping States and local educational
    agencies implement programs shown to work in randomized
    controlled trials and other rigorous studies. The Committee
    therefore requests the Secretary to submit a report to the
    Committee, within 90 days of the enactment of this Act, on the
    actions that program offices have taken or will take in the
    selection, oversight, and evaluation of grantees, to ensure
    that grantees effectively implement such research-based
    programs, including close replication of the specific elements
    of these programs.
        The Committee understands that the Department is taking
    steps to implement the proposed reorganization of the regional
    office structure within the Rehabilitation Services
    Administration [RSA] that was described in the fiscal year 2006
    congressional budget justification. The Committee is concerned
    about the impact that this proposal will have on regional
    office staff, as well as the ability of the Department to
    effectively administer RSA programs. The Committee understands
    that the Department believes that its proposed reorganization
    will result in more consistent, timely and higher quality
    policy guidance, technical assistance and program monitoring.
    The Committee believes these are worthy goals, given the
    millions of individuals served through RSA programs. Therefore,
    the Committee requests a report that describes the steps taken
    to reach out to stakeholder groups on this issue; a detailed
    plan for ensuring that policy guidance, technical assistance
    and program monitoring will be of higher quality and more
    timely than that currently available; and the specific
    performance goals under the proposed reorganization for
    frequency of monitoring visits, and timeliness and relevancy of
    technical assistance, compared to the actual performance under
    the current administrative structure. The Committee expects to
    receive this report not later than 60 days after enactment of
    this Act, but urges the Department to make it available as soon
    as possible.

                            OFFICE FOR CIVIL RIGHTS

    Appropriations, 2005....................................     $89,375,000
    Budget estimate, 2006...................................      91,526,000
    House allowance.........................................      91,526,000
    Committee recommendation................................      91,526,000

        The Committee bill includes $91,526,000 for the Office for
    Civil Rights [OCR]. The comparable fiscal year 2005 amount was
    $89,375,000 and the budget request is $91,526,000 for this
    purpose.
        The Office for Civil Rights is responsible for the
    enforcement of laws that prohibit discrimination on the basis
    of race, color, national origin, sex, disability, and age in
    all programs and institutions funded by the Department of
    Education. To carry out this responsibility, OCR investigates
    and resolves discrimination complaints, monitors desegregation
    and equal educational opportunity plans, reviews possible
    discriminatory practices by recipients of Federal education
    funds, and provides technical assistance to recipients of funds
    to help them meet civil rights requirements.
        The Committee understands that Title IX of the Education
    Amendments of 1972 and their implementing regulations, which
    prohibit discrimination on the basis of sex in federally funded
    education programs or activities, have been instrumental in
    providing unprecedented opportunities for women in the Nation's
    classrooms and athletic programs. While much progress has been
    made, the Committee continues to recognize that more needs to
    be done to ensure equal access for women. The Committee
    believes that the intent of the Department's clarification is
    to provide institutions with additional guidance on compliance
    with the third part of the three-part test, as stated in the
    Department's March 17, 2005 Dear Colleague. The Committee
    acknowledges this effort, but is concerned that confusion has
    been created with regard to the use of interest surveys to
    demonstrate compliance. The Committee believes survey results
    are not sufficient to demonstrate compliance if other evidence
    exists, such as requests for athletic teams, that contradicts
    the conclusions drawn from the survey. The Committee urges the
    Department to clarify that a presumption of compliance is not
    achieved by a survey if evidence to the contrary exists,
    whether that knowledge is known or it is reasonable to expect
    an institution to have known. Further, the Committee urges that
    the Department clarify that institutions must show that they
    have made reasonable, good faith efforts to explore such
    evidence if they choose to use part three of the three-part
    test to comply with Title IX. The Committee also encourages the
    Department to provide additional technical assistance to
    institutions on the appropriate use of interest surveys to
    comply with Title IX.
        The Committee requests that the Department prepare a
    report, based on random compliance reviews of institutions
    utilizing interest surveys, to determine what actions, if any,
    they take to gather and consider other sources of information
    for assessing student interest used in demonstrating compliance
    with part three of the Title IX test. The report should include
    what other information was considered in assessing student
    interest, if any, and the decisions made about athletic
    opportunities at these institutions. The Committee requests to
    receive this report no later than March 17, 2006.

                        OFFICE OF THE INSPECTOR GENERAL

    Appropriations, 2005....................................     $47,327,000
    Budget estimate, 2006...................................      49,408,000
    House allowance.........................................      49,000,000
    Committee recommendation................................      49,408,000

        The Committee recommends $49,408,000 for the Office of the
    Inspector General. The comparable fiscal year 2005 amount is
    $47,327,000 and the budget request includes $49,408,000 for
    authorized activities.
        The Office of the Inspector General has the authority to
    investigate all departmental programs and administrative
    activities, including those under contract or grant, to prevent
    and detect fraud and abuse, and to ensure the quality and
    integrity of those programs. The Office investigates alleged
    misuse of Federal funds, and conducts audits to determine
    compliance with laws and regulations, efficiency of operations,
    and effectiveness in achieving program goals.

                               General Provisions

        The Committee bill contains language which has been
    included in the bill since 1974, prohibiting the use of funds
    for the transportation of students or teachers in order to
    overcome racial imbalance (sec. 301).
        The Committee bill contains language included in the bill
    since 1977, prohibiting the transportation of students other
    than to the school nearest to the student's home (sec. 302).
        The Committee bill contains language which has been
    included in the bill since 1980, prohibiting the use of funds
    to prevent the implementation of programs of voluntary prayer
    and meditation in public schools (sec. 303).
        The Committee bill includes a provision giving the
    Secretary of Education authority to transfer up to 1 percent of
    any discretionary funds between appropriations (sec. 304).
        The Committee bill includes a new provision, pursuant to
    section 303 of the Congressional Budget Resolution, to
    eliminate the accumulated shortfall in the Pell Grant program
    (sec. 305).
        The Committee bill includes a new provision which expands
    the programs authorized under subpart 12 of part D of title V
    of the Elementary and Secondary Education Act of 1965 (sec.
    306).

                           TITLE IV--RELATED AGENCIES

     Committee for Purchase from People Who Are Blind or Severely Disabled

    Appropriations, 2005....................................      $4,669,000
    Budget estimate, 2006...................................       4,669,000
    House allowance.........................................       4,669,000
    Committee recommendation................................       4,669,000

        The Committee recommends $4,669,000 for fiscal year 2006
    for Committee for Purchase from People Who Are Blind or
    Severely Disabled. The comparable funding level for fiscal year
    2005 is $4,669,000 and the budget request includes $4,669,000
    for this program.
        The Committee for Purchase From People Who Are Blind or
    Severely Disabled was established by the Javits, Wagner-O'Day
    Act of 1938 as amended. Its primary objective is to increase
    the employment opportunities for people who are blind or have
    other severe disabilities and, whenever possible, to prepare
    them to engage in competitive employment.

                 Corporation for National and Community Service

    Appropriations, 2005....................................    $927,006,000
    Budget estimate, 2006...................................     921,049,000
    House allocation........................................     909,049,000
    Committee recommendation................................     935,205,000

        The Committee recommends $935,205,000 for the Corporation
    for National and Community Service, an increase of $8,199,000
    over the fiscal year 2005 enacted level and $14,156,000 above
    the budget request.
        The Committee requests that the Corporation include
    information in the fiscal year 2007 budget justification on the
    economic impact of its programs.
        The Corporation for National and Community Service, a
    Corporation owned by the Federal Government, was established by
    the National and Community Service Trust Act of 1993 (Public
    Law 103-82) to enhance opportunities for national and community
    service and provide national service education awards. The
    Corporation makes grants to States, institutions of higher
    education, public and private nonprofit organizations, and
    others to create service opportunities for students, out-of-
    school youth, and adults.

                      DOMESTIC VOLUNTEER SERVICE PROGRAMS

        The Committee recommends $316,212,000 for fiscal year 2006
    for the domestic volunteer service programs of the Corporation
    for National and Community Service. The comparable funding
    level for fiscal year 2005 is $353,745,000 and the budget
    request includes $359,962,000 for these programs. Programs
    authorized under the Domestic Volunteer Service Act include:
    the Volunteers in Service to America Program [VISTA]; the
    Foster Grandparent Program; the Senior Companion Program; and
    the Retired and Senior Volunteer Program.

    VISTA

        The Committee recommends $96,428,000 for fiscal year 2006
    for the Volunteers in Service to America [VISTA] Program. The
    comparable funding level for fiscal year 2005 is $94,240,000
    and the budget request includes $96,428,000 for this program.
        VISTA, created in 1964 under the Economic Opportunity Act,
    provides capacity building for small community-based
    organizations. VISTA volunteers raise resources for local
    projects, recruit and organize volunteers, and establish and
    expand local community-based programs in housing, employment,
    health, and economic development activities.
        The Committee is pleased by reports that the Corporation is
    moving toward integrating grant writing and issue specific
    presentations into the training sessions currently given to all
    new VISTA members. The Committee feels that more substantive
    training is needed to enhance the effectiveness of VISTA
    members in their placements. As part of their capacity-building
    mission, VISTA members are increasingly called upon to write
    grant applications and to raise funds as a way of making their
    service projects self-sufficient, requiring knowledge of grant
    writing that cannot be gained in the local organization, as
    well as training in the general field in which they are slated
    to serve. The Committee looks forward to a report in the fiscal
    year 2007 budget justification on the percentage of training
    funds and percentage of training time spent on each of the
    following categories: organizational training, grant writing
    and fundraising training, and issue specific training (i.e.
    early childhood education, environment, disaster assistance,
    etc).

    Special Volunteer Programs

        The Committee has included no funding for the Special
    Volunteer programs. The comparable funding level for fiscal
    year 2005 was $4,960,000. The budget requested $4,000,000 for
    an expansion of Teach For America under the Special Volunteer
    Programs. Teach for America has been a long-standing grantee
    under the Americorps State and National Program. Therefore, the
    Committee has recommended that funds for this expansion be
    allocated within the appropriation for the National and
    Community Service Act programs.
        The Special Volunteer Program is authorized under Part C of
    Title I of the Domestic Volunteer Service Act of 1973, which
    provides grants to volunteer organizations to encourage and
    enable persons from all age groups to perform volunteer service
    in agencies, institutions, and situations of need.

    National Senior Volunteer Corps

        The Committee recommends $219,784,000 for fiscal year 2006
    for the National Senior Volunteer Corps programs. The
    comparable funding level for fiscal year 2005 is $215,857,000
    and the budget request includes $219,784,000 for these
    programs. The Committee recognizes the valuable contributions
    of seniors participating in the Foster Grandparent [FGP],
    Retired and Senior Volunteer Program [RSVP], and Senior
    Companion Programs [SCP]. In accordance with the Domestic
    Volunteer Service Act [DVSA], the Committee intends that at
    least one-third of each program's increase over the fiscal year
    2005 level shall be used to fund Programs of National
    Significance [PNS] expansion grants to allow existing FGP,
    RSVP, and SCP programs to expand the number of volunteers
    serving in areas of critical need as identified by Congress in
    the DVSA. All remaining funds shall be used to fund an
    administrative cost increase for each existing program
    nationwide. The amount to be allocated to individual grantees
    shall be calculated based on a percentage of the entire Federal
    grant award in fiscal year 2005, including the amount specified
    for payment of non-taxable stipends. The Committee directs that
    the Corporation shall comply with the directive that use of PNS
    funding increases in the FGP, RSVP, SCP, and VISTA shall not be
    restricted to any particular activity. The Committee further
    directs that the Corporation shall not stipulate a minimum or
    maximum for PNS grant augmentation.
        In addition, the maximum dollars CNCS may use in fiscal
    year 2006 for Communications and Training, Technical
    Assistance, and Recruitment and Retention activities shall not
    exceed the amount enacted for these two activities in fiscal
    year 2005. Funds appropriated for fiscal year 2006 may not be
    used to implement or support service collaboration agreements
    or any other changes in the administration and/or governance of
    national service programs prior to passage of a bill by the
    authorizing committee of jurisdiction specifying such changes.
    In addition, none of these increases may be used to fund
    demonstration activities.

    Foster Grandparent Program

        The Committee recommends $112,058,000 for fiscal year 2006
    for the Foster Grandparent Program. The comparable funding
    level for fiscal year 2005 is $111,424,000 and the budget
    request includes $112,058,000 for this program.
        This program provides volunteer opportunities to seniors
    age 60 and over who serve at-risk youth. This program not only
    involves seniors in their communities, but it also provides a
    host of services to children.

    Senior Companion Program

        The Committee recommends $47,438,000 for fiscal year 2006
    for the Senior Companion Program. The comparable funding level
    for fiscal year 2005 is $45,905,000 and the budget request
    includes $47,438,000 for this program.
        This program enables senior citizens to provide personal
    assistance and companionship to adults with physical, mental,
    or emotional difficulties. Senior companions provide vital in-
    home services to elderly Americans who would otherwise have to
    enter nursing homes. The volunteers also provide respite care
    to relieve care givers.

    Retired and Senior Volunteer Program

        The Committee recommends $60,288,000 for fiscal year 2006
    for the Retired and Senior Volunteer Program. The comparable
    funding level for fiscal year 2005 is $58,528,000 and the
    budget request includes $60,288,000 for this program. This
    program involves persons age 55 and over in volunteer
    opportunities in their communities such as tutoring youth,
    responding to natural disasters, teaching parenting skills to
    teen parents, and mentoring troubled youth.

    Program Administration

        The Committee included funds for the administration of the
    DVSA program administration in the NCSA Salaries and Expenses
    account. The Committee believes that the integration of these
    accounts will streamline the management of the Corporation and
    increase efficiency and accountability across the agency. The
    comparable funding level for fiscal year 2005 is $38,688,000
    and the budget request includes $39,750,000 for program
    administration.

                    NATIONAL AND COMMUNITY SERVICE PROGRAMS

        The Committee recommends $546,243,000 for the programs
    authorized under the National Community Service Act of 1990, an
    increase of $4,726,000 over the fiscal year 2005 enacted level
    and $18,156,000 above the budget request.
        The National and Community Service Programs of the
    Corporation for National and Community Service include: the
    AmeriCorps program (including AmeriCorps State and National and
    the National Civilian Community Corps); Learn and Serve
    America, Innovation, Demonstration, Assistance and Evaluation
    activities; State Commission Administration grants; and the
    National Service Trust.
        The Committee recommendation includes: $546,243,000 for the
    Corporation's programs operating expenses. This appropriation
    provides $280,000,000 for AmeriCorps State and National
    operating grants (including $12,642,000 for State
    administrative expenses); $149,000,000 for the National Service
    Trust; $15,945,000 for subtitle H fund activities; $27,000,000
    for AmeriCorps NCCC; $42,656,000 for Learn and Serve;
    $4,000,000 for audits and evaluations; $10,000,000 for the
    Points of Light Foundation; $5,000,000 for America's Promise.

    AmeriCorps Grants Program (not including NCCC)

        Within the amount provided for AmeriCorps grants, the
    Committee is providing $55,000,000 for national direct
    grantees.
        The Committee requests that the Corporation continue
    providing monthly reports to the Committee on Appropriations
    and the Corporation's Inspector General on the actual and
    projected year-end level of AmeriCorps membership enrollment,
    usage, and earnings, and the financial status of the Trust fund
    (revenue, expenses, outstanding liabilities, reserve, etc.).
        To keep the Committee better informed of the recipients
    receiving AmeriCorps funding, the Committee directs the
    Corporation to publish in its fiscal year 2007 budget
    justifications a list of recipients that have received more
    than $500,000 from the Corporation, delineated by program, and
    the amount and source of both other Federal and non-Federal
    funds that were received by each recipient.

    Innovation, Assistance and Other Activities

        Within the amount recommended for innovation,
    demonstration, and assistance activities, the Committee
    recommends $1,300,000 for next generation grants; $500,000 for
    Martin Luther King Jr. Day grants; $725,000 for Service
    Learning Clearinghouse and Exchange; $2,250,000 for training
    and technical assistance; $4,338,000 for disability programs;
    $400,000 for Presidential Freedom Scholarships; $125,000 for
    Faith-Based and Community Initiatives; $52,000 for the
    Presidential Council on Service; $250,000 for Presidential
    Volunteer Service Award; $5,000 for the National Volunteer
    Hotline; $4,000,000 for Teach for America; and $2,000,000 for
    Communities in Schools, Inc. The Committee is not allocating
    any money for the challenge grant programs in fiscal year 2006,
    in accordance with the budget request and House allocation.

    AmeriCorps National Civilian Community Corps

        Within the amount provided, $1,500,000 is to conduct an
    evaluation of current NCCC site placement and expansion of new
    sites in the Southern and Midwestern United States, in
    accordance with the report issued on March 1, 2005.

                             SALARIES AND EXPENSES

        The Committee recommends an appropriation of $66,750,000
    for the Corporation's salaries and expenses. This amount is
    equal to the budget request and $2,270,000 above the fiscal
    year 2005 enacted level. This includes $39,750,000 for
    administration of the DVSA programs. The Committee reiterates
    the directive under the program account that the Corporation
    must fund all staffing needs from the salaries and expenses
    account.
        The salaries and expenses appropriation provides funds for
    staff salaries, benefits, travel, training, rent, advisory and
    assistance services, communications and utilities expenses,
    supplies, equipment, and other operating expenses necessary for
    management of the Corporation's activities under the National
    and Community Service Act of 1990 and the Domestic Volunteer
    Service Act of 1973.
        The Committee is disappointed in the quality of assistance
    provided by the Corporation during the reorganization of the
    Corporation's appropriation. Periodically, the Committee
    requires technical assistance from officers of the Corporation.
    The Committee expects that such assistance will be provided
    without prejudice in a straightforward and timely manner.
        The Committee is aware that local administrative support
    offices are critical to the success of programs such as the
    National Senior Volunteer Corps, especially in areas that are
    difficult to reach such as rural areas and islands like Hawaii.
    Mainland United States is over 1,500 miles from the State of
    Hawaii and the Committee is concerned that program support
    would suffer from locating that support across this distance.
    The Committee urges the Department to continue funding existing
    full-time, local administrative CNCS offices.

                          OFFICE OF INSPECTOR GENERAL

        The Committee recommends an appropriation of $6,000,000 for
    the Office of Inspector General [OIG]. This amount is equal to
    the budget request and $48,000 above the fiscal year 2005
    enacted level.
        The Committee directs the OIG to continue reviewing the
    Corporation's management of the National Service Trust fund.
    The Committee directs the OIG to review the monthly Trust
    reports and to notify the Committees on Appropriations on the
    accuracy of the reports.
        The goals of the Office of Inspector General are to
    increase organizational efficiency and effectiveness and to
    prevent fraud, waste, and abuse. The Office of Inspector
    General within the Corporation for National and Community
    Service was transferred to the Corporation from the former
    ACTION agency when ACTION was abolished and merged into the
    Corporation in April 1994.

                           ADMINISTRATIVE PROVISIONS

        The Committee has included four administrative provisions
    carried in prior year appropriations acts as follows: language
    regarding: qualified student loans eligible for education
    awards; the availability of funds for the placement of
    volunteers with disabilities; the Inspector General to levy
    sanctions in accordance with standard Inspector General audit
    resolutions procedures; and language regarding the Corporation
    to make significant changes to program requirements or policy
    through public rulemaking and public notice and grant selection
    process.

                      Corporation for Public Broadcasting

    Appropriations, 2006....................................    $400,000,000
    Appropriations, 2007....................................     400,000,000
    Budget estimate, 2008...................................................
    House allowance.........................................     400,000,000
    Committee recommendation................................     400,000,000

        The Committee recommends $400,000,000 be made available for
    the Corporation for Public Broadcasting [CPB], an advance
    appropriation for fiscal year 2008. The comparable funding
    level provided last year was $400,000,000 for fiscal year 2007.
    The budget request does not include advance funds for this
    program.
        In addition, the Committee recommends $35,000,000 be made
    available in fiscal year 2006 for the conversion to digital
    broadcasting. The comparable funding level for fiscal year 2005
    was $39,387,000. The budget request included no funding for
    this purpose. The House included authority to permit CPB to
    spend up to $30,000,000 in previously appropriated fiscal year
    2006 funds for digital conversion activities.
        In addition, the Committee recommends $40,000,000 be made
    available in fiscal year 2006 for the replacement project of
    the interconnection system. In fiscal year 2005, $39,680,000
    was appropriated for this purpose. The House included authority
    to permit CPB to spend up to $52,000,000 in previously
    appropriated fiscal year 2006 funds for the Satellite
    Interconnection system.
        The current interconnection system is entirely satellite
    based. This satellite is currently nearing the end of its
    useful life, and while satellite technology is currently the
    most cost-effective method for distribution in a point-to-
    multipoint system, terrestrial technology is far more
    economical when data is distributed between single points. The
    Next Generation Interconnection System will utilize a
    combination of satellite and terrestrial technologies for a
    more flexible system. In addition, a portion of the provided
    funds will be used to upgrade existing ground station and
    transmit/receive equipment to be compatible with the new
    system.
        The Committee recognizes the importance of the partnership
    CPB has with the National Minority Public Broadcasting
    Consortia, which helps develop, acquire, and distribute public
    television programming to serve the needs of African American,
    Asian American, Latino, Native American, Pacific Islander, and
    many other viewers. As many communities in the Nation welcome
    increased numbers of citizens of diverse ethnic backgrounds,
    the local public television stations should strive to meet
    these viewers' needs. With an increased focus on programming to
    meet local community needs, the Committee encourages CPB to
    continue to support and expand this critical partnership.
        The Committee is aware that public radio stations are
    taking advantage of experimental authority to develop their
    digital operations including multicasting. We encourage the
    Corporation to work with the Federal Communications Commission
    to enable public radio and television stations to utilize the
    full range of digital broadcasting technology as soon as
    possible, including the use of multicasting for public radio
    stations.

                   Federal Mediation and Conciliation Service

    Appropriations, 2005....................................     $44,439,000
    Budget estimate, 2006...................................      42,331,000
    House allowance.........................................      42,331,000
    Committee recommendation................................      43,439,000

        The Committee recommends $43,439,000 for fiscal year 2006
    for the Federal Mediation and Conciliation Service [FMCS]. The
    comparable funding level for fiscal year 2005 is $44,439,000
    and the budget request includes $42,331,000 for this program.
        The FMCS was established by Congress in 1947 to provide
    mediation, conciliation, and arbitration services to labor and
    management. FMCS is authorized to provide dispute resolution
    consultation and training to all Federal agencies.
        The Committee continues to support the FMCS program to
    prevent youth violence and is especially pleased with the
    initiative to train educators in conflict resolution. The
    Committee commends FMCS for their innovative look at youth
    violence conflict resolution and their development of a CD-ROM
    that will address this issue among preschool and elementary age
    children.

                Federal Mine Safety and Health Review Commission

    Appropriations, 2005....................................      $7,809,000
    Budget estimate, 2006...................................       7,809,000
    House allowance.........................................       7,809,000
    Committee recommendation................................       7,809,000

        The Committee recommends $7,809,000 for fiscal year 2006
    for the Federal Mine Safety and Health Review Commission. The
    comparable funding level for fiscal year 2005 is $7,809,000 and
    the budget request includes $7,809,000 for this program.
        The Federal Mine Safety and Health Review Commission
    provides administrative trial and appellate review of legal
    disputes under the Federal Mine Safety and Health Act of 1977.
    The five-member Commission provides review of the Commission's
    administrative law judge decisions.

                    Institute of Museum and Library Services

    Appropriations, 2005....................................    $280,564,000
    Budget estimate, 2006...................................     262,240,000
    House allowance.........................................     249,640,000
    Committee recommendation................................     290,129,000

        The Committee recommends $290,129,000 for fiscal year 2006
    for the Institute of Museum and Library Services. The
    comparable funding level for fiscal year 2005 is $280,564,000
    and the budget request includes 262,240,000 for this program.

    Office of Museum Services Operations Grants

        The Committee recommends $17,500,000 for operations grants.
    These funds support grants to museums for building increased
    public access, expanding educational services, reaching
    families and children, and using technology more effectively in
    support of these goals. In addition, non-competitive grants are
    awarded for technical assistance in four types of assessments:
    Institutional, Collections Management, Public Dimension, and
    Governance. In addition to the total recommended, $992,000 has
    been provided for the 21st Century Museum Professionals
    program, $446,000 for museum assessment, $850,000 for Native
    American Museum service grants, and $850,000 for Museum Grants
    for African American History and Culture.

    Museum Conservation Programs

        The Committee recommends $3,615,000 for Conservation
    programs. These funds support grants to allow museums to survey
    collections, perform training, research, treatment, and
    environmental improvements. In addition, grantees may receive
    additional funds to develop an education component that relates
    to their conservation project. In addition, non-competitive
    grants are awarded for technical assistance in conservation
    efforts.

    Museum National Leadership Projects

        The Committee recommends $29,000,000 for National
    Leadership projects. The National Leadership Grants encourage
    innovation in meeting community needs, widespread and creative
    use of new technologies, greater public access to museum
    collections, and an extended impact of Federal dollars through
    collaborative projects.

    Office of Library Services State Grants

        The Committee recommends $165,000,000 for State grants.
    Funds are provided to States by formula to carry out 5-year
    State plans. These plans must set goals and priorities for the
    State consistent with the purpose of the Act, describe
    activities to meet the goals and priorities and describe the
    methods by which progress toward the goals and priorities and
    the success of activities will be evaluated. States may
    apportion their funds between two activities, technology and
    targeted services. For technology, States may use funds for
    electronic linkages among libraries, linkages to educational,
    social and information services, accessing information through
    electronic networks, or link different types of libraries or
    share resources among libraries. For targeted services, States
    may direct library and information services to persons having
    difficulty using a library, underserved urban and rural
    communities, and children from low income families. In addition
    to the total recommended, $3,675,000 has been provided for
    library services to Native Americans and Native Hawaiians. The
    Committee is aware that many traditional healers are aging and
    the world may soon lose the knowledge that they possess. For
    that reason, the Committee encourages IMLS to work for the
    preservation and documentation of Native Hawaiian traditional
    cultural healing practices. It is essential that these
    practices be documented in creative media formats due to the
    variety and complexity of the practices and the healers.

    Library National Leadership Projects

        The Committee recommends $33,284,000 for national
    leadership projects. These funds support activities of national
    significance to enhance the quality of library services
    nationwide and to provide coordination between libraries and
    museums. Activities are carried out through grants and
    contracts awarded on a competitive basis to libraries,
    agencies, institutions of higher education and museums.
    Priority is given to projects that focus on education and
    training of library personnel, research and development for the
    improvement of libraries, preservation, digitization of library
    materials, partnerships between libraries and museums and other
    activities that enhance the quality of library services
    nationwide. In addition to the total recommended, $23,000,000
    has been provided for the 21st Century Librarian Initiative.

    Museum and Library Services Administration

        The Committee recommends $11,917,000 for program
    administration, the same as the budget request. Funds support
    personnel compensation and benefits, travel, rent,
    communications, utilities, printing, equipment and supplies,
    automated data processing, and other services.

                      Medicare Payment Advisory Commission

    Appropriations, 2005....................................      $9,899,000
    Budget estimate, 2006...................................      10,168,000
    House allowance.........................................      10,168,000
    Committee recommendation................................      10,168,000

        The Committee recommends $10,168,000 for fiscal year 2006
    for the Medicare Payment Advisory Commission. The comparable
    funding level for fiscal year 2005 is $9,899,000 and the budget
    request includes $10,168,000 for this program.
        The Medicare Payment Advisory Commission [MedPAC] was
    established by Congress as part of the Balanced Budget Act of
    1997 (Public Law 105-33). Congress merged the Physician Payment
    Review Commission with the Prospective Payment Assessment
    Commission to create MedPAC.

            National Commission on Libraries and Information Science

    Appropriations, 2005....................................        $993,000
    Budget estimate, 2006...................................         993,000
    House allowance.........................................         993,000
    Committee recommendation................................         993,000

        The Committee recommends $993,000 for fiscal year 2006 for
    the National Commission on Libraries and Information Science.
    The comparable funding level for fiscal year 2005 is $993,000
    and the budget request includes $993,000 for this program.
        The Commission determines the need for, and makes
    recommendations on, library and information services, and
    advises the President and Congress on the development and
    implementation of national policy in library and information
    sciences.

                         National Council on Disability

    Appropriations, 2005....................................      $3,344,000
    Budget estimate, 2006...................................       2,800,000
    House allowance.........................................       2,800,000
    Committee recommendation................................       3,344,000

        The Committee recommends $3,344,000 for fiscal year 2006
    for the National Council on Disability. The comparable funding
    level for fiscal year 2005 is $3,344,000 and the budget request
    includes $2,800,000 for this program.
        The Council is mandated to make recommendations to the
    President, the Congress, the Rehabilitation Services
    Administration, and the National Institute on Disability and
    Rehabilitation Research, on the public issues of concern to
    individuals with disabilities. The Council gathers information
    on the implementation, effectiveness, and impact of the
    Americans with Disabilities Act and looks at emerging policy
    issues as they affect persons with disabilities and their
    ability to enter or reenter the Nation's work force and to live
    independently.

                         National Labor Relations Board

    Appropriations, 2005....................................    $249,860,000
    Budget estimate, 2006...................................     252,268,000
    House allowance.........................................     252,268,000
    Committee recommendation................................     252,268,000

        The Committee recommends $252,268,000 for fiscal year 2006
    for the National Labor Relations Board [NLRB]. The comparable
    funding level for fiscal year 2005 is $249,860,000 and the
    budget request includes $252,268,000 for this program.
        The Committee continues to be concerned that the NLRB's
    plan to restructure its regional offices will slow the decision
    making process in some regions and hurt workers access to a
    fair and timely hearing. The Committee reiterates its
    opposition to the elimination of Region 30 and the subsequent
    downgrading of the Region 30 Office to sub-regional status.
    Downgrading this office will force interested parties to travel
    long distances while increasing the backlog of cases in Region
    18.
        The NLRB is a law enforcement agency which adjudicates
    disputes under the National Labor Relations Act.
        The Committee is aware that the mission of the NLRB is to
    carry out the statutory responsibilities of the National Labor
    Relations Act as efficiently as possible and in a manner that
    gives full effect to the rights afforded to employees, unions,
    and employers under the Act. The Committee strongly supports
    this mission and understands that the caseload fluctuates based
    on economic conditions and changes in labor regulations. The
    Committee continues to be disappointed that the Administration
    has repeatedly underestimated the funding necessary to process
    the increase in case intakes, but stands firm in its commitment
    to ensure that all cases are heard and given due process.

                            National Mediation Board

    Appropriations, 2005....................................     $11,628,000
    Budget estimate, 2006...................................      11,628,000
    House allowance.........................................      11,628,000
    Committee recommendation................................      11,628,000

        The Committee recommends $11,628,000 for fiscal year 2006
    for the National Mediation Board. The comparable funding level
    for fiscal year 2005 is $11,628,000 and the budget request
    includes $11,628,000 for this program.
        The National Mediation Board protects interstate commerce
    as it mediates labor-management relations in the railroad and
    airline industries under the Railway Labor Act. The Board
    mediates collective bargaining disputes, determines the choice
    of employee bargaining representatives through elections, and
    administers arbitration of employee grievances.
        The Committee notes that the National Mediation Board has
    yet to issue a final rule regarding certain administrative
    changes to case management. The Committee has made repeated
    statements that the institution of a fee, such as the one
    outlined in the initial proposed rule, would require statutory
    authorization that the Board currently lacks. The fiscal year
    2006 President's Budget included no request to change the
    authorization of the Board to include the collection of any
    fees. Therefore, the Committee concludes that the Board has
    abandoned the effort to institute new fees in the coming year
    and expects that any final rule the Board may publish will omit
    the fee proposal.

                Occupational Safety and Health Review Commission

    Appropriations, 2005....................................     $10,510,000
    Budget estimate, 2006...................................      10,510,000
    House allowance.........................................      10,510,000
    Committee recommendation................................      10,510,000

        The Committee recommends $10,510,000 for fiscal year 2006
    for the Occupational Safety and Health Review Commission. The
    comparable funding level for fiscal year 2005 is $10,510,000
    and the budget request includes $10,510,000 for this program.
        The Commission serves as a court to justly and
    expeditiously resolve disputes between the Occupational Safety
    and Health Administration [OSHA] and employers charged with
    violations of health and safety standards enforced by OSHA.

                           Railroad Retirement Board

                         DUAL BENEFITS PAYMENTS ACCOUNT

    Appropriations, 2005....................................     $99,200,000
    Budget estimate, 2006...................................      97,000,000
    House allowance.........................................      97,000,000
    Committee recommendation................................      97,000,000

        The Committee recommends $97,000,000 for fiscal year 2006
    for the Dual Benefits Payments Account, of these funds
    $7,000,000 is from income taxes on vested dual benefits. The
    comparable funding level for fiscal year 2005 is $99,200,000
    and the budget request includes $97,000,000 for this program.
        This appropriation provides for vested dual benefit
    payments authorized by the Railroad Retirement Act of 1974, as
    amended by the Omnibus Reconciliation Act of 1981. This
    separate account, established for the payment of dual benefits,
    is funded by general fund appropriations and income tax
    receipts of vested dual benefits.

              FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNT

    Appropriations, 2005....................................        $150,000
    Budget estimate, 2006...................................         150,000
    House allowance.........................................         150,000
    Committee recommendation................................         150,000

        The Committee recommends $150,000 for fiscal year 2006 for
    interest earned on unnegotiated checks. The comparable funding
    level for fiscal year 2005 is $150,000 and the budget request
    includes $150,000 for this program.

                          LIMITATION ON ADMINISTRATION

    Appropriations, 2005....................................    $102,543,000
    Budget estimate, 2006...................................     102,543,000
    House allowance.........................................     102,543,000
    Committee recommendation................................     102,543,000

        The Committee recommends $102,543,000 for fiscal year 2006
    for the administration of railroad retirement/survivor benefit
    programs. The comparable funding level for fiscal year 2005 is
    $102,543,000 and the budget request includes $102,543,000 for
    this program.
        The Board administers comprehensive retirement-survivor and
    unemployment-sickness insurance benefit programs for the
    Nation's railroad workers and their families. This account
    limits the amount of funds in the railroad retirement and
    railroad unemployment insurance trust funds which may be used
    by the Board for administrative expenses.
        The Committee has included language to prohibit funds from
    the railroad retirement trust fund from being spent on any
    charges over and above the actual cost of administering the
    trust fund, including commercial rental rates.

               LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

    Appropriations, 2005....................................      $7,196,000
    Budget estimate, 2006...................................       7,196,000
    House allowance.........................................       7,196,000
    Committee recommendation................................       7,196,000

        The Committee recommends $7,196,000 for fiscal year 2006
    for the Office of the Inspector General. The comparable funding
    level for fiscal year 2005 is $7,196,000 and the budget request
    includes $7,196,000 for this program.
        The Committee has included bill language to allow the
    Office of the Inspector General to use funds to conduct audits,
    investigations, and reviews of the Medicare program. The
    Committee finds that as long as the RRB has the authority to
    negotiate and administer the separate Medicare contract, the
    RRB Inspector General should not be prohibited from using funds
    to review, audit, or investigate the Railroad Retirement
    Board's separate Medicare contract.

                         Social Security Administration

                    PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

    Appropriations, 2005....................................     $20,454,000
    Budget estimate, 2006...................................      20,470,000
    House allowance.........................................      20,470,000
    Committee recommendation................................      20,470,000

        The Committee recommends an appropriation of $20,470,000
    for payments to Social Security trust funds. The comparable
    fiscal year 2005 funding level is $20,454,000 and the budget
    request includes $20,470,000 for this purpose. This amount
    reimburses the old age and survivors and disability insurance
    trust funds for special payments to certain uninsured persons,
    costs incurred administering pension reform activities, and the
    value of the interest for benefit checks issued but not
    negotiated. This appropriation restores the trust funds to the
    same financial position they would have been in had they not
    borne these costs, properly charged to the general funds.

                          SUPPLEMENTAL SECURITY INCOME

    Appropriations, 2005.................................... $28,586,829,000
    Budget estimate, 2006...................................  29,533,174,000
    House allowance.........................................  29,533,174,000
    Committee recommendation................................  29,510,574,000

        The Committee recommends an appropriation of
    $29,510,574,000 for supplemental security income. This is in
    addition to the $10,930,000,000 appropriated last year as an
    advance for the first quarter of fiscal year 2006. The
    comparable fiscal year 2005 funding level is $28,586,829,000
    and the budget request includes $29,533,174,000. The Committee
    also recommends an advance appropriation of $11,110,000,000 for
    the first quarter of fiscal year 2007 to ensure uninterrupted
    benefits payments. The program level supported by the Committee
    recommendation is $40,440,574,000, compared to the total
    program level requested in the budget of $40,463,174,000. The
    Committee recommendation also includes bill language which
    adjusts the timing of the October 2006 SSI benefit payment.
        These funds are used to pay benefits under the SSI Program,
    which was established to ensure a Federal minimum monthly
    benefit for aged, blind, and disabled individuals, enabling
    them to meet basic needs. It is estimated that approximately 7
    million persons will receive SSI benefits each month during
    fiscal year 2006. In many cases, SSI benefits supplement income
    from other sources, including Social Security benefits. The
    funds are also used to reimburse the Social Security trust
    funds for the administrative costs for the program with a final
    settlement by the end of the subsequent fiscal year as required
    by law, to reimburse vocational rehabilitation agencies for
    costs incurred in successfully rehabilitating SSI recipients
    and for research and demonstration projects.

    Beneficiary Services

        The Committee recommendation includes $52,000,000 for
    beneficiary services. The comparable funding level in fiscal
    year 2005 is $45,929,000 and the budget request includes
    $52,000,000 for these services. This amount is available for
    payments to Employment Networks for successful outcomes or
    milestone payments under the Ticket to Work program and for
    reimbursement of State vocational rehabilitation agencies and
    alternate public or private providers. Carryover budget
    authority of more than $130,000,000 is available for
    obligations made during fiscal years 2005 and 2006.

    Research and Demonstration Projects

        The Committee recommendation includes $27,000,000 for
    research and demonstration projects conducted under sections
    1110 and 1115 of the Social Security Act. The comparable fiscal
    year 2005 funding level is $35,000,000 and the budget request
    includes $27,000,000 for authorized activities.
        This amount will support SSA's efforts to strengthen its
    policy evaluation capability and focus on research of: program
    issues, the impact of demographic changes on future workloads
    and effective return-to-work strategies for disabled
    beneficiaries.

    Administration

        The Committee recommendation includes $2,874,400,000 for
    payment to the Social Security trust funds for the SSI
    Program's share of SSA's base administrative expenses. The
    comparable fiscal year 2005 amount is $2,986,900,000 and the
    budget request includes $2,897,000,000 for such activities.

                     LIMITATION ON ADMINISTRATIVE EXPENSES

    Appropriations, 2005....................................  $8,729,901,000
    Budget estimate, 2006...................................   9,388,400,000
    House allowance.........................................   9,279,700,000
    Committee recommendation................................   9,329,400,000

        The Committee recommends a program funding level of
    $9,329,400,000 for the limitation on administrative expenses.
    The comparable fiscal year 2005 funding level is $8,729,901,000
    and the budget request includes $9,388,400,000 for this
    purpose.
        This account provides resources from the Social Security
    trust funds to administer the Social Security retirement and
    survivors and disability insurance programs, and certain Social
    Security health insurance functions. As authorized by law, it
    also provides resources from the trust funds for certain
    nontrust fund administrative costs, which are reimbursed from
    the general funds. These include administration of the
    supplemental security income program for the aged, blind and
    disabled; work associated with the Pension Reform Act of 1984;
    and the portion of the annual wage reporting work done by the
    Social Security Administration for the benefit of the Internal
    Revenue Service. The dollars provided also support automated
    data processing activities and fund the State disability
    determination services which make initial and continuing
    disability determinations on behalf of the Social Security
    Administration. Additionally, the limitation provides funding
    for computer support, and other administrative costs.
        The Committee recommendation includes $9,209,400,000 for
    routine operating expenses of the Agency, as well as the
    resources derived from the user fees which are discussed below.
        The budget request includes bill language earmarking not
    less than $412,000,000 of funds available within this account
    for continuing disability reviews under Social Security's
    disability programs. The Committee bill language includes this
    earmark and also includes an additional $189,000,000 for this
    purpose requested in the budget and provided for by section
    404(b)(1) of the Concurrent Resolution on the Budget for fiscal
    year 2006. The Committee requests that the Social Security
    Administration provide reports to the Committee for each fiscal
    year 2005, 2006, and 2007 that detail the amount of funds spent
    on continuing disability reviews for each year and the number
    of such reviews, by category of review; the results of such
    continuing disability reviews in terms of cessation of benefits
    or determinations of continuing eligibility, by programs; and
    the amount of savings generated over the short-, medium-, and
    long-term by each program administered by the Agency. The
    Committee notes that during the last period of special funding
    for continuing disability reviews the benefit to cost ratio was
    more than $10 for each $1 spent on this workload.
        The Committee bill also includes language that authorizes
    fiscal year 2006 funds available to SSA to be used to complete
    Medicare appeals received by the Agency prior to July 1, 2005.
    Medicare appeals filed after this date were transferred to the
    Department of Health and Human Services, as required by the
    Medicare Prescription Drug, Improvement and Modernization Act
    of 2003. The Committee bill also allows the Commissioner of
    Social Security to enter into a reimbursable agreement with the
    Secretary of Health and Human Services to provide assistance
    with and process Medicare appeals work received prior to
    October 1, 2005. This language will ensure that Medicare
    beneficiaries are not impacted negatively by the transfer of
    this workload.
        The Committee recommendation also includes $320,000,000,
    the full amount included in the budget request, to support the
    implementation of the Medicare Prescription Drug Benefit
    program. These resources will be used to identify low-income
    beneficiaries who may be eligible for financial assistance with
    their prescription drug costs; to make eligibility
    determinations for those individuals eligible for financial
    assistance; and to withhold premiums associated with
    beneficiaries' plans; and to calculate Medicare Part B premiums
    for high-income beneficiaries.
        The Committee encourages SSA officials to educate
    adjudicators at all levels about the functional impact of CFS
    and the application of the April 1999 CFS ruling (99-2p) to
    ensure that adjudicators remain up-to-date on the evaluation of
    disability that results from this condition. The Committee
    encourages SSA to examine obstacles to benefits for persons
    with CFS and to keep medical information updated throughout all
    levels of the application and review process.

    Social Security Advisory Board

        The Committee has included not less than $2,000,000 within
    the limitation on administrative expenses account for the
    Social Security Advisory Board for fiscal year 2006.

    User Fees

        In addition to other amounts provided, the Committee
    recommends $120,000,000 for administrative activities funded
    from user fees. Of this amount, $119,000,000 is derived from
    fees paid to SSA by States that request SSA to administer State
    SSI supplementary payments. The remaining $1,000,000 will be
    generated from a fee payment process for non-attorney
    representatives of claimants.

                        OFFICE OF THE INSPECTOR GENERAL

    Appropriations, 2005....................................     $90,378,000
    Budget estimate, 2006...................................      93,000,000
    House allowance.........................................      92,805,000
    Committee recommendation................................      93,000,000

        The Committee recommends $93,000,000 for activities for the
    Office of the Inspector General. The comparable fiscal year
    2005 funding level is $90,378,000 and the budget request
    includes $93,000,000 for this office. This includes a general
    fund appropriation of $26,000,000 together with an obligation
    limitation of $67,000,000 from the Federal old-age and
    survivors insurance trust fund and the Federal disability
    insurance trust fund.

                          TITLE V--GENERAL PROVISIONS

        The Committee recommendation includes provisions which:
    authorize transfers of unexpended balances (sec. 501); limit
    funding to 1 year availability unless otherwise specified (sec.
    502); limit lobbying and related activities (sec. 503); limit
    official representation expenses (sec. 504); prohibit funding
    of any program to carry out distribution of sterile needles for
    the hypodermic injection of any illegal drug (sec. 505);
    clarify Federal funding as a component of State and local grant
    funds (sec. 506); limit use of funds for abortion (sec. 507 and
    sec. 508); restrict human embryo research (sec. 509); limit the
    use of funds for promotion of legalization of controlled
    substances included last year (sec. 510); limits use of funds
    to enter into or review contracts with entities subject to the
    requirement in section 4212(d) of title 38, United States Code,
    if the report required by that section has not been submitted
    (sec. 511); prohibits the use of funds to promulgate
    regulations regarding the individual health identifier (sec.
    512); prohibits transfer of funds made available in this Act to
    any department, agency, or instrumentality of the U.S.
    Government, except as otherwise provided by this or any other
    Act (sec. 513); prohibits funds for the Railroad Retirement
    Board from being used for a non-governmental disbursing agent
    (sec. 514); maintains a provision clarifying procedures for
    reprogramming of funds (sec. 515); and specifies that none of
    the funds made available by this Act may be used to reimburse,
    or provide reimbursement for drugs approved to treat erectile
    dysfunction (sec. 516).

                                                BUDGETARY IMPACT OF BILL
      PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
                                                         AMENDED
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                      Budget authority               Outlays
                                                                 ---------------------------------------------------
                                                                   Committee    Amount  of   Committee    Amount  of
                                                                   allocation      bill      allocation      bill
    ----------------------------------------------------------------------------------------------------------------
    Comparison of amounts in the bill with Committee allocations
     to its subcommittees of amounts in the Budget Resolution
     for 2006: Subcommittee on Labor-HHS-Education.
        Discretionary...........................................      141,344      141,653      142,975  \1\ 141,350
        Mandatory...............................................      405,311      405,311      405,171  \1\ 405,171
    Projection of outlays associated with the recommendation:
        2006....................................................  ...........  ...........  ...........  \2\ 368,096
        2007....................................................  ...........  ...........  ...........       58,074
        2008....................................................  ...........  ...........  ...........       15,470
        2009....................................................  ...........  ...........  ...........        3,789
        2010 and future years...................................  ...........  ...........  ...........          542
    Financial assistance to State and local governments for                NA      221,957           NA      159,755
     2006.......................................................
    ----------------------------------------------------------------------------------------------------------------
    \1\ Includes outlays from prior-year budget authority.
    \2\ Excludes outlays from prior-year budget authority.

    NA: Not applicable.

      COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
                                     SENATE

        Paragraph 7 of rule XVI requires that Committee report on
    general appropriations bills identify each Committee amendment
    to the House bill ``which proposes an item of appropriation
    which is not made to carry out the provisions of an existing
    law, a treaty stipulation, or an act or resolution previously
    passed by the Senate during that session.''

        The following items are identified pursuant to this
    requirement: Workforce Investment Act; Title VII and Title VIII
    of the Public Health Services Act; National Cord Blood Stem
    Cell Bank Program; Universal Newborn Hearing Screening; Organ
    Transplantation; Rural Hospital Flexibility Grants; Denali
    Commission; Family Planning; State Offices of Rural Health;
    Rural and Community Access to Emergency Devices; Trauma/EMS;
    Infectious Diseases; Health Promotion; Health Information and
    Services; Environmental Health and Injury; Occupational Safety
    and Health; Global Health; Public Health Research; Public
    Health Improvement and Leadership; Preventive Health and Health
    Services Block Grant; CDC Business Services; Title V of the
    Public Health Services Act; Adolescent Family Life; Office of
    Minority Health; Office of Disease Prevention and Health
    Promotion; Low Income Home Energy Assistance Program; Refugee
    and Entrant Assistance; Child Care and Development Block Grant;
    Head Start; Abstinence Education; Native American Programs;
    Community Services; Alzheimer's Disease Demonstration Grants to
    States; High school equivalency program; College assistance
    migrant program; State grants for incarcerated youth offenders;
    Rehabilitation Services and Disability Research, except
    sections 4, 5 and 6 of the Assistive Technology Program;
    National Technical Institute for the Deaf; Gallaudet
    University; Vocational Education; Adult Education; Student
    Financial Assistance; Student Aid Administration; Higher
    Education, except for section 102(b)(6) of the Mutual
    Educational and Cultural Exchange Act; Corporation for National
    and Community Service; National Council on Disability.

    COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE
                                     SENATE

        Pursuant to paragraph 7(c) of rule XXVI, on July 14, 2005,
    the Committee ordered reported, H.R. 3010, making
    appropriations for the Departments of Labor, Health and Human
    Services, and Education, and related agencies for the fiscal
    year ending September 30, 2006, and for other purposes, with an
    amendment in the nature of a substitute, provided that the bill
    be subject to further amendment and the bill be consistent with
    its budget allocation, by a recorded vote of 27-0, a quorum
    being present. The vote was as follows:
            Yeas                          Nays
    Chairman Cochran
    Mr. Stevens
    Mr. Specter
    Mr. Domenici
    Mr. Bond
    Mr. McConnell
    Mr. Burns
    Mr. Shelby
    Mr. Gregg deg.
    Mr. Bennett
    Mr. Craig
    Mrs. Hutchison
    Mr. DeWine
    Mr. Brownback
    Mr. Allard
    Mr. Byrd
    Mr. Inouye
    Mr. Leahy
    Mr. Harkin
    Ms. Mikulski
    Mr. Reid
    Mr. Kohl
    Mrs. Murray
    Mr. Dorgan
    Mrs. Feinstein
    Mr. Durbin
    Mr. Johnson
    Ms. Landrieu

     COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
                                     SENATE

        Paragraph 12 of rule XXVI requires that Committee reports
    on a bill or a joint resolution repealing or amending any
    statute include ``(a) the text of the statute or part thereof
    which is proposed to be repealed; and (b) a comparative print
    of that part of the bill or joint resolution making the
    amendment and of the statute or part thereof proposed to be
    amended, showing by stricken through type and italics, parallel
    columns, or other appropriate typographical devices the
    omissions and insertions which would be made by the bill or
    joint resolution if enacted in the form recommended by the
    committee.''
        With respect to this bill, it is the opinion of the
    Committee that it is necessary to dispense with these
    requirements in order to expedite the business of the
    Senate. deg.

    NO CHILD LEFT BEHIND ACT OF 2001, PUBLIC LAW 107-110

               *       *       *       *       *       *       *

       ``Subpart 12--Educational, Cultural, Apprenticeship, and Exchange
      Programs for Alaska Natives, Native Hawaiians, and Their Historical
                 Whaling and Trading Partners in Massachusetts

    ``SEC. 5521. SHORT TITLE.

        ``This subpart may be cited as the `Alaska Native and
    Native Hawaiian Education Through Cultural and Historical
    Organizations Act'.

    ``SEC. 5522. FINDINGS AND PURPOSES.

        ``(a) * * *

               *       *       *       *       *       *       *

        ``(b) Purposes.--The purposes of this subpart are the
    following:
                ``(1) To authorize and develop innovative
            culturally-based educational programs and cultural
            exchanges to assist Alaska Natives, Native Hawaiians,
            and children and families of Massachusetts linked by
            history and tradition to Alaska and Hawaii to learn
            about shared culture and traditions.
                ``(2) To authorize and develop internship and
            apprentice programs to assist Alaska Natives, Native
            Hawaiians, and children and families of Massachusetts
            linked by history and tradition with Alaska and Hawaii
            to prepare for careers with cultural institutions.
                ``(3) To supplement programs and authorities in the
            area of education to further the objectives of this
            subpart.
                ``(4) To authorize and develop cultural and
            educational programs relating to the Mississippi Band
            of Choctaw Indians.''

    ``SEC. 5523. PROGRAM AUTHORIZATION.

        ``(a) Grants and Contracts.--In order to carry out programs
    that fulfill the purposes of this subpart, the Secretary is
    authorized to make grants to, or enter into contracts with, the
    following:
                ``(1) The Alaska Native Heritage Center in
            Anchorage, Alaska.
                ``(2) The Inupiat Heritage Center in Barrow,
            Alaska.
                ``(3) The Bishop Museum in Hawaii.
                ``(4) The Peabody-Essex Museum in Salem,
            Massachusetts.
                ``(5) The New Bedford Whaling Museum and the New
            Bedford Oceanarium in New Bedford, Massachusetts.
                ``(6) The Mississippi Band of Choctaw Indians in
            Choctaw, Mississippi.''
                ``[(6)] (7) Other Alaska Native and Native Hawaiian
            cultural and educational organizations.
                ``[(7)] (8) Cultural and educational organizations
            with experience in developing or operating programs
            that illustrate and interpret the contributions of
            Alaska Natives, Native Hawaiians, the whaling industry,
            and the China trade to the economic, social, and
            environmental history of the United States.
                ``[(8)] (9) Consortia of the organizations and
            entities described in this subsection.

               *       *       *       *       *       *       *

    ``SEC. 5525. AVAILABILITY OF FUNDS.

        ``If sufficient funds are made available under section 5401
    to carry out this subpart for a fiscal year, the Secretary
    shall make available, to support activities described in
    section 5523(b), the following amounts:
                ``(1) Not less than $2,000,000 each to--
                        ``(A) the New Bedford Whaling Museum, in
                    partnership with the New Bedford Oceanarium, in
                    Massachusetts; and
                        ``(B) the Inupiat Heritage Center in
                    Alaska.
                ``(2) For the New Trade Winds project, not less
            than $1,000,000 each to--
                        ``(A) the Alaska Native Heritage Center in
                    Alaska;
                        ``(B) the Bishop Museum in Hawaii; and
                        ``(C) the Peabody-Essex Museum in
                    Massachusetts.
                ``(3) For internship and apprenticeship programs
            (including the Museum Action Corps of the Peabody-Essex
            Museum), not less than $1,000,000 each to--
                        ``(A) the Alaska Native Heritage Center in
                    Alaska;
                        ``(B) the Bishop Museum in Hawaii; and
                        ``(C) the Peabody-Essex Museum in
                    Massachusetts.
                ``(4) For cultural and educational programs, not
            less than $2,000,000 to the Mississippi Band of Choctaw
            Indians in Choctaw, Mississippi.''

                     COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2005 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL YEAR 2006
                                                                                        [In thousands of dollars]
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                Senate Committee recommendation compared with (+ or
                                                                                                                                  Committee                               )
                                   Item                                  2005 comparable   Budget estimate   House allowance   recommendation  -----------------------------------------------------
                                                                                                                                                 2005 comparable   Budget estimate   House allowance
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                       TITLE I--DEPARTMENT OF LABOR

                  EMPLOYMENT AND TRAINING ADMINISTRATION

                     TRAINING AND EMPLOYMENT SERVICES
    Grants to States:
        Adult Training, current year..................................          184,618           153,736           153,736           181,618            -3,000           +27,882           +27,882
            Advance from prior year...................................         (706,304)         (712,000)         (712,000)         (712,000)          (+5,696)  ................  ................
            Fiscal year 2007..........................................          712,000           712,000           712,000           712,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Adult Training..........................................          896,618           865,736           865,736           893,618            -3,000           +27,882           +27,882

        Youth Training................................................          986,288           950,000           950,000           986,288   ................          +36,288           +36,288
        Dislocated Worker Assistance, current year....................          345,264           226,867           345,264           345,264   ................         +118,397   ................
            Advance from prior year...................................         (841,216)         (848,000)         (848,000)         (848,000)          (+6,784)  ................  ................
            Fiscal year 2007..........................................          848,000           848,000           848,000           848,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Dislocated Worker Assistance............................        1,193,264         1,074,867         1,193,264         1,193,264   ................         +118,397   ................

    Federally Administered Programs:
        Dislocated Worker Assistance National Reserve:
            Current year..............................................           70,800            56,717   ................           70,800   ................          +14,083           +70,800
            Advance from prior year...................................         (210,304)         (212,000)         (212,000)         (212,000)          (+1,696)  ................  ................
            Fiscal year 2007..........................................          212,000           212,000           212,000           212,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Dislocated Worker Assistance Nat'l Reserve..............          282,800           268,717           212,000           282,800   ................          +14,083           +70,800

            Less funding reserved for Community College Initiative            (-125,000)  ................  ................        (-125,000)  ................        (-125,000)        (-125,000)
             (NA).....................................................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                Dislocated Worker Assistance Nat'l Reserve............          157,800           268,717           212,000           157,800   ................         -110,917           -54,200
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                Total, Dislocated Worker Assistance...................        1,476,064         1,343,584         1,405,264         1,476,064   ................         +132,480           +70,800

        Native Americans..............................................           54,238            54,238            54,238            54,238   ................  ................  ................

        Migrant and Seasonal Farmworkers..............................           75,759   ................           75,759            80,053            +4,294           +80,053            +4,294

        Job Corps:
            Operations................................................          844,670           851,019           851,019           881,000           +36,330           +29,981           +29,981
                Advance from prior year...............................         (586,272)         (591,000)         (591,000)         (591,000)          (+4,728)  ................  ................
                Fiscal year 2007......................................          591,000           591,000           591,000           591,000   ................  ................  ................
            Construction and Renovation...............................           16,190   ................  ................           10,000            -6,190           +10,000           +10,000
                Advance from prior year...............................          (99,200)         (100,000)         (100,000)         (100,000)            (+800)  ................  ................
                Fiscal year 2007......................................          100,000            75,000           100,000           100,000   ................          +25,000   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                  Subtotal, Job Corps.................................        1,551,860         1,517,019         1,542,019         1,582,000           +30,140           +64,981           +39,981

        National Activities:
            Pilots, Demonstrations and Research.......................           85,167            30,000            74,000            90,367            +5,200           +60,367           +16,367
            Responsible Reintegration of Youthful Offender............           49,600   ................  ................           50,000              +400           +50,000           +50,000
            Evaluation................................................            7,936             7,936             7,936             7,936   ................  ................  ................
            Prisoner Re-entry.........................................           19,840            35,000            19,840            19,840   ................          -15,160   ................
            Community College initiative..............................          124,000           250,000           125,000   ................         -124,000          -250,000          -125,000
                Community College initiative (NA) \1\.................         (125,000)  ................  ................         (125,000)  ................        (+125,000)        (+125,000)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                  Subtotal, CC initiative, program level..............          249,000           250,000           125,000           125,000          -124,000          -125,000   ................

            Denali Commission.........................................            6,944   ................  ................            6,944   ................           +6,944            +6,944
            Other.....................................................            3,458             2,000             2,000             3,458   ................           +1,458            +1,458
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, National activities...........................          296,945           324,936           228,776           178,545          -118,400          -146,391           -50,231
                                                                       =============================================================================================================================
              Subtotal, Federal activities............................        2,261,602         2,164,910         2,112,792         2,177,636           -83,966           +12,726           +64,844
                  Current Year........................................        1,358,602         1,286,910         1,209,792         1,274,636           -83,966           -12,274           +64,844
                  Fiscal year 2007....................................          903,000           878,000           903,000           903,000   ................          +25,000   ................
                                                                       =============================================================================================================================
              Total, Training and Employment Services.................        5,337,772         5,055,513         5,121,792         5,250,806           -86,966          +195,293          +129,014
                  Current Year........................................       (2,874,772)       (2,617,513)       (2,658,792)       (2,787,806)         (-86,966)        (+170,293)        (+129,014)
                  Fiscal year 2007....................................       (2,463,000)       (2,438,000)       (2,463,000)       (2,463,000)  ................         (+25,000)  ................

    COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS..................          436,678           436,678           436,678           436,678   ................  ................  ................
    FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES......................        1,057,300           966,400           966,400           966,400           -90,900   ................  ................

      STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

    Unemployment Compensation:
        State Operations..............................................        2,663,040         2,622,499         2,622,499         2,600,000           -63,040           -22,499           -22,499
        National Activities...........................................           10,416            10,416            10,416            10,000              -416              -416              -416
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Unemployment Compensation.........................        2,673,456         2,632,915         2,632,915         2,610,000           -63,456           -22,915           -22,915

    Employment Service:
        Allotments to States:
            Federal Funds.............................................           23,114            23,300            23,300            23,114   ................             -186              -186
            Trust Funds...............................................          757,478           672,700           672,700           723,188           -34,290           +50,488           +50,488
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, allotments to States..........................          780,592           696,000           696,000           746,302           -34,290           +50,302           +50,302

        ES National Activities........................................           64,976            33,766            33,766            33,766           -31,210   ................  ................
                                                                       =============================================================================================================================
          Subtotal, Employment Service................................          845,568           729,766           729,766           780,068           -65,500           +50,302           +50,302
              Federal Funds...........................................           23,114            23,300            23,300            23,114   ................             -186              -186
              Trust Funds.............................................          822,454           706,466           706,466           756,954           -65,500           +50,488           +50,488

    One-Stop Career Centers/Labor Market Information..................           97,974            87,974            87,974            90,000            -7,974            +2,026            +2,026
    Work Incentives Grants............................................           19,711            19,711            19,711            19,711   ................  ................  ................
                                                                       =============================================================================================================================
          Total, State Unemployment & Employment Srvcs................        3,636,709         3,470,366         3,470,366         3,499,779          -136,930           +29,413           +29,413
              Federal Funds...........................................          140,799           130,985           130,985           132,825            -7,974            +1,840            +1,840
              Trust Funds.............................................        3,495,910         3,339,381         3,339,381         3,366,954          -128,956           +27,573           +27,573

    ADVANCES TO THE UI AND OTHER TRUST FUNDS \2\......................          517,000           465,000           465,000           465,000           -52,000   ................  ................

                          PROGRAM ADMINISTRATION

    Adult Employment and Training.....................................           38,874            44,631            44,631            43,631            +4,757            -1,000            -1,000
        Trust Funds...................................................            6,901             7,925             7,925             7,925            +1,024   ................  ................
    Youth Employment and Training.....................................           39,627            38,805            38,805            38,805              -822   ................  ................
    Employment Security...............................................            6,045             6,039             6,039             6,039                -6   ................  ................
        Trust Funds...................................................           48,235            77,952            77,952            72,841           +24,606            -5,111            -5,111
    Apprenticeship Services...........................................           21,136            21,655            21,655            21,655              +519   ................  ................
    Executive Direction...............................................            6,845             6,993             6,993             6,993              +148   ................  ................
        Trust Funds...................................................            2,065             2,111             2,111             2,111               +46   ................  ................
    Welfare to Work...................................................              373   ................  ................  ................             -373   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Program Administration...............................          170,101           206,111           206,111           200,000           +29,899            -6,111            -6,111
              Federal Funds...........................................          112,900           118,123           118,123           117,123            +4,223            -1,000            -1,000
              Trust Funds.............................................           57,201            87,988            87,988            82,877           +25,676            -5,111            -5,111
                                                                       =============================================================================================================================
          Total, Employment and Training Administration...............       11,155,560        10,600,068        10,666,347        10,818,663          -336,897          +218,595          +152,316
              Federal Funds...........................................        7,602,449         7,172,699         7,238,978         7,368,832          -233,617          +196,133          +129,854
                  Current Year........................................       (5,139,449)       (4,734,699)       (4,775,978)       (4,905,832)        (-233,617)        (+171,133)        (+129,854)
                  Fiscal year 2007....................................       (2,463,000)       (2,438,000)       (2,463,000)       (2,463,000)  ................         (+25,000)  ................
              Trust Funds.............................................        3,553,111         3,427,369         3,427,369         3,449,831          -103,280           +22,462           +22,462

                 EMPLOYEE BENEFITS SECURITY ADMINISTRATION

                           SALARIES AND EXPENSES

    Enforcement and Participant Assistance............................          109,374           114,462           114,462           112,362            +2,988            -2,100            -2,100
    Policy and Compliance Assistance..................................           17,357            17,458            17,458            17,458              +101   ................  ................
    Executive Leadership, Program Oversight and Admin.................            4,482             5,080             5,080             5,080              +598   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, EBSA.................................................          131,213           137,000           137,000           134,900            +3,687            -2,100            -2,100

                   PENSION BENEFIT GUARANTY CORPORATION

    Pension insurance activities......................................          (12,211)          (42,122)          (42,122)          (42,122)         (+29,911)  ................  ................
    Pension plan termination..........................................         (169,739)         (161,117)         (161,117)         (161,117)          (-8,622)  ................  ................
    Operational support...............................................          (84,380)          (93,739)          (93,739)          (93,739)          (+9,359)  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, PBGC (Program level).................................         (266,330)         (296,978)         (296,978)         (296,978)         (+30,648)  ................  ................

                    EMPLOYMENT STANDARDS ADMINISTRATION

                           SALARIES AND EXPENSES

    Enforcement of Wage and Hour Standards............................          164,493           167,359           167,359           167,359            +2,866   ................  ................
    Office of Labor-Management Standards..............................           41,681            48,799            48,799            43,599            +1,918            -5,200            -5,200
    Federal Contractor EEO Standards Enforcement......................           80,059            82,106            82,106            82,106            +2,047   ................  ................
    Federal Programs for Workers' Compensation........................           97,339           100,129           100,129           100,129            +2,790   ................  ................
        Trust Funds...................................................            2,023             2,048             2,048             2,048               +25   ................  ................
    Program Direction and Support.....................................           15,252            15,891            15,891            17,375            +2,123            +1,484            +1,484
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, ESA salaries and expenses............................          400,847           416,332           416,332           412,616           +11,769            -3,716            -3,716
              Federal Funds...........................................          398,824           414,284           414,284           410,568           +11,744            -3,716            -3,716
              Trust Funds.............................................            2,023             2,048             2,048             2,048               +25   ................  ................

                             SPECIAL BENEFITS

    Federal employees compensation benefits...........................          230,000           234,000           234,000           234,000            +4,000   ................  ................
    Longshore and harbor workers' benefits............................            3,000             3,000             3,000             3,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Special Benefits.....................................          233,000           237,000           237,000           237,000            +4,000   ................  ................

                 SPECIAL BENEFITS FOR DISABLED COAL MINERS

    Benefit payments..................................................          358,806           308,000           308,000           308,000           -50,806   ................  ................
    Administration....................................................            5,191             5,250             5,250             5,250               +59   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Fiscal year 2006 program level....................          363,997           313,250           313,250           313,250           -50,747   ................  ................

              Less funds advanced in prior year.......................          -88,000           -81,000           -81,000           -81,000            +7,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                Total, Current Year, Fiscal year 2006.................          275,997           232,250           232,250           232,250           -43,747   ................  ................
              New advances, 1st quarter Fiscal year 2007..............           81,000            74,000            74,000            74,000            -7,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
                Total, Special Benefits for Disabled Coal Miners......          356,997           306,250           306,250           306,250           -50,747   ................  ................

    ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION FUND, Part B              40,321            96,081            96,081            96,081           +55,760   ................  ................
     Administrative Expenses..........................................

                     BLACK LUNG DISABILITY TRUST FUND

    Benefit payments and interest on advances.........................        1,004,951         1,010,011         1,010,011         1,010,011            +5,060   ................  ................
    Employment Standards Adm. S&E.....................................           32,615            33,050            33,050            33,050              +435   ................  ................
    Departmental Management S&E.......................................           23,705            24,239            24,239            24,239              +534   ................  ................
    Departmental Management, Inspector General........................              342               344               344               344                +2   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Black Lung Disability.............................        1,061,613         1,067,644         1,067,644         1,067,644            +6,031   ................  ................

    Treasury Administrative Costs.....................................              356               356               356               356   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Black Lung Disability Trust Fund.....................        1,061,969         1,068,000         1,068,000         1,068,000            +6,031   ................  ................
                                                                       =============================================================================================================================
          Total, Employment Standards Administration..................        2,093,134         2,123,663         2,123,663         2,119,947           +26,813            -3,716            -3,716
              Federal Funds...........................................        2,091,111         2,121,615         2,121,615         2,117,899           +26,788            -3,716            -3,716
                  Current year........................................       (2,010,111)       (2,047,615)       (2,047,615)       (2,043,899)         (+33,788)          (-3,716)          (-3,716)
                  Fiscal year 2007....................................          (81,000)          (74,000)          (74,000)          (74,000)          (-7,000)  ................  ................
              Trust Funds.............................................            2,023             2,048             2,048             2,048               +25   ................  ................

               OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

                           SALARIES AND EXPENSES

    Safety and Health Standards.......................................           16,003            16,628            16,628            16,628              +625   ................  ................
    Federal Enforcement...............................................          169,652           174,318           174,318           174,318            +4,666   ................  ................
    State Programs....................................................           91,013            92,013            92,013            92,013            +1,000   ................  ................
    Technical Support.................................................           20,742            21,652            21,652            21,652              +910   ................  ................

    Compliance Assistance:
        Federal Assistance............................................           70,859            73,278            73,278            73,278            +2,419   ................  ................
        State Consultation Grants.....................................           53,362            53,896            53,896            53,896              +534   ................  ................
        Training Grants...............................................           10,218   ................           10,218            10,510              +292           +10,510              +292
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Compliance Assistance.............................          134,439           127,174           137,392           137,684            +3,245           +10,510              +292

    Safety and Health Statistics......................................           22,203            24,498            24,498            24,498            +2,295   ................  ................
    Executive Direction and Administration............................           10,106            10,698            10,698            10,698              +592   ................  ................
                                                                       =============================================================================================================================
          Total, OSHA.................................................          464,158           466,981           477,199           477,491           +13,333           +10,510              +292

                   MINE SAFETY AND HEALTH ADMINISTRATION

                           SALARIES AND EXPENSES

    Coal Enforcement..................................................          115,251           118,335           118,335           118,335            +3,084   ................  ................
    Metal/Non-Metal Enforcement.......................................           66,752            68,750            68,750            68,750            +1,998   ................  ................
    Standards Development.............................................            2,334             2,506             2,506             2,506              +172   ................  ................
    Assessments.......................................................            5,238             5,445             5,445             5,445              +207   ................  ................
    Educational Policy and Development................................           31,255            32,021            32,021            32,021              +766   ................  ................
    Technical Support.................................................           25,111            25,736            25,736            25,736              +625   ................  ................
    Program evaluation and information resources (PEIR)...............           17,525            15,671            15,671            15,671            -1,854   ................  ................
    Program Administration............................................           15,670            12,026            12,026            12,026            -3,644   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Mine Safety and Health Administration................          279,136           280,490           280,490           280,490            +1,354   ................  ................

                        BUREAU OF LABOR STATISTICS

                           SALARIES AND EXPENSES

    Employment and Unemployment Statistics............................          162,714           167,047           167,047           167,047            +4,333   ................  ................
    Labor Market Information (Trust Funds)............................           77,845            77,845            77,845            77,845   ................  ................  ................
    Prices and Cost of Living.........................................          169,370           174,779           174,779           174,779            +5,409   ................  ................
    Compensation and Working Conditions...............................           78,942            81,532            81,532            81,532            +2,590   ................  ................
    Productivity and Technology.......................................           10,503            10,847            10,847            10,847              +344   ................  ................
    Executive Direction and Staff Services............................           29,629            30,473            30,473            30,473              +844   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Bureau of Labor Statistics...........................          529,003           542,523           542,523           542,523           +13,520   ................  ................
              Federal Funds...........................................          451,158           464,678           464,678           464,678           +13,520   ................  ................
              Trust Funds.............................................           77,845            77,845            77,845            77,845   ................  ................  ................

                  OFFICE OF DISABILITY EMPLOYMENT POLICY

    Ofce of Disability Employ. Policy, Salaries & expenses............           47,164            27,934            27,934            47,164   ................          +19,230           +19,230

                          DEPARTMENTAL MANAGEMENT

                           SALARIES AND EXPENSES

    Executive Direction...............................................           26,720            29,504            24,864            26,720   ................           -2,784            +1,856
    Departmental IT Crosscut..........................................           29,760            29,760            29,760            29,760   ................  ................  ................
    Departmental Management Crosscut..................................            4,960             1,700             1,700             1,700            -3,260   ................  ................
    Legal Services....................................................           79,769            81,907            81,907            80,000              +231            -1,907            -1,907
        Trust Funds...................................................              311               311               311               311   ................  ................  ................
    International Labor Affairs.......................................           93,248            12,419            12,419            93,248   ................          +80,829           +80,829
    Administration and Management.....................................           32,414            33,197            33,197            33,197              +783   ................  ................
    Frances Perkins building security enhancements....................            6,944             6,944             6,944             6,944   ................  ................  ................
    Adjudication......................................................           25,665            27,126            27,126            27,126            +1,461   ................  ................
    Women's Bureau....................................................            9,478             9,764             9,764             9,764              +286   ................  ................
    Civil Rights Activities...........................................            6,237             6,451             6,451             6,451              +214   ................  ................
    Chief Financial Officer...........................................            5,182             5,340             5,340             5,340              +158   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Salaries and expenses................................          320,688           244,423           239,783           320,561              -127           +76,138           +80,778
              Federal Funds...........................................          320,377           244,112           239,472           320,250              -127           +76,138           +80,778
              Trust Funds.............................................              311               311               311               311   ................  ................  ................

                     VETERANS EMPLOYMENT AND TRAINING

    State administration, Grants......................................          161,097           162,415           162,415           162,415            +1,318   ................  ................
    Federal Administration............................................           30,438            30,435            31,935            30,435                -3   ................           -1,500
    National Veterans Training Institute..............................            1,984             1,984             2,484             1,984   ................  ................             -500
    Homeless Veterans Program.........................................           20,832            22,000            25,000            22,000            +1,168   ................           -3,000
    Veterans Workforce Investment Programs............................            8,482             7,500             7,500             7,500              -982   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Veterans Employment and Training.....................          222,833           224,334           229,334           224,334            +1,501   ................           -5,000
              Federal Funds...........................................           29,314            29,500            32,500            29,500              +186   ................           -3,000
              Trust Funds.............................................          193,519           194,834           196,834           194,834            +1,315   ................           -2,000

                      OFFICE OF THE INSPECTOR GENERAL

    Program Activities................................................           63,478            65,211            65,211            67,211            +3,733            +2,000            +2,000
        Trust Funds...................................................            5,517             5,608             5,608             5,608               +91   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Office of the Inspector General......................           68,995            70,819            70,819            72,819            +3,824            +2,000            +2,000
              Federal funds...........................................           63,478            65,211            65,211            67,211            +3,733            +2,000            +2,000
              Trust funds.............................................            5,517             5,608             5,608             5,608               +91   ................  ................
                                                                       =============================================================================================================================
          Total, Departmental Management..............................          612,516           539,576           539,936           617,714            +5,198           +78,138           +77,778
              Federal Funds...........................................          413,169           338,823           337,183           416,961            +3,792           +78,138           +79,778
              Trust Funds.............................................          199,347           200,753           202,753           200,753            +1,406   ................           -2,000

                           WORKING CAPITAL FUND

    Working capital fund..............................................            9,920             6,230             6,230             6,230            -3,690   ................  ................
                                                                       =============================================================================================================================
          Total, Title I, Department of Labor.........................       15,321,804        14,724,465        14,801,322        15,045,122          -276,682          +320,657          +243,800
              Federal Funds...........................................       11,489,478        11,016,450        11,091,307        11,314,645          -174,833          +298,195          +223,338
                  Current Year........................................       (8,945,478)       (8,504,450)       (8,554,307)       (8,777,645)        (-167,833)        (+273,195)        (+223,338)
                  Fiscal year 2007....................................       (2,544,000)       (2,512,000)       (2,537,000)       (2,537,000)          (-7,000)         (+25,000)  ................
              Trust Funds.............................................        3,832,326         3,708,015         3,710,015         3,730,477          -101,849           +22,462           +20,462

             TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

               HEALTH RESOURCES AND SERVICES ADMINISTRATION

                       HEALTH RESOURCES AND SERVICES

                       BUREAU OF PRIMARY HEALTH CARE

    Community health centers..........................................        1,734,311         2,037,871         1,834,311         1,839,311          +105,000          -198,560            +5,000
    Free Clinics Medical Malpractice..................................               99   ................  ................               99   ................              +99               +99
    Radiation Exposure Compensation Act...............................            1,958             1,936             1,900             1,958   ................              +22               +58
    Healthy Community Access Program..................................           82,993   ................  ................           60,000           -22,993           +60,000           +60,000
    Hansen's Disease Services.........................................           17,251            16,066            16,066            17,066              -185            +1,000            +1,000
    Buildings and Facilities..........................................              247               222               222               222               -25   ................  ................
    Payment to Hawaii, treatment of Hansen's..........................            2,017             2,016             2,016             2,017   ................               +1                +1
    Black lung clinics................................................            5,951             5,912             5,912             5,975               +24               +63               +63
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Bureau of Primary Health Care.....................        1,844,827         2,064,023         1,860,427         1,926,648           +81,821          -137,375           +66,221

                       BUREAU OF HEALTH PROFESSIONS

    National Health Service Corps:
        Field placements..............................................           45,068            40,705            40,705            40,705            -4,363   ................  ................
        Recruitment...................................................           86,380            86,091            86,091            86,091              -289   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, National Health Service Corps.....................          131,448           126,796           126,796           126,796            -4,652   ................  ................

                            Health Professions

    Training for Diversity:
        Centers of excellence.........................................           33,609   ................           12,000            33,609   ................          +33,609           +21,609
        Health careers opportunity program............................           35,647   ................  ................           35,647   ................          +35,647           +35,647
        Faculty loan repayment........................................            1,302   ................  ................            1,302   ................           +1,302            +1,302
        Scholarships for disadvantaged students.......................           47,128             9,831            35,128            47,128   ................          +37,297           +12,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Training for Diversity............................          117,686             9,831            47,128           117,686   ................         +107,855           +70,558

    Training in Primary Care Medicine and Dentistry...................           88,816   ................  ................           90,000            +1,184           +90,000           +90,000

    Interdisciplinary Community-Based Linkages:
        Area health education centers.................................           28,971   ................  ................           28,971   ................          +28,971           +28,971
        Health education and training centers.........................            3,819   ................  ................            3,819   ................           +3,819            +3,819
        Allied health and other disciplines...........................           11,753   ................  ................           11,753   ................          +11,753           +11,753
        Geriatric programs............................................           31,548   ................  ................           29,548            -2,000           +29,548           +29,548
        Quentin N. Burdick program for rural training.................            6,076   ................  ................            6,076   ................           +6,076            +6,076
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Interdisciplinary Comm. Linkages..................           82,167   ................  ................           80,167            -2,000           +80,167           +80,167

    Health Professions Workforce Info & Analysis......................              716               712   ................              712                -4   ................             +712

    Public Health Workforce Development:
        Public health, preventive med. and dental programs............            9,097   ................  ................            9,097   ................           +9,097            +9,097
        Health administration programs................................            1,070   ................  ................            1,070   ................           +1,070            +1,070
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Public Health Workforce Development...............           10,167   ................  ................           10,167   ................          +10,167           +10,167

    Nursing Programs:
        Advanced Education Nursing....................................           58,160            42,806            57,637            58,160   ................          +15,354              +523
        Nurse education, practice, and retention......................           36,468            46,325            36,468            40,468            +4,000            -5,857            +4,000
        Nursing workforce diversity...................................           16,270            21,244            16,270            17,270            +1,000            -3,974            +1,000
        Loan repayment and scholarship program........................           31,482            31,369            31,369            31,482   ................             +113              +113
        Comprehensive geriatric education.............................            3,450             3,426             3,426             3,450   ................              +24               +24
        Nursing faculty loan program..................................            4,831             4,821             4,821             4,831   ................              +10               +10
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Nursing programs..................................          150,661           149,991           149,991           155,661            +5,000            +5,670            +5,670
                                                                       =============================================================================================================================
          Subtotal, Health Professions................................          450,213           160,534           197,119           454,393            +4,180          +293,859          +257,274

    Children's Hospitals Graduate Medical Education...................          300,730           200,000           300,000           300,000              -730          +100,000   ................
    National Practitioner Data Bank...................................           15,700            15,700            15,700            15,700   ................  ................  ................
        User Fees.....................................................          -15,700           -15,700           -15,700           -15,700   ................  ................  ................
    Health Care Integrity and Protection Data Bank....................            4,000             4,000             4,000             4,000   ................  ................  ................
        User Fees.....................................................           -4,000            -4,000            -4,000            -4,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Bureau of Health Professions......................          882,391           487,330           623,915           881,189            -1,202          +393,859          +257,274

                     MATERNAL AND CHILD HEALTH BUREAU

    Maternal and Child Health Block Grant.............................          723,928           723,928           700,000           710,000           -13,928           -13,928           +10,000
    Sickle cell service demonstration program.........................              198   ................  ................              500              +302              +500              +500
    Traumatic Brain Injury............................................            9,297   ................            9,000             9,297   ................           +9,297              +297
    Healthy Start.....................................................          102,543            97,747            97,747           104,000            +1,457            +6,253            +6,253
    Universal Newborn Hearing.........................................            9,792   ................           10,000             9,792   ................           +9,792              -208
    Emergency medical services for children...........................           19,830   ................           19,000            20,000              +170           +20,000            +1,000
    Poison control....................................................           23,499            23,301            23,301            23,301              -198   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Maternal and Child Health Bureau..................          889,087           844,976           859,048           876,890           -12,197           +31,914           +17,842

                              HIV/AIDS BUREAU

    Ryan White AIDS Programs:
        Emergency Assistance..........................................          610,094           610,094           610,094           610,094   ................  ................  ................
        Comprehensive Care Programs...................................        1,121,836         1,131,836         1,131,836         1,131,836           +10,000   ................  ................
            AIDS Drug Assistance Program (ADAP) (NA)..................         (787,521)         (797,521)         (797,521)         (797,521)         (+10,000)  ................  ................
        Early Intervention Program....................................          195,578           195,578           195,578           195,578   ................  ................  ................
        Pediatric HIV/AIDS............................................           72,519            72,519            72,519            72,519   ................  ................  ................
        AIDS Dental Services..........................................           13,218            13,218            13,218            13,218   ................  ................  ................
        Education and Training Centers................................           35,051            35,051            35,051            35,051   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Ryan White AIDS programs..........................        2,048,296         2,058,296         2,058,296         2,058,296           +10,000   ................  ................

        Evaluation Tap Funding (NA)...................................          (25,000)          (25,000)          (25,000)          (25,000)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Ryan White AIDs program level.....................       (2,073,296)       (2,083,296)       (2,083,296)       (2,083,296)         (+10,000)  ................  ................

        Telehealth....................................................            3,916             3,888             3,888             3,888               -28   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, HIV/AIDS Bureau...................................        2,052,212         2,062,184         2,062,184         2,062,184            +9,972   ................  ................

                          SPECIAL PROGRAMS BUREAU

    Organ Transplantation.............................................           24,413            23,282            23,282            24,413   ................           +1,131            +1,131
    Cord Blood Stem Cell Bank.........................................            9,859   ................  ................            9,859   ................           +9,859            +9,859
    Bone Marrow Program...............................................           25,416            22,916            25,416            22,916            -2,500   ................           -2,500
    Trauma Care.......................................................            3,418   ................  ................            3,418   ................           +3,418            +3,418
    State Planning Grants for Health Care Access......................           10,910   ................  ................  ................          -10,910   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Special programs bureau...........................           74,016            46,198            48,698            60,606           -13,410           +14,408           +11,908

                           RURAL HEALTH PROGRAMS

    Rural outreach grants.............................................           39,278            10,767            10,767            39,278   ................          +28,511           +28,511
    Rural Health Research.............................................            8,825             8,528   ................            8,825   ................             +297            +8,825
    Rural Hospital Flexibility Grants.................................           39,180   ................           39,180            64,180           +25,000           +64,180           +25,000
    Rural and community access to emergency devices...................            8,927             1,960             1,960             8,927   ................           +6,967            +6,967
    Rural EMS.........................................................              496   ................  ................              500                +4              +500              +500
    State Offices of Rural Health.....................................            8,321             8,223             8,223             8,321   ................              +98               +98
    Denali Commission.................................................           39,680   ................  ................           39,680   ................          +39,680           +39,680
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Rural health programs.............................          144,707            29,478            60,130           169,711           +25,004          +140,233          +109,581

    Bioterrorism preparedness \3\.....................................  ................  ................          500,000           510,500          +510,500          +510,500           +10,500
    Family Planning...................................................          285,963           285,963           285,963           285,963   ................  ................  ................
    Health Care-related Facilities and activities.....................          482,729   ................  ................          480,751            -1,978          +480,751          +480,751
    Program Management................................................          147,080           145,992           143,072           143,992            -3,088            -2,000              +920
                                                                       =============================================================================================================================
          Total, Health resources and services........................        6,803,012         5,966,144         6,443,437         7,398,434          +595,422        +1,432,290          +954,997
          Total, Health resources & services program level............       (6,828,012)       (5,991,144)       (6,468,437)       (7,423,434)        (+595,422)      (+1,432,290)        (+954,997)
              Evaluation tap funding..................................          (25,000)          (25,000)          (25,000)          (25,000)  ................  ................  ................

    HEALTH EDUCATION ASSISTANCE LOANS (HEAL) PROGRAM:
        Liquidating account...........................................           (4,000)           (4,000)           (4,000)           (4,000)  ................  ................  ................
        Program management............................................            3,244             2,916             2,916             2,916              -328   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, HEAL.................................................            3,244             2,916             2,916             2,916              -328   ................  ................

    VACCINE INJURY COMPENSATION PROGRAM TRUST FUND:
        Post-Fiscal Year 1988 claims..................................           66,000            70,884            70,884            70,884            +4,884   ................  ................
        HRSA administration...........................................            3,151             2,832             3,500             3,600              +449              +768              +100
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Vaccine Injury Compensation Trust Fund...............           69,151            73,716            74,384            74,484            +5,333              +768              +100
                                                                       =============================================================================================================================
          Total, Health Resources and Services Admin..................        6,875,407         6,042,776         6,520,737         7,475,834          +600,427        +1,433,058          +955,097
          Total, HRSA program level...................................       (6,904,407)       (6,071,776)       (6,549,737)       (7,504,834)        (+600,427)      (+1,433,058)        (+955,097)

                CENTERS FOR DISEASE CONTROL AND PREVENTION

    Infectious Diseases...............................................        1,667,095         1,696,964         1,704,529         1,696,567           +29,472              -397            -7,962
        Evaluation Tap Funding........................................          (12,794)          (12,794)          (12,794)          (12,794)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................       (1,679,889)       (1,709,758)       (1,717,323)       (1,709,361)         (+29,472)            (-397)          (-7,962)

    Health Promotion..................................................        1,021,709           964,421           983,647           974,080           -47,629            +9,659            -9,567
    Health Information and Service....................................           94,438            89,564           195,069            89,564            -4,874   ................         -105,505
        Evaluation Tap Funding........................................         (134,235)         (134,235)          (28,730)         (134,235)  ................  ................        (+105,505)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................         (228,673)         (223,799)         (223,799)         (223,799)          (-4,874)  ................  ................

    Environmental health and injury...................................          285,721           284,820           285,721           288,982            +3,261            +4,162            +3,261
    Occupational safety and health \4\................................          198,970           198,859           164,170           170,050           -28,920           -28,809            +5,880
        Evaluation Tap Funding........................................          (87,071)          (87,071)          (87,071)          (87,071)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level \4\.................................         (286,041)         (285,930)         (251,241)         (257,121)         (-28,920)         (-28,809)          (+5,880)

    Global health.....................................................          293,863           306,079           309,076           313,227           +19,364            +7,148            +4,151
        Supplemental (Public Law 109-13) (emergency)..................           15,000   ................  ................  ................          -15,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................         (308,863)         (306,079)         (309,076)         (313,227)          (+4,364)          (+7,148)          (+4,151)

    Terrorism preparedness and response \3\...........................  ................  ................        1,616,723         1,566,471        +1,566,471        +1,566,471           -50,252

    Public Health research:
        Evaluation Tap Funding........................................          (31,000)          (31,000)          (31,000)          (31,000)  ................  ................  ................
    Public health improvement and leadership..........................          266,842           206,541           258,541           269,055            +2,213           +62,514           +10,514
    Preventive health and health services block grant.................          118,526   ................          100,000           100,000           -18,526          +100,000   ................
    Buildings and Facilities..........................................          269,708            30,000            30,000           225,000           -44,708          +195,000          +195,000
    Business services.................................................          278,838           263,715           298,515           296,119           +17,281           +32,404            -2,396
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Centers for Disease Control..........................        4,510,710         4,040,963         5,945,991         5,989,115        +1,478,405        +1,948,152           +43,124
              Evaluation Tap Funding (NA).............................         (265,100)         (265,100)         (159,595)         (265,100)  ................  ................        (+105,505)
          Total, Centers for Disease Control program level............       (4,775,810)       (4,306,063)       (6,105,586)       (6,254,215)      (+1,478,405)      (+1,948,152)        (+148,629)

                       NATIONAL INSTITUTES OF HEALTH

    National Cancer Institute.........................................        4,825,259         4,841,774         4,841,774         4,960,828          +135,569          +119,054          +119,054
    National Heart, Lung, and Blood Institute.........................        2,941,201         2,951,270         2,951,270         3,023,381           +82,180           +72,111           +72,111
    National Institute of Dental & Craniofacial Research..............          391,829           393,269           393,269           405,269           +13,440           +12,000           +12,000
    National Institute of Diabetes and Digestive and Kidney Diseases..        1,713,584         1,722,146         1,722,146         1,767,919           +54,335           +45,773           +45,773
        Juvenile diabetes (mandatory).................................         (150,000)         (150,000)         (150,000)         (150,000)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, NIDDK.............................................       (1,863,584)       (1,872,146)       (1,872,146)       (1,917,919)         (+54,335)         (+45,773)         (+45,773)

    National Institute of Neurological Disorders & Stroke.............        1,539,448         1,550,260         1,550,260         1,591,924           +52,476           +41,664           +41,664

    National Institute of Allergy and Infectious Diseases.............        4,303,640         4,359,395         4,359,395         4,447,136          +143,496           +87,741           +87,741
        Global HIV/AIDS Fund Transfer.................................           99,200           100,000   ................          100,000              +800   ................         +100,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, NIAID.............................................        4,402,840         4,459,395         4,359,395         4,547,136          +144,296           +87,741          +187,741

    National Institute of General Medical Sciences....................        1,944,067         1,955,170         1,955,170         2,002,622           +58,555           +47,452           +47,452
    National Institute of Child Health & Human Development............        1,270,321         1,277,544         1,277,544         1,310,989           +40,668           +33,445           +33,445
    National Eye Institute............................................          669,070           673,491           673,491           693,559           +24,489           +20,068           +20,068
    National Institute of Environmental Health Sciences...............          644,505           647,608           647,608           667,372           +22,867           +19,764           +19,764
    National Institute on Aging.......................................        1,051,990         1,057,203         1,057,203         1,090,600           +38,610           +33,397           +33,397
    National Institute of Arthritis and Musculoskeletal and Skin Dis-           511,157           513,063           513,063           525,758           +14,601           +12,695           +12,695
     eases............................................................
    National Institute on Deafness and Other Communication Dis-                 394,259           397,432           397,432           409,432           +15,173           +12,000           +12,000
     orders...........................................................
    National Institute of Nursing Research............................          138,072           138,729           138,729           142,549            +4,477            +3,820            +3,820
    National Institute on Alcohol Abuse and Alcoholism................          438,277           440,333           440,333           452,271           +13,994           +11,938           +11,938
    National Institute on Drug Abuse..................................        1,006,419         1,010,130         1,010,130         1,035,167           +28,748           +25,037           +25,037
    National Institute of Mental Health...............................        1,411,933         1,417,692         1,417,692         1,460,393           +48,460           +42,701           +42,701
    National Human Genome Research Institute..........................          488,608           490,959           490,959           502,804           +14,196           +11,845           +11,845
    National Institute of Biomedical Imaging and Bioengineering.......          298,209           299,808           299,808           309,091           +10,882            +9,283            +9,283
    National Center for Research Resources............................        1,115,090         1,100,203         1,100,203         1,188,079           +72,989           +87,876           +87,876
    National Center for Complementary and Alternative Medicine........          122,105           122,692           122,692           126,978            +4,873            +4,286            +4,286
    National Center on Minority Health and Health Disparities.........          196,159           197,379           197,379           203,367            +7,208            +5,988            +5,988
    John E. Fogarty International Center..............................           66,632            67,048            67,048            68,745            +2,113            +1,697            +1,697
    National Library of Medicine......................................          315,146           318,091           318,091           327,222           +12,076            +9,131            +9,131
        Evaluation Tap Funding........................................           (8,200)           (8,200)           (8,200)           (8,200)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, NLM...............................................          323,346           326,291           326,291           335,422           +12,076            +9,131            +9,131

    Office of the Director \3\........................................          358,047           385,195           482,216           487,434          +129,387          +102,239            +5,218
        Biodefense countermeasures....................................  ................  ................          (97,021)          (97,021)         (+97,021)         (+97,021)  ................
    Buildings and Facilities..........................................          110,288            81,900            81,900           113,626            +3,338           +31,726           +31,726
                                                                       =============================================================================================================================
          Total, National Institutes of Health (NIH)..................       28,364,515        28,509,784        28,506,805        29,414,515        +1,050,000          +904,731          +907,710
              Global HIV/AIDS Fund Transfer...........................          -99,200          -100,000   ................         -100,000              -800   ................         -100,000
              Evaluation Tap Funding..................................           (8,200)           (8,200)           (8,200)           (8,200)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, NIH, Program Level...................................      (28,273,515)      (28,417,984)      (28,515,005)      (29,322,715)      (+1,049,200)        (+904,731)        (+807,710)

    SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

    Mental Health:
        Programs of Regional and National Significance................          274,297           210,213           253,257           274,297   ................          +64,084           +21,040
        Mental Health block grant.....................................          410,953           410,953           410,953           410,953   ................  ................  ................
            Evaluation Tap Funding....................................          (21,803)          (21,803)          (21,803)          (21,803)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................         (432,756)         (432,756)         (432,756)         (432,756)  ................  ................  ................

        Children's Mental Health......................................          105,112           105,129           105,129           105,129               +17   ................  ................
        Grants to States for the Homeless (PATH)......................           54,809            54,809            54,809            54,809   ................  ................  ................
        Protection and Advocacy.......................................           34,343            34,343            34,343            34,343   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Mental Health.....................................          879,514           815,447           858,491           879,531               +17           +64,084           +21,040
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................         (901,317)         (837,250)         (880,294)         (901,334)             (+17)         (+64,084)         (+21,040)

    Substance Abuse Treatment:
        Programs of Regional and National Significance................          418,066           442,752           405,131           407,791           -10,275           -34,961            +2,660
            Evaluation Tap Funding....................................           (4,300)           (4,300)           (4,300)           (4,300)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................         (422,366)         (447,052)         (409,431)         (412,091)         (-10,275)         (-34,961)          (+2,660)

        Substance Abuse block grant...................................        1,696,355         1,696,355         1,696,355         1,696,355   ................  ................  ................
            Evaluation Tap Funding....................................          (79,200)          (79,200)          (79,200)          (79,200)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................       (1,775,555)       (1,775,555)       (1,775,555)       (1,775,555)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Substance Abuse Treatment.....................        2,114,421         2,139,107         2,101,486         2,104,146           -10,275           -34,961            +2,660
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................       (2,197,921)       (2,222,607)       (2,184,986)       (2,187,646)         (-10,275)         (-34,961)          (+2,660)

    Substance Abuse Prevention:
        Programs of Regional and National Significance................          198,725           184,349           194,950           202,289            +3,564           +17,940            +7,339
        Program Management............................................           75,806            75,817            75,817            75,817               +11   ................  ................
            Evaluation Tap funding (NA)...............................          (18,000)          (16,000)          (16,000)          (18,000)  ................          (+2,000)          (+2,000)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................           93,806            91,817            91,817            93,817               +11            +2,000            +2,000
                                                                       =============================================================================================================================
              Total, SAMHSA...........................................        3,268,466         3,214,720         3,230,744         3,261,783            -6,683           +47,063           +31,039
                  Evaluation Tap funding..............................         (123,303)         (121,303)         (121,303)         (123,303)  ................          (+2,000)          (+2,000)
              Total, SAMHSA program level.............................       (3,391,769)       (3,336,023)       (3,352,047)       (3,385,086)          (-6,683)         (+49,063)         (+33,039)

                AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

    Research on Health Costs, Quality, and Outcomes:
        Federal Funds.................................................  ................  ................          318,695   ................  ................  ................         -318,695
        Evaluation Tap funding (NA)...................................         (260,695)         (260,695)  ................         (265,695)          (+5,000)          (+5,000)        (+265,695)
            Clinial effectiveness research (NA).......................          (15,000)          (15,000)  ................          (20,000)          (+5,000)          (+5,000)         (+20,000)
            Reducing medical errors (NA)..............................          (84,000)          (84,000)  ................          (84,000)  ................  ................         (+84,000)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Program level.................................         (260,695)         (260,695)         (318,695)         (265,695)          (+5,000)          (+5,000)         (-53,000)

    Health Insurance and Expenditure Surveys:
        Evaluation Tap funding (NA)...................................          (55,300)          (55,300)  ................          (55,300)  ................  ................         (+55,300)

    Program Support:
        Evaluation Tap funding (NA)...................................           (2,700)           (2,700)  ................           (2,700)  ................  ................          (+2,700)
                                                                       =============================================================================================================================
          Total, AHRQ.................................................  ................  ................          318,695   ................  ................  ................         -318,695
              Evaluation Tap funding (NA).............................         (318,695)         (318,695)  ................         (323,695)          (+5,000)          (+5,000)        (+323,695)
          Total, AHRQ program level...................................         (318,695)         (318,695)         (318,695)         (323,695)          (+5,000)          (+5,000)          (+5,000)
                                                                       =============================================================================================================================
          Total, Public Health Service appropriation..................       43,019,098        41,808,243        44,522,972        46,141,247        +3,122,149        +4,333,004        +1,618,275
          Total, Public Health Service program level..................      (43,664,196)      (42,450,541)      (44,841,070)      (46,790,545)      (+3,126,349)      (+4,340,004)      (+1,949,475)

      CENTERS FOR MEDICARE AND MEDICAID SERVICES GRANTS TO STATES FOR
                                 MEDICAID

    Medicaid current law benefits.....................................      171,407,893       204,166,276       204,166,276       204,166,276       +32,758,383   ................  ................
    State and local administration....................................        9,318,602         9,803,100         9,803,100         9,803,100          +484,498   ................  ................
    Vaccines for Children.............................................        1,468,799         1,502,333         1,502,333         1,502,333           +33,534   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Medicaid program level............................      182,195,294       215,471,709       215,471,709       215,471,709       +33,276,415   ................  ................
              Less funds advanced in prior year.......................      -58,416,275       -58,517,290       -58,517,290       -58,517,290          -101,015   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Grants to States for medicaid........................      123,779,019       156,954,419       156,954,419       156,954,419       +33,175,400   ................  ................
              New advance, 1st quarter................................       58,517,290        62,783,825        62,783,825        62,783,825        +4,266,535   ................  ................

                    PAYMENTS TO HEALTH CARE TRUST FUNDS

    Supplemental medical insurance....................................      114,002,000       128,015,000       128,015,000       128,015,000       +14,013,000   ................  ................
    Hospital insurance for the uninsured..............................           87,000           202,000           202,000           202,000          +115,000   ................  ................
    Federal uninsured payment.........................................          199,000           206,000           206,000           206,000            +7,000   ................  ................
    Program management................................................          215,000           164,000           164,000           164,000           -51,000   ................  ................
    General revenue for Part D benefit................................  ................       53,596,000        53,596,000        53,596,000       +53,596,000   ................  ................
    General revenue for Part D administration (CMS)...................  ................          357,000           357,000           357,000          +357,000   ................  ................
    General revenue for Part D administration (SSA)...................  ................          320,000           320,000           320,000          +320,000   ................  ................
    HCFAC reimbursement...............................................  ................           80,000   ................           80,000           +80,000   ................          +80,000
    Prescription drug eligibility determinations......................          105,900            99,100            99,100            99,100            -6,800   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Payments to Trust Funds, current law..............      114,608,900       183,039,100       182,959,100       183,039,100       +68,430,200   ................          +80,000
              Less funds advanced in prior year.......................  ................       -5,216,900        -5,216,900        -5,216,900        -5,216,900   ................  ................
              New Advance Fiscal Year 2007............................        5,216,900   ................  ................  ................       -5,216,900   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Payments to Trust Funds, current law.................      119,825,800       177,822,200       177,742,200       177,822,200       +57,996,400   ................          +80,000

                            PROGRAM MANAGEMENT

    Medicare reform funding \5\ \6\ \7\ (NA)..........................         (250,000)         (250,000)         (250,000)         (250,000)  ................  ................  ................
    Research, Demonstration, Evaluation...............................           77,494            45,194            65,000            78,494            +1,000           +33,300           +13,494

    Medicare Operations...............................................        1,722,984         2,189,987         2,172,987         2,184,984          +462,000            -5,003           +11,997
        H.R. 3103 funding (NA)........................................         (720,000)         (720,000)         (720,000)         (720,000)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Medicare Operations program level.................       (2,442,984)       (2,909,987)       (2,892,987)       (2,904,984)        (+462,000)          (-5,003)         (+11,997)

    Revitalization plan...............................................           24,205            24,205            24,205            24,205   ................  ................  ................
    State Survey and Certification....................................          258,735           260,735           260,735           260,735            +2,000   ................  ................
    Federal Administration............................................          581,493           657,357           657,357           655,000           +73,507            -2,357            -2,357
                                                                       =============================================================================================================================
          Total, Program management, Limitation on new BA.............        2,664,911         3,177,478         3,180,284         3,203,418          +538,507           +25,940           +23,134
          Total, Program management, program level....................       (3,384,911)       (3,897,478)       (3,900,284)       (3,923,418)        (+538,507)         (+25,940)         (+23,134)

    Health Care Fraud and Abuse Control:
        Part D drug benefit/medicare advantage (MIP)..................  ................           75,000   ................           75,000           +75,000   ................          +75,000
        Medicaid and SCHIP financial management.......................  ................            5,000   ................            5,000            +5,000   ................           +5,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Health Care Fraud and Abuse Control..................  ................           80,000   ................           80,000           +80,000   ................          +80,000
                                                                       =============================================================================================================================
          Total, Center for Medicare and Medicaid Services............      304,787,020       400,817,922       400,660,728       400,843,862       +96,056,842           +25,940          +183,134
              Federal funds...........................................      302,122,109       397,560,444       397,480,444       397,560,444       +95,438,335   ................          +80,000
                  Current year........................................     (238,387,919)     (334,776,619)     (334,696,619)     (334,776,619)     (+96,388,700)  ................         (+80,000)
                  New advance, fiscal year 2007.......................      (63,734,190)      (62,783,825)      (62,783,825)      (62,783,825)        (-950,365)  ................  ................
              Trust Funds.............................................        2,664,911         3,257,478         3,180,284         3,283,418          +618,507           +25,940          +103,134

                 ADMINISTRATION FOR CHILDREN AND FAMILIES

                     FAMILY SUPPORT PAYMENTS TO STATES

    Payments to territories...........................................           23,000            33,000            33,000            33,000           +10,000   ................  ................
    Repatriation......................................................            1,000             1,300             1,300             1,000   ................             -300              -300
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Welfare payments..................................           24,000            34,300            34,300            34,000           +10,000              -300              -300

    Child Support Enforcement:
        State and local administration................................        3,610,465         3,715,816         3,715,816         3,767,816          +157,351           +52,000           +52,000
        Federal incentive payments....................................          446,000           458,000           458,000           458,000           +12,000   ................  ................
        Access and visitation.........................................           10,000            12,000            12,000            10,000   ................           -2,000            -2,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Child Support Enforcement.........................        4,066,465         4,185,816         4,185,816         4,235,816          +169,351           +50,000           +50,000
                                                                       =============================================================================================================================
          Total, Family support payments program level................        4,090,465         4,220,116         4,220,116         4,269,816          +179,351           +49,700           +49,700
              Less funds advanced in previous years...................       -1,200,000        -1,200,000        -1,200,000        -1,200,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Family support payments, current request.............        2,890,465         3,020,116         3,020,116         3,069,816          +179,351           +49,700           +49,700
              New advance, 1st quarter, fiscal year 2007..............        1,200,000         1,200,000         1,200,000         1,200,000   ................  ................  ................
                                                                       =============================================================================================================================
          Total, Family support payments..............................        4,090,465         4,220,116         4,220,116         4,269,816          +179,351           +49,700           +49,700

                 LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

    Formula grants....................................................        1,884,799         1,800,000         2,006,799         1,883,000            -1,799           +83,000          -123,799
    Emergency allocation:
        Contingent emergency allocation...............................  ................          200,000   ................  ................  ................         -200,000   ................
        Emergency allocation..........................................          297,600   ................  ................          300,000            +2,400          +300,000          +300,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Low income home energy assistance....................        2,182,399         2,000,000         2,006,799         2,183,000              +601          +183,000          +176,201

                      REFUGEE AND ENTRANT ASSISTANCE

    Transitional and Medical Services.................................          192,028           264,129           264,129           264,129           +72,101   ................  ................
    Victims of Trafficking............................................            9,915             9,915             9,915             9,915   ................  ................  ................
    Social Services...................................................          164,888           151,121           160,000           151,121           -13,767   ................           -8,879
    Preventive Health.................................................            4,796             4,796             4,796             4,796   ................  ................  ................
    Targeted Assistance...............................................           49,081            49,081            49,081            49,081   ................  ................  ................
    Unaccompanied minors..............................................           53,771            63,083            63,083            63,083            +9,312   ................  ................
        Emergency appropriations......................................  ................  ................  ................           19,100           +19,100           +19,100           +19,100
    Victims of Torture................................................            9,915             9,915             9,915             9,915   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Refugee and entrant assistance.......................          484,394           552,040           560,919           571,140           +86,746           +19,100           +10,221

    CHILD CARE AND DEVELOPMENT BLOCK GRANT............................        2,082,921         2,082,910         2,082,910         2,082,910               -11   ................  ................
    SOCIAL SERVICES BLOCK GRANT (TITLE XX)............................        1,700,000         1,700,000         1,700,000         1,700,000   ................  ................  ................

                  CHILDREN AND FAMILIES SERVICES PROGRAMS

    Programs for Children, Youth and Families:
        Head Start, current funded....................................        5,454,314         5,499,336         5,499,000         5,474,314           +20,000           -25,022           -24,686
            Advance from prior year...................................       (1,388,800)       (1,400,000)       (1,400,000)       (1,400,000)         (+11,200)  ................  ................
            Fiscal year 2007..........................................        1,400,000         1,388,800         1,400,000         1,388,800           -11,200   ................          -11,200
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Head Start, program level.....................        6,843,114         6,899,336         6,899,000         6,874,314           +31,200           -25,022           -24,686

        Consolidated Runaway, Homeless Youth Program..................           88,724            88,728            88,728            88,724   ................               -4                -4
        Maternity Group Homes.........................................  ................           10,000   ................  ................  ................          -10,000   ................
        Prevention grants to reduce abuse of runaway youth............           15,178            15,179            15,179            15,179                +1   ................  ................
        Child Abuse State Grants......................................           27,280            27,280            27,280            27,280   ................  ................  ................
        Child Abuse Discretionary Activities..........................           31,640            31,645            31,645            31,640   ................               -5                -5
        Community based child abuse prevention........................           42,858            42,859            42,859            42,859                +1   ................  ................
        Abandoned Infants Assistance..................................           11,955            11,955            11,955            11,955   ................  ................  ................
        Child Welfare Services........................................          289,650           289,650           289,650           289,650   ................  ................  ................
        Child Welfare Training........................................            7,409             7,409             7,409             7,409   ................  ................  ................
        Adoption Opportunities........................................           27,116            27,119            27,119            27,119                +3   ................  ................
        Adoption Incentive (no cap adjustment)........................           31,846            31,846            31,846            22,846            -9,000            -9,000            -9,000
        Adoption Awareness............................................           12,802            12,802            12,802            12,802   ................  ................  ................
        Compassion Capital Fund.......................................           54,549           100,000            75,000            95,000           +40,451            -5,000           +20,000

    Social Services and Income Maintenance Research...................           26,012   ................            2,621            26,012   ................          +26,012           +23,391
        Evaluation tap funding........................................           (6,000)           (6,000)           (8,000)           (6,000)  ................  ................          (-2,000)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................          (32,012)           (6,000)          (10,621)          (32,012)  ................         (+26,012)         (+21,391)

    Developmental Disabilities Programs:
        State Councils................................................           72,496            72,496            72,496            72,496   ................  ................  ................
        Protection and Advocacy.......................................           38,109            38,109            38,109            39,109            +1,000            +1,000            +1,000
        Voting access for individuals with disabilities...............           14,879            14,879            14,879            14,879   ................  ................  ................
        Developmental Disabilities Projects of National Significance..           11,542            11,529            11,529            11,529               -13   ................  ................
        University Centers for Excellence in Developmental                       31,549            31,548            33,548            33,548            +1,999            +2,000   ................
         Disabilities.................................................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Developmental disabilities programs...............          168,575           168,561           170,561           171,561            +2,986            +3,000            +1,000

    Native American Programs..........................................           44,786            44,780            44,780            44,780                -6   ................  ................
    Community Services:
        Grants to States for Community Services.......................          636,793   ................          320,000           636,793   ................         +636,793          +316,793

        Community Initiative Program:
            Economic Development......................................           32,731   ................           32,731            32,731   ................          +32,731   ................
            Individual Development Account Initiative.................           24,704            24,699            24,699            24,699                -5   ................  ................
            Rural Community Facilities................................            7,242   ................            7,242             7,492              +250            +7,492              +250
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Community Initiative Program..................           64,677            24,699            64,672            64,922              +245           +40,223              +250

    National Youth Sports.............................................           17,856   ................  ................  ................          -17,856   ................  ................
    Community Food and Nutrition......................................            7,180   ................  ................            7,180   ................           +7,180            +7,180
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Community Services................................          726,506            24,699           384,672           708,895           -17,611          +684,196          +324,223

    Domestic Violence Hotline.........................................            3,224             3,000             3,000             3,000              -224   ................  ................
    Family Violence/Battered Women's Shelters.........................          125,630           125,991           125,991           125,991              +361   ................  ................
    Early Learning Fund...............................................           35,712   ................  ................  ................          -35,712   ................  ................
    Mentoring Children of Prisoners...................................           49,598            49,993            49,993            49,993              +395   ................  ................
    Independent Living Training Vouchers..............................           46,623            59,999            50,000            46,623   ................          -13,376            -3,377
    Abstinence Education..............................................           99,198           138,045           110,000           101,000            +1,802           -37,045            -9,000
        Evaluation Tap Funding........................................           (4,500)           (4,500)           (4,500)           (4,500)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Program level.....................................         (103,698)         (142,545)         (114,500)         (105,500)          (+1,802)         (-37,045)          (-9,000)

    Faith-Based Center................................................            1,375             1,400             1,400             1,400               +25   ................  ................
    Program Direction.................................................          185,210           185,217           185,217           186,000              +790              +783              +783
                                                                       =============================================================================================================================
          Total, Children and Families Services Programs..............        9,007,770         8,386,293         8,688,707         9,000,832            -6,938          +614,539          +312,125
              Current Year............................................       (7,607,770)       (6,997,493)       (7,288,707)       (7,612,032)          (+4,262)        (+614,539)        (+323,325)
              Fiscal year 2007........................................       (1,400,000)       (1,388,800)       (1,400,000)       (1,388,800)         (-11,200)  ................         (-11,200)
              Evaluation Tap funding..................................          (10,500)          (10,500)          (12,500)          (10,500)  ................  ................          (-2,000)
                                                                       =============================================================================================================================
          Total, Program level........................................        9,018,270         8,396,793         8,701,207         9,011,332            -6,938          +614,539          +310,125

    PROMOTING SAFE AND STABLE FAMILIES................................          305,000           305,000           305,000           305,000   ................  ................  ................
        Discretionary Funds...........................................           98,586           105,000            99,000            90,000            -8,586           -15,000            -9,000

              PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION

    Foster Care.......................................................        4,895,500         4,685,000         4,685,000         4,685,000          -210,500   ................  ................
    Adoption Assistance...............................................        1,770,100         1,795,000         1,795,000         1,795,000           +24,900   ................  ................
    Independent living................................................          140,000           140,000           140,000           140,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Payments to States...................................        6,805,600         6,620,000         6,620,000         6,620,000          -185,600   ................  ................
              Less Advances from Prior Year...........................       -1,767,700        -1,767,200        -1,767,200        -1,767,200              +500   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, payments, current year...............................        5,037,900         4,852,800         4,852,800         4,852,800          -185,100   ................  ................
              New Advance, 1st quarter................................        1,767,200         1,730,000         1,730,000         1,730,000           -37,200   ................  ................
                                                                       =============================================================================================================================
          Total, Administration for Children & Families...............       26,756,635        25,934,159        26,246,251        26,785,498           +28,863          +851,339          +539,247
              Current year............................................      (22,389,435)      (21,615,359)      (21,916,251)      (22,466,698)         (+77,263)        (+851,339)        (+550,447)
              Fiscal year 2007........................................       (4,367,200)       (4,318,800)       (4,330,000)       (4,318,800)         (-48,400)  ................         (-11,200)
              Evaluation Tap funding..................................          (10,500)          (10,500)          (12,500)          (10,500)  ................  ................          (-2,000)
                                                                       =============================================================================================================================
          Total, Administration for Children & Families...............       26,767,135        25,944,659        26,258,751        26,795,998           +28,863          +851,339          +537,247

                          ADMINISTRATION ON AGING

    Grants to States:
        Supportive Services and Centers...............................          354,136           354,136           354,136           354,136   ................  ................  ................
        Preventive Health.............................................           21,616            21,616            21,616            21,616   ................  ................  ................
        Protection of vulnerable older americans-Title VII............           19,288            19,360            19,360            20,360            +1,072            +1,000            +1,000
        Family Caregivers.............................................          155,744           155,744           155,744           160,744            +5,000            +5,000            +5,000
        Native American Caregivers Support............................            6,304             6,304             6,304             6,304   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Caregivers........................................          162,048           162,048           162,048           167,048            +5,000            +5,000            +5,000

        Nutrition:
            Congregate Meals..........................................          387,274           387,274           391,147           387,274   ................  ................           -3,873
            Home Delivered Meals......................................          182,827           182,826           184,656           182,827   ................               +1            -1,829
            Nutrition Services Incentive Program......................          148,596           148,596           150,082           148,596   ................  ................           -1,486
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Nutrition.....................................          718,697           718,696           725,885           718,697   ................               +1            -7,188
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Grants to States..............................        1,275,785         1,275,856         1,283,045         1,281,857            +6,072            +6,001            -1,188

    Grants for Native Americans.......................................           26,398            26,398            26,398            26,398   ................  ................  ................
    Program Innovations...............................................           43,286            23,843            23,843            40,513            -2,773           +16,670           +16,670
    Aging Network Support Activities..................................           13,266            13,266            13,266            13,266   ................  ................  ................
    Alzheimer's Disease Demonstrations................................           11,786            11,786            11,786            11,786   ................  ................  ................
    White House Conference on Aging...................................            4,520   ................  ................  ................           -4,520   ................  ................
    Program Administration............................................           18,301            17,879            17,879            17,879              -422   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Administration on Aging..............................        1,393,342         1,369,028         1,376,217         1,391,699            -1,643           +22,671           +15,482

                          OFFICE OF THE SECRETARY

    GENERAL DEPARTMENTAL MANAGEMENT:
        Federal Funds.................................................          179,837           172,643           172,643           182,810            +2,973           +10,167           +10,167
        Trust Funds...................................................            5,804             5,851             5,851             5,851               +47   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal....................................................          185,641           178,494           178,494           188,661            +3,020           +10,167           +10,167

        Adolescent Family Life (Title XX).............................           30,900            30,742            30,742            30,742              -158   ................  ................
        Minority health...............................................           50,518            47,236            47,236            50,980              +462            +3,744            +3,744
        Office of Women's Health......................................           28,818            28,715            28,715            28,715              -103   ................  ................
        Minority HIV/AIDS.............................................           52,415            52,415            52,415            52,415   ................  ................  ................
        Afghanistan...................................................            5,952             5,952             5,952             5,952   ................  ................  ................
        Embryo adoption awareness campaign............................              992               992               992             2,000            +1,008            +1,008            +1,008
        IT Security and Innovation Fund...............................           14,695            14,630   ................  ................          -14,695           -14,630   ................
        Evaluation tap funding (ASPE) (NA)............................          (39,552)          (39,552)          (39,552)          (39,552)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, General Departmental Management......................          369,931           359,176           344,546           359,465           -10,466              +289           +14,919
              Federal Funds...........................................          364,127           353,325           338,695           353,614           -10,513              +289           +14,919
              Trust Funds.............................................            5,804             5,851             5,851             5,851               +47   ................  ................
              Evaluation tap funding..................................          (39,552)          (39,552)          (39,552)          (39,552)  ................  ................  ................

    OFFICE OF MEDICARE HEARINGS AND APPEALS...........................           57,536            80,000            60,000            75,000           +17,464            -5,000           +15,000

    OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION                     4,318            75,000            46,100            32,800           +28,482           -42,200           -13,300
     TECHNOLOGY \6\...................................................
        Evaluation tap funding........................................          (19,693)           (2,750)          (28,900)          (12,350)          (-7,343)          (+9,600)         (-16,550)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Health Information Tech. program level...............          (24,011)          (77,750)          (75,000)          (45,150)         (+21,139)         (-32,600)         (-29,850)

    OFFICE OF THE INSPECTOR GENERAL:
        Federal Funds.................................................           39,930            39,813            39,813            39,813              -117   ................  ................
            HIPAA funding (NA)........................................         (160,000)         (160,000)         (160,000)         (160,000)  ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Total, Inspector General program level..................         (199,930)         (199,813)         (199,813)         (199,813)            (-117)  ................  ................

    OFFICE FOR CIVIL RIGHTS:
        Federal Funds.................................................           31,726            31,682            31,682            31,682               -44   ................  ................
        Trust Funds...................................................            3,287             3,314             3,314             3,314               +27   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Office for Civil Rights..............................           35,013            34,996            34,996            34,996               -17   ................  ................

    MEDICAL BENEFITS FOR COMMISSIONED OFFICERS:
        Retirement payments...........................................          241,294           256,193           256,193           256,193           +14,899   ................  ................
        Survivors benefits............................................           14,750            15,600            15,600            15,600              +850   ................  ................
        Dependents' medical care......................................           74,592            56,759            56,759            56,759           -17,833   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Medical benefits for Commissioned Officers...........          330,636           328,552           328,552           328,552            -2,084   ................  ................

              PUBLIC HEALTH AND SOCIAL SERVICE EMERGENCY FUND

    HRSA homeland security activities \3\.............................          514,618           510,500   ................  ................         -514,618          -510,500   ................
    CDC homeland security activities \3\..............................        1,622,757         1,616,723   ................  ................       -1,622,757        -1,616,723   ................
    NIH homeland security activities \3\..............................           47,021            97,021   ................  ................          -47,021           -97,021   ................
    Office of the Secretary homeland sercurity activities.............           63,821            83,589            63,589            63,589              -232           -20,000   ................
    Other PHSSEF homeland security activities.........................          109,198           120,000           120,000           120,000           +10,802   ................  ................
        Supplemental (Public Law 108-234) (emergency).................           50,000   ................  ................  ................          -50,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, PHSSEF...............................................        2,407,415         2,427,833           183,589           183,589        -2,223,826        -2,244,244   ................
                                                                       =============================================================================================================================
          Total, Office of the Secretary..............................        3,244,779         3,345,370         1,037,596         1,054,215        -2,190,564        -2,291,155           +16,619
              Federal Funds...........................................        3,178,152         3,256,205           968,431           970,050        -2,208,102        -2,286,155            +1,619
              Trust Funds.............................................           66,627            89,165            69,165            84,165           +17,538            -5,000           +15,000
                                                                       =============================================================================================================================
          Total, Title II, Dept of Health & Human Services............      379,200,874       473,274,722       473,843,764       476,216,521       +97,015,647        +2,941,799        +2,372,757
              Federal Funds...........................................      376,469,336       469,928,079       470,594,315       472,848,938       +96,379,602        +2,920,859        +2,254,623
                  Current year........................................     (308,367,946)     (402,825,454)     (403,480,490)     (405,746,313)     (+97,378,367)      (+2,920,859)      (+2,265,823)
                  Fiscal year 2007....................................      (68,101,390)      (67,102,625)      (67,113,825)      (67,102,625)        (-998,765)  ................         (-11,200)
              Trust Funds.............................................        2,731,538         3,346,643         3,249,449         3,367,583          +636,045           +20,940          +118,134

                    TITLE III--DEPARTMENT OF EDUCATION

                      EDUCATION FOR THE DISADVANTAGED

    Grants to Local Educational Agencies (LEAs):
        Basic Grants:
            Advance from prior year...................................       (1,883,584)       (1,383,584)       (1,383,584)       (1,383,584)        (-500,000)  ................  ................
            Forward funded............................................        5,547,798         5,955,508         5,452,798         5,452,798           -95,000          -502,710   ................
            Current funded............................................            3,472             3,500             3,472             3,472   ................              -28   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Basic grants current year approp..............        5,551,270         5,959,008         5,456,270         5,456,270           -95,000          -502,738   ................
              Subtotal, Basic grants total funds available............       (7,434,854)       (7,342,592)       (6,839,854)       (6,839,854)        (-595,000)        (-502,738)  ................

        Basic Grants Fiscal Year 2007 Advance.........................        1,383,584           975,846         1,478,584         1,478,584           +95,000          +502,738   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Basic grants, program level.......................        6,934,854         6,934,854         6,934,854         6,934,854   ................  ................  ................

        Concentration Grants:
            Advance from prior year...................................       (1,365,031)       (1,365,031)       (1,365,031)       (1,365,031)  ................  ................  ................
            Fiscal Year 2007 Advance..................................        1,365,031         1,365,031         1,365,031         1,365,031   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Concentration Grants program level............        1,365,031         1,365,031         1,365,031         1,365,031   ................  ................  ................

        Targeted Grants:
            Advance from prior year...................................       (1,969,843)       (2,219,843)       (2,219,843)       (2,219,843)        (+250,000)  ................  ................
            Fiscal Year 2007 Advance..................................        2,219,843         2,822,581         2,269,843         2,269,843           +50,000          -552,738   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Targeted Grants program level.................        2,219,843         2,822,581         2,269,843         2,269,843           +50,000          -552,738   ................

        Education Finance Incentive Grants:
            Advance from prior year...................................       (1,969,843)       (2,219,843)       (2,219,843)       (2,219,843)        (+250,000)  ................  ................
            Fiscal Year 2007 Advance..................................        2,219,843         2,219,843         2,269,843         2,269,843           +50,000           +50,000   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Education Finance Incentive Grants............        2,219,843         2,219,843         2,269,843         2,269,843           +50,000           +50,000   ................
                                                                       =============================================================================================================================
              Subtotal, Grants to LEAs, program level.................       12,739,571        13,342,309        12,839,571        12,839,571          +100,000          -502,738   ................

    Even Start........................................................          225,095   ................          200,000   ................         -225,095   ................         -200,000

    Reading First:
        State Grants (forward funded).................................          846,600         1,041,600         1,041,600         1,041,600          +195,000   ................  ................
        Advance from prior year.......................................         (195,000)         (195,000)         (195,000)         (195,000)  ................  ................  ................
        Fiscal Year 2007 Advance......................................          195,000   ................  ................  ................         -195,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Reading First State Grants........................        1,041,600         1,041,600         1,041,600         1,041,600   ................  ................  ................

    Early Reading First...............................................          104,160           104,160           104,160           104,160   ................  ................  ................
    Striving readers..................................................           24,800           200,000            30,000            35,000           +10,200          -165,000            +5,000
    Literacy through School Libraries.................................           19,683            19,683            19,683            19,683   ................  ................  ................
    High School Intervention..........................................  ................        1,240,000   ................  ................  ................       -1,240,000   ................

    State Agency Programs:
        Migrant.......................................................          390,428           390,428           390,428           390,428   ................  ................  ................
        Neglected and Delinquent/High Risk Youth......................           49,600            49,600            49,600            51,000            +1,400            +1,400            +1,400
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, State Agency programs.............................          440,028           440,028           440,028           441,428            +1,400            +1,400            +1,400

    Evaluation........................................................            9,424             9,424             9,424             9,424   ................  ................  ................
    Comprehensive School Reform Demonstration.........................          205,344   ................           10,000   ................         -205,344   ................          -10,000

    Migrant Education:
        High School Equivalency Program...............................           18,737            18,737            18,737            18,737   ................  ................  ................
        College Assistance Migrant Program............................           15,532            15,532            15,532            15,532   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Migrant Education.................................           34,269            34,269            34,269            34,269   ................  ................  ................
                                                                       =============================================================================================================================
          Total, Education for the disadvantaged......................       14,843,974        16,431,473        14,728,735        14,525,135          -318,839        -1,906,338          -203,600
              Current Year............................................       (7,460,673)       (9,048,172)       (7,345,434)       (7,141,834)        (-318,839)      (-1,906,338)        (-203,600)
              Fiscal Year 2007........................................       (7,383,301)       (7,383,301)       (7,383,301)       (7,383,301)  ................  ................  ................
          Subtotal, forward funded....................................       (7,264,865)       (8,677,136)       (7,144,426)       (6,935,826)        (-329,039)      (-1,741,310)        (-208,600)

                                IMPACT AID

    Basic Support Payments............................................        1,075,018         1,075,018         1,102,896         1,102,896           +27,878           +27,878   ................
    Payments for Children with Disabilities...........................           49,966            49,966            49,966            49,966   ................  ................  ................
    Facilities Maintenance (Sec. 8008)................................            7,838             7,838             5,000             5,000            -2,838            -2,838   ................
    Construction (Sec. 8007)..........................................           48,544            45,544            18,000            18,000           -30,544           -27,544   ................
    Payments for Federal Property (Sec. 8002).........................           62,496            62,496            65,000            65,000            +2,504            +2,504   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Impact aid...........................................        1,243,862         1,240,862         1,240,862         1,240,862            -3,000   ................  ................

                        SCHOOL IMPROVEMENT PROGRAMS

    State Grants for Improving Teacher Quality........................        1,481,605         1,481,605         1,481,605         1,481,605   ................  ................  ................
        Advance from prior year.......................................       (1,435,000)       (1,435,000)       (1,435,000)       (1,435,000)  ................  ................  ................
        Fiscal Year 2007..............................................        1,435,000         1,435,000         1,435,000         1,435,000   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, State Grants for Improving Teacher Quality,              (2,916,605)       (2,916,605)       (2,916,605)       (2,916,605)  ................  ................  ................
           program level..............................................

    Early Childhood Educator Professional Development.................           14,696            14,696            14,696            14,696   ................  ................  ................
    Mathematics and Science Partnerships..............................          178,560           269,000           190,000           178,560   ................          -90,440           -11,440
    State Grants for Innovative Education (Education Block Grant).....          198,400           100,000           198,400           100,000           -98,400   ................          -98,400
    Educational Technology State Grants...............................          496,000   ................          300,000           425,000           -71,000          +425,000          +125,000
    Supplemental Education Grants.....................................           18,183            18,183            18,183            18,183   ................  ................  ................
    21st Century Community Learning Centers...........................          991,077           991,077           991,077           991,077   ................  ................  ................
    State Assessments/Enhanced Assessment Instruments.................          411,680           411,680           411,680           411,680   ................  ................  ................
    High school assessments...........................................  ................          250,000   ................  ................  ................         -250,000   ................
    Javits gifted and talented education..............................           11,022   ................  ................           11,022   ................          +11,022           +11,022
    Foreign language assistance.......................................           17,856   ................  ................           25,000            +7,144           +25,000           +25,000
    Education for Homeless Children and Youth.........................           62,496            62,496            62,496            62,496   ................  ................  ................
    Training and Advisory Services (Civil Rights).....................            7,185             7,185             7,185             7,185   ................  ................  ................
    Education for Native Hawaiians....................................           34,224            32,624            24,770            34,500              +276            +1,876            +9,730
    Alaska Native Education Equity....................................           34,224            31,224            31,224            34,500              +276            +3,276            +3,276
    Rural Education...................................................          170,624           170,624           170,624           170,624   ................  ................  ................
    Comprehensive Centers.............................................           56,825            56,825            56,825            56,825   ................  ................  ................
                                                                       =============================================================================================================================
          Total, School improvement programs..........................        5,619,657         5,332,219         5,393,765         5,457,953          -161,704          +125,734           +64,188
              Current Year............................................       (4,184,657)       (3,897,219)       (3,958,765)       (4,022,953)        (-161,704)        (+125,734)         (+64,188)
              Fiscal Year 2007........................................       (1,435,000)       (1,435,000)       (1,435,000)       (1,435,000)  ................  ................  ................
          Subtotal, forward funded....................................       (3,990,442)       (3,736,482)       (3,805,882)       (3,821,042)        (-169,400)         (+84,560)         (+15,160)

                             INDIAN EDUCATION

    Grants to Local Educational Agencies..............................           95,165            96,294            96,294            96,294            +1,129   ................  ................

    Federal Programs:
        Special Programs for Indian Children..........................           19,595            19,595            19,595            19,595   ................  ................  ................
        National Activities...........................................            5,129             4,000             4,000             4,000            -1,129   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Federal Programs..................................           24,724            23,595            23,595            23,595            -1,129   ................  ................
                                                                       =============================================================================================================================
          Total, Indian Education.....................................          119,889           119,889           119,889           119,889   ................  ................  ................

                        INNOVATION AND IMPROVEMENT

    Troops-to-Teachers................................................           14,793            14,793            14,793            14,793   ................  ................  ................
    Transition to Teaching............................................           44,933            44,933            44,933            44,933   ................  ................  ................
    National Writing Project..........................................           20,336   ................           20,336            23,000            +2,664           +23,000            +2,664
    Teaching of Traditional American History..........................          119,040           119,040            50,000           121,000            +1,960            +1,960           +71,000
    School Leadership.................................................           14,880   ................           14,880            15,000              +120           +15,000              +120
    Advanced Credentialing............................................           16,864             8,000            16,864            10,000            -6,864            +2,000            -6,864
    Charter Schools Grants............................................          216,952           218,702           216,952           216,952   ................           -1,750   ................
    Credit Enhancement for Charter School Facilities..................           36,981            36,981            36,981   ................          -36,981           -36,981           -36,981
    Voluntary Public School Choice....................................           26,543            26,543            26,543            26,543   ................  ................  ................
    Magnet Schools Assistance.........................................          107,771           107,771           107,771           107,771   ................  ................  ................
    Choice Incentive fund.............................................  ................           50,000   ................  ................  ................          -50,000   ................
    Fund for the Improvement of Education (FIE).......................          414,078           106,296            27,000           417,924            +3,846          +311,628          +390,924
    Teacher Incentive Fund............................................  ................          500,000           100,000   ................  ................         -500,000          -100,000
    Ready to Learn television.........................................           23,312            23,312   ................           25,000            +1,688            +1,688           +25,000
    Dropout Prevention Programs.......................................            4,930   ................  ................  ................           -4,930   ................  ................
    Close Up Fellowships..............................................            1,469   ................            1,469             1,469   ................           +1,469   ................
    Advanced Placement................................................           29,760            51,500            30,000            33,000            +3,240           -18,500            +3,000
                                                                       =============================================================================================================================
          Total, Innovation and Improvement...........................        1,092,642         1,307,871           708,522         1,057,385           -35,257          -250,486          +348,863

                  SAFE SCHOOLS AND CITIZENSHIP EDUCATION

    Safe and Drug Free Schools and Communities: State Grants, forward           437,381   ................          400,000           300,000          -137,381          +300,000          -100,000
     funded...........................................................
    National Programs.................................................          152,537           267,967           152,537           150,000            -2,537          -117,967            -2,537
    Alcohol Abuse Reduction...........................................           32,736   ................  ................           33,500              +764           +33,500           +33,500
    Mentoring Programs................................................           49,307            49,307            49,307            49,307   ................  ................  ................
    Character education...............................................           24,493            24,493            24,493            24,493   ................  ................  ................
    Elementary and Secondary School Counseling........................           34,720   ................           34,720            36,000            +1,280           +36,000            +1,280
    Carol M. White Physical Education Program.........................           73,408            55,000            73,408            74,000              +592           +19,000              +592
    Civic Education...................................................           29,405   ................           29,405            30,000              +595           +30,000              +595
                                                                       =============================================================================================================================
          Total, Safe Schools and Citizenship Education...............          833,987           396,767           763,870           697,300          -136,687          +300,533           -66,570
              Current Year............................................         (833,987)         (396,767)         (763,870)         (697,300)        (-136,687)        (+300,533)         (-66,570)
          Subtotal, forward funded....................................         (437,381)  ................         (400,000)         (300,000)        (-137,381)        (+300,000)        (-100,000)

                       ENGLISH LANGUAGE ACQUISITION

    Current funded....................................................           84,816            43,925   ................           43,925           -40,891   ................          +43,925
    Forward funded....................................................          590,949           631,840           675,765           631,840           +40,891   ................          -43,925
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, English Language Acquisition.........................          675,765           675,765           675,765           675,765   ................  ................  ................

                             SPECIAL EDUCATION

    State Grants:
        Grants to States Part B current year..........................        5,176,746         4,893,746         5,326,746         5,265,546           +88,800          +371,800           -61,200
            Part B advance from prior year............................       (5,413,000)       (5,413,000)       (5,413,000)       (5,413,000)  ................  ................  ................
        Grants to States Part B (Fiscal Year 2007)....................        5,413,000         6,204,000         5,413,000         5,424,200           +11,200          -779,800           +11,200
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Grants to States, program level...................       10,589,746        11,097,746        10,739,746        10,689,746          +100,000          -408,000           -50,000

        Preschool Grants..............................................          384,597           384,597           384,597           384,597   ................  ................  ................
        Grants for Infants and Families...............................          440,808           440,808           440,808           444,308            +3,500            +3,500            +3,500
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, State grants, program level.......................       11,415,151        11,923,151        11,565,151        11,518,651          +103,500          -404,500           -46,500

    IDEA National Activities (current funded):
        State Personnel Development...................................           50,653   ................           50,653            50,653   ................          +50,653   ................
        Special Education-Voc Rehab transition initiative.............  ................            5,000   ................  ................  ................           -5,000   ................
        Technical Assistance and Dissemination........................           52,396            49,397            49,397            49,397            -2,999   ................  ................
        Personnel Preparation.........................................           90,626            90,626            90,626            90,626   ................  ................  ................
        Parent Information Centers....................................           25,964            25,964            25,964            25,964   ................  ................  ................
        Technology and Media Services.................................           38,816            31,992            31,992            38,816   ................           +6,824            +6,824
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, IDEA special programs.............................          258,455           202,979           248,632           255,456            -2,999           +52,477            +6,824
                                                                       =============================================================================================================================
          Total, Special education....................................       11,673,606        12,126,130        11,813,783        11,774,107          +100,501          -352,023           -39,676
              Current Year............................................       (6,260,606)       (5,922,130)       (6,400,783)       (6,349,907)         (+89,301)        (+427,777)         (-50,876)
              Fiscal Year 2007........................................       (5,413,000)       (6,204,000)       (5,413,000)       (5,424,200)         (+11,200)        (-779,800)         (+11,200)
          Subtotal, Forward funded....................................       (6,052,804)       (5,719,151)       (6,202,804)       (6,145,104)         (+92,300)        (+425,953)         (-57,700)

              REHABILITATION SERVICES AND DISABILITY RESEARCH

    Vocational Rehabilitation State Grants............................        2,635,845         2,720,192         2,720,192         2,720,192           +84,347   ................  ................
    Client Assistance State grants....................................           11,901            11,901            11,901            11,901   ................  ................  ................
    Training..........................................................           38,826            38,826            38,826            38,826   ................  ................  ................
    Demonstration and training programs...............................           25,607             6,577             6,577             6,577           -19,030   ................  ................
    Migrant and seasonal farmworkers..................................            2,302   ................            2,302             2,302   ................           +2,302   ................
    Recreational programs.............................................            2,543   ................            2,543             2,543   ................           +2,543   ................
    Protection and advocacy of individual rights (PAIR)...............           16,656            16,656            16,656            16,656   ................  ................  ................
    Projects with industry............................................           21,625   ................           19,735            19,735            -1,890           +19,735   ................
    Supported employment State grants.................................           37,379   ................           30,000            30,000            -7,379           +30,000   ................

    Independent living:
        State grants..................................................           22,816            22,816            22,816            22,816   ................  ................  ................
        Centers.......................................................           75,392            75,392            75,392            75,392   ................  ................  ................
        Services for older blind individuals..........................           33,227            33,227            33,227            33,227   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Independent living................................          131,435           131,435           131,435           131,435   ................  ................  ................

    Program Improvement...............................................              843               843               843               843   ................  ................  ................
    Evaluation........................................................            1,488             1,488             1,488             1,488   ................  ................  ................
    Helen Keller National Center for Deaf/Blind Youth and Adults......           10,581             8,597             8,597             8,597            -1,984   ................  ................
    National Inst. Disability and Rehab. Research (NIDRR).............          107,783           107,783           107,783           107,783   ................  ................  ................
    Assistive Technology..............................................           29,760            15,000            29,760            34,760            +5,000           +19,760            +5,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, discretionary programs............................          438,729           339,106           408,446           413,446           -25,283           +74,340            +5,000
                                                                       =============================================================================================================================
          Total, Rehabilitation services..............................        3,074,574         3,059,298         3,128,638         3,133,638           +59,064           +74,340            +5,000

            SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

    AMERICAN PRINTING HOUSE FOR THE BLIND.............................           16,864            16,864            17,000            18,500            +1,636            +1,636            +1,500

    NATIONAL TECHNICAL INSTITUTE FOR THE DEAF (NTID):
        Operations....................................................           53,672            53,672            55,337            56,479            +2,807            +2,807            +1,142
        Construction..................................................            1,672               800               800               800              -872   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, NTID.................................................           55,344            54,472            56,137            57,279            +1,935            +2,807            +1,142

    GALLAUDET UNIVERSITY..............................................          104,557           104,557           107,657           108,500            +3,943            +3,943              +843
                                                                       =============================================================================================================================
          Total, Special Institutions for Persons with Disabilities...          176,765           175,893           180,794           184,279            +7,514            +8,386            +3,485

                      VOCATIONAL AND ADULT EDUCATION

    Vocational Education:
        Basic State Grants/Secondary & Technical Education:
            State Grants..............................................          403,331   ................          403,331           403,331   ................         +403,331   ................
            Advance from prior year...................................         (791,000)         (791,000)         (791,000)         (791,000)  ................  ................  ................
            Fiscal Year 2007..........................................          791,000   ................          791,000           791,000   ................         +791,000   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, Basic State Grants, program level.............        1,194,331   ................        1,194,331         1,194,331   ................       +1,194,331   ................

        Tech-Prep Education State Grants..............................          105,812   ................          105,812           105,812   ................         +105,812   ................
        National Programs.............................................           11,757   ................           11,757             9,257            -2,500            +9,257            -2,500
        Tech-Prep Education Demonstration.............................            4,900   ................  ................  ................           -4,900   ................  ................
        Occupational and Employment Information Program...............            9,307   ................  ................  ................           -9,307   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Vocational Education..............................        1,326,107   ................        1,311,900         1,309,400           -16,707        +1,309,400            -2,500

    Adult Education:
        State Grants/Adult basic and literacy education: State Grants,          569,672           200,000           569,672           569,672   ................         +369,672   ................
         current funded...............................................

        National Programs:
            National Leadership Activities............................            9,096             9,096             9,096             9,096   ................  ................  ................
            National Institute for Literacy...........................            6,638             6,638             6,638             6,638   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, National programs.............................           15,734            15,734            15,734            15,734   ................  ................  ................
                                                                       =============================================================================================================================
              Subtotal, Adult education...............................          585,406           215,734           585,406           585,406   ................         +369,672   ................

    Smaller Learning Communities, current funded......................            4,724   ................            4,724   ................           -4,724   ................           -4,724
    Smaller Learning Communities, forward funded......................           89,752   ................           89,752   ................          -89,752   ................          -89,752
    Community Technology Centers......................................            4,960   ................  ................            4,960   ................           +4,960            +4,960
    State Grants for Incarcerated Youth Offenders.....................           21,824   ................  ................           24,000            +2,176           +24,000           +24,000
    Literacy programs for prisoners...................................            4,960   ................  ................  ................           -4,960   ................  ................
                                                                       =============================================================================================================================
          Total, Vocational and adult education.......................        2,037,733           215,734         1,991,782         1,923,766          -113,967        +1,708,032           -68,016
              Current Year............................................       (1,246,733)         (215,734)       (1,200,782)       (1,132,766)        (-113,967)        (+917,032)         (-68,016)
              Fiscal Year 2007........................................         (791,000)  ................         (791,000)         (791,000)  ................        (+791,000)  ................
          Subtotal, forward funded....................................       (1,232,089)         (215,734)       (1,196,058)       (1,127,806)        (-104,283)        (+912,072)         (-68,252)

                       STUDENT FINANCIAL ASSISTANCE

    Pell Grants--maximum grant (NA)...................................           (4,050)           (4,050)           (4,100)           (4,050)  ................  ................             (-50)
    Pell Grants:
        Regular Program...............................................       12,364,997        13,199,000        13,383,000        13,177,000          +812,003           -22,000          -206,000
        Enhanced Pell grants for State scholars.......................  ................           33,000   ................  ................  ................          -33,000   ................
    Federal Supplemental Educational Opportunity Grants...............          778,720           778,720           778,720           804,763           +26,043           +26,043           +26,043
    Federal Work Study................................................          990,257           990,257           990,257           990,257   ................  ................  ................
    Federal Perkins Loans: Loan Cancellations.........................           66,132   ................           66,132            66,132   ................          +66,132   ................
    Presidential math and science scholars............................  ................           50,000   ................  ................  ................          -50,000   ................
    LEAP program......................................................           65,643   ................           65,643            65,643   ................          +65,643   ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, discretionary programs............................       14,265,749        15,050,977        15,283,752        15,103,795          +838,046           +52,818          -179,957
                                                                       =============================================================================================================================
          Total, Student Financial Assistance.........................       14,265,749        15,050,977        15,283,752        15,103,795          +838,046           +52,818          -179,957

                        STUDENT AID ADMINISTRATION

    Administrative Costs..............................................          119,084           939,285           124,084           120,000              +916          -819,285            -4,084
    Fed Direct Student Loan Reclassification (Leg prop)...............  ................         -625,000   ................  ................  ................         +625,000   ................
    LOANS FOR SHORT-TERM TRAINING.....................................  ................           11,000   ................  ................  ................          -11,000   ................

                             HIGHER EDUCATION

    Aid for Institutional Development:
        Strengthening Institutions....................................           80,338            80,338            80,338            80,338   ................  ................  ................
        Hispanic Serving Institutions.................................           95,106            95,873            95,873            95,873              +767   ................  ................
        Strengthening Historically Black Colleges (HBCUs).............          238,576           240,500           240,500           240,500            +1,924   ................  ................
        Strengthening historically black graduate insts...............           58,032            58,500            58,500            58,500              +468   ................  ................
        Strengthening Alaska Native and Native Hawaiian-Serving                  11,904             6,500             6,500            11,904   ................           +5,404            +5,404
         Institutions.................................................
        Strengthening Tribal Colleges.................................           23,808            23,808            23,808            23,808   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Aid for Institutional development.................          507,764           505,519           505,519           510,923            +3,159            +5,404            +5,404

    International Education and Foreign Language:
        Domestic Programs.............................................           92,465            92,466            92,466            92,466                +1   ................  ................
        Overseas Programs.............................................           12,737            12,737            12,737            12,737   ................  ................  ................
        Institute for International Public Policy.....................            1,616             1,616             1,616             1,616   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, International Education & Foreign Lang............          106,818           106,819           106,819           106,819                +1   ................  ................

    Fund for the Improvement of Postsec. Ed. (FIPSE)..................          162,108            22,211            49,211           162,211              +103          +140,000          +113,000
    Minority Science and Engineering Improvement......................            8,818             8,818             8,818             8,818   ................  ................  ................
    Interest Subsidy Grants...........................................            1,488   ................  ................  ................           -1,488   ................  ................
    Tribally Controlled Postsec Voc/Tech Institutions.................            7,440             7,440             7,440             7,440   ................  ................  ................
    Federal TRIO Programs.............................................          836,543           369,390           836,543           836,543   ................         +467,153   ................
    GEAR UP...........................................................          306,488   ................          306,488           306,488   ................         +306,488   ................
    Byrd Honors Scholarships..........................................           40,672   ................  ................           41,000              +328           +41,000           +41,000
    Javits Fellowships................................................            9,797             9,797             9,797             9,797   ................  ................  ................
    Graduate Assistance in Areas of National Need.....................           30,371            30,371            30,371            30,371   ................  ................  ................
    Teacher Quality Enhancement Grants................................           68,337   ................           58,000            58,000           -10,337           +58,000   ................
    Child Care Access Means Parents in School.........................           15,970            15,970            15,970            15,970   ................  ................  ................
    Community college access..........................................  ................          125,000   ................  ................  ................         -125,000   ................
    Demonstration in Disabilities/Higher Education....................            6,944   ................  ................            6,944   ................           +6,944            +6,944
    Underground Railroad Program......................................            2,204   ................  ................            2,204   ................           +2,204            +2,204
    GPRA data/HEA program evaluation..................................              980               980               980               980   ................  ................  ................
    B.J. Stupak Olympic Scholarships..................................              980   ................              980   ................             -980   ................             -980
    Thurgood Marshall legal education opportunity program.............            2,976   ................  ................  ................           -2,976   ................  ................
                                                                       =============================================================================================================================
          Total, Higher education.....................................        2,116,698         1,202,315         1,936,936         2,104,508           -12,190          +902,193          +167,572

                             HOWARD UNIVERSITY

    Academic Program..................................................          205,507           205,430           207,507           205,430               -77   ................           -2,077
    Endowment Program.................................................            3,524             3,600             3,524             3,600               +76   ................              +76
    Howard University Hospital........................................           29,759            29,759            29,759            29,759   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Howard University....................................          238,790           238,789           240,790           238,789                -1   ................           -2,001

    COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM: (CHAFL)....              573               573               573               573   ................  ................  ................
    HBCU CAPITAL FINANCING PROGRAM--Federal Adm.......................              210               210               210               210   ................  ................  ................

                      INSTITUTE OF EDUCATION SCIENCES

    Research, development and dissemination...........................          164,194           164,194           164,194           164,194   ................  ................  ................
    Statistics........................................................           90,931            90,931            90,931            90,931   ................  ................  ................
    Regional Educational Laboratories.................................           66,132   ................           66,132            66,131                -1           +66,131                -1
    Research in special education.....................................           83,104            72,566            72,566            72,566           -10,538   ................  ................
    Special education studies and evaluations.........................  ................           10,000            10,000            10,000           +10,000   ................  ................
    Statewide data systems............................................           24,800            24,800            24,800            24,800   ................  ................  ................

    Assessment:
        National Assessment...........................................           88,985           111,485            88,985            88,985   ................          -22,500   ................
        National Assessment Governing Board...........................            5,088             5,088             5,088             5,088   ................  ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Assessment........................................           94,073           116,573            94,073            94,073   ................          -22,500   ................
                                                                       =============================================================================================================================
          Total, IES..................................................          523,234           479,064           522,696           522,695              -539           +43,631                -1

                          DEPARTMENTAL MANAGEMENT

    PROGRAM ADMINISTRATION............................................          419,280           418,992           410,612           418,992              -288   ................           +8,380
    OFFICE FOR CIVIL RIGHTS...........................................           89,375            91,526            91,526            91,526            +2,151   ................  ................
    OFFICE OF THE INSPECTOR GENERAL...................................           47,327            49,408            49,000            49,408            +2,081   ................             +408
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Departmental management..............................          555,982           559,926           551,138           559,926            +3,944   ................           +8,788

          Total: Elementary and Secondary Education Act programs......       24,529,212        25,504,846        23,725,884        23,779,249          -749,963        -1,725,597           +53,365

                       TITLE III GENERAL PROVISIONS

    Pell grant shortfall payoff \9\...................................  ................        4,300,000         4,300,000         4,300,000        +4,300,000   ................  ................
                                                                       =============================================================================================================================
          Total, Title III, Department of Education...................       59,212,774        63,239,040        63,706,584        63,740,575        +4,527,801          +501,535           +33,991
              Current Year............................................      (44,190,473)      (48,216,739)      (48,684,283)      (48,707,074)      (+4,516,601)        (+490,335)         (+22,791)
              Fiscal Year 2007........................................      (15,022,301)      (15,022,301)      (15,022,301)      (15,033,501)         (+11,200)         (+11,200)         (+11,200)

                        TITLE IV--RELATED AGENCIES

    COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY                  4,669             4,669             4,669             4,669   ................  ................  ................
     DISABLED.........................................................

              CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

                    DOMESTIC VOLUNTEER SERVICE PROGRAMS

    Volunteers in Service to America (VISTA)..........................           94,240            96,428            96,428            96,428            +2,188   ................  ................
    Volunteers in Homeland Security...................................            4,960   ................  ................  ................           -4,960   ................  ................
    Teach for America.................................................  ................            4,000             2,000   ................  ................           -4,000            -2,000

    National Senior Volunteer Corps:
        Foster Grandparents Program...................................          111,424           112,058           112,058           112,058              +634   ................  ................
        Senior Companion Program......................................           45,905            47,438            47,438            47,438            +1,533   ................  ................
        Retired Senior Volunteer Program..............................           58,528            60,288            60,288            60,288            +1,760   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Senior Volunteers.................................          215,857           219,784           219,784           219,784            +3,927   ................  ................

    Program Administration............................................           38,688            39,750            39,750   ................          -38,688           -39,750           -39,750
                                                                       =============================================================================================================================
          Total, Domestic Volunteer Service Programs..................          353,745           359,962           357,962           316,212           -37,533           -43,750           -41,750

    National and Community Service Programs: \10\
        National service trust........................................          142,848           146,000           146,000           149,000            +6,152            +3,000            +3,000
        AmeriCorps grants.............................................          287,680           275,000           267,500           280,000            -7,680            +5,000           +12,500
        Innovation, assistance, and other activities..................           13,227             9,945             9,945            15,945            +2,718            +6,000            +6,000
        Evaluation....................................................            3,522             4,000             4,000             4,000              +478   ................  ................
        National Civilian Community Corps.............................           25,296            25,500            25,500            27,000            +1,704            +1,500            +1,500
        Learn and Serve America: K-12 and Higher Ed...................           42,656            40,000            37,500            42,656   ................           +2,656            +5,156
        State Commission Administrative Grants........................           11,904            12,642            12,642            12,642              +738   ................  ................
        Points of Light Foundation....................................            9,920            10,000            10,000            10,000               +80   ................  ................
        America's Promise.............................................            4,464             5,000             5,000             5,000              +536   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, National and Community Service Programs...........          541,517           528,087           518,087           546,243            +4,726           +18,156           +28,156

    National and Community Service, Salaries and expenses \10\........           25,792            27,000            27,000            66,750           +40,958           +39,750           +39,750

    Office of Inspector General \10\..................................            5,952             6,000             6,000             6,000               +48   ................  ................
                                                                       =============================================================================================================================
          Total, Corp. for National and Community Service.............          927,006           921,049           909,049           935,205            +8,199           +14,156           +26,156

    CORPORATION FOR PUBLIC BROADCASTING:
        Fiscal year 2008 (current) with fiscal year 2007 comparable...          400,000   ................          400,000           400,000   ................         +400,000   ................
        Fiscal year 2007 advance with fiscal year 2006 comparable              (400,000)         (400,000)         (400,000)         (400,000)  ................  ................  ................
         (NA).........................................................
        Fiscal year 2006 advance with fiscal year 2005 comparable              (386,880)         (400,000)         (400,000)         (400,000)         (+13,120)  ................  ................
         (NA).........................................................
            Rescission of fiscal year 2006 funds (NA).................  ................         (-10,000)  ................  ................  ................         (+10,000)  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, fiscal year 2006 program level................          386,880           390,000           400,000           400,000           +13,120           +10,000   ................

        Digitalization program, current funded \11\...................           39,387   ................  ................           35,000            -4,387           +35,000           +35,000
            Previous appropriated funds (NA) \12\.....................  ................          (30,000)          (30,000)  ................  ................         (-30,000)         (-30,000)
        Interconnection, current funded \11\..........................           39,680   ................  ................           40,000              +320           +40,000           +40,000
            Previous appropriated funds (NA) \12\.....................          (75,000)          (52,000)          (52,000)  ................         (-75,000)         (-52,000)         (-52,000)
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, fiscal year 2006 appropriation................           79,067   ................  ................           75,000            -4,067           +75,000           +75,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
              Subtotal, fiscal year 2006 comparable...................         (154,067)          (82,000)          (82,000)          (75,000)         (-79,067)          (-7,000)          (-7,000)

    FEDERAL MEDIATION AND CONCILIATION SERVICE........................           44,439            42,331            42,331            43,439            -1,000            +1,108            +1,108
    FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION..................            7,809             7,809             7,809             7,809   ................  ................  ................
    INSTITUTE OF MUSEUM AND LIBRARY SERVICES..........................          280,564           262,240           249,640           290,129            +9,565           +27,889           +40,489
    MEDICARE PAYMENT ADVISORY COMMISSION..............................            9,899            10,168            10,168            10,168              +269   ................  ................
    NATIONAL COMMISSION ON LIBRARIES AND INFO SCIENCE.................              993               993               993               993   ................  ................  ................
    NATIONAL COUNCIL ON DISABILITY....................................            3,344             2,800             2,800             3,344   ................             +544              +544
    NATIONAL LABOR RELATIONS BOARD....................................          249,860           252,268           252,268           252,268            +2,408   ................  ................
    NATIONAL MEDIATION BOARD..........................................           11,628            11,628            11,628            11,628   ................  ................  ................
    OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION..................           10,510            10,510            10,510            10,510   ................  ................  ................

                         RAILROAD RETIREMENT BOARD

    Dual Benefits Payments Account....................................          107,136            97,000            97,000            97,000           -10,136   ................  ................
    Less Income Tax Receipts on Dual Benefits.........................           -7,936            -7,000            -7,000            -7,000              +936   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, Dual Benefits.....................................           99,200            90,000            90,000            90,000            -9,200   ................  ................

    Federal Payment to the RR Retirement Account......................              150               150               150               150   ................  ................  ................
    Limitation on Administration......................................          102,543           102,543           102,543           102,543   ................  ................  ................
        Inspector General.............................................            7,196             7,196             7,196             7,196   ................  ................  ................

                      SOCIAL SECURITY ADMINISTRATION

    Payments to Social Security Trust Funds...........................           20,454            20,470            20,470            20,470               +16   ................  ................

                       SUPPLEMENTAL SECURITY INCOME

    Federal benefit payments..........................................       38,109,000        37,487,174        37,487,174        37,487,174          -621,826   ................  ................
    Beneficiary services..............................................           45,929            52,000            52,000            52,000            +6,071   ................  ................
    Research and demonstration........................................           35,000            27,000            27,000            27,000            -8,000   ................  ................
    Administration....................................................        2,986,900         2,733,000         2,897,000         2,710,400          -276,500           -22,600          -186,600
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, SSI program level.................................       41,176,829        40,299,174        40,463,174        40,276,574          -900,255           -22,600          -186,600

              Less funds advanced in prior year.......................      -12,590,000       -10,930,000       -10,930,000       -10,930,000        +1,660,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, regular SSI current year..........................       28,586,829        29,369,174        29,533,174        29,346,574          +759,745           -22,600          -186,600
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, SSI, current request.................................       28,586,829        29,369,174        29,533,174        29,346,574          +759,745           -22,600          -186,600
              New advance, 1st quarter, fiscal year 2007..............       10,930,000        11,110,000        11,110,000        11,110,000          +180,000   ................  ................
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, SSI program..........................................       39,516,829        40,479,174        40,643,174        40,456,574          +939,745           -22,600          -186,600

                   LIMITATION ON ADMINISTRATIVE EXPENSES

    OASDI Trust Funds.................................................        4,359,033         4,640,400         4,617,600         4,604,000          +244,967           -36,400           -13,600
    HI/SMI Trust Funds................................................        1,256,968         1,704,000         1,643,100         1,704,000          +447,032   ................          +60,900
    Social Security Advisory Board....................................            2,000             2,000             2,000             2,000   ................  ................  ................
    SSI...............................................................        2,986,900         2,733,000         2,897,000         2,710,400          -276,500           -22,600          -186,600
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, regular LAE.......................................        8,604,901         9,079,400         9,159,700         9,020,400          +415,499           -59,000          -139,300

    Additional CDR Funding:
        OASDI.........................................................  ................           25,000   ................           25,000           +25,000   ................          +25,000
        SSI...........................................................  ................          164,000   ................          164,000          +164,000   ................         +164,000
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Subtotal, CDR Funding.......................................  ................          189,000   ................          189,000          +189,000   ................         +189,000

    SSI User Fee activities...........................................          124,000           119,000           119,000           119,000            -5,000   ................  ................
    SSPA User Fee Activities..........................................            1,000             1,000             1,000             1,000   ................  ................  ................
                                                                       =============================================================================================================================
          Total, Limitation on Administrative Expenses................        8,729,901         9,388,400         9,279,700         9,329,400          +599,499           -59,000           +49,700

                          MEDICARE REFORM FUNDING

    Medicare reform funding \13\ \14\.................................         (446,054)  ................  ................  ................        (-446,054)  ................  ................

                        OFFICE OF INSPECTOR GENERAL

    Federal Funds.....................................................           25,542            26,000            26,000            26,000              +458   ................  ................
    Trust Funds.......................................................           64,836            67,000            66,805            67,000            +2,164   ................             +195
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Total, Office of Inspector General..........................           90,378            93,000            92,805            93,000            +2,622   ................             +195

    Adjustment: Trust fund transfers from general revenues............       -2,986,900        -2,733,000        -2,897,000        -2,710,400          +276,500           +22,600          +186,600
                                                                       =============================================================================================================================
          Total, Social Security Administration.......................       45,370,662        47,248,044        47,139,149        47,189,044        +1,818,382           -59,000           +49,895
              Federal funds...........................................       39,687,825        40,834,644        40,809,644        40,812,044        +1,124,219           -22,600            +2,400
                  Current year........................................      (28,757,825)      (29,724,644)      (29,699,644)      (29,702,044)        (+944,219)         (-22,600)          (+2,400)
                  New advances, 1st quarter...........................      (10,930,000)      (11,110,000)      (11,110,000)      (11,110,000)        (+180,000)  ................  ................
              Trust funds.............................................        5,682,837         6,413,400         6,329,505         6,377,000          +694,163           -36,400           +47,495
                                                                       =============================================================================================================================
          Total, Title IV, Related Agencies...........................       47,609,539        48,974,398        49,240,903        49,434,095        +1,824,556          +459,697          +193,192
              Federal Funds...........................................       41,807,064        42,441,091        42,791,491        42,937,188        +1,130,124          +496,097          +145,697
                  Current Year........................................      (30,477,064)      (31,331,091)      (31,281,491)      (31,427,188)        (+950,124)         (+96,097)        (+145,697)
                  Fiscal Year 2007 Advance............................      (10,930,000)      (11,110,000)      (11,110,000)      (11,110,000)        (+180,000)  ................  ................
                  Fiscal Year 2008 Advance............................         (400,000)  ................         (400,000)         (400,000)  ................        (+400,000)  ................
              Trust Funds.............................................        5,802,475         6,533,307         6,449,412         6,496,907          +694,432           -36,400           +47,495

                                  SUMMARY

    Federal Funds.....................................................      488,978,652       586,624,660       588,183,697       590,841,346      +101,862,694        +4,216,686        +2,657,649
        Current year..................................................     (391,980,961)     (490,877,734)     (492,000,571)     (494,658,220)    (+102,677,259)      (+3,780,486)      (+2,657,649)
        2007 advance..................................................      (96,597,691)      (95,746,926)      (95,783,126)      (95,783,126)        (-814,565)         (+36,200)  ................
        2008 advance..................................................         (400,000)  ................         (400,000)         (400,000)  ................        (+400,000)  ................
    Trust Funds.......................................................       12,366,339        13,587,965        13,408,876        13,594,967        +1,228,628            +7,002          +186,091
                                                                       -----------------------------------------------------------------------------------------------------------------------------
          Grand Total.................................................      501,344,991       600,212,625       601,592,573       604,436,313      +103,091,322        +4,223,688        +2,843,740
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ Funding from the Dislocated Worker National Reserve.
    \2\ Two year availability.
    \3\ Funds provided for biodefense activities are reflected within HRSA, CDC, and NIH respectively.
    \4\ Includes Mine Safety and Health.
    \5\ Funds provided in Public Law 108-173, the 2003 Medicare Prescription Drug, Improvement and Modernization Act.
    \6\ $1 billion available for fiscal years 2004-2005.
    \7\ $250 million available for fiscal years 2005-2008.
    \8\ An additional $50 million for Health IT within AHRQ.
    \9\ Part of the HEA reauthorization budget request.
    \10\ Fiscal year 2006 House jurisdiction change account moved from former VA-HUD Appropriations.
    \11\ Current funded.
    \12\ Requested funds for these activities are from previously appropriated funds.
    \13\ Funds provided in Public Law 108-173, the 2003 Medicare Prescription Drug, Improvement and Modernization Act and are available in fiscal year 2004 and 2005.
    \14\ Funds required to continue implementing this Act are provided under the regular LAE account.