[Senate Report 118-84]
[From the U.S. Government Publishing Office]


                                                      Calendar No. 187
118th Congress      }                                   {       Report
                                 SENATE
 1st Session        }                                   {       118-84

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2024
                                _______
                                

                 July 27, 2023.--Ordered to be printed

                                _______
                                

          Ms. Baldwin, from the Committee on Appropriations, 
                        submitted the following

                                 REPORT

                         [To accompany S. 2624]

    The Committee on Appropriations reports an original bill 
(S. 2624) making appropriations for Departments of Labor, 
Health and Human Services, and Education, and related agencies 
for the fiscal year ending September 30, 2024, and for other 
purposes, reports favorably thereon without amendment and 
recommends that the bill do pass.


  
Amounts to new budget authority

Total of bill as reported to the Senate...............$1,445,830,783,000
Amount of 2023 
    appropriations............................         1,430,661,909,000
Amount of 2024 budget estimate.........................1,470,554,232,000
Bill as recommended to Senate compared to:
    2023 appropriations................................. +15,168,874,000
    2024 budget estimate................................ -24,723,449,000




















                                CONTENTS

                              ----------                              
                                                                   Page

List of Abbreviations............................................     4
Summary of Budget Estimates and Committee Recommendations........     7
    Overview.....................................................     7
Title I: Department of Labor:
    Employment and Training Administration.......................     9
    Employee Benefits Security Administration....................    20
    Pension Benefit Guaranty Corporation.........................    21
    Wage and Hour Division.......................................    22
    Office of Labor-Management Standards.........................    23
    Office of Federal Contract Compliance Programs...............    23
    Office of Workers' Compensation Programs.....................    24
    Division of Energy Employees Occupational Illness 
      Compensation...............................................    25
    Occupational Safety and Health Administration................    26
    Mine Safety and Health Administration........................    27
    Bureau of Labor Statistics...................................    28
    Office of Disability Employment Policy.......................    29
    Departmental Management......................................    30
    General Provisions...........................................    34
Title II: Department of Health and Human Services:
    Health Resources and Services Administration.................    36
    Centers for Disease Control and Prevention...................    57
    National Institutes of Health................................    88
    Substance Abuse and Mental Health Services Administration....   137
    Agency for Healthcare Research and Quality...................   154
    Centers for Medicare and Medicaid Services...................   156
    Administration for Children and Families.....................   163
    Administration for Community Living..........................   180
    Administration for Strategic Preparedness and Response.......   186
    Office of the Secretary......................................   196
    General Provisions...........................................   208
Title III: Department of Education:
    Education for the Disadvantaged..............................   211
    Impact Aid...................................................   214
    School Improvement Programs..................................   216
    School Readiness.............................................   220
    Indian Education.............................................   220
    Innovation and Improvement...................................   222
    Safe Schools and Citizenship Education.......................   227
    English Language Acquisition.................................   229
    Special Education............................................   230
    Rehabilitation Services......................................   232
    Special Institutions for Persons With Disabilities:
        American Printing House for the Blind....................   234
        National Technical Institute for the Deaf................   234
        Gallaudet University.....................................   234
    Career, Technical, and Adult Education.......................   235
    Student Financial Assistance.................................   236
    Student Aid Administration...................................   238
    Higher Education.............................................   239
    Howard University............................................   246
    College Housing and Academic Facilities Loans Program........   246
    Historically Black College and University Capital Financing 
      Program Account............................................   247
    Institute of Education Sciences..............................   247
    Departmental Management:
        Program Administration...................................   250
        Office for Civil Rights..................................   256
        Office of the Inspector General..........................   257
    General Provisions...........................................   257
Title IV: Related Agencies:
    Committee for Purchase From People Who Are Blind or Severely 
      Disabled...................................................   259
    Corporation for National and Community Service...............   259
    Corporation for Public Broadcasting..........................   263
    Federal Mediation and Conciliation Service...................   264
    Federal Mine Safety and Health Review Commission.............   264
    Institute of Museum and Library Services.....................   264
    Medicaid and CHIP Payment and Access Commission..............   266
    Medicare Payment Advisory Commission.........................   266
    National Council on Disability...............................   266
    National Labor Relations Board...............................   267
    National Mediation Board.....................................   267
    Occupational Safety and Health Review Commission.............   267
    Railroad Retirement Board....................................   267
    Social Security Administration...............................   268
Title V: General Provisions......................................   274
Compliance With Paragraph 7, Rule XVI of the Standing Rules of 
  the Sen- ate...................................................   276
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules 
  of the Senate..................................................   277
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of 
  the Senate.....................................................   278
Budgetary Impact of Bill.........................................   280
Disclosure of Congressionally Directed Spending Items............   281
Comparative Statement of New Budget Authority....................   363

                         LIST OF ABBREVIATIONS

    ACA--Patient Protection and Affordable Care Act
    ACL--Administration for Community Living
    AHRQ--Agency for Healthcare Research and Quality
    ASH--Assistant Secretary for Health
    ASPR--Administration for Strategic Preparedness and 
Response
    BARDA--Biomedical Advanced Research and Development 
Authority
    CDC--Centers for Disease Control and Prevention
    CJ--Congressional Justification of Estimates for 
Appropriations Committees
    CMS--Centers for Medicare and Medicaid Services
    CNCS--Corporation for National and Community Service
    CPB--Corporation for Public Broadcasting
    DOD--Department of Defense
    DOL--Department of Labor
    EBSA--Employee Benefits Security Administration
    ESEA--Elementary and Secondary Education Act
    ETA--Employment and Training Administration
    FDA--Food and Drug Administration
    FIC--Fogarty International Center
    FMCS--Federal Mediation and Coalition Service
    FMSHRC--Federal Mine Safety and Health Review Commission
    FTE--full-time equivalent
    GAO--Government Accountability Office
    HBCUs--Historically Black Colleges and Universities
    HCFAC--Health Care Fraud and Abuse Control
    HELP--Health, Education, Labor, and Pensions
    HHS--Health and Human Services
    HRSA--Health Resources and Services Administration
    IC--Institute and Center
    IDEA--Individuals with Disabilities Education Act
    IMLS--Institute of Museum and Library Services
    LEA--local educational agency
    MACPAC--Medicaid and CHIP Payment and Access Commission
    MedPAC--Medicare Payment Advisory Commission
    MSHA--Mine Safety and Health Administration
    NCATS--National Center for Advancing Translational Sciences
    NCI--National Cancer Institute
    NEI--National Eye Institute
    NHGRI--National Human Genome Research Institute
    NHLBI--National Heart, Lung, and Blood Institute
    NIA--National Institute on Aging
    NIAAA--National Institute on Alcohol Abuse and Alcoholism
    NIAID--National Institute of Allergy and Infectious 
Diseases
    NIAMS--National Institute of Arthritis and Musculoskeletal 
and Skin Diseases
    NIBIB--National Institute of Biomedical Imaging and 
Bioengineering
    NICHD--Eunice Kennedy Shriver National Institute of Child 
Health and Human Development
    NIDA--National Institute on Drug Abuse
    NIDCD--National Institute on Deafness and Other 
Communication Disorders
    NIDCR--National Institute of Dental and Craniofacial 
Research
    NIDDK--National Institute of Diabetes and Digestive and 
Kidney Disease
    NIDRR--National Institute on Disability and Rehabilitation 
Research
    NIEHS--National Institute of Environmental Health Sciences
    NIGMS--National Institute of General Medical Sciences
    NIH--National Institutes of Health
    NIMH--National Institute of Mental Health
    NIMHD--National Institute on Minority Health and Health 
Disparities
    NINDS--National Institute of Neurological Disorders and 
Stroke
    NINR--National Institute of Nursing Research
    NLM--National Library of Medicine
    NLRB--National Labor Relations Board
    NSF--National Science Foundation
    NTID--National Technical Institute for the Deaf
    OAR--Office of AIDS Research
    OCR--Office for Civil Rights
    ODEP--Office of Disability Employment Policy
    OFCCP--Office of Federal Contract Compliance Programs
    OIG--Office of the Inspector General
    OLMS--Office of Labor-Management Standards
    OMB--Office of Management and Budget
    OMH--Office of Minority Health
    OMHA--Office of Medicare Hearings and Appeals
    ONC--Office of the National Coordinator for Health 
Information Technology
    ORWH--Office of Research on Women's Health
    OSHA--Occupational Safety and Health Administration
    OWCP--Office of Workers' Compensation Programs
    OWH--Office of Women's Health
    PBGC--Pension Benefit Guaranty Corporation
    PHS--Public Health Service
    PPH Fund--Prevention and Public Health Fund
    PRNS--Programs of Regional and National Significance
    RSA--Rehabilitation Services Administration
    SAMHSA--Substance Abuse and Mental Health Services 
Administration
    SEA--State educational agency
    SPRANS--Special Projects of Regional and National 
Significance
    SSA--Social Security Administration
    SSI--Supplemental Security Income
    STEM--science, technology, engineering, and mathematics
    UI--unemployment insurance
    USAID--U.S. Agency for International Development
    VETS--Veterans' Employment and Training Services
    VISTA--Volunteers in Service to America
    WANTO--Women in Apprenticeship and Non-Traditional 
Occupations
    WHD--Wage and Hour Division
    WIA--Workforce Investment Act
    WIOA--Workforce Innovation and Opportunity Act

 COMMITTEE REPORT FOR DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, 
     AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2024

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2024, the Committee recommends total budget 
authority of $1,445,830,783,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
This amount includes $195,231,000,000 in current year base 
discretionary funding consistent with the subcommittee's 
allocation. In addition, the bill includes $4,500,000,000 in 
discretionary funding designated as emergency, and 
$2,447,000,000 in program integrity cap adjustments.
    Fiscal year 2023 levels cited in this Committee Report 
reflect the enacted amounts in Public Law 117-328, the 
Consolidated Appropriations Act, 2023, adjusted for 
comparability where noted.

                                OVERVIEW

    The Labor, Health and Human Services, and Education, and 
Related Agencies [Labor-HHS-Education] appropriations bill 
constitutes the largest share of non-defense discretionary 
funding, 28 percent of the total for regular base discretionary 
funding in fiscal year 2024. The subcommittee's effective base 
discretionary funding allocation, which includes discretionary 
funding offset by savings in changes in mandatory programs and 
other similar adjustments is $1,218,000,000 below the 
comparable fiscal year 2023 level. This required difficult 
choices to prioritize funding in a bill that funds programs 
that touch the lives of every American. The Labor-HHS-Education 
bill supports critical investments in a wide range of areas 
including early learning, substance use and mental health, 
biomedical research, public health and preparedness, elementary 
and secondary education, higher education, workforce 
development, and social security, among many others.
    This Committee Report provides additional direction and 
specificity on the uses of funds provided in this bill. During 
fiscal year 2024, for the purposes of the Balanced Budget and 
Emergency Deficit Control Act of 1985, as amended, with respect 
to appropriations contained in the accompanying bill, the terms 
``program, project, and activity'' [PPA] shall mean any item 
for which a dollar amount is contained in appropriations acts 
(including joint resolutions providing continuing 
appropriations) or accompanying reports of the House and Senate 
Committees on Appropriations, or accompanying conference 
reports and joint explanatory statements of the committee of 
conference. The Committee continues longstanding reprogramming 
requirements and limitations regarding changes to funding for 
PPAs. The Committee expects agencies to submit any 
reprogramming requests in compliance with requirements of this 
act and to provide a thorough explanation of the proposed 
reallocations, including a detailed justification of increases 
and reductions. The Committee expects each agency to manage the 
expenditures of its programs and activities to remain within 
the amounts appropriated by Congress.
    The Committee also continues the longstanding requirement 
that each agency submit an operating plan to the House and 
Senate Committees on Appropriations not later than 45 days 
after enactment of this act, in order to establish the baseline 
for application of reprogramming and transfer authorities 
provided in this act. The operating plan should include at 
minimum funding for PPAs as specified above.
    The Committee also appreciates the close working 
relationship with the various budget offices of the agencies 
funded in this bill. Maintaining these relationships is 
critical for the Committee to perform its duties in both 
developing these funding recommendations and providing 
oversight over the execution of funds.
    Finally, each reference to the Committees or Committees on 
Appropriations in this Committee Report, unless otherwise 
noted, is to the House of Representatives Subcommittee on 
Labor, Health and Human Services, Education, and Related 
Agencies and the Senate Subcommittee on Labor, Health and Human 
Services, Education, and Related Agencies.

                                TITLE I

                          DEPARTMENT OF LABOR

    Any references in this title of the report to the 
``Secretary'' or the ``Department'' shall be interpreted to 
mean the Secretary of Labor or the Department of Labor, 
respectively, unless otherwise noted.

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2023....................................  $4,140,911,000
Budget estimate, 2024...................................   4,420,684,000
Committee recommendation................................   4,016,526,000

    The Training and Employment Services [TES] account provides 
funding primarily for activities under the Workforce Innovation 
and Opportunity Act [WIOA] (Public Law 113-128), and is a 
decentralized, integrated system of skill training and related 
services designed to enhance the employment and earnings of 
economically disadvantaged and dislocated workers. Funds 
provided for many training programs for fiscal year 2024 will 
support the program from July 1, 2024, through June 30, 2025. A 
portion of this account's funding, $1,772,000,000, becomes 
available on October 1, 2024, for the 2024 program year.
    Advanced Robotics Manufacturing.--The Committee recognizes 
the need for workforce training and certificate programs 
targeting collaborative robotics and additive manufacturing to 
adequately prepare the current and future workforce for the 
challenges of tomorrow. The Committee encourages the Department 
to appropriately address this need through the prioritization 
of such programs, with an emphasis on programs that re-skill 
incumbent manufacturing workers.
    Apprenticeship Grants.--The Committee supports the 
expansion of apprenticeship opportunities and notes that they 
can often provide more affordable pathways to high-paying jobs. 
Not later than 180 days after the enactment of this act, the 
Department shall publicly disclose on its website grantees 
receiving funding under the Apprenticeship Program, the number 
of apprentices attributable to each grantee, and the respective 
employment and earnings outcomes of program participants as 
required under section 116(b)(2)(A)(i) of the Workforce 
Innovation and Opportunity Act. Additionally, the Department 
shall report to the Committee on the extent to which it is 
engaging with the Department of Education to address mismatches 
between worker skills or their participation in the labor force 
and employer needs and the steps that the Department has taken 
or plans to take to study the drivers of skills mismatches, 
workforce shortages, productivity fluctuations, turnover 
fluctuations, stagnant wages, and poor working conditions 
across occupations, industries, and the economy as a whole.
    Communities Affected by Substance Use.--The Committee 
encourages the Secretary to prioritize funding for grants to 
serve or retrain workers in communities impacted by the health 
and economic effects of widespread substance use, including 
methamphetamine use, addiction, and overdose.
    Collaboration Between Workforce Development Systems and 
State and Local Educational Agencies.--The Committee recognizes 
the unique role the workforce development system plays in 
providing in-school and out-of-school youth with opportunities 
that deepen learning and create pathways into high-quality 
jobs. The Committee also remains concerned with the adverse 
impacts of COVID-19 on educational attainment, particularly for 
students from underserved communities. The Committee encourages 
the Department, in partnership with the Department of 
Education, to facilitate greater collaboration between the 
workforce development system and State and local educational 
agencies to engage and support youth (particularly disconnected 
youth), and to strengthen completion rates of secondary and 
postsecondary education and improve pathways into high-quality 
jobs. The Committee requests a briefing within 120 days of 
enactment for the Committees on Appropriations, the Senate 
Committee on Health, Education, Labor, and Pensions, and the 
House Committee on Education and the Workforce on any actions 
taken and any recommendations for statutory changes that can 
support greater collaboration between the workforce development 
and education systems.
    Creative Economy.--The Committee recognizes that the 
creative economy was severely impacted by COVID-19 and 
encourages the Department to partner with the National 
Endowment for the Arts and the National Endowment for the 
Humanities to explore the feasibility and expansion of 
Registered Apprenticeship programs for creative workers who 
previously received income through creative, cultural, or 
artistic-based pursuits to produce ideas, content, goods, and 
services, without regard to whether such income is earned 
through employment as an independent contractor or as an 
employee for an employer.
    Direct Care Worker Shortage.--The Committee is concerned 
about worker shortages in the direct care sector, particularly 
regarding aging care and disability care. Expanding access to 
long-term care will become more urgent as the U.S. population 
of adults who are 65 and older will nearly double by 2050, with 
10,000 people turning 65 every day. The Committee encourages 
the Department, in coordination with the Department of Health 
and Human Services and the Centers for Medicare and Medicaid 
Services, to study the effects of worker shortages in the 
direct care sector and the impact that worker shortages will 
have on long-term care affordability and accessibility, and 
long-term care programs and submit a report to the Committees 
on Appropriations not later than 270 days after enactment.
    Occupational Barriers for Healthcare Professionals.--The 
Committee recognizes that immigrants arriving in the United 
States holding healthcare degrees and credentials from their 
home countries face significant barriers that lead to 
underemployment, including in lower-skilled healthcare jobs 
than they are trained for and jobs outside of healthcare. The 
Committee supports efforts to strengthen the healthcare 
workforce and reduce barriers for in-demand occupations. As 
such, the Committee encourages the Secretary to issue guidance 
that identifies ways to bridge the gap between unemployed 
immigrants and healthcare professions.
    Modernizing Workforce Development Programming.--The 
Committee encourages ETA to collaborate with state workforce 
agencies to modernize workforce development programming. The 
Committee is concerned about the continued difficulty of 
underemployed workers transitioning to full employment and 
encourages ETA to explore new avenues for training, including 
the use of virtual resources that take into account the time 
constraints of underemployed workers who may work multiple jobs 
or have caretaking responsibilities that limit their ability to 
use in-person services. Finally, the Committee further 
encourages the Department to develop a comprehensive long-term 
strategy for the delivery of online training and development 
programming.
    Opportunity Youth.--The Committee encourages the Department 
to use funds provided to carry out sections 168(b) and 169(c) 
of WIOA, which may be used for technical assistance and 
demonstration projects, to support demonstration programs that 
allow at-risk youth who are out-of-school, have limited work 
experience, and live in communities experiencing high rates of 
unemployment and high rates of community violence, to 
participate in the workforce.
    Public Libraries.--The Committee continues to encourage ETA 
to expand its collaborative work with the Institute of Museum 
and Library Services [IMLS] to assist in the implementation of 
WIOA to help States and local boards integrate the education, 
employment, and training services provided by public libraries 
into the workforce investment system. Libraries can play a 
critical role in helping people access benefits and get back to 
work and the Committee encourages ETA to work with IMLS to 
identify barriers to libraries participating in programs funded 
under WIOA and to develop a plan to address those barriers.
    Regional Coordination.--The Committee encourages the 
Department to include regional councils and councils of 
governments as eligible entities in grant competitions when 
allowable. Furthermore, the Committee encourages the Department 
to actively seek opportunities to encourage and expand greater 
regional collaboration and to work with entities that have 
previous experience with administering Federal funding that 
resulted in successful, comprehensive, well-coordinated 
outcomes.
    Small Businesses.--The Committee encourages the Department 
to support the employment needs of small businesses and 
entrepreneurial skills training through WIOA programs.
    Submarine Construction Workforce.--The Committee encourages 
ETA to collaborate with the Departments of Defense and 
Education to address critical workforce needs in the submarine 
construction pipeline.
    Water and Wastewater Operators.--The Committee continues to 
be concerned by the Nationwide shortage of water and wastewater 
operators, particularly in rural areas. The Committee strongly 
encourages the Secretary to make funding available through 
workforce development and apprenticeship programs, consistent 
with National Guideline Standards of Apprenticeship for Water 
and Wastewater System Operations Specialists and the WIOA 
system, to establish, implement, and expand registered 
apprenticeship programs to address shortages of such workers.

Grants to States

    The Committee recommends $2,929,332,000 for Training and 
Employment Services Grants to States.
    Under WIOA, a local board is given up to 100 percent 
transfer authority between Adult and Dislocated Worker 
activities upon approval of the Governor.
    Adult Employment and Training.--The Committee recommends 
$885,649,000 for adult employment and training. Formula funding 
is provided to States and further distributed to local 
workforce investment areas through one-stop centers. The 
program provides employment and training services to 
disadvantaged, low-skilled, unemployed, and underemployed 
adults, including veterans.
    Funds are made available in this bill for adult employment 
and training activities in program year 2024, which occurs from 
July 1, 2024, through June 30, 2025. The bill provides that 
$173,649,000 is available for obligation on July 1, 2024, and 
that $712,000,000 is available on October 1, 2024. Both 
categories of funding are available for obligation through June 
30, 2025.
    Youth Training.--The Committee recommends $948,130,000 for 
youth training. The purpose of this program is to provide low-
income youth who are facing barriers to employment with 
services that prepare them to succeed in the knowledge-based 
economy. Funds are made available for youth training activities 
in program year 2024, which occurs from April 1, 2024, through 
June 30, 2025.
    Dislocated Worker Assistance.--The Committee recommends 
$1,095,553,000 for dislocated worker assistance. This program 
is a State-operated effort that provides training services and 
support to help permanently separated workers return to 
productive unsubsidized employment. In addition, States must 
use State-wide reserve funds for rapid response assistance to 
help workers affected by mass layoffs and plant closures. 
States must also use these funds to carry out additional State-
wide employment and training activities, such as providing 
technical assistance to certain low-performing local areas, 
evaluating State programs, and assisting with the operation of 
one-stop delivery systems. States may also use funds for 
implementing innovative training programs.
    Funds made available in this bill support activities in 
program year 2024, which occurs from July 1, 2024, through June 
30, 2025. The bill provides that $235,553,000 is available for 
obligation on July 1, 2024, and that $860,000,000 is available 
on October 1, 2024. Both categories of funding are available 
for obligation through June 30, 2025.

National Programs

            Dislocated Worker Assistance National Reserve
    The Committee recommends $305,859,000 for the Dislocated 
Worker Assistance National Reserve, which is available to the 
Secretary for activities such as responding to mass layoffs, 
plant and/or military base closings, and natural disasters, as 
well as for technical assistance, training, and demonstration 
projects.
    Funds made available for the National Reserve in this bill 
support activities in program year 2024. The bill provides that 
$105,859,000 is available for obligation on July 1, 2024, and 
that $200,000,000 is available on October 1, 2024. Both 
categories of funding are available for obligation through 
September 30, 2025.
    Automation Impacted Industries.--The Committee supports 
funding to support demonstration and pilot projects relating to 
the training needs of workers who are, or are likely to become, 
dislocated as a result of automation.
    Career Pathways for Youth Grants.--The Committee continues 
to recognize that multiple career pathways should be available 
to young people and the need for early workforce readiness, 
employment, and training opportunities that help youth develop 
soft skills, such as responsibility, organization, and time 
management, and to learn workplace safety. The Committee 
recommendation includes $10,000,000 to utilize the 
demonstration grant authority under the dislocated worker 
national reserve for grants to support national out-of-school 
time organizations that serve youth and teens, and place an 
emphasis on age-appropriate workforce readiness programming to 
expand job training and workforce pathways for youth and 
disconnected youth. This programming includes soft skill 
development, career exploration, job readiness and 
certification, summer jobs, year-round job opportunities, and 
apprenticeships. Funding will also support partnerships between 
workforce investment boards and youth serving organizations. 
Additionally, the Committee encourages the Department to 
determine the feasibility of utilizing the existing one-stop 
infrastructure to develop and execute career pathways for youth 
at the local or regional level.
    Disaster Resilience and Infrastructure.--The Committee 
recognizes the need for workforce development pathways in 
disaster resilience and infrastructure sectors and the role 
that public and non-profit workforce development providers and 
apprenticeship programs should play in helping provide hands-on 
experience through projects on a pathway to jobs. The Committee 
supports funding for programs to address these issues, 
including DOL's coordination with other agencies implementing 
the Infrastructure Investment and Jobs Act, and Inflation 
Reduction Act, and the Corporation for National and Community 
Service.
    Higher Education Workforce Development Programs.--The 
Committee supports funding for projects to help better align 
workforce development efforts with postsecondary education, 
including supporting expanded skills instruction, 
apprenticeships, and other work-based learning opportunities, 
including cooperative education and upskilling and reskilling 
efforts in industries like manufacturing, information 
technology, healthcare, and energy, among others.
    Multi-state National Dislocated Coal Miners Assistance 
Grant Program.--The Committee is aware of the difficulties 
experienced by dislocated coal miners as a result of continuing 
energy sector restructuring. The Committee strongly supports 
funding for non-profit organizations that provide employment 
and training assistance, as well as related supportive 
services, to individuals who are dislocated by coal plant 
closures or substantial layoffs at coal mine operations and 
their immediate family.
    Strengthening Community College Training Grants [SCCTG].--
The Committee recommendation includes $55,000,000 for SCCTG. 
This program builds the capacity of community colleges to 
address workforce development needs in in-demand industries and 
career pathways leading to quality jobs.
    Workforce Opportunity for Rural Communities.--The Committee 
recommendation includes $50,000,000 for the Workforce 
Opportunity for Rural Communities program, to provide enhanced 
worker training in the Appalachian, Delta, and Northern Border 
regions. These funds provide reemployment and training 
assistance to dislocated workers in rural areas to help them 
adapt existing skills and learn new ones demanded by growing 
industries. The Committee strongly encourages the Department to 
develop funding opportunity announcements and make grant awards 
in coordination with the Appalachian Regional Commission [ARC], 
Delta Regional Authority [DRA], and Northern Border Regional 
Commission [NBRC], for which each award shall not exceed 
$1,500,000. Within the total, the recommendation includes 
$21,750,000 for grants in areas served by the ARC, $21,750,000 
for areas served by the DRA, and $6,500,000 for areas served by 
the NBRC.
            Indian and Native American Programs
    The Committee recommends $60,000,000 for Indian and Native 
American Programs. These programs are designed to improve the 
academic, occupational, and literacy skills of Native 
Americans, Alaskan Natives, and Native Hawaiians to aid the 
participants in securing permanent, unsubsidized employment. 
Allowable training services include adult basic education, 
general educational development attainment, literacy training, 
English language training, as well as the establishment of 
linkages with remedial education.
            Migrant and Seasonal Farmworker Programs
    The Committee recommends $97,396,000 for migrant and 
seasonal farmworkers programs, which serve members of 
economically disadvantaged families whose principal livelihood 
is derived from migratory and other forms of seasonal farm 
work, 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.
    The Committee recommendation provides that $90,134,000 be 
used for State service area grants. The Committee 
recommendation also includes bill language directing that 
$6,591,000 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 recommendation also includes 
$671,000 to be used for section 167 training, technical 
assistance, and related activities, including funds for migrant 
rest center activities.
            YouthBuild
    The Committee recommendation includes $105,000,000 for 
YouthBuild, which helps provide disconnected youth with work 
readiness and industry-driven credential attainment 
opportunities.
    The Committee encourages the Department to ensure 
YouthBuild grants reach geographically diverse areas, including 
rural areas.
            Reentry Employment Opportunities [REO]
    The Committee recommends $115,000,000 for the REO program, 
including $30,000,000 for national and regional intermediaries. 
The REO program provides current or formerly incarcerated youth 
and adults involved in the justice system with occupational 
skills training that leads to industry recognized credentials 
and apprenticeships leading to employment in good, well-paying 
jobs and careers with opportunities for advancement. Programs 
are carried out directly through State and local governmental 
entities and community-based organizations, as well as 
indirectly through intermediary organizations.
    The Committee directs the Department to ensure grantees 
establish formal partnerships with employers and that program 
participants receive industry recognized credentials and 
training in fields that prepare them for successful 
reintegration, including ensuring participants receive training 
and credentials in fields where their record is not a barrier 
to entry or continued employment. The Committee also directs 
the Department to consider the needs of communities that have 
recently experienced significant unrest.
            Apprenticeship Grants
    The Committee recommendation includes $290,000,000 for 
Apprenticeship Grants.
    The Committee continues to support the prioritization of 
funding to expand registered apprenticeships into new 
industries and for underserved or underrepresented populations. 
The Committee supports the use of apprenticeship grants that 
provide worker education in in-demand and emerging fields, 
including first responder; disaster resilience, response, and 
recovery; utility (energy and water) and resource management; 
transportation and infrastructure; goods movement sectors such 
as global logistics, rail and other freight-related employment; 
and outdoor recreation economy-related employment. The 
Committee also encourages the Department to support 
apprenticeship opportunities that incorporate non-traditional 
industries. Additionally, the Committee encourages the use of 
``next-gen'' apprenticeship grants to encourage higher 
education institutions to support registered apprenticeships in 
emerging and nontraditional industries. This can expand 
registered apprenticeship to industries and careers that are 
not currently using or are underutilizing this system, deliver 
transferable, durable 21st century skills, and create 
affordable transfer opportunities to a college education for 
our youth. Further, the Committee encourages the Department to 
fund apprenticeship opportunities in local communities that 
have high rates of unemployment and high rates of community 
violence.
            Workforce Data Quality Initiative
    The Committee recommendation includes $6,000,000 for the 
Workforce Data Quality Initiative, which provides competitive 
grants to support States in developing, connecting, and 
enhancing their longitudinal data systems that integrate 
education and workforce data. This supports evaluation and 
research on the effectiveness of education and workforce 
programs, and helps provide consumer-friendly information so 
that individuals can select the programs that best meet their 
needs.
            Civilian Climate Corps
    The Committee recommendation does not include funding for a 
new Civilian Climate Corps program.
            SECTOR Partnerships
    The Committee recommendation does not include funding for a 
new SECTOR Partnerships program.
            Congressionally Directed Spending
    The Committee recommendation includes $107,939,000 for the 
projects, and in the amounts, specified in the table at the end 
of this Committee Report.

                               JOB CORPS

Appropriations, 2023....................................  $1,760,155,000
Budget estimate, 2024...................................   1,835,467,000
Committee recommendation................................   1,760,155,000

    The recommendation for operations of Job Corps centers is 
$1,603,325,000.
    The Committee recommendation for administrative costs is 
$33,830,000.
    The Committee recommends a total of $123,000,000 in 
construction, renovation, and acquisition [CRA] funds. This 
amount is available from July 1, 2024, to June 30, 2026. The 
Committee continues bill language allowing the Secretary to 
transfer up to 15 percent of CRA funds, if necessary, to meet 
the operational needs of Job Corps centers or to achieve 
administrative efficiencies. The bill continues to require the 
Secretary to notify the Committees on Appropriations of the 
House of Representatives and the Senate at least 15 days in 
advance of any transfer. The Committee expects any notification 
to include a justification.
    Civilian Conservation Centers.--The Committee continues to 
strongly encourage the Department to prioritize the development 
of new natural resource and conservation trade offerings, 
particularly focused on wildland firefighting and emergency 
response. The Committee encourages the Department to maximize 
the utilization of Job Corps trade offerings, particularly 
those focused on natural resources and wildland firefighting, 
including by reclassifying enrollees engaged in wildland 
firefighting or off-campus work-based learning as out of the 
career and technical training classroom so that another 
enrollee may occupy that slot.
    Gulfport Job Corps Center.--The Committee remains 
encouraged by the continued progress made toward the rebuilding 
of the Gulfport Job Corps Center, including the significant 
design development work made by the architecture and 
engineering firm. The Committee expects the Department to 
remain diligently committed to this project and directs the 
Department to continue to prioritize the Gulfport Job Corps 
Center among pending construction cases in the CRA account. The 
Committee requests updates biannually regarding progress on 
this project.
    Homeless Youth.--The Committee strongly encourages the 
Department to streamline application requirements for homeless 
youth in Job Corps.
    Rural Training Sites.--The Committee encourages the 
Department to support and incentivize high quality center 
operators to develop and enhance partnerships with existing 
rural training sites to enhance opportunities and work 
experiences for students in underserved rural or remote 
communities. Such rural partnerships should use student-focused 
industry-backed curricula, prepare students for employment in 
high-demand fields, offer students the opportunity to take 
coursework leading to college credit, and demonstrate strong 
employer partnerships within the region in which the center is 
located. Such partnerships will also promote the ability of Job 
Corps centers to meet local workforce and cultural needs in 
communities far removed from their locations.
    Slot Utilization.--As millions of disconnected youth 
struggle with housing instability, food insecurity, and 
unemployment, the Committee encourages the full resumption of 
Job Corps operations, including the reintegration of 
nonresidential students into normal classes, similar to other 
schools and institutions of higher education across the 
country.
    Substance Use and Behavioral Health.--The Committee 
requests that the Department make recommendations, including 
legislative changes, to address substance use and behavioral 
health challenges of Job Corps participants.
    Wages and Benefits.--The Committee has previously expressed 
concern regarding the impact of the transition to fixed-price 
Job Corps contracts on staff compensation. The Committee looks 
forward to the report required in House Report 117-403 on this 
issue and requests a briefing within 120 days of enactment on 
how the Department is ensuring that Job Corps centers are able 
to provide high quality services under fixed-price contracts.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2023....................................    $405,000,000
Budget estimate, 2024...................................     405,000,000
Committee recommendation................................     405,000,000

    Community Service Employment for Older Americans [CSEOA] 
provides part-time employment in community service activities 
for unemployed, low-income persons aged 55 and older. The 
Committee recommendation includes $405,000,000 for CSEOA.
    The Committee encourages the Department to reserve amounts 
proportionate to the Asian American Native Hawaiian Pacific 
Islander [AANHPI] and the Native American Indian populations 
for national grants to national AANHPI and Native American 
Indian aging organizations who have a track record of reaching, 
in a linguistically and culturally competent manner, this 
underserved population of older workers across the country with 
significant barriers to employment.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2023....................................    $494,400,000
Budget estimate, 2024...................................      30,700,000
Committee recommendation................................      30,700,000

    The Committee recommendation includes mandatory funds for 
the Federal unemployment benefits and allowances program that 
assists trade-impacted workers with benefits and services to 
upgrade skills and retrain in new careers. These benefits and 
services are designed to help participants find a path back 
into middle-class jobs, improve earnings, and increase 
credential and education rates.
    The Trade Adjustment Assistance [TAA] program provides 
assistance to workers who have been adversely affected by 
international trade. TAA provides benefits and services to 
those who qualify, to include job training, job search and 
relocation allowances, and wage supplements for workers age 50 
and older.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2023....................................  $4,009,150,000
Budget estimate, 2024...................................   4,592,414,000
Committee recommendation................................   4,072,150,000

    The Committee recommendation includes $3,988,084,000 
authorized to be drawn from the Employment Security 
Administration account of the Unemployment Trust Fund and 
$84,066,000 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 that 
administer Federal and State unemployment compensation laws and 
operate the public employment service.

Unemployment Insurance

    The Committee recommends a total of $3,206,635,000 for 
Unemployment Insurance [UI] activities. For UI State 
operations, the Committee recommends $2,815,635,000.
    The Committee recommendation includes $382,000,000 for 
Reemployment Services and Eligibility Assessments, to expand 
intensive, individualized reemployment assistance, and to help 
address and prevent long-term unemployment, and reduce improper 
payments. This includes $117,000,000 in base funding and 
$265,000,000 in cap adjustment funding consistent with the 
Fiscal Responsibility Act. The recommendation also includes 
$9,000,000 for the UI Integrity Center of Excellence, including 
supporting an integrated data hub, training modules, and data 
analytics capacity to help States reduce fraud.
    Finally, the Committee recommends $18,000,000 for UI 
national activities, which will support activities that benefit 
the entire Federal-State UI system, including supporting the 
continuation of IT upgrades and technical assistance.

Employment Service

    For the Employment Service allotments to States, the 
Committee recommends $675,052,000. This amount includes 
$21,413,000 in general funds together with an authorization to 
spend $653,639,000 from the Employment Security Administration 
account of the Unemployment Trust Fund.
    The Committee also recommends $25,000,000 for Employment 
Service national activities.
    The Committee recommendation includes $2,500,000 to 
continue efforts to reduce the processing backlog for the work 
opportunity tax credit [WOTC] program and for assisting States 
to modernize information technology for processing 
certification requests, which may include training and 
technical assistance. Consistent with this effort, the 
Committee encourages DOL to encourage States to adopt 
compatible rules, and State Workforce Agencies to enter into 
cooperative information exchange agreements with Federal and 
State agencies that have the data needed to determine WOTC 
eligibility. Finally, the Committee recognizes that processing 
requests for remote workers may be best accomplished in the 
State where the workers reside and not where the employer is 
located.

Foreign Labor Certification

    For carrying out the Department's responsibilities related 
to foreign labor certification activities, the Committee 
recommends $61,528,000. In addition, 5 percent of the revenue 
from H-1B fees is available to the Department for costs 
associated with processing H-1B alien labor certification 
applications, and $23,282,000 is available for related State 
grants.
    Prompt Processing of H-2B Visas.--The Committee strongly 
encourages the Department to take steps to ensure prompt 
processing of H-2B visa applications and to minimize future 
interruptions to the H-2B visa program. The Committee looks 
forward to receiving the report the Department was directed to 
complete in the joint explanatory statement accompanying the 
Consolidated Appropriations Act, 2023.

One Stop Career Centers/Labor Market Information

    For one-stop career centers and labor market information, 
the Committee recommends $62,653,000.
    The Committee is encouraged by progress made through the 
Department's efforts to incentivize States to reduce barriers 
to entry into licensed occupations and increase license 
portability to facilitate mobility of workers in such 
occupations, with an emphasis on transitioning service members, 
veterans, and military spouses. The Committee looks forward to 
receiving the Occupational Licensing report detailing best 
practices learned and a breakdown of future resources needed 
for continued implementation of such initiative. The Committee 
encourages the Department to expand on these past efforts to 
encourage occupational licensing reform, which could include 
grants to States, and associations of States, to review, 
eliminate and reform licensing requirements, and to promote 
portability of State licenses. Grant funding would support 
institutions of higher education and occupational licensing 
partners to address barriers to licensure for veterans and 
transitioning service members, immigrants with work 
authorization, individuals with a criminal history, and 
dislocated, low-wage workers.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

    The Committee bill continues language providing such sums 
as necessary in mandatory funds for this account. 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.

                         PROGRAM ADMINISTRATION

Appropriations, 2023....................................    $172,915,000
Budget estimate, 2024...................................     225,466,000
Committee recommendation................................     172,915,000

    The Committee recommendation of $172,915,000 for program 
administration includes $118,900,000 in general funds and 
$54,015,000 from the Employment Security Administration account 
of the Unemployment Trust Fund.
    General funds in this account pay for the Federal staff 
needed to administer employment and training programs under 
WIOA, Older Americans Act [OAA] (Public Law 116-131), the Trade 
Act of 1974 (Public Law 93-618), and the National 
Apprenticeship Act. Trust funds provide for the Federal 
administration of employment security, training and employment, 
and executive direction functions.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $191,100,000
Budget estimate, 2024...................................     248,959,000
Committee recommendation................................     191,100,000

    The Committee recommends $191,100,000 for the Employee 
Benefits Security Administration [EBSA]. EBSA is responsible 
for the enforcement of title I of the Employee Retirement 
Income Security Act [ERISA] in both civil and criminal areas 
and for enforcement of sections 8477 and 8478 of the Federal 
Employees' Retirement Security Act of 1986 (Public Law 99-335). 
EBSA administers an integrated program of regulation, 
compliance assistance and education, civil and criminal 
enforcement, and research and analysis. Bill language continues 
to allow EBSA to obligate up to $3,000,000 for two fiscal years 
for the expert witness program. The budget requests similar 
language, except such funds would remain available until 
expended. The authority is needed for services on cases 
extending beyond fiscal year limitation.
    The Committee requests that DOL's required operating plan 
and future CJs continue to include budget activity detail 
provided in last year's CJ.
    Implementation of Employee Ownership Initiative.--Within 
available resources, the Committee expects EBSA to create and 
widely disseminate educational materials focused on promoting 
best practices in employee ownership through the Employee 
Ownership Initiative authorized by section 346 of the SECURE 
2.0 Act of 2022. The Committee requests EBSA to describe in its 
fiscal year 2025 CJ actions completed and planned related to 
the initiative.
    Adequate Consideration Guidance.--The Committee notes that 
the SECURE 2.0 Act of 2022 also directs the Department to issue 
formal guidance on the adequate consideration exemption, as 
defined in section 407(d)(6) of ERISA. The Committee urges the 
Department to prioritize a timely, formal notice and comment 
rulemaking on the adequate consideration exemption that ensures 
taxpayers benefit from stakeholder input and experience, 
consistent with congressional intent.
    Mental Health Parity.--The Committee urges continued work 
to achieve compliance with requirements for parity between 
mental and physical healthcare coverage.

                  Pension Benefit Guaranty Corporation

Appropriations, 2023....................................    $493,314,000
Budget estimate, 2024...................................     512,900,000
Committee recommendation................................     512,900,000

    The Pension Benefit Guaranty Corporation's [PBGC] estimated 
obligations for fiscal year 2024 include single-employer 
benefit payments of $7,419,000,000, multi-employer financial 
assistance of $197,000,000, Investment Management Fees Program 
of $139,800,000 and consolidated administrative expenses of 
$512,900,000, including $7,857,000 available for the Office of 
Inspector General. Administrative expenses are comprised of 
three activities: pension insurance activities, pension plan 
termination expenses, and operational support. These 
expenditures are financed by permanent authority. PBGC also 
anticipates obligations of $13,966,000,000 for Special 
Financial Assistance and $15,000,000 for related administrative 
expenses from the American Rescue Plan Act of 2021.
    Previously, the Committee accepted the PBGC's proposal to 
reform the administrative apportionment classifications from 
three budget activities to one budget activity to make 
operations more efficient and improve stewardship of resources. 
That consolidated approach for the three activities is 
continued, but PBGC is directed to continue providing detail 
every year on the three activities in its annual CJ.
    The PBGC is a wholly owned Government corporation 
established by ERISA. The law places it within DOL and makes 
the Secretary 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. The primary 
purpose of the PBGC is to guarantee the payment of pension plan 
benefits to participants if covered defined benefit plans fail 
or go out of existence.
    The bill continues authority for a contingency fund for the 
PBGC that provides additional administrative resources when the 
number of new plan participants in terminated plans exceeds 
100,000. When that threshold is reached, an additional 
$9,200,000 becomes available through September 30, 2028, for 
every 20,000 additional participants in terminated plans. The 
bill also continues authority allowing the PBGC additional 
obligation authority for unforeseen and extraordinary pre-
termination expenses, after approval by the Office of 
Management and Budget and notification to the Committees on 
Appropriations. Finally, the bill includes authority for PBGC 
to expend not more than an additional $100 per affected person 
for credit or identity monitoring to individuals upon suffering 
a security incident or privacy breach in the event PBGC's costs 
exceed $250,000. Those funds are available for obligation 
through September 30, 2028.

                         Wage and Hour Division


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $260,000,000
Budget estimate, 2024...................................     340,953,000
Committee recommendation................................     264,500,000

    The Committee recommends $264,500,000 for the Wage and Hour 
Division [WHD].
    WHD is responsible for administering and enforcing laws 
that provide minimum standards for wages and working conditions 
in the United States. The Fair Labor Standards Act 
[FLSA](Public Law 75-718), employment rights under the Family 
and Medical Leave Act (Public Law 103-3), and the Migrant and 
Seasonal Agricultural Worker Protection Act (Public Law 97-470) 
are several of the important laws that WHD is charged with 
administering and/or enforcing.
    WHD administers and enforces laws covering more than 165 
million workers in 11 million workplaces in the United States 
and its territories. The Committee supports WHD in its efforts 
to be more strategic in enforcement activities, which can lead 
to more significant results for workers at an industry-level 
and deter employers from violating the law, particularly in key 
areas of protecting the rights and wages of essential workers, 
ensuring prevailing wage protections, and combatting 
exploitative child labor.
    Preventing Exploitative Child Labor.--The Committee 
recommendation supports further efforts to combat exploitative 
child labor and violations of child labor provisions of the 
FLSA and work with employers on removing illegal child labor 
from their supply chains. WHD should utilize strategic 
enforcement in industries known to have high incidents of child 
labor violations. The Committee supports the improved 
collaboration and information sharing established between the 
Department of Labor, WHD, and the Department of Health and 
Human Services Administration for Children and Families, 
including through the interagency taskforce to combat child 
labor exploitation and recently signed memorandum of agreement. 
The Committee expects the fiscal year 2025 CJ to describe WHD 
accomplishments in preventing exploitative child labor in the 
prior year and plans for the budget year.
    Protecting Vulnerable Workers.--The Committee is aware WHD 
continues to work toward prioritizing high impact cases 
involving the most vulnerable worker populations that can have 
the greatest positive effect in reducing employer exploitation 
of workers and improving compliance with applicable 
requirements. This must include protecting American and an 
increasing number of temporary foreign workers by preventing 
abuses of temporary foreign worker programs. The Committee 
requests a briefing not later than 45 days after enactment of 
this act on WHD's prioritization process for investigations in 
foreign worker programs, including the H-1B, H-2A, H-2B and TN 
visa programs, and its plans and resource requirements to 
improve employer compliance with applicable requirements given 
the increasing numbers of such workers.
    14(c) Program Oversight.--The WHD processes certificate 
applications and conducts oversight of the FLSA 14(c) program 
allowing employers to pay sub-minimum wages to certain 
employees if the employer holds a certificate from DOL. The 
Government Accountability Office [GAO] issued a report in 
February 2023 regarding Department oversight of the program and 
recommendations to improve certificate processing and 
oversight. The Committee requests a briefing not later than 60 
days after enactment of this act on WHD implementation of the 
GAO recommendations. Such briefing must also cover WHD plans 
and associated timeline to archive all approved and pending 
certificate applications and make such data available each 
quarter of the fiscal year on a Department website.

                  Office of Labor-Management Standards


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $48,515,000
Budget estimate, 2024...................................      53,469,000
Committee recommendation................................      48,515,000

    The Committee recommends $48,515,000 for the Office of 
Labor-Management Standards [OLMS].
    OLMS administers the Labor-Management Reporting and 
Disclosure Act of 1959 [LMRDA] (Public Law 86-257) and related 
laws. These laws establish safeguards for union democracy and 
financial integrity. They also require public disclosure by 
unions, union officers, employers, labor relations consultants 
and others. In addition, the Office administers employee 
protections under federally sponsored transportation programs.

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $110,976,000
Budget estimate, 2024...................................     151,462,000
Committee recommendation................................     110,976,000

    The Committee recommends $110,976,000 for the Office of 
Federal Contract Compliance Programs.
    This Office protects workers and potential employees of 
Federal contractors from employment discrimination prohibited 
under Executive Order 11246, section 503 of the Rehabilitation 
Act of 1973, and the Vietnam Era Veterans' Readjustment 
Assistance Act of 1974. These prohibitions make it unlawful for 
contractors and subcontractors doing business with the Federal 
Government to discriminate in employment because of race, 
color, religion, sex (including sexual orientation and gender 
identity), national origin, disability, or status as a 
protected veteran.

                Office of Workers' Compensation Programs


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $122,705,000
Budget estimate, 2024...................................     151,946,000
Committee recommendation................................     122,705,000

    The Committee recommends $122,705,000 for the Office of 
Workers' Compensation Programs [OWCP]. The bill provides 
authority to expend $120,500,000 from the special fund 
established by the Longshore and Harbor Workers' Compensation 
Act. In addition, $2,205,000 is available by transfer from the 
Black Lung Disability Trust Fund.
    OWCP administers four distinct compensation programs: the 
Federal Employees' Compensation Act [FECA], the Longshore and 
Harbor Workers' Compensation Act (Public Law 69-803), the Black 
Lung Benefits programs, and the Energy Employees Occupational 
Illness Compensation Program Act (Public Law 106-398). In 
addition, OWCP houses the Division of Information Technology 
Management and Services.

                            SPECIAL BENEFITS

Appropriations, 2023....................................    $250,000,000
Budget estimate, 2024...................................     700,000,000
Committee recommendation................................     700,000,000

    The Committee recommends $700,000,000 for this account. 
This mandatory appropriation, which is administered by OWCP, 
primarily provides benefits under FECA.
    The Committee continues to provide authority to require 
disclosure of Social Security numbers by individuals filing 
claims under FECA or the Longshore and Harbor Workers' 
Compensation Act (Public Law 69-803) and its extensions.
    The Committee continues language that provides authority to 
use FECA funds to reimburse a new employer for a portion of the 
salary of a newly reemployed injured Federal worker. 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, and declining thereafter.
    The Committee continues language that allows carryover of 
unobligated balances to be used in the following year and 
provides authority to draw such sums as needed after August 15 
to pay current beneficiaries. Such funds are charged to the 
subsequent year appropriation.
    The Committee continues 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.
    Finally, the Committee maintains language consistent with 
long-standing interpretations and implementation of this 
appropriation stating that, along with the other compensation 
statutes already specifically enumerated, the appropriation is 
used to pay obligations that arise under the War Hazards 
Compensation Act (Public Law 77-784), and the appropriation is 
deposited in the Employees' Compensation Fund and assumes its 
attributes, namely availability without time limit as provided 
by 5 U.S.C. section 8147.33.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2023....................................     $47,031,000
Budget estimate, 2024...................................      33,140,000
Committee recommendation................................      33,140,000

    The Committee recommends a mandatory appropriation of 
$22,890,000 in fiscal year 2024 for special benefits for 
disabled coal miners. This is in addition to the $10,250,000 
appropriated last year as an advance for the first quarter of 
fiscal year 2024, for a total program level of $33,140,000 in 
fiscal year 2024.
    These mandatory funds are used to provide monthly benefits 
to coal miners disabled by black lung disease, their widows, 
and certain other dependents, as well as to pay related 
administrative costs.
    The Committee also recommends an advance appropriation of 
$7,000,000 for the first quarter of fiscal year 2025. These 
funds will ensure uninterrupted benefit payments as promised to 
coal miners, their widows, and dependents.

     Division of Energy Employees Occupational Illness Compensation


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $64,564,000
Budget estimate, 2024...................................      66,532,000
Committee recommendation................................      66,532,000

    The Committee recommends $66,532,000 for the Division of 
Energy Employees Occupational Illness Compensation Program 
[EEOICP]. This is a mandatory appropriation for administrative 
expenses for administration of Part B of the Energy Employees 
Occupational Illness Compensation program.
    The Division administers the Energy Employees Occupational 
Illness Compensation Program Act [EEOICPA] (Public Law 106-
398), which provides benefits to eligible employees and former 
employees of the Department of Energy, its contractors and 
subcontractors, or to certain survivors of such individuals. 
The mission also includes delivering benefits to certain 
beneficiaries of the Radiation Exposure Compensation Act 
(Public Law 106-245). The Division is part of OWCP.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2023....................................    $394,896,000
Budget estimate, 2024...................................     452,867,000
Committee recommendation................................     452,867,000

    The bill provides an estimated $452,867,000 as requested 
for this mandatory appropriations account. This estimate is 
comprised of $85,961,000 for administrative expenses and an 
estimated $366,906,000 for benefit payment and interest costs.
    The bill continues to provide indefinite authority for the 
Black Lung Disability Trust Fund to provide for benefit 
payments. The Trust Fund pays all black lung compensation/
medical and survivor benefit expenses when no responsible mine 
operation can be assigned liability or refuses to pay for such 
benefits, as well as all administrative costs that are incurred 
in administering the benefits program and operating the trust 
fund. As proposed in the President's budget, the bill provides 
for transfers from the trust fund for administrative expenses 
for the following Department agencies: up to $44,059,000 for 
the part C costs of the Division of Coal Mine Workers' 
Compensation Programs; up to $41,178,000 for Departmental 
Management, Salaries and Expenses; and up to $368,000 for 
Departmental Management, Inspector General. The bill also 
allows a transfer of up to $356,000 for the Department of the 
Treasury.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $632,309,000
Budget estimate, 2024...................................     738,668,000
Committee recommendation................................     628,522,000

    The Committee recommends $628,522,000 for the Occupational 
Safety and Health Administration [OSHA], which is responsible 
for enforcing the Occupational Safety and Health Act of 1970 
(Public Law 91-596) in the Nation's workplaces.
    The Committee continues bill language to allow OSHA to 
retain course tuition and fees for training institute courses 
used for occupational safety and health training and education 
activities in the private sector. The cap established by the 
bill is $499,000 per year, consistent with current law.
    The Committee also continues bill language to exempt farms 
employing 10 or fewer people from the provisions of the 
Occupational Safety and Health Act, with the exception of those 
farms having a temporary labor camp. The exemption of small 
farming operations from OSHA regulation has been in place since 
1976. OSHA clarified the limits of its authority under the 
appropriations rider to conduct enforcement on small farms in 
July 2014, particularly regarding post-harvest activities of a 
farming operation. It is also important the Department of 
Agriculture and National Institute for Occupational Safety and 
Health are consulted in any future attempt by OSHA to redefine 
or modify any aspect of the small farm exemption. The Committee 
also continues language exempting employers with fewer than 10 
employees in industry classifications having a lost workday 
injury rate less than the National average from general 
schedule safety inspections, except for the small farms covered 
by the broader exemption.
    State Plan States.--The Committee recommends $120,000,000 
for grants to States under section 23(g) of the Occupational 
Safety and Health Act (Public Law 91-596). These funds 
primarily are provided to States that have taken responsibility 
for administering their own occupational safety and health 
programs for the private sector and/or the public sector. State 
plans must be at least as effective as the Federal program and 
are monitored by OSHA. The bill continues language that allows 
OSHA to provide grants of up to 50 percent for the costs of 
State plans approved by the agency.
    Workplace Violence in Healthcare and Social Services.--A 
survey in 2019 reported one in four nurses were assaulted at 
work, with more recent data showing physical and verbal 
violence against healthcare workers continuing to rise. The 
Healthcare and Social Assistance industry sector includes 
nearly 21 million employees and these workers face an increased 
risk of workplace violence that is nearly six times that of 
workers in all other industries. This violence dramatically 
impacts nurse well-being and burnout. It exacerbates the nurse 
staffing crisis and affects the quality of patient care. The 
Committee notes OSHA's progress to release a workplace violence 
prevention standard for healthcare and social assistance. The 
Committee requests that OSHA describe in its fiscal year 2025 
CJ progress made toward and timeline for publishing a final 
rule, and the agency's implementation plan, including related 
training and support for Compliance Safety and Health Officers.
    Compliance Assistance.--The Committee continues language 
requiring OSHA to dedicate no less than $3,500,000 for 
administering the Voluntary Protection Program [VPP] in its 
Federal Compliance Assistance budget. OSHA shall not reduce 
funding levels or the number of employees administering the 
VPP, the Safety and Health Achievement Recognition Program, or 
Federal Compliance Assistance, and shall not collect any monies 
from participants for the purpose of administering these 
programs.
    The Committee recommendation also includes $10,000,000 for 
the OSHA Susan Harwood Training Grant program. The Committee 
adopts language proposed in the President's budget to eliminate 
the set-aside for Capacity Building Developmental grants. The 
Committee understands OSHA intends to continue to offer a 
funding opportunity for such grant types, as well as those for 
Targeted Topic and Training and Educational Materials. The 
Committee urges OSHA to prioritize these funds to support non-
profit, community-based groups and other non-profit 
organizations with the capability to reach and effectively 
train vulnerable workers in low-wage industries and workers in 
dangerous industries.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $387,816,000
Budget estimate, 2024...................................     438,094,000
Committee recommendation................................     387,816,000

    The Committee recommendation includes $387,816,000 for the 
Mine Safety and Health Administration [MSHA].
    MSHA enforces the Federal Mine Safety and Health Act 
(Public Law 91-173) 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.
    The Committee continues language authorizing MSHA to use up 
to $2,000,000 for mine rescue and recovery activities. It also 
retains the provision allowing the Secretary 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. To prepare properly for an emergency, the Committee 
also directs MSHA to continue to devote sufficient resources 
toward a competitive grant activity for effective emergency 
response and recovery training in various types of mine 
conditions.
    In addition, bill language continues to allow the National 
Mine Health and Safety Academy to collect not more than 
$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 $2,499,000 from fees collected for the approval 
and certification of equipment, materials, and explosives for 
use in mines, and to utilize such sums for these activities.
    The Committee continues to emphasize the importance of mine 
safety enforcement, and instructs MSHA to fully implement the 
requirements of Section 103 of the Federal Mine Safety and 
Health Act of 1977 (Public Law 91-173). MSHA shall make 
inspections of each underground coal mine in its entirety at 
least four times a year and each surface coal or other mine in 
its entirety at least two times a year. Further, MSHA shall 
fully and effectively enforce the Final Rule Reducing Miners' 
Exposure to Coal Dust and not use any funds to weaken or 
eliminate the Final Rule Lowering Miners' Exposure to 
Respirable Coal Mine Dust.
    Respirable Crystalline Silica Standard [RCS].--The 
Committee is aware of numerous reports from recent years 
indicating concerning trends in black lung cases, particularly 
in central Appalachia. According to these studies, one in every 
five miners with 25 years or more experience has black lung. In 
many of these miners, the disease has progressed to its most 
severe stage as a result of coal and silica dust inhalation. 
The administration's June 2023 Notice of Proposed Rulemaking to 
address the existing permissible exposure limit of RCS for all 
miners and to update the existing respiratory protection 
standards for miner exposure to RCS is an important step in 
helping reverse these troubling trends. The Committee directs 
MSHA to provide regular updates on progress toward a final 
rule.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $697,952,000
Budget estimate, 2024...................................     758,370,000
Committee recommendation................................     697,952,000

    The Committee recommends $697,952,000 for the Bureau of 
Labor Statistics [BLS]. This amount includes $68,000,000 from 
the Employment Security Administration account of the 
Unemployment Trust Fund and $629,952,000 in Federal funds.
    BLS is the principal fact finding agency in the Federal 
Government in the broad field of labor economics. The Committee 
recognizes that the Nation requires current, accurate, detailed 
workforce statistics for Federal and non-Federal data users as 
provided by BLS. This should include, to the extent 
practicable, appropriate methods to gather data on sexual 
orientation, gender identity, and variations on sex 
characteristics.
    National Longitudinal Survey of Youth.--The Committee 
continues to recognize the importance of the National 
Longitudinal Survey of Youth [NLSY], which has provided 
valuable information about labor market trends for decades. The 
Committee maintains current funding for the purposes of 
continuing to plan and develop the new NLSY cohort established 
by the Further Consolidated Appropriations Act, 2020 and 
maintained in the last three fiscal years.
    The Committee expects BLS will develop an appropriate 
methodology that will maintain continuity in key measurements 
across the cohorts, which will be of value to understanding our 
changing economy and society. The Committee intends for the 
funds to be used to support continued planning and development 
of the new cohort and, specifically in fiscal year 2024, on 
design efforts, including methodological areas such as 
sampling, survey operations, content determinations, 
questionnaire and materials development, dissemination 
planning, and systems work. The Committee expects BLS to 
continue fielding the NLSY79 and NLSY97 cohorts and maintain 
the current design, methodology, and data quality. Further, BLS 
shall brief the Committees on its plans for executing these 
directives and carrying out its implementation of the new NLSY 
cohort 5-year plan without delay.
    Worker Sentiment Survey.--The Committee recognizes there is 
a lack of available information about the feelings employed 
workers have about the economy, their job satisfaction, and 
opportunities for growth and advancement. Better understanding 
worker sentiment could provide important insights into 
workplaces and the economy and help shape better worker-focused 
policies for the future. The Committee request BLS provide 
recommendations for such a survey program and an estimated 
budget for development and annual operating costs in the fiscal 
year 2025 CJ. The Committee requests BLS work with the Census 
Bureau on how to integrate questions into current surveys and 
collections that would provide information on worker sentiment 
on a monthly basis and jointly report to the Committee not 
later than 180 days after enactment the options and costs for 
such a monthly data collection.
    Non-Profit Employment and Wage Data.--The Committee 
recognizes the importance of the non-profit sector workforce as 
a critical partner to government and a frontline service 
provider in communities nationwide. The Committee directs BLS 
to report in its fiscal year 2025 CJ the cost and operational 
steps necessary to provide distinct, public, and quarterly data 
on non-profit employment. Covered non-profit data should 
include the number of establishments, employment figures, and 
average worker wages at the National, State, county, and 
metropolitan area, and be provided by field and major subfield. 
Specifically, the report shall analyze the cost and steps for 
including this data as part of the BLS Quarterly Census of 
Employment and Wages program.

                 Office of Disability Employment Policy

Appropriations, 2023....................................     $43,000,000
Budget estimate, 2024...................................      60,549,000
Committee recommendation................................      37,000,000

    The Committee recommends $37,000,000 for the Office of 
Disability Employment Policy [ODEP] to provide leadership, 
develop policy and initiatives, support technical assistance 
and implementation and award grants furthering the objective of 
eliminating physical and programmatic barriers to the training, 
labor force participation and employment of people with 
disabilities and to design and implement research and technical 
assistance grants and contracts that support the transition to 
competitive, integrated employment for youth and adults with 
disabilities. The bill includes requested language continuing 
to allow not less than $9,000,000 to be used for research and 
demonstration projects related to testing effective ways to 
promote greater labor force participation of people with 
disabilities. These funds may be transferred to the ``State 
Unemployment Insurance and Employment Service Operations'' 
account for such purpose. The Committee requests notification 
at least 14 days prior to any such transfer.

                        Departmental Management


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $392,197,000
Budget estimate, 2024...................................     545,524,000
Committee recommendation................................     392,697,000

    The Committee recommendation includes $392,697,000 for the 
Departmental Management account. Of this amount, $392,389,000 
is available from general funds and $308,000 is available by 
transfer from the Employment Security account of the 
Unemployment Trust Fund. In addition, $41,178,000 is available 
by transfer from the Black Lung Disability Trust Fund.
    The Departmental Management appropriation pays the salaries 
and related expenses of 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 appropriations for salaries and 
expenses are not suitable.
    Preventing Exploitative Child Labor.--The Committee 
recommendation supports further efforts to combat exploitative 
child labor and violations of child labor provisions of the 
Fair Labor Standards Act and work with employers to remove 
child labor from their supply chains. The Secretary is directed 
to report to the Committees not later than 45 days after the 
end of the fiscal year on the Department's efforts to enforce 
child labor provisions of the FLSA with particular focus on 
hazardous occupations, child labor trafficking and child labor 
exploitation, including by reporting for fiscal year 2023 and 
2024: enforcement resources expended by agency including on 
child labor enforcement; the number of concluded cases and 
violations by industry; the number and type of enforcement 
actions imposed by industry, including the number of employers 
held liable for child labor violations; the number of referrals 
to other agencies for support or legal services for effected 
children and youth and the number of criminal referrals for 
violations of child labor provisions.
    The Committee recognizes the efforts of the Department to 
increase collaboration to robustly enforce Federal child labor 
laws. The Committee directs the agency to continue to review 
and evaluate current enforcement efforts, rescind harmful 
regulations and sub-regulatory guidance that impede 
coordination, and ensure all parts of the Department are using 
the tools and policies at their disposal to combat this crisis. 
This includes robust coordinated outreach and education to 
rebuild trust in government enforcement, and bolstering data 
collection. The Committee requests the Department to describe 
in the fiscal year 2025 CJ steps taken and planned to fulfill 
this directive.
    Bureau of International Labor Affairs [ILAB].--The 
Committee recommendation includes $116,125,000 for the Bureau 
of International Labor Affairs [ILAB] to carry out its 
statutory responsibilities, of which $81,725,000 is available 
for obligation through December 31, 2024. These funds are in 
addition to the supplemental appropriations for ILAB in Public 
Law 116-113, the United States-Mexico-Canada Agreement 
Implementation Act, for its responsibilities under that law.
    ILAB's appropriation is available to help improve working 
conditions and labor standards for workers around the world by 
carrying out ILAB's statutory mandates and international 
responsibilities, including in promoting the elimination of the 
worst forms of child labor and forced labor. ILAB works to 
ensure workers and businesses in the United States are not put 
at a competitive disadvantage by trading partner countries not 
adhering to their labor commitments under trade agreements and 
trade preference programs. The bill continues language setting 
aside funding for grants, contracts and other arrangements for 
technical assistance on worker rights and for combatting child 
labor, with no less than $30,175,000 available for worker 
rights programs and no less than $30,175,000 for combatting 
exploitative child labor internationally. This flexibility will 
allow ILAB to target additional resources where conditions on 
the ground and other factors create the greatest opportunities 
to make significant progress on these issues and maintain a 
robust level of support for both critically important 
activities.
    The Department shall report on plans for and uses of all 
funds available to DOL in the United States-Mexico-Canada 
Agreement Implementation Act (Public Law 116-113) in the fiscal 
year 2025 and subsequent year CJs. Such plans and updates shall 
also include information on how funds are being used for 
monitoring, oversight, and technical assistance in support of 
the purposes of such act, including Mexico's implementation of 
nationwide labor reforms and compliance with labor obligations.
    The Committee continues to support the critical role ILAB 
plays in working to eradicate child labor, forced labor, and 
human trafficking, including through its research and reporting 
in its Findings on the Worst Forms of Child Labor, List of 
Goods Produced by Child Labor or Forced Labor, List of Products 
Produced by Forced or Indentured Child Labor. The appropriation 
will support continued publication of these important reports, 
including the tracking of goods through supply chains and 
identifying inputs made with child and forced labor.
    Evaluation, and Evidence-Building and Use.--The Committee 
recommendation provides $4,281,000 for program evaluation and 
allows these funds to be available for obligation through 
September 30, 2025. The Committee bill also continues the 
authority of the Secretary to transfer these funds to any other 
account in the Department for evaluation purposes. The 
Committee bill continues authority to use up to 0.75 percent of 
certain Department appropriations for evaluation activities 
identified by the chief evaluation officer. The Committee 
expects to be notified of the planned uses of funds derived 
from this authority.
    Foundation for Evidence-Based Policymaking Act.--The 
Committee continues to believe that the execution of the 
Foundations for Evidence-Based Policymaking Act will enhance 
the evidence-building capacity of Federal agencies, strengthen 
privacy protections, improve secure access to data, and provide 
more and higher quality evidence to policymakers. Therefore, 
the Committee directs the Department to continue to include in 
the fiscal year 2025 and future CJs updates on the 
implementation and planned implementation of such act for the 
current and future budget years.
    Women's Bureau.--The Committee recommendation provides 
$23,000,000 for the Women's Bureau. The Committee continues 
bill language allowing the Bureau to award grants, including 
not less than $5,000,000 for grants authorized by the Women in 
Apprenticeship and Nontraditional Occupations Act. The 
Committee is particularly supportive of the Bureau's plans to 
expand WANTO grants and continue to support paid leave 
programs.
    Paid Family Leave Tax Credit Awareness.--The Committee 
encourages WB to begin coordinating a campaign designed to 
increase awareness of tax credits for paid family and medical 
leave authorized under section 45S of the Internal Revenue Code 
of 1986 and similar provisions. The Committee directs the 
Department to submit a report within 180 days after enactment 
on the progress of the awareness campaign.
    Voting-Related Activities.--The Committee directs the 
Secretary to brief the House and Senate Committees on 
Appropriations no later than 90 days after enactment of this 
act regarding any strategic plans developed by the Department 
over the three prior fiscal years outlining the ways that the 
Department has promoted voter registration, and voter 
participation.

                   VETERANS' EMPLOYMENT AND TRAINING

Appropriations, 2023....................................    $335,341,000
Budget estimate, 2024...................................     347,627,000
Committee recommendation................................     335,341,000

    The Committee recommendation of $335,341,000 for the 
Veterans' Employment and Training Service [VETS] includes 
$65,500,000 in general revenue funding and $269,841,000 to be 
expended from the Employment Security Administration account of 
the Unemployment Trust Fund.
    This account provides resources for VETS to maximize 
employment opportunities for veterans and transitioning service 
members, including protecting their employment rights. VETS 
carries out its mission through a combination of grants to 
States, competitive grants, and Federal enforcement and 
oversight.
    The Committee provides $185,000,000 for the Jobs for 
Veterans State Grants [JVSG] program. This funding will enable 
Disabled Veterans' Outreach Program specialists and Local 
Veterans' Employment Representatives to continue providing 
intensive employment services to veterans and eligible spouses; 
transitioning service members early in their separation from 
military service; wounded warriors recuperating in military 
treatment facilities or transition units; and spouses and 
family caregivers to help ensure the family has income to 
provide sufficient support. The Committee maintains language 
providing authority for JVSG funding to be used for data 
systems and contract support to allow for the tracking of 
participant and performance information.
    The Committee provides $34,379,000 for the Transition 
Assistance Program [TAP] to support apprenticeship 
opportunities and employment workshops at military 
installations, and in virtual classrooms, worldwide for exiting 
service members and spouses.
    The Committee recommendation includes $47,048,000 for 
Federal administration costs. This funding level will support 
oversight and administration of the VETS grant programs, TAP 
employment workshops, and compliance and enforcement 
activities.
    The Committee recommends $65,500,000 for the Homeless 
Veterans' Reintegration Program [HVRP] to help homeless 
veterans attain the skills they need to gain meaningful 
employment. The bill allows Incarcerated Veterans' Transition 
funds to be awarded to serve veterans who have recently been 
released from incarceration but are at risk of homelessness.
    The Committee recommendation includes $3,414,000 for the 
National Veterans' Training Institute, which provides training 
to Federal staff and veteran service providers.
    The Committee recommendation includes $500,000 to support 
the HIRE Vets Medallion program.

                  INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2023....................................     $34,269,000
Budget estimate, 2024...................................      79,193,000
Committee recommendation................................      29,269,000

    The Committee recommends $29,269,000 for the Information 
Technology [IT] Modernization account. Funds available in this 
account have been used for two primary activities. The first is 
departmental support systems, for which $6,889,000 is provided. 
The second activity, IT Infrastructure Modernization, is 
provided $22,380,000 to support necessary activities associated 
with the Federal Data Center Consolidation Initiative and other 
efforts. These funds are available for obligation through 
September 30, 2025.
    The Committee continues to request that the Department 
submit a report to the Committees on Appropriations not later 
than 90 days after enactment of this act that provides an 
update on projects to be funded, planned activities and 
associated timelines, expected benefits, and planned 
expenditures. The report should also include completed 
activities, remaining activities and associated timelines, 
actual and remaining expenditures, explanation of any cost 
overruns and delays, and corrective actions, as necessary, to 
keep the project on track and within budget.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2023....................................     $97,028,000
Budget estimate, 2024...................................     111,280,000
Committee recommendation................................      97,028,000

    The Committee recommends $97,028,000 for the DOL Office of 
the Inspector General. The bill includes $91,187,000 in general 
funds and authority to transfer $5,841,000 from the Employment 
Security Administration account of the Unemployment Trust Fund. 
In addition, an amount of $368,000 is available by transfer 
from the Black Lung Disability Trust Fund. The bill continues 
to allow up to $2,000,000 of the appropriation to be available 
until expended.
    Through a comprehensive program of audits, investigations, 
inspections, and program evaluations, the Inspector General 
attempts to reduce the incidence of fraud, waste, abuse, and 
mismanagement, and to promote economy, efficiency, and 
effectiveness.

                           General Provisions

    Section 101. The bill continues a provision limiting the 
use of Job Corps funding for compensation of an individual that 
is not a Federal employee at a rate not to exceed Executive 
Level II.
    Section 102. The bill continues a provision providing for 
general transfer authority.
    Section 103. The bill continues a provision prohibiting 
funding for the procurement of goods and services utilizing 
forced or indentured child labor in industries and host 
countries already identified by the Department in accordance 
with Executive Order 13126.
    Section 104. The bill continues a provision requiring that 
funds available under section 414(c) of the American 
Competitiveness and Workforce Improvement Act (Public Law 106-
313) may only be used for competitive grants that train 
individuals over the age of 16 who are not enrolled in school, 
in occupations and industries for which employers are using H-
1B visas to hire foreign workers.
    Section 105. The bill continues a provision limiting the 
use of the Employment and Training Administration [ETA] funds 
by a recipient or subrecipient for compensation of an 
individual at a rate not to exceed Executive Level II.
    Section 106. The bill modifies a provision regarding 
transfer authority related to funds for technical assistance 
and program integrity.
    Section 107. The bill continues a provision allowing up to 
0.75 percent of discretionary appropriations provided in this 
act for all Department agencies to be used by the Office of the 
Chief Evaluation Officer for evaluation purposes consistent 
with the terms and conditions in this act applicable to such 
office.
    Section 108. The bill continues a longstanding provision 
regarding the application of the Fair Labor Standards Act 
(Public Law 74-718) after the occurrence of a major disaster.
    Section 109. The bill continues a longstanding provision 
that provides flexibility with respect to the crossing of H-2B 
nonimmigrants.
    Section 110. The bill continues a provision related to the 
wage methodology under the H-2B program.
    Section 111. The bill continues a provision regarding the 
three-fourths guarantee and definitions of corresponding 
employment and temporary need for purposes of the H-2B program.
    Section 112. The bill continues a provision providing 
authority related to the disposition of excess property related 
to the training of apprentices.
    Section 113. The bill continues a provision related to the 
Secretary's security detail.
    Section 114. The bill continues a provision related to Job 
Corps property.
    Section 115. The bill continues a provision related to Job 
Corps Civilian Conservation Centers.
    Section 116. The bill modifies a provision rescinding funds 
from the H-1B program.
    Section 117. The bill includes a new provision rescinding 
certain funds available to the Employment and Training 
Administration.
    Section 118. The bill includes a new provision regarding 
the provision of technical assistance.
    Section 119. The bill includes a new provision extending 
the period to liquidate obligations for construction of the 
Atlanta Job Corps center.

                                TITLE II

                DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Any references in this title of the report to the 
``Secretary'' or the ``Department'' shall be interpreted to 
mean the Secretary of HHS or the Department of HHS, 
respectively, unless otherwise noted.

              Health Resources and Services Administration

    The Health Resources and Services Administration [HRSA] 
activities support programs to provide healthcare services to 
disadvantaged, medically underserved, and special populations; 
mothers and infants; the elderly and homeless; and rural 
communities. HRSA supports cooperative programs in maternal and 
child health, AIDS care, healthcare provider training, and 
healthcare delivery systems and facilities.

                     BUREAU OF PRIMARY HEALTH CARE

Appropriations, 2023....................................  $1,858,772,000
Budget estimate, 2024...................................   1,938,772,000
Committee recommendation................................   1,858,772,000

Community Health Centers

    The Committee provides $1,858,772,000 for the Bureau of 
Primary Health Care. Programs supported by this funding include 
community health centers, migrant health centers, healthcare 
for the homeless, school-based, and public housing health 
service grants. The Committee continues to support the ongoing 
effort to increase the number of people who have access to 
medical services at health centers. Health centers play a vital 
role in ensuring access to primary care in underserved areas of 
the country, including urban, rural, and frontier areas.
    In addition, within the amount provided, the Committee 
provides up to $120,000,000 under the Federal Tort Claims Act 
[FTCA] (Public Law 102-501 and Public Law 104-73), available 
until expended. These funds are used to pay judgments and 
settlements, occasional witness fees and expenses, and related 
administrative costs. The Committee intends FTCA coverage 
funded through this bill to be inclusive of all providers, 
activities, and services included within the health centers' 
federally approved scope of project.
    Addressing Intimate Partner Violence and Project 
Catalyst.--The Committee includes no less than $2,000,000 for 
the HRSA Strategy to Address Intimate Partner Violence.
    Alzheimer's Disease.--Little is known about people with 
Alzheimer's disease and related forms of dementia served by 
HRSA funded health centers and look-alikes in the CHC program 
due to the lack of available data. Data is essential to 
understanding the level of need, resources, training and 
challenges needed to keep people currently served in the CHC 
programs as they continue to age. The Committee strongly 
encourages HRSA to include Alzheimer's and related Dementia 
ICD-10 codes in the Uniform Data Collection System.
    Brain Health Equity Initiative.--The Committee urges HRSA 
to establish a Brain Health Equity initiative to help drive the 
integration of brain health services into the workflow of 
primary care delivery that reaches underserved populations 
served by HRSA funded health centers and look-alikes.
    Children's Mental Health Services.--The Committee continues 
to urge HRSA to provide funding to Health Centers to support 
vital mental health services for children.
    Early Childhood Development.--The Committee continues no 
less than $30,000,000 to further integrate early childhood 
development services and expertise, including by hiring or 
contracting for early childhood development specialists.
    Ending the HIV Epidemic.--The Committee provides 
$157,250,000 within the health centers program for the Ending 
the HIV Epidemic initiative. The initiative provides funding to 
Health Centers in high-need jurisdictions to increase 
prevention and treatment services for people at high risk for 
HIV transmission, including Pre-Exposure Prophylaxis [PrEP] 
related services, outreach, and care coordination through new 
grant awards in areas currently served by health centers.
    Free Clinics Medical Malpractice Coverage.--The Committee 
provides $1,000,000 for payments of claims under the FTCA to be 
made available for free clinic health professionals as 
authorized by section 224(o) of the Public Health Service [PHS] 
Act (Public Law 104-73). This appropriation extends FTCA 
coverage to medical volunteers in free clinics to expand access 
to healthcare services to low-income individuals in medically 
underserved areas.
    Native Hawaiian Health Care.--The Committee includes no 
less than $27,000,000 for the Native Hawaiian Health Care 
Program. Of the total amount appropriated for the Native 
Hawaiian Health Care Program, not less than $10,000,000 shall 
be provided to Papa Ola Lokahi for administrative purposes 
authorized under 42 U.S.C. 11706, including to coordinate and 
support healthcare service provision to Native Hawaiians and 
strengthen the capacity of the Native Hawaiian Health Care 
Systems to provide comprehensive health education and 
promotion, disease prevention services, traditional healing 
practices, and primary health services to Native Hawaiians.
    School-Based Health Centers [SBHCs].--The Committee 
includes $55,000,000 for awards to Health Centers operating 
school-based service sites under section 330 of the Public 
Health Service [PHS] Act to increase their capacity to meet the 
increasing demand for health services, including mental health 
services.
    Technical Assistance.--The Committee believes funding for 
the training and technical assistance available for health 
centers through national and State cooperative agreements and 
grants is critical to the successful operation and expansion of 
the health centers program. Funds are available within the 
amount provided to enhance technical assistance and training 
activities and further quality improvement initiatives that 
improve health outcomes.
    Vaccination and Screening for Hepatitis B.--The Committee 
encourages HRSA to redouble its efforts to support health 
center grantees to adopt the necessary practices and policies 
to comply with the November 2021 Advisory Committee on 
Immunization Practices [ACIP] recommendation that all adults 
between 19 and 59 be vaccinated and March 2023 ACIP 
recommendation that all adults between 19 and 59 be screened 
for hepatitis B. To implement these policies, the Committee 
further encourages HRSA to ensure that health centers screen 
patients aged 19-59 for hepatitis B, offer to immunize all non-
infected patients in the 19-59 age cohort, and navigate 
infected individuals into care. The Committee requests an 
update from HRSA before the end of fiscal year 2024 of its 
progress to meet this goal, including the number of individuals 
screened and number of individuals vaccinated for hepatitis B 
at HRSA-funded health centers.

                       BUREAU OF HEALTH WORKFORCE

Appropriations, 2023....................................  $1,390,376,000
Budget estimate, 2024...................................   1,747,486,000
Committee recommendation................................   1,391,376,000

    The Bureau of Health Workforce provides policy leadership 
and grant support for health professions workforce development. 
The mission of the Bureau is to identify shortage areas while 
working to eliminate them. Its programs are intended to ensure 
that the Nation has the right clinicians, with the right 
skills, working where they are needed.
    The Committee also encourages HRSA to conduct outreach, 
provide technical assistance, and give priority in awarding 
cooperative agreements and grants to entities in high poverty 
areas and historically marginalized communities. The Committee 
encourages HRSA to work with these communities to develop their 
mental health workforce and requests an update in the fiscal 
year 2025 CJ on best practices and strategies to attract mental 
healthcare practitioners to these disproportionately impacted 
communities.

National Health Service Corps

    The Committee provides $128,600,000 for the National Health 
Service Corps [Corps], an increase of $3,000,000 above the 
fiscal year 2023 enacted level. The Committee recognizes the 
success of the Corps program in building healthy communities in 
areas with limited access to care. The program has shown 
increases in retention of healthcare professionals located in 
underserved areas.
    Within this total, the Committee continues support for 
access to quality opioid and substance use disorder [SUD] 
treatment in rural and underserved areas nationwide. The 
Committee continues language that expands eligibility for loan 
repayment awards through the Corps to include SUD counselors. 
The Committee also continues to include section 206 of this act 
to modify the rules governing the Corps to allow every Corps 
member 60 days to cancel their contract. The Committee 
recognizes the importance of the National Health Service Corps 
scholarship and loan-repayment programs with Corps members in 
all 50 States. Therefore, the Committee encourages HRSA to 
ensure that no State has fewer than five National Health 
Service Corps awardees in fiscal year 2024 and shall give 
preference to individuals working in their home State or the 
State in which they received their education.
    Maternity Care Target Areas [MCTAs].--The Committee 
recognizes HRSA's progress in determining MCTAs in order to 
begin making loan repayment awards to maternal health 
practitioners, such as OB/GYNs and Certified Nurse Midwives, 
who agree to serve in MCTAs. Within the total for the Corps, 
the Committee includes $8,000,000, an increase of $3,000,000 
above fiscal year 2023, to support loan repayment and 
scholarships for maternity care health services in health 
professional shortage areas. The Committee requests that HRSA 
provide a briefing for the Senate Committee on Appropriations 
on this effort within 120 days of enactment of this act.
    Rural Health Equity.--The Committee recognizes the 
importance of the Corps Scholarship Program, especially in 
combatting the rural healthcare provider shortage, and 
recommends that HRSA increase the number of scholarships 
provided. Providing NHSC scholarships, particularly to students 
from rural communities, will increase equitable access to 
medical school and help to solve the rural provider workforce 
shortages throughout the United States.

Training for Diversity

    The Committee supports programs that improve the diversity 
of the healthcare workforce. HRSA's diversity pipeline programs 
help advance patient care and ensure opportunity for all 
healthcare providers.

Centers of Excellence

    The Committee recommends $28,422,000 for the Centers of 
Excellence Program. This program provides grants to health 
professions schools and other institutions to serve as resource 
and education centers for the recruitment, training, and 
retention of underrepresented minority students and faculty. 
The Committee notes that COEs educate a disproportionate share 
of health professionals from minority and underserved 
backgrounds and address the need for a diverse and culturally 
competent healthcare workforce.

Health Careers Opportunity Program

    The Committee includes $16,000,000 for the Health Careers 
Opportunity Program [HCOP]. The Committee notes that HCOPs 
assist students from minority and economically disadvantaged 
backgrounds navigate careers into the health professions.

Faculty Loan Repayment

    The Committee provides $2,310,000 for the Faculty Loan 
Repayment Program. This program provides loan repayment to 
health profession graduates from disadvantaged backgrounds who 
serve as faculty at eligible health professions academic 
institutions.

Scholarships for Disadvantaged Students

    The Committee provides $55,014,000 for Scholarships for 
Disadvantaged Students. This program provides grants to 
eligible health professions and nursing schools to award 
scholarships to students from disadvantaged backgrounds who 
have financial need.

Primary Care Training and Enhancement

    The Committee provides $49,924,000 for the Primary Care 
Training and Enhancement [PCTE] program to support the 
expansion of training in internal medicine, family medicine, 
and pediatrics. Funds may be used to develop training programs 
or provide direct financial assistance to students and 
residents.
    Administrative Academic Units.--Funding of academic 
administrative units, such as medical school departments and 
divisions, under the PCTE program has been a critical part of 
the program both in its role in medical student selection of 
primary care training programs and in facilitating scholarly 
activity in departments of family medicine. The Committee 
directs HRSA to maintain this funding and to continue funding 
opportunities to support administrative academic units within 
medical schools.
    Eating Disorders Screening and Referrals.--Within the total 
for PCTE, the Committee continues to support up to $1,000,000 
in coordination with SAMHSA's Center of Excellence for Eating 
Disorders, to provide trainings for primary care health 
professionals to screen, intervene, and refer patients to 
treatment for the severe mental illness of eating disorders, as 
authorized under section 13006 of the 21st Century Cures Act 
(Public Law 114-255).

Training in Oral Health Care

    The Committee provides $42,673,000 for Training in Oral 
Health Care programs, which includes not less than $13,000,000 
for General Dentistry Programs and not less than $13,000,000 
for Pediatric Dentistry Programs, and not less than $14,000,000 
for State Oral Health Workforce grants. The Committee directs 
HRSA to provide continuation funding for section 748 post-
doctoral training grants, predoctoral dental grants, and dental 
faculty loan repayment program [DFLRP] grants. The Committee 
directs HRSA to initiate a new DFLRP grant cycle with a 
preference for pediatric dentistry faculty supervising dental 
students or residents and providing clinical services in dental 
clinics located in dental schools, hospitals, and community-
based affiliated sites.

Medical Student Education

    The Committee recommends $36,000,000 to support colleges of 
medicine at public universities located in the top quintile of 
States projected to have a primary care provider shortage in 
2025. The Committee notes that this program has significant 
unspent balances from previous fiscal year appropriations that 
will continue to be available to public universities that meet 
the program criteria.

Interdisciplinary, Community-Based Linkages

Area Health Education Centers

    The Committee provides $47,000,000 for Area Health 
Education Centers [AHECs]. The 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 AHEC grants; 
and model programs to extend AHEC programs with 50 percent 
Federal funding.
    Health Care Simulation Labs.--The Committee provides no 
less than $3,000,000 to continue competitive grants for AHEC 
recipients to expand experiential learning opportunities 
through simulation labs designed to educate and train 
healthcare professionals serving rural, medically underserved 
communities. HRSA shall include as an allowable use the 
purchase of simulation training equipment.

Behavioral Health Workforce Education and Training Program

    The Committee provides $172,000,000 for Behavioral Health 
Workforce Education and Training [BHWET] program, $19,000,000 
above the fiscal year 2023 enacted level. This program 
establishes and expands internships or field placement programs 
in behavioral health serving populations in rural and medically 
underserved areas.
    Addiction Medicine Fellowship Program [AMF].--Within the 
total for BHWET, The Committee includes $30,000,000 for AMF to 
foster robust community-based clinical training of addiction 
medicine or addiction psychiatry physicians in underserved, 
community-based settings who see patients at various access 
points of care and provide addiction prevention, treatment, and 
recovery services across healthcare sectors.
    Peer Support Specialists.--Within BHWET, the Committee 
includes $16,000,000 to fund training, internships, and 
national certification for mental health and substance abuse 
peer support specialists to create an advanced peer workforce 
prepared to work in clinical settings.
    Substance Use Disorder Treatment and Recovery [STAR] Loan 
Repayment Program.--The Committee also includes $52,000,000 for 
this program within the total for BHWET. This program addresses 
shortages in the SUD workforce by providing for the repayment 
of education loans for individuals working in a full-time SUD 
treatment job that involves direct patient care in either a 
Mental Health Professional Shortage Area or a county where the 
overdose death rate exceeds the National average. The Committee 
also encourages HRSA to actively recruit SUD counselors to take 
advantage of its STAR Loan Repayment Program, so that 
underserved communities may benefit from the presence of these 
professionals.

Geriatric Workforce Enhancement Program

    The Committee provides $48,245,000 for the Geriatric 
Workforce Enhancement Program. This program supports training 
to integrate geriatrics into primary care delivery and develops 
academic primary care community based partnerships to address 
gaps in healthcare for older adults.

Mental and Behavioral Health Programs

    The Committee includes $44,053,000 for Mental and 
Behavioral Health programs.
    Graduate Psychology Education [GPE].--Within the total for 
Mental and Behavioral Health programs, the Committee includes 
$25,000,000 for the inter-professional GPE program to increase 
the number of health service psychologists trained to provide 
integrated services to high-need, underserved populations in 
rural and urban communities. The Committee recognizes the 
growing need for highly trained mental and behavioral health 
professionals to deliver evidence-based behavioral 
interventions for pain management in addressing the opioid 
epidemic. The Committee also notes new data from CDC 
demonstrating a mental health crisis among youth and 
adolescents and urges HRSA to strengthen investments in the 
training of health service psychologists to help meet these 
demands.

Health Professions Workforce Information and Analysis

    The Committee provides $5,663,000 for health professions 
workforce information and analysis. The program provides for 
the collection and analysis of targeted information on the 
Nation's healthcare workforce, research on high-priority 
workforce questions, the development of analytic and research 
infrastructure, and program evaluation and assessment.
    U.S. Healthcare Workforce Analysis.--The Committee 
recognizes that the U.S. healthcare workforce, including 
physicians and nurses, is a critical national resource that 
requires up-to-date, accurate analysis of current trends and 
projections for future workforce needs. This data may inform 
recruiting and training practices to ensure an adequate supply 
of medical professionals in medically underserved areas. 
However, current data streams do not provide real-time insight 
into the health care workforce supply pipeline. The Committee 
directs HRSA to submit a report to the Committees of 
jurisdiction, not later than 12 months from the date of 
enactment of this act, providing data on: how the training and 
supply pipeline is matched against health workforce 
projections; whether any capability gaps exist; how regional 
conditions impact local and regional supply; what information 
is needed to implement the use of such data going forward; and 
if there are existing resources available to access that data 
more expediently.

Public Health Workforce Development

    The Committee provides $18,000,000 for Public Health 
Workforce Development. This program line, also called Public 
Health and Preventive Medicine, funds programs that are 
authorized in titles III and VII of the PHS Act (Public Law 
111-148) and supports awards to schools of medicine, 
osteopathic medicine, public health, and integrative medicine 
programs.

Nursing Workforce Development Programs

    The Committee provides $302,472,000 for Nursing Workforce 
Development programs. These programs provide funding to address 
all aspects of nursing workforce demand, including education, 
practice, recruitment, and retention.
    Native Hawaiian and Pacific Islander Recruitment.--The 
Committee recognizes the importance of striving to ensure 
representation from underrepresented populations in the nursing 
workforce for better care and patient outcomes. The Committee 
also recognizes that nurses of Native Hawaiian and Pacific 
Islander backgrounds represent a far smaller share of 
registered nurses and advanced practice registered nurses than 
their proportional representation in the United States. The 
Committee encourages HRSA to increase efforts to recruit and 
retain graduate and undergraduate nursing students and faculty 
from Native Hawaiian and Pacific Islander backgrounds.
    Palliative Care Nursing Workforce.--Palliative care is 
patient and family-centered care, involving the support of an 
inter-professional team of doctors, nurses, social workers, and 
other providers and specialists who provide care for people 
with serious illnesses. As the healthcare needs of the Nation 
evolve and grow in complexity, the Committee encourages HRSA to 
expand opportunities to train and strengthen the palliative 
care nursing workforce through existing programs and 
activities.

Advanced Education Nursing

    The Committee recommends $89,581,000 for Advanced Education 
Nursing programs, which increase the number of qualified nurses 
in the workforce by improving nursing education through 
curriculum and faculty development. The Committee recognizes 
the importance of strengthening the primary care workforce and 
training providers to work in community-based settings, 
particularly by funding Advanced Nursing Education and 
Residency Programs.
    Certified Nurse Midwives.--The Committee includes 
$8,000,000 to grow and diversify the maternal and perinatal 
nursing workforce by increasing and diversifying the number of 
Certified Nurse Midwives with a focus on practitioners working 
in rural and underserved communities. The program will help 
advance equity and address disparities in maternal mortality by 
awarding scholarships to students and Registered Nurses to 
cover the total cost of tuition for the duration of the nurse 
midwifery program.
    Sexual Assault Nurse Examiners Program.--The Committee 
provides $15,000,000 to support training and certification of 
Registered Nurses, Advanced Practice Registered Nurses, and 
Forensic Nurses to practice as sexual assault nurse examiners.

Nurse Education, Practice, Quality and Retention Program

    The Committee includes $60,413,000 for competitive grants 
within the Nurse Education, Practice, Quality and Retention 
program to enhance nurse education and strengthen the nursing 
workforce through the expansion of experiential learning 
opportunities. Within this total, the Committee continues 
support for grants to enhance nurse education through the 
expansion of experiential learning opportunities. HRSA is 
directed to ensure that these grants include as an allowable 
use the purchase of simulation training equipment.
    Traineeships to Address the Nursing Shortage and Prepare 
Academic Faculty.--The National Academies of Science, 
Engineering, and Medicine [NASEM] recently issued a report that 
provided recommendations to Congress to ease the nursing 
shortage in America. The Committee recognizes the urgent need 
to address the nursing shortage existing in all parts of the 
United States and grow the pipeline of nurse educators to meet 
the demand to grow the workforce. Therefore, the Committee 
encourages HRSA to provide traineeships and fellowships, 
including stipends, for eligible entities at both public and 
private institutions to expand opportunities that prepare 
individuals for careers in nursing.

Nurse Practitioner Fellowship Program

    The Committee provides $6,000,000 for grants to community-
based nurse practitioner residency and fellowship training 
programs that are accredited, or in the accreditation process, 
for practicing postgraduate nurse practitioners in primary care 
or behavioral health, where supported education and training 
specialties will include family, adult family, adult 
gerontology, pediatric, women's healthcare, nurse midwife, and 
psychiatric mental health.

Nurse Corps Scholarship and Loan Repayment

    The Committee includes $92,635,000 for Nurse Corps. This 
program supports scholarships and loan repayment assistance for 
nurses and nursing students committed to working in communities 
with inadequate access to care.

Nurse Faculty Loan Repayment

    The Committee includes $29,500,000 for Nurse Faculty Loan 
Repayment, an increase of $1,000,000, to expand the number of 
qualified nursing faculty nationwide by providing low interest 
loans for individuals studying to be nurse faculty and loan 
cancellation for those who then go on to work as faculty.

Nursing Workforce Diversity

    The Committee includes $24,343,000 for Nursing Workforce 
Diversity to increase nursing education opportunities for 
individuals from disadvantaged backgrounds by providing student 
stipends, scholarships, and preparation and retention 
activities.

Children's Hospitals Graduate Medical Education

    The Committee provides $385,000,000 for the Children's 
Hospitals Graduate Medical Education [CHGME] program. The 
Committee strongly supports the CHGME program, which provides 
support for graduate medical education training programs in 
both ambulatory and in-patient settings within freestanding 
children's teaching hospitals. CHGME payments are determined by 
a per-resident formula that includes an amount for direct 
training costs added to a payment for indirect costs. Payments 
support training of resident physicians as defined by Medicare 
in both ambulatory and inpatient settings.

Pediatric Subspecialty Loan Repayment Program

    The Committee recognizes that significant shortages of 
pediatric medical subspecialists, pediatric surgical 
specialists, child and adolescent psychiatrists, and other 
pediatric mental health professionals is impeding access to 
care for children and adolescents in underserved areas. The 
Committee includes $10,000,000 for section 775 of the PHS Act. 
The Committee understands that high student loan debt is a 
significant barrier to providers choosing to complete training 
that would enable them to provide specialized care to children 
with special needs.

National Practitioner Data Bank

    The Committee provides $18,814,000 for the National 
Practitioner Data Bank. As mandated by the Health Care Quality 
Improvement Act (Public Law 99-660), the National Practitioner 
Data Bank does not receive appropriated funds, but instead is 
financed by the collection of user fees.
    The National Practitioner Data Bank collects certain 
adverse information, medical malpractice payment history, and 
information related to healthcare fraud and abuse. The data 
bank is open to healthcare agencies and organizations that make 
licensing and employment decisions. The Committee is aware that 
limitations may prevent certain healthcare providers, 
especially those who predominantly serve seniors, from 
accessing the National Practitioner Data Bank in a timely 
manner. HRSA shall evaluate opportunities to expand access to 
the National Practitioner Data Bank to all Medicare and 
Medicaid providers, with particular emphasis on providers who 
serve the senior population.

                       MATERNAL AND CHILD HEALTH

Appropriations, 2023....................................  $1,171,430,000
Budget estimate, 2024...................................   1,357,830,000
Committee recommendation................................   1,169,430,000

    The mission of the Bureau is to improve the physical and 
mental health, safety, and well-being of the Nation's women, 
infants, children, adolescents, and their families. This 
population includes fathers and children with special 
healthcare needs.

Maternal and Child Health [MCH] Block Grant

    The Committee provides $603,584,000 for the MCH Block 
Grant, which provides a flexible source of funding that allows 
States to target their most urgent maternal and child health 
needs. Within this total, the Committee also proposes increases 
for a number of special projects to address the Nation's rising 
rate of maternal mortality. The program supports a broad range 
of activities, including providing prenatal care, well-child 
services, and immunizations; reducing infant mortality; 
preventing injury and violence; expanding access to oral 
healthcare; addressing racial and ethnic disparities; and 
providing comprehensive care through clinics, home visits, and 
school-based health programs.
    Stillbirth Prevention Technical Assistance.--Stillbirth 
affects one in 175 pregnancies, with more than 21,000 babies 
stillborn each year. Despite medical advances, the Committee is 
concerned that the rate of early stillbirth has remained 
relatively the same over the past 30 years. The Committee 
directs HRSA to update its materials and guidance to States to 
clarify that stillbirth prevention activities are an allowable 
use of funds under title V, Maternal and Child Health Block 
Grant program. The Committee also urges HRSA to provide 
technical assistance to States and healthcare providers in 
carrying out stillbirth prevention activities.

MCH Block Grant-Special Projects of Regional and National Significance 
        [SPRANS]

    Early Childhood Development Expert Grants.--The Committee 
provides $10,000,000 expand placements of early childhood 
development experts in pediatrician offices with a high 
percentage of Medicaid and Children's Health Insurance Program 
patients.
    Infant-Toddler Court Teams.--The Committee includes 
$18,000,000 to continue and expand research-based Infant-
Toddler Court Teams to change child welfare practices to 
improve well-being for infants, toddlers, and their families.
    Minority-Serving Institutions.--The Committee continues 
$10,000,000 for a research network for minority-serving 
institutions to study health disparities in maternal health 
outcomes and develop curricula for training health 
professionals to identify and address the risks that climate 
change poses for vulnerable individuals and individuals that 
plan to become pregnant.
    Regional Pediatric Pandemic Network.--The Committee 
provides $25,000,000 within SPRANS to continue the work of the 
Regional Pediatric Pandemic Network to coordinate among the 
Nation's pediatric hospitals and their communities to prepare 
for and coordinate research-informed responses to future 
pandemics.
    State Maternal Health Innovation Grants.--The Committee 
provides $55,000,000 to support innovation among States to 
improve maternal health outcomes and address disparities in 
maternal health. With this funding, States collaborate with 
maternal health experts to implement State-specific action 
plans in order to improve access to maternal care services, 
identify and address workforce needs, and support postpartum 
and inter-conception care services.

Maternal and Child Health Programs

Sickle Cell Anemia

    The Committee provides $8,205,000 for grants and contracts 
to help coordinate service delivery for individuals with sickle 
cell disease, including genetic counseling and testing, long-
term follow-up and care coordination, and training of health 
professionals.
    Sickle Cell Disease Data Collection.--The Committee 
recognizes that more than 100,000 Americans have sickle cell 
disease, which disproportionately affects patients of color 
and, every year, over 2,000 infants in the United States are 
born with this condition. Supporting sickle cell disease 
research helps identify and examine barriers to quality care 
services for patients living with sickle cell disease, 
including transportation barriers for patients seeking trained 
specialists in urban and rural communities. The Committee 
directs HRSA to submit a report to the Committee within a year 
of enactment of this act on current Federal efforts to: expand 
data collection through the Sickle Cell Anemia Demonstration 
Program and the Data Coordination Center; support existing 
programs that provide transition support for sickle cell 
disease patients who are aging out of pediatric care and 
receiving adult care; provide training, technical assistance, 
and educational opportunities; support education and advocacy 
programs that engage populations affected by sickle cell 
disease; disseminate information on health and community 
services; and improve access to care and treatment decision-
making processes. The Committee encourages HRSA, in 
collaboration with the National Center for Birth Defects and 
Developmental Disabilities at the CDC, to support sickle cell 
disease surveillance activities.

Autism and Other Developmental Disorders

    The Committee provides $56,344,000 for the Autism and Other 
Developmental Disorders program. The program supports 
surveillance, early detection, education, and intervention 
activities for autism and other developmental disorders, as 
reauthorized in the Autism Collaboration, Accountability, 
Research, Education and Support Act of 2019 (Public Law 116-
60).
    The Committee provides continued funding for the Leadership 
Education in Neurodevelopmental and Related Disabilities [LEND] 
programs. LEND programs are uniquely positioned to provide 
innovative strategies to integrate and enhance existing 
investments, including translating research findings on 
interventions, guidelines, tools, and systems management 
approaches to training settings, to communities, and into 
practice, and to promote life-course considerations--from 
developmental screening in early childhood to transition to 
adulthood issues. The funding is critical to the LENDs' role in 
providing direct clinical assessment and evidence-based 
interventions.

Healthy Start

    The Committee provides $145,000,000 for Healthy Start. The 
primary purpose of Healthy Start is to reduce infant mortality 
and generally improve maternal and infant health in at-risk 
communities. Grants are awarded to State and local health 
departments and nonprofit organizations to conduct an infant 
mortality review, develop a package of innovative health and 
social services for pregnant women and infants, and evaluate 
these efforts.
    Maternal Mortality.--The Committee continues to support a 
new targeted expansion of an enhanced Healthy Start program 
model that began in fiscal year 2023. The Committee also 
continues to support nurse practitioners, certified nurse 
midwives, physician assistants, and other maternal-child 
advance practice health professionals within all program sites 
nationwide.

Newborn Screening for Heritable Disorders

    The Committee provides $20,833,000 for the Newborn 
Heritable Disorders Screening program, as described in section 
1109 of the Newborn Screening Saves Lives Act of 2008 (Public 
Law 113-240). This program provides funding to improve States' 
ability to provide newborn and child screening for heritable 
disorders. Newborn screening provides early identification and 
follow-up for treatment of infants affected by certain genetic, 
metabolic, hormonal, and/or functional conditions.
    Newborn Screening for Duchenne Muscular Dystrophy.--The 
Committee is aware that at its February 2023 meeting, the 
Advisory Committee on Heritable Disorders in Newborns and 
Children [ACHDNC] voted not to advance the nomination of 
Duchenne muscular dystrophy for evidence-based review for 
newborn screening. The Committee recognizes the challenges in 
collecting data for rare diseases, particularly in young 
children. Duchenne muscular dystrophy typically isn't diagnosed 
until age five despite the efforts of CDC and others to move 
the age of diagnosis earlier. As a result, it is difficult to 
meet the newborn screening criteria despite strong potential 
for benefit. The Committee recommends expediting consideration 
of Duchenne muscular dystrophy for the Recommended Uniform 
Screening Panel for newborn screening, incorporating the 
patient community voice in the ACHDNC review, and developing 
appropriate flexible criteria.

Universal Newborn Hearing Screening and Early Intervention

    The Committee provides $18,818,000 for universal newborn 
hearing screening and early intervention activities. This 
program awards grants to 53 States and territories that support 
statewide systems of newborn hearing screening, audiologic 
diagnostic testing before 3 months of age, and enrollment in 
early intervention programs before the age of 6 months.

Emergency Medical Services for Children

    The Committee provides $24,334,000 for the Emergency 
Medical Services for Children program which focuses on 
improving the pediatric components of the emergency medical 
services system and improving the quality of care provided to 
children in the pre-hospital setting. Funding is available to 
every State emergency medical services office to improve the 
quality of emergency care for children and to pay for research 
and dissemination of best practices.

Screening and Treatment for Maternal Mental Health and Substance Use 
        Disorders [MMHSUD]

    The Committee provides $11,000,000 for the Screening and 
Treatment for the MMHSUD program, which was reauthorized in the 
Consolidated Appropriations Act of 2023 (Public Law 117-328). 
HRSA is directed to make grants to States to establish, 
improve, or maintain programs to train professionals to screen, 
assess, and treat for maternal depression in women who are 
pregnant or who have given birth within the preceding 12 
months.
    According to Maternal Mortality Review Committee data in 36 
States mental health conditions are the leading cause of 
maternal mortality, accounting for 22 percent of pregnancy-
related deaths from 2017-2019. Maternal mental health [MMH] 
conditions impact one in five pregnant or postpartum women, 
including as many as one in three in high-risk populations. 
MMHSUD, trains healthcare providers to screen, assess, and 
treat MMH conditions and substance use disorders, and provides 
specialized psychiatric consultation to providers. The 
Committee encourages HRSA to improve or maintain existing State 
programs, prioritizing States with high rates of adverse 
maternal health outcomes. Grants shall include culturally and 
linguistically appropriate approaches to assist in the 
reduction of maternal health inequities. The Committee 
encourages HRSA to provide technical assistance to both grantee 
and non-grantee States to implement activities under this 
program. The Committee requests a report within 6 months of 
enactment detailing the technical assistance HRSA has provided 
to States and steps HRSA has taken to expand the number of 
grants to States.

Pediatric Mental Health Care Access

    The Committee provides $13,000,000 for expanding access to 
behavioral health services in pediatric primary care by 
supporting the development of pediatric mental healthcare 
telehealth access programs.

Poison Control Centers

    The Committee provides $26,846,000 for Poison Control 
Centers.

Alliance for Maternal Health Safety Bundles

    The Committee includes $15,300,000 to support continued 
implementation of the Alliance for Innovation on Maternal 
Health program's maternal safety bundles to all U.S. States, 
the District of Columbia, and U.S. territories, as well as 
Tribal entities.

Pregnancy Medical Home Demonstration

    The Committee provides $10,000,000 to reduce adverse 
maternal health outcomes and maternal deaths by incentivizing 
maternal healthcare providers to provide integral healthcare 
services to pregnant women and new mothers to optimize maternal 
and infant health outcomes.

Maternal Mental Health Hotline

    The Committee provides $7,000,000 to expand support for a 
maternal mental health hotline. The hotline shall provide 24 
hours a day voice and text support that is culturally and 
linguistically appropriate. Funds provided shall also be used 
to raise public awareness about maternal mental health issues 
and the hotline.

                            HIV/AIDS BUREAU

Appropriations, 2023....................................  $2,571,041,000
Budget estimate, 2024...................................   2,696,041,000
Committee recommendation................................   2,571,041,000

    The Committee recommendation includes $2,571,041,000 for 
the HIV/AIDS Bureau. The mission of the Bureau is to address 
the unmet care and treatment needs of persons living with HIV/
AIDS. The Bureau administers the Ryan White Care Act (Public 
Law 111-87), which provides a wide range of community-based 
services, including primary and home healthcare, case 
management, substance abuse treatment, mental health, and 
nutritional services.
    Ending the HIV Epidemic [EHE].--The Committee provides 
$165,000,000 for the EHE initiative. The investment will 
support HIV care and treatment services; support evidence 
informed practices to link, engage, and retain HIV-positive 
individuals in care; and continue to build capacity into the 
system.

Emergency Assistance

    The Committee provides $680,752,000 for emergency 
assistance grants to eligible metropolitan areas 
disproportionately affected by the HIV/AIDS epidemic. Grants 
are provided to metropolitan areas meeting certain criteria. 
Two-thirds of the funds are awarded by formula, and the 
remainder is awarded through supplemental competitive grants.

Comprehensive Care Programs

    The Committee provides $1,364,878,000 for HIV healthcare 
and support services. 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 provides $900,313,000 
for AIDS medications in ADAP.

Early Intervention Services

    The Committee provides $208,970,000 for early intervention 
grants. These funds are awarded competitively to primary 
healthcare providers to enhance healthcare services available 
to people at risk of HIV and AIDS. Funds are used for 
comprehensive primary care, including counseling, testing, 
diagnostic, and therapeutic services.

Children, Youth, Women, and Families

    The Committee provides $77,935,000 for grants for 
coordinated services to women, infants, children, and youth. 
Funds are awarded to a variety of providers, including 
community health centers, comprehensive hemophilia centers, 
county and municipal health departments, and other nonprofit 
community-based programs that provide comprehensive primary 
healthcare services to populations with or at risk for HIV.

AIDS Dental Services

    The Committee provides $13,620,000 for the AIDS Dental 
Services program. This program provides grants to dental 
schools, dental hygiene schools, and post-doctoral dental 
education programs to assist with the cost of providing 
unreimbursed oral healthcare to patients with HIV.
    The Ryan White Part F program provides for the Dental 
Reimbursement Program, which covers the unreimbursed costs of 
providing dental care to persons living with HIV/AIDS. Programs 
that qualify for reimbursement are dental schools, hospitals 
with post-doctoral dental education programs, and colleges with 
dental hygiene programs.

AIDS Education and Training Centers

    The Committee provides $34,886,000 for AIDS Education and 
Training Centers [AETCs], which train healthcare practitioners, 
faculty, and students who care for AIDS patients outside of the 
traditional health professions education venues and support 
curriculum development on the diagnosis and treatment of HIV 
infection for health professions schools and training 
organizations.

Special Projects of National Significance

    The Committee provides $25,000,000 for the Special Projects 
of National Significance program. This program supports the 
development, evaluation, and dissemination of innovative models 
of HIV care and treatment to improve the retention and health 
outcomes of Ryan White HIV/AIDS Program clients.

                          HEALTH CARE SYSTEMS

Appropriations, 2023....................................     $99,009,000
Budget estimate, 2024...................................     135,009,000
Committee recommendation................................     101,009,000

    The Committee recommendation for the Health Care Systems 
Bureau is $101,009,000.
    The Health Care Systems Bureau protects the public health 
and improves the health of individuals through efforts to 
support and enhance the systems by which healthcare is 
delivered in America.

Organ Donation and Transplantation

    The Committee provides $33,049,000, an increase of 
$2,000,000 above the fiscal year 2023 enacted level, for organ 
donation and transplantation activities that provide financial 
support for living donors and increase public education and 
awareness about organ donation.
    OPTN Modernization Initiative.--HRSA has launched the OPTN 
Modernization Initiative, which aims to accelerate progress on 
technology improvements, data transparency and analytics, 
governance, operations, and quality improvement. The Committee 
encourages HRSA to implement its stated objectives and requests 
a briefing within 90 days of enactment that details the: 
actions the Department has or plans to take to improve 
oversight of the OPTN contractor(s), and the performance of 
duties and responsibilities under said contract(s); actions the 
Department will take to increase public and stakeholder trust 
in the OPTN organ allocation process; and the plan for tracking 
and evaluating the effectiveness and impact of the Initiative.

National Cord Blood Inventory

    The Committee provides $19,266,000 for the National Cord 
Blood Inventory [NCBI]. The purpose of this program is to 
provide funds to cord blood banks to build an inventory of the 
highest quality cord blood units for transplantation.
    NCBI builds a racially and ethnically diverse inventory of 
high-quality umbilical cord blood for transplantation. The 
Committee applauds HRSA for increasing the number of units 
collected and maintained under NCBI.

C.W. Bill Young Cell Transplantation Program

    The Committee provides $33,009,000 for the C.W. Bill Young 
Cell Transplantation Program. The Committee continues to 
support cell transplantation through the use of bone marrow, 
peripheral blood stem cells, and cord blood. The Committee 
appreciates HRSA's efforts to increase the diversity of the 
volunteer registry.

National Hansen's Disease Program

    The Committee includes $13,706,000 for the Hansen's Disease 
Program, $122,000 for Hansen's Disease Buildings and 
Facilities, and $1,857,000 for Payments to Hawaii for Treatment 
of Hansen's Disease. These programs support inpatient, 
outpatient, long-term care, as well as training and research in 
Baton Rouge, Louisiana; a residential facility at Carville, 
Louisiana; 11 outpatient clinic sites in the continental U.S. 
and Puerto Rico; repair and maintenance of buildings at the 
Gillis W. Long Hansen's Disease Center; and medical care and 
treatment of persons with Hansen's disease in hospital and 
clinic facilities at Kalaupapa, Molokai, and Honolulu, Hawaii.

                              RURAL HEALTH

Appropriations, 2023....................................    $352,407,000
Budget estimate, 2024...................................     415,852,000
Committee recommendation................................     364,407,000

    The Committee recommendation for Rural Health programs is 
$364,407,000, an increase of $12,000,000 above the fiscal year 
2023 enacted level.
    The Federal Office of Rural Health Policy [FORHP] 
administers HHS rural health programs, coordinates activities 
related to rural healthcare within HHS, and analyzes the 
possible effects of policy on the more than 60 million 
residents of rural communities. FORHP advises the Secretary on 
the effects of Medicare and Medicaid on rural citizens' access 
to care, the viability of rural hospitals, and the availability 
of physicians and other health professionals.
    Rural-Urban Commuting Area [RUCA] Codes.--The Committee 
recognizes FORHP's use of RUCA codes and the Frontier and 
Remote codes, which are developed to define rural populations. 
However, neither of these codes sufficiently measure rurality 
in mountainous regions, such as the Appalachian Mountains. The 
Committee directs FORHP to coordinate with the U.S. Department 
of Agriculture's Economic Research Service on reviewing and 
implementing the ``Difficult Terrain and Access to Urban Area'' 
project. The Committee also requests a report on how FORHP 
plans to utilize this project to better define rural in 
mountainous areas, such as Appalachia.
    Rural Communities Opioid Response Program [RCORP].--The 
Committee provides $155,000,000 for RCORP, an increase of 
$10,000,000 to expand the program. Within the funding provided, 
the Committee includes $10,000,000 to continue at least three 
Rural Centers of Excellence [Centers], as established by Public 
Law 115-245 and continued through Public Law 116-260 and 117-
103. The Committee recognizes the success of the Centers in 
addressing substance use disorders within rural communities 
through various evidence-based treatment and recovery models. 
The Committee supports HRSA's continued investment in the 
current Centers and would encourage HRSA to consider how the 
centers can expand their outreach into other underserved 
communities. Within the total provided for the Rural 
Communities Opioid Response program, the Committee includes 
$4,000,000 to support career and workforce training services 
and other needs related to substance use challenges within the 
Northern Border Regional Commission's rural regions to assist 
individuals affected by a substance use disorder.
    Rural Maternity and Obstetrics Management Strategies 
[RMOMS].--The Committee provides no less than $8,000,000 for 
RMOMS to support grants to improve access to and continuity of 
maternal and obstetrics care in rural communities by increasing 
the delivery of and access to preconception, pregnancy, labor 
and delivery, and postpartum services, as well as developing 
sustainable financing models for the provision of maternal and 
obstetrics care.

Rural Health Outreach

    The Committee provides $94,975,000 for the Rural Health 
Outreach program, an increase of $2,000,000 above the fiscal 
year 2023 level. This program supports projects that 
demonstrate new and innovative modes of outreach in rural 
areas, such as integration and coordination of health services. 
Outreach grant programs include Outreach Service Grants, Rural 
Network Development Grants, Delta States Network Grant Program, 
Network Planning Grants, and Small Health Care Provider Quality 
Improvement Grants.
    Regional Grant Programs.--The Committee includes no more 
than $22,000,000 for the Delta States Rural Development Network 
Grant program and not less than $10,000,000 for the Delta 
Region Community Health Systems Development program. The 
Committee provides no less than $5,000,000 for HRSA's 
collaboration with the Northern Border Regional Commission to 
provide direct support to member States and help underserved 
rural communities with planning and implementing service 
coordination improvements that better population health. 
Lastly, the Committee provides no more than $3,000,000 for 
HRSA's collaboration with the Appalachian Regional Commission.

Rural Health Research

    The Committee provides $11,076,000 for the Rural Health 
Research program. Funds are used for rural health research 
centers, the National Advisory Committee on Rural Health, and a 
reference and information service. Supported activities focus 
on improving the delivery of health services to rural 
communities and populations.

Rural Hospital Flexibility Grants

    The Committee provides $64,277,000 for Rural Hospital 
Flexibility grants and the Small Hospital Improvement Program. 
Under these grant programs, HRSA works with States to provide 
support and technical assistance to Critical Access Hospitals 
to focus on quality and performance improvement and to 
integrate emergency medical services.
    The Committee continues to recognize the importance of 
supporting hospitals located in rural or underserved 
communities and recommends HRSA give preference in grant awards 
to Critical Access Hospitals serving rural communities that 
create community health teams to help coordinate care among 
rural populations to foster better outcomes in chronic disease 
management.

State Offices of Rural Health

    The Committee provides $12,500,000 for State Offices of 
Rural Health. These offices help States strengthen rural 
healthcare delivery systems by enabling them to coordinate care 
and improve support and outreach in rural areas.

Black Lung Clinics

    The Committee provides $12,190,000 for the Black Lung 
Clinics program. This program funds clinics that treat 
respiratory and pulmonary diseases of active and retired coal 
miners, steel mill workers, agricultural workers, and others 
with occupationally related respiratory and pulmonary 
impairments. These clinics reduce the incidence of high-cost 
inpatient treatment for these conditions.

Radiation and Exposure Screening and Education Program

    The Committee provides $1,889,000 for activities authorized 
by the Radiation Exposure Compensation Act (Public Law 109-
482). This program provides grants for the education, 
prevention, and early detection of radiogenic cancers and 
diseases resulting from exposure to uranium during mining and 
milling at nuclear test sites.

Rural Residency Planning and Development

    The Committee provides $12,500,000 for the Rural Residency 
Planning and Development program. The Committee commends FORHP 
for efforts to expand the physician workforce in rural areas 
and supports continuation and expansion of the program to 
develop new rural residency programs, or Rural Training Tracks.
    The Committee provides $2,000,000 to support family 
medicine/obstetrics training programs in States with high 
infant morbidity rates. The funding will reduce infant 
mortality and maternal morbidity by improving availability and 
accessibility of prenatal care through increasing family 
medicine/obstetrics training programs and graduates, increasing 
Family Medicine and OB/GYN faculty to train physicians, and by 
providing equipment, such as ultrasound, electronic fetal 
monitors, and telemedicine equipment with the training and 
support for this equipment to rural areas. HRSA is directed to 
brief the Committee on their plans no less than 15 days prior 
to releasing a Funding Opportunity Announcement.

                            FAMILY PLANNING

Appropriations, 2023....................................    $286,479,000
Budget estimate, 2024...................................     512,000,000
Committee recommendation................................     286,479,000

    The Committee provides $286,479,000 for the title X Family 
Planning program. This program supports preventive and primary 
healthcare services at clinics nationwide.

                HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT

Appropriations, 2023....................................  $1,735,769,000
Budget estimate, 2024...................................     360,709,000
Committee recommendation................................   1,112,585,000

    The Committee provides $1,112,585,000 for HRSA-wide 
activities. Within the total, $165,300,000 is provided for 
program management.
    Congressionally Directed Spending.--Within the total for 
program management, the Committee also includes $891,997,000 
for projects financing the construction and renovation 
(including equipment) of healthcare and other facilities and 
for one-time grants supporting other health-related activities. 
The projects are specified in the table at the end of this 
Committee Report.
    Long COVID Centers of Excellence.--The extensive incidence 
of individuals suffering from Long COVID (Post-Acute Sequelae 
of SARS CoV-2 COVID [PASC]) presents an ongoing challenge to 
the healthcare system, patients and their caregivers. The 
Committee supports the establishment of a network of Long COVID 
Centers of Excellence that can gather, develop and disseminate 
data regarding evidence-based treatment; educate and train 
providers on best practices; conduct outreach to affected 
populations and community organizations; and coordinate access 
to care. The Committee provides $5,000,000 to competitively 
fund a network of such sites. In making awards, HRSA is 
instructed to leverage existing federally funded Long COVID 
research efforts, prioritize geographically diverse entities 
with experience recruiting, enrolling, and working with Long 
COVID patient populations on research and clinical care, and 
institutions with the ability to coordinate on data sharing and 
the identification of evidence-based treatments.

Telehealth

    The Committee provides $38,050,000 for the Office for the 
Advancement of Telehealth [OAT], which promotes the effective 
use of technologies to improve access to health services for 
people who are isolated from healthcare and to provide distance 
education for health professionals. The Committee strongly 
supports OAT and their mission to expand high quality medical 
care to rural communities that do not have adequate access to 
medical providers including many medical specialties.
    Expanding Capacity for Health Outcomes.--The Committee 
supports HRSA's use of technology-enabled collaborative 
learning and capacity building models, as authorized in Public 
Law 116-260, division BB, title III, section 313. The Committee 
urges HRSA to explore addressing Alzheimer's disease and other 
dementias, including improving Alzheimer's person-centered care 
coordination, improving care transitions, evaluating models to 
build the evidence-base, increasing advanced care planning and 
strengthening quality improvement measures.
    Telehealth Centers of Excellence [Centers].--The Committee 
provides $8,500,000 for the Centers to continue to validate 
technologies and reimbursement mechanisms, establish training 
protocols, and develop comprehensive templates for States to 
integrate telehealth into their State health provider networks. 
The Centers identify best practices, serve as national training 
resources and test the efficacy of different telehealth 
clinical applications. The Centers serve to promote the 
adoption of telehealth programs across the country by 
validating technology, establishing training protocols and by 
providing a comprehensive template for States to integrate 
telehealth into their State health provider network. Funding 
should serve to promote the adoption of telehealth services 
nationwide and help address the access to care issue faced by 
rural America.

Office of Pharmacy Affairs

    The Committee provides $12,238,000 for the Office of 
Pharmacy Affairs [OPA]. OPA administers the 340B drug-pricing 
program, which requires drug manufacturers to provide discounts 
or rebates to a set of programs and hospitals that serve a 
disproportionate share of low-income patients. The 340B program 
is a critical lifeline to many of its program participants, 
including FQHCs, FQHC Look-Alikes, children's hospitals, Ryan 
White HIV/AIDS clinics, and other safety-net hospitals and 
providers. These covered entities are model stewards of the 
program and reinvest 340B savings to ``stretch scarce Federal 
resources as far as possible, reaching more eligible patients 
and providing more comprehensive services'', as Congress 
intended.
    The Committee is concerned that manufacturers continue to 
deny 340B pricing for drugs purchased by covered entities for 
use in contract pharmacies, which threatens the ability of 
safety-net providers to care for patients in need. The 
Committee supports HRSA's continued use of its authorities and 
any available measures, including the imposition of civil 
penalties, as appropriate, to hold those drug manufacturers in 
violation of the law directly accountable. The Committee urges 
HRSA to continue to take actions to safeguard covered entities' 
lawful access to discounted drugs.

             VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2023....................................     $15,200,000
Budget estimate, 2024...................................      26,200,000
Committee recommendation................................      15,200,000

    The Committee includes $15,200,000 for administrative costs 
associated with the Vaccine Injury Compensation Program. 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 death 
benefits. The Vaccine Injury Compensation Trust Fund is funded 
by excise taxes on certain childhood vaccines.

                  COVERED COUNTERMEASURES PROCESS FUND

Appropriation, fiscal year 2023.........................      $7,000,000
Budget request, fiscal year 2024........................      15,000,000
Committee Recommendation................................       7,000,000

    The Committee includes $7,000,000 for administrative costs 
associated with the Countermeasures Injury Compensation Program 
[CICP]. The CICP provides benefits to individuals who are 
seriously injured as a result of a vaccination, medication, 
device, or other item recommended to diagnose, prevent or treat 
a declared pandemic, epidemic or security threat.

               Centers for Disease Control and Prevention

    The Committee recommendation provides a program level of 
$9,197,590,000 for the Centers for Disease Control and 
Prevention [CDC], which includes $55,358,000 in mandatory funds 
under the terms of the Energy Employees Occupational Illness 
Compensation Program Act [EEOICPA], and $1,186,200,000 in 
transfers from the Prevention and Public Health [PPH] Fund.
    The activities of CDC focus on several major priorities: 
providing core public health infrastructure and functions; 
detecting and responding to urgent health threats; monitoring 
the Nation's health using sound scientific methods; preventing 
the leading causes of illness, injury, and death; assuring the 
Nation's preparedness for emerging infectious diseases and 
potential pandemics; and providing training, support and 
leadership for the public health workforce.

                 IMMUNIZATION AND RESPIRATORY DISEASES

Appropriations, 2023....................................    $919,291,000
Budget estimate, 2024...................................   1,255,930,000
Committee recommendation................................     919,291,000

    The Committee recommendation for the activities of the 
National Center for Immunization and Respiratory Diseases is 
$919,291,000, which includes $702,250,000 in transfers from the 
PPH Fund.
    The mission of the National Center for Immunization and 
Respiratory Diseases is the prevention of disease, disability, 
and death through immunization and by control of respiratory 
and related diseases.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Section 317 Immunization Program....       681,933,000       681,933,000
Acute Flaccid Myelitis..............         6,000,000         6,000,000
Influenza Planning and Response.....       231,358,000       231,358,000
------------------------------------------------------------------------

    317 Immunization Program.--The Committee recognizes CDC's 
immunization program plays a fundamental role in achieving 
national immunization goals and sustaining high vaccination 
coverage. In addition, this program underpins the protection of 
all children being vaccinated, even those fully insured, by 
providing Federal, State and local resources to investigate 
outbreaks, conduct surveillance, and provide public awareness 
campaigns to address vaccine hesitancy that continues to be the 
root cause of outbreaks for measles and other preventable 
diseases. The Committee continues to expect funding be used to 
promote health equity related to protection from vaccine 
preventable diseases [VPDs] as well as address vaccine 
hesitancy. CDC is directed to expand the existing immunization 
infrastructure, including implementing new strategies for hard-
to-reach populations, such as those who may be vaccine-
hesitant, those who are members of racial and ethnic or other 
minority groups, and those who are underserved due to 
socioeconomic or other reasons.
    Advisory Committee on Immunization Practices [ACIP] 
Process.--The Committee recognizes the important work of ACIP 
in regularly evaluating and providing informed vaccine 
recommendations. Following an ACIP recommendation that the CDC 
Director has reviewed and approved, timely publication in the 
CDC Morbidity and Mortality Weekly Report [MMWR] is critical to 
ensuring health insurance coverage and timely provider 
implementation. Given the importance of the review, 
recommendation, and publication process, the Committee requests 
that CDC provide a report to the Committee outlining the 
resources necessary to support both routine and emergency 
reviews in real time as well as timely MMWR publication of 
recommendations to ensure appropriate patient access. The 
report should include recommendations for changes necessary to 
improve efficiency in the ACIP process that will result in 
expedited communication of recommendations.
    Cost Estimates.--The Committee requests that the report on 
estimated funding needs of the Section 317 Immunization Program 
be updated and submitted not later than February 1, 2024, to 
the Committees on Appropriations. The updated report should 
include an estimate of optimum State and local operations 
funding, as well as a discussion of the role of the 317 
Program, as coverage for vaccination under public and private 
resources continues to evolve. The Committee also requests that 
the report include specific information on the estimated cost 
to fully address evidence-based public health strategies that 
could be funded through CDC to improve coverage for HPV and 
influenza. The Committee directs CDC to provide a professional 
judgment budget estimate to the Committee that specifically 
outlines the cost to fully fund an uninsured adult immunization 
program that includes the cost of purchase, storage, and 
administration of all ACIP-recommended adult vaccines and 
allows for provider choice of product, outreach, and counseling 
grants to providers and community-based organizations.
    Immunization Data Optimization.--The Committee is aware 
that some States that receive resources to support Immunization 
Information Systems [IIS] allow providers to opt-into 
transmitting vaccination data for some populations to the IIS. 
The Committee is concerned that this could lead to gaps in data 
and potential outbreaks in VPDs. The Committee requests CDC, 
along with the Office of the National Coordinator for Health 
Information Technology [ONC], work with States to develop a 
plan to encourage all providers who vaccinate to report 
immunization data across the life course.
    Increasing Adult Hepatitis B Vaccination.--The Committee 
urges CDC to promote hepatitis B vaccination among all adults 
ages 19 through 59 as recommended by ACIP. The Committee urges 
CDC to provide leadership to ensure the recommendation is 
implemented, and to coordinate implementation activities with 
the HHS Assistant Secretary for Health and HRSA and engage 
providers and community-based organizations as necessary. The 
Committee requests a report to Congress on current challenges 
and barriers to access that are limiting vaccination rates and 
preventing vaccine series completion required to achieve full 
immunity.
    Long COVID.--The Committee encourages CDC to monitor and 
track incidence of Long COVID among children and adults, 
including developing a patient registry for Long COVID.
    Promoting Routine Vaccination.--The Committee is concerned 
by the continued lag in routine vaccination across the life 
course due to the COVID-19 pandemic, with underserved 
populations affected to a greater degree and adolescents 
affected disproportionately. If not addressed, these trends 
will increasingly expose Americans to VPDs, outbreaks, and 
exacerbate existing disparities in care. The Committee urges 
CDC to prioritize and to allocate resources to engage 
providers, healthcare stakeholders, educators, community 
organizations, and families on the importance of ensuring that 
all receive routinely recommended vaccinations, ensuring that 
resources are allocated to address disparities in vaccination 
rates based on race/ethnicity and age. Within 60 days of the 
enactment, CDC shall provide the Committee with an update on 
the ongoing ``Vaccinate with Confidence'' campaign and the rate 
of routine vaccination across all ages, as well as an update on 
the forward-looking plan to administer missed doses. CDC should 
include updated recommendations about what other tools it could 
employ to address this health equity issue.
    Protecting Immunization Data.--The Committee encourages CDC 
to continue its work with State and local health departments 
and affiliated partner organizations toward adoption of and 
adherence to nationally accepted privacy and security standards 
for immunization data captured across the life course that 
includes bi-directional data reporting between public health 
authorities and providers at the point of care. The Committee 
further asks CDC to provide an update on the status of 
immunization work to date in the context of the CDC data 
modernization initiative in the fiscal year 2025 CJ.

 HIV, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS 
                               PREVENTION

Appropriations, 2023....................................  $1,391,056,000
Budget estimate, 2024...................................   1,544,556,000
Committee recommendation................................   1,395,056,000

    The Committee recommendation for the activities of the 
National Center for HIV, Viral Hepatitis, Sexually Transmitted 
Diseases [STDs], and Tuberculosis Prevention [TB] is 
$1,395,056,000.
    The Center administers CDC's activities on HIV/AIDS, viral 
hepatitis, STDs, and TB, with the exception of the Global AIDS 
program, which is housed in the Center on Global Health.
    The Committee recommends funding for the following 
activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and         1,013,712,000     1,016,712,000
 Research...........................
    HIV Initiative..................       220,000,000       223,000,000
    School Health...................        38,081,000        38,081,000
Viral Hepatitis.....................        43,000,000        43,000,000
Sexually Transmitted Infections.....       174,310,000       174,310,000
Tuberculosis........................       137,034,000       137,034,000
Infectious Diseases and Opioid              23,000,000        24,000,000
 Epidemic...........................
------------------------------------------------------------------------

    Ending the HIV Epidemic [EHE] Initiative.--The Committee 
includes $223,000,000 for the EHE Initiative. The Committee is 
aware that having a sexually transmitted infection [STI] poses 
an increased risk of HIV acquisition. The Committee commends 
CDC for including dedicated funding in the EHE initiative for 
STI clinics, sexual health clinics and the STD Clinical 
Prevention Training Centers. Additionally, the Committee 
supports efforts to increase equitable access to pre-exposure 
prophylaxis [PrEP] medication that prevents HIV infection. CDC 
is encouraged to support the building blocks of a national 
program to increase awareness of PrEP, increase access to PrEP 
medication, laboratory services, essential support services 
such as case management, counseling, linkage, and adherence 
services, robust PrEP outreach and education activities, and 
PrEP provider capacity expansion.
    Hepatitis.--The Committee has included funding to enhance 
efforts to eliminate the public health threat of viral 
hepatitis and to specifically implement and help fund the HHS 
National Viral Strategic Plan which offers a framework to 
eliminate viral hepatitis as a public health threat. The 
Committee is aware of the November 2021 ACIP recommendation 
that all adults between ages 19 and 59 be vaccinated for 
hepatitis B and the CDC's recent universal screening guidelines 
and urges a coordinated Federal effort to implement these 
goals. Therefore, the Committee requests HHS complete a report 
before the end of fiscal year 2024 on government-wide 
coordinated efforts to make progress to meet this vaccination 
goal. Finally, the Committee encourages that funds provided by 
the Center be prioritized for jurisdictions with the highest 
infection rates.
    Infectious Diseases and Opioids.--The Committee encourages 
CDC to prioritize jurisdictions with the highest age-adjusted 
mortality rate related to SUDs and acute hepatitis C infection. 
CDC is also encouraged to prioritize jurisdictions that are 
experiencing outbreaks or emerging clusters of infectious 
diseases associated with drug use, including those not eligible 
for EHE funding.
    School Health.--The Committee has provided $38,081,000 to 
promote school-based health and disease prevention for 
adolescents, including mental health. CDC is urged to collect 
and integrate data on school policies and practices that 
support student and staff physical and emotional well-being and 
positive mental health and wellness.
    Self-Testing.--The Committee notes the important role that 
self-testing, self-collection, and rapid testing has played for 
HIV, COVID-19, and other conditions. The Committee encourages 
CDC to continue to advance opportunities to enhance access to 
these innovative technologies in order to further promote 
interventions that address inequities, including through the 
Ending the HIV Epidemic initiative, the Viral Hepatitis 
National Plan, the National STI Strategic Plan, and ongoing 
activities.
    Sexually Transmitted Infections [STIs].--The Committee 
includes $174,310,000 to combat and prevent the high incidence 
of STIs. The Committee further directs that a portion of these 
funds be used to ensure that none of the grantees receives less 
than the amount received in fiscal year 2023. Additionally, the 
Committee directs CDC to continue to move the grant year 
forward by 1 month to provide for a more efficient expenditure 
of funds and improve grantee activities, with the intention 
that the grant year will be moved forward by 1 month each year 
for the next 3 years, contingent on the availability of funds. 
Finally, the Committee encourages CDC to work with other 
agencies, as appropriate, to develop innovative approaches 
including the use of telehealth platforms and at home specimen 
collection to increase screening, treatment, and education to 
curb the spread of STIs in vulnerable populations.
    Tribal Tuberculosis.--The Committee is concerned about the 
insufficient staffing of tuberculosis technicians in Tribal 
areas. The Committee encourages CDC in conjunction with State 
and local health departments, to continue supporting TB 
prevention and treatment activities in populations at highest 
risk for TB disease, including American Indian/Native American 
communities.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2023....................................    $750,772,000
Budget estimate, 2024...................................     845,772,000
Committee recommendation................................     750,772,000

    The Committee recommendation for the activities of the 
National Center for Emerging and Zoonotic Diseases is 
$750,772,000, which includes $52,000,000 in transfers from the 
PPH Fund.
    The National Center for Emerging and Zoonotic Infectious 
Diseases aims to detect, prevent, and control infectious 
diseases from spreading, whether they are naturally occurring, 
unintentional, or the result of terrorism.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Antibiotic Resistance Initiative....       197,000,000       197,000,000
Vector-Borne Diseases...............        62,603,000        64,103,000
Lyme Disease........................        26,000,000        27,500,000
Prion Disease.......................         7,500,000         7,500,000
Chronic Fatigue Syndrome............         5,400,000         5,400,000
Emerging Infectious Diseases........       202,997,000       204,997,000
Harmful Algal Blooms................         3,500,000         3,500,000
Food Safety.........................        71,000,000        71,000,000
National Health Care Safety Network.        24,000,000        24,000,000
Quarantine..........................        58,772,000        53,772,000
Advanced Molecular Detection........        40,000,000        40,000,000
Epidemiology and Laboratory Capacity        40,000,000        40,000,000
Healthcare-Associated Infections....        12,000,000        12,000,000
------------------------------------------------------------------------

    Advanced Molecular Detection [AMD].--The Committee includes 
$40,000,000 and recognizes the critical role the AMD program 
plays in bringing cutting edge technology to the front lines of 
public health by harnessing the power of advanced sequencing 
methods and high performance computing with bioinformatics and 
epidemiology expertise to study pathogens.
    Antimicrobial Resistance [AMR].--The Committee continues to 
support the Administration's proposal to address the problem of 
antimicrobial resistant bacteria and fungi through a ``One 
Health'' approach and by tracking and preventing the spread of 
resistance at the local, regional, national and global levels. 
The Committee continues to encourage CDC to competitively award 
research activities that address aspects of AMR related to 
``One Health'', including global surveillance and research and 
development for new tools to counter AMR.
    Lyme Disease and Related Tick-Borne Illnesses.--With recent 
2020 CDC data showing that nearly 500,000 Americans contract 
Lyme disease every year, especially in rural States across the 
United States, an improved understanding of the disease is 
essential to the health and wellbeing of Americans. CDC 
tracking of Nationally Notifiable Infectious Diseases shows 
that Lyme disease is the most common tick-borne disease and the 
most common vector-borne disease in the United States. In 
patients who suffer from long-term complications associated 
with Lyme disease, clear treatment pathways are often missed as 
a result of inaccurate and incomplete testing. The Committee 
provides $27,500,000, an increase of $1,500,000, to expand the 
programs authorized under the Kay Hagan Tick Act (Public Law 
116-94) to promote a public health approach to combat rising 
cases of tick-borne diseases. In distributing these funds, the 
Committee directs CDC to prioritize entities focused on Lyme 
disease and related tick-borne diseases in the areas of 
surveillance, control, prevention, diagnosis, treatment, and 
education. The Committee directs CDC to develop and implement 
methods to improve surveillance to more accurately report the 
disease burden, including through the development of real time 
data for reporting Lyme disease and other tick-borne diseases 
as well as a process for estimating the prevalence of Post-
Treatment Lyme Disease Syndrome. The Committee directs CDC to 
direct funding to improve early diagnosis of Lyme and related 
tick-borne diseases to prevent the development of late stage 
disease and more serious and long-term disability. The 
Committee recognizes the growing public health threat of Lyme 
disease and related tick-borne diseases and directs CDC to 
provide support in endemic areas as well as areas not yet 
considered endemic.
    Given the impact of Lyme disease and the status of ongoing 
clinical trials, the Committee requests a report within 180 
days on CDC's research to date and recommendations on actions 
needed to facilitate a successful Lyme disease vaccine rollout 
that will build confidence and encourage uptake should a 
vaccine be approved by the FDA.
    Mosquito Control Activities.--The Committee continues to 
urge CDC to direct funding from within the Vector-Borne 
Diseases budget to coordinate with States, mosquito control 
districts, universities, and other Federal partners to update 
spray drift models used in the pesticide registration process. 
The Committee urges CDC to move expeditiously in support of 
these activities. The Committee further encourages CDC, 
consistent with the provisions of the Strengthening Mosquito 
Abatement for Safety and Health Act (Public Law 116-22) to 
increase support to State and local mosquito control programs 
for mosquito-borne and other vector-borne diseases surveillance 
and control.
    Myalgic Encephalomyelitis/Chronic Fatigue Syndrome [ME/
CFS].--Given that a subset of patients with post-acute COVID-19 
and other post-infectious syndromes meet the diagnostic 
criteria for ME/CFS, the Committee continues to encourage CDC 
to develop a national epidemiological and disease tracking 
study of post-infectious syndromes prevalence, specifically the 
rates of ME/CFS in adults and children. The Committee expects 
CDC to strengthen collaboration with 1) interagency partners, 
2) disease experts and stakeholders, and 3) the NIH's 
Collaborative Research Centers on study design protocol. 
Additionally, the Committee urges CDC to conduct a series of 
epidemiological studies into the causes, diagnosis, and risk 
factors of ME/CFS. Finally, the Committee expects CDC to engage 
physicians and patients in an effort to increase awareness of 
ME/CFS and disseminate updated clinical guidance.
    National Healthcare Safety Network [NHSN].--The Committee 
includes $24,000,000 for NHSN and recognizes the critical value 
of this system for healthcare quality measurement and 
improvement, as well as supporting national security needs for 
situational awareness of health systems capacity during major 
outbreaks and pandemic responses. The Committee supports the 
modernization of the system's infrastructure resulting in 
increased timeliness and accuracy, reduced burden on healthcare 
facilities, and the ability to collect urgent data as called 
for by the National Biodefense Strategy to create an enduring 
domestic all-hazards hospital data collection capability.
    Prion Disease Surveillance.--The Committee includes 
$7,500,000 for surveillance efforts of human prion diseases, 
including Creutzfeldt-Jakob Disease, through the National Prion 
Disease Pathology Surveillance Center and CDC. Monitoring the 
prevalence of prion diseases, including whether a disease was 
acquired from animals or other humans, is particularly critical 
for Chronic Wasting disease endemic areas.
    Sepsis.--The Committee provides $2,000,000 within Emerging 
Infectious Diseases to integrate sepsis data from hospitals 
into the National Healthcare Safety Network [NHSN] to enable 
CDC to assess the impact of policies and programs (including 
sepsis `Core Elements') across hospitals and assist in the 
improvement of sepsis care. These data will promote awareness 
and uptake of CDC's sepsis initiatives including the sepsis 
Core Elements through public and private clinical care 
partnerships and events based on the successful CDC strategy 
employed for antibiotic resistance and stewardship campaign, as 
appropriate. CDC, in collaboration with CMS, will use the 
quality measure development process to develop new, or identify 
existing, hospital quality measures for adult and pediatric 
sepsis.
    Vector-Borne Diseases [VBDs].--The Committee is concerned 
about the risk of a vector-borne infectious disease outbreak in 
the U.S. and our readiness to quickly respond to and stop its 
spread. The recommendation includes $64,103,000, an increase of 
$1,500,000, to support activities like those of the Regional 
Centers of Excellence program, including State-level 
surveillance and research being conducted by partners in order 
to prevent and rapidly respond to emerging VBDs across the 
United States. The Committee encourages CDC to examine options 
to provide greater coverage of the Northwest region for VBD 
resources. Additionally, the Committee recognizes the 
importance of strong surveillance data to monitor and forecast 
the risk of infectious disease outbreaks in the U.S. The 
Committee notes that the pandemic response necessitated the 
disruption of mosquito control and abatement efforts by many 
State and local health departments and notes the importance of 
continuing mosquito prevention efforts. The Committee is aware 
of the ongoing challenges faced in the Caribbean and the 
Pacific regarding control and management of VBDs, the increased 
risk for prevalence and spread of these diseases due to their 
tropical climate, and how cases in these islands can impact the 
rest of the country. The Committee urges CDC to support the 
training and research needs of the U.S. territories and 
encourages the use of the Mosquito Abatement for Safety and 
Health program to provide grants and technical assistance to 
States and political subdivisions to prevent and control 
mosquito-borne diseases. In addition, the Committee requests 
CDC, in consultation with other appropriate agencies, to 
provide information in the fiscal year 2025 CJ on the 
ecological structure and epidemiological factors that must be 
known and monitored to estimate the mosquito-borne infectious 
disease outbreak risk.
    Wastewater Surveillance.--The Committee continues to 
recognize the important role wastewater surveillance plays for 
our Nation's biosecurity. In a January 2023 report, the 
National Academies of Sciences, Engineering, and Medicine 
highlighted how critical wastewater surveillance has been in 
detecting, managing and preventing further spread of the COVID-
19 virus and affirms its continued value for managing 
infectious disease outbreaks, including resurgences of known 
pathogens and newly emergent pathogens. The Committee shares 
the National Academies' vision of a wastewater surveillance 
system that is ``flexible, equitable, integrated, actionable 
and sustainable.'' This should include a system that would be 
able to track multiple pathogens simultaneously, has an open 
and transparent process for prioritizing targets, and can pivot 
quickly to detect emerging pathogens. The Committee further 
underscores the importance of a national wastewater 
surveillance system with geographic and temporal design 
informed by data and that strategically incorporates sites as a 
mechanism for early detection. Additionally, the Committee 
encourages CDC to continue working with States and localities 
to broaden the scope of wastewater surveillance capabilities to 
track COVID-19, additional pathogens, and high-risk substances 
such as fentanyl to assist with public health data analysis.
    The Committee requests CDC provide information in the 
fiscal year 2025 CJ on how the National Wastewater Surveillance 
System program, and wastewater surveillance more broadly, can 
be leveraged to include analysis of future public health 
threats beyond infectious diseases, which may include high-risk 
substances such as fentanyl and other natural or manmade 
biothreats.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2023....................................  $1,430,414,000
Budget estimate, 2024...................................   1,813,539,000
Committee recommendation................................   1,435,414,000

    The Committee recommendation for the activities of the 
National Center for Chronic Disease Prevention and Health 
Promotion is $1,435,414,000, which includes $254,950,000 in 
transfers from the PPH Fund.
    The mission of the Center is to provide national leadership 
in promoting health and well-being through prevention and 
control of chronic diseases. More than one-half of all American 
adults have at least one chronic illness, and such diseases 
account for 70 percent of all U.S. deaths and over three-
quarters of all healthcare costs in the United States. Chronic 
diseases are the leading causes of death and disability and 
while they affect all populations, the most disadvantaged 
Americans often suffer the highest burden of disease.
    These conditions are largely preventable or improved 
through evidence-based programs and strategies. The Committee 
encourages CDC to continue working with State and local health 
departments and national organizations to maximize their 
investments in evidence-based programming and strategies at the 
community level.
    Within the total provided for the National Center for 
Chronic Disease Prevention and Health Promotion, the following 
amounts are available for the following activities:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Tobacco.............................       246,500,000       246,500,000
    Nutrition, Physical Activity,           58,420,000        58,420,000
     and Obesity....................
        High Obesity Rate Counties..        16,500,000        16,500,000
School Health.......................        19,400,000        19,400,000
    Health Promotion................        62,600,000        64,100,000
        Glaucoma....................         4,000,000         4,000,000
        Vision and Eye Health.......         2,500,000         2,500,000
        Alzheimer's Disease.........        38,500,000        40,000,000
        Inflammatory Bowel Disease..         1,500,000         1,500,000
        Interstitial Cystitis.......         1,100,000         1,100,000
        Excessive Alcohol Use.......         6,000,000         6,000,000
        Chronic Kidney Disease......         4,500,000         4,500,000
        Chronic Disease Education            4,500,000         4,500,000
         and Awareness..............
Prevention Research Centers.........        28,961,000        28,961,000
Heart Disease and Stroke............       155,105,000       155,105,000
Diabetes............................       155,129,000       156,129,000
National Diabetes Prevention Program        37,300,000        37,300,000
Cancer Prevention and Control.......       409,549,000       409,549,000
    Breast and Cervical Cancer......       235,500,000       235,500,000
        WISEWOMAN...................        34,620,000        34,620,000
    Breast Cancer Awareness for              6,960,000         6,960,000
     Young Women....................
    Cancer Registries...............        53,440,000        53,440,000
    Colorectal Cancer...............        44,294,000        44,294,000
    Comprehensive Cancer............        22,425,000        22,425,000
    Johanna's Law...................        11,500,000        11,500,000
    Ovarian Cancer..................        14,500,000        14,500,000
    Prostate Cancer.................        15,205,000        15,205,000
    Skin Cancer.....................         5,000,000         5,000,000
    Cancer Survivorship Resource               725,000           725,000
     Center.........................
Oral Health.........................        20,250,000        20,250,000
Safe Motherhood/Infant Health.......       108,000,000       110,500,000
Arthritis...........................        11,000,000        11,000,000
Epilepsy............................        11,500,000        11,500,000
National Lupus Registry.............        10,000,000        10,000,000
Racial and Ethnic Approaches to             68,950,000        68,950,000
 Community Health (REACH)...........
    Good Health and Wellness in             24,000,000        24,000,000
     Indian Country.................
Social Determinants of Health.......         8,000,000         8,000,000
Million Hearts......................         5,000,000         5,000,000
National Early Child Care                    5,000,000         5,000,000
 Collaboratives.....................
Hospitals Promoting Breastfeeding...         9,750,000         9,750,000
------------------------------------------------------------------------

    Alzheimer's Disease.--The Committee is encouraged by 
research demonstrating the positive impact of risk reduction on 
dementia prevalence and commends the Secretary for updating the 
National Alzheimer's Plan to reflect the latest science. To 
ensure high burden populations are reached, the Committee 
directs CDC to increase capacity to reach populations 
disproportionately burdened by Alzheimer's disease, including 
Black/African American and Latino/Hispanic population through 
public health promotion and workforce development.
    Breast and Cervical Cancer.--The Committee includes 
$235,500,000 for the provision of critical, lifesaving breast 
cancer screening and diagnostic services to uninsured and 
underinsured women. The Committee is aware that there are still 
substantial barriers to screening like geographic isolation, 
limited health literacy, lack of provider recommendation, 
inconvenient times to access services, and language barriers. 
The Committee directs CDC to continue efforts to reduce breast 
and cervical cancer disparities especially in underserved 
communities and to work to reach women who may have delayed 
screening services during the COVID-19 pandemic.
    Chronic Disease Education and Awareness [CDEA] Program.--
The Committee is pleased with the administration of the CDEA 
program and includes $4,500,000 for fiscal year 2024 to support 
existing and additional grants for chronic health conditions 
that do not have line item in CDC's budget. The CDEA program is 
supporting several important multi-year projects that are 
improving public and professional awareness, and the Committee 
urges CDC to continue to support these activities along with 
new initiatives.
    Chronic Disease Research on Children, Adolescents, and 
Young Adults.--The Committee recognizes that children, 
adolescents, and young adults living with chronic conditions 
can be disproportionately affected by barriers to access to 
quality healthcare services. An estimated 39.8 million adults 
between ages of 18 and 34 years have at least one chronic 
condition and about 16.5 million adults in this age group have 
more than one condition. Limited access to quality care often 
results in a lack of awareness among healthcare providers, 
limited treatment options, and adverse health outcomes for 
children, adolescents, and young adults living with chronic 
conditions. The Committee directs the National Center for 
Chronic Disease Prevention and Health Promotion to submit a 
report to the Committee within a year of enactment of this act 
on the current state of Federal research on children, 
adolescents, and young adults living with chronic conditions, 
including information on disease prevalence, an evaluation of 
existing data collection programs for chronic conditions 
affecting this population, barriers to available treatment 
options, and related health outcomes. The report should also 
identify remaining knowledge gaps among healthcare providers 
and patients in understanding of chronic conditions affecting 
children, adolescents, and young adults, and recommendations 
for filling these gaps. Further, the Committee encourages CDC, 
in collaboration with NIH, to continue to support education, 
outreach, and awareness to promote early and accurate diagnosis 
of chronic conditions among children, adolescents, and young 
adults.
    Comprehensive Cancer.--The Committee includes $22,425,000 
to advance the goals of the Cancer Moonshot Initiative through 
CDC's cancer prevention, early detection and treatment, 
survivor support, and health equity activities. CDC is urged to 
use a portion of this increase to expand evidence-based cancer 
survivorship programs by State, Tribal and territorial program 
recipients in partnership with community-based organizations.
    Diabetes.--The Committee includes $156,129,000 to prevent 
diabetes and its complications, and to reduce inequities 
through prevention strategies, translational research, and 
education. In addition, the Committee includes $37,300,000 for 
the National Diabetes Prevention Program to expand efforts of 
this public-private partnership that provides diabetes 
prevention for people with prediabetes. The Committee supports 
the continued expansion of CDC-recognized community-based 
prevention programs and encourages flexibility for 
organizations serving low-income populations to address 
barriers these populations face in losing weight.
    Early Child Care Collaboratives.--The Committee includes 
$5,000,000 to enable training of early care and education 
providers in the implementation of healthy eating and physical 
activity best practices. Funds will also support assistance for 
integration of healthy eating and physical activity best 
practices into existing State and local professional 
development systems' early care and education settings, and 
health initiatives.
    Eating Disorders.--The Committee remains concerned that 
mental health problems among youth are at an all-time high, 
with eating disorder-related emergency room admissions for 
youth doubling during the pandemic. Eating disorders have one 
of the highest fatality rates of any psychiatric illness, and 
the rate of diagnosis for youth ages 12-18 rose 25 percent 
since 2019. For 23 years, CDC conducted surveillance of the 
signs and symptoms of eating disorders within the Youth Risk 
Behavioral Surveillance System but ended that data collection 
in 2015. The resulting gap in data collection has left public 
health experts and researchers with limited data to address the 
current eating disorders crisis among youth. Additionally, the 
Committee supports the implementation of public awareness 
campaigns for eating disorders including education on proper 
prevention strategies.
    Epilepsy.--The Committee includes $11,500,000 and commends 
CDC for its ongoing leadership of this successful program and 
effective community collaborations, and encourages further 
efforts to eliminate stigma, improve awareness and education, 
and better connect people with epilepsy to health and community 
services. Additionally, the Committee recognizes the importance 
of surveillance to accurately understand the incidence, 
prevalence, and mortality rate of epilepsies and to address the 
long-term health outcomes, complications, and healthcare access 
needs of people living with epilepsies. The Committee requests 
CDC to report to the Committee within 120 days of enactment of 
this act on current gaps in surveillance data of people living 
with epilepsies and on the feasibility, cost, and timing of 
case reporting epilepsy through the addition of the disease to 
the National Neurological Conditions Surveillance System.
    Farm-to-School.--The Committee continues $2,000,000 within 
Nutrition, Physical Activity, and Obesity for research and 
education activities related to farm-to-school programs that 
result in promoting healthy eating habits for students. The 
Committee intends that these grants support multi-agency, 
multi-organizational State farm to early childhood initiatives. 
The Committee also directs CDC to coordinate farm-to-early 
childhood program efforts with the Office of Community Food 
Systems at the Department of Agriculture.
    Food Allergies.--The Committee recognizes the serious issue 
of food allergies, which affect approximately 8 percent of 
children in the United States. The Committee includes 
$2,000,000 for a school-based effort to address food allergies 
and reduce potentially fatal anaphylactic reactions.
    Food Service Guidelines [FSG] for Federal Facilities.--The 
Committee supports the goal set forth in the National Strategy 
on Hunger, Nutrition, and Health to implement the Federal Food 
Service Guidelines for Federal Facilities. The Committee 
encourages CDC, in consultation with the Federal FSG Work Group 
it has convened, to create a comprehensive plan including an 
assessment of resources and other needs for implementation of 
the FSG across Federal food service operations and procurement 
where practicable for food served, sold, and distributed.
    Heart Disease and Stroke.--The Committee includes 
$155,105,000 for CDC's Heart Disease and Stroke Prevention 
program. CDC is encouraged to support community partnerships in 
additional States to control heart disease and stroke and help 
the more than 116.0 million Americans living with high blood 
pressure. The Committee continues funding to support 
implementation of the Cardiovascular Advances in Research and 
Opportunities Legacy Act (Public Law 117-224). In addition, the 
Committee also continues the WISEWOMAN program to increase the 
number of low-income, uninsured and underinsured women who are 
assessed and connected to resources.
    High Obesity Rate Counties.--The Committee remains 
concerned about the growing body of evidence suggesting that 
obesity is one of the most significant challenges facing the 
public health system. The Committee continues to support land 
grant universities in partnership with their cooperative 
extensions for counties with an obesity prevalence over 40 
percent. CDC grantees are expected to work with State and local 
public health departments and other partners to support 
measurable outcomes through community and population-level 
evidence-based obesity intervention and prevention programs. 
Funded projects should integrate evidence-based policy, 
systems, and environmental approaches to better understand and 
address the environmental and societal implications of obesity.
    Inflammatory Bowel Disease [IBD].--The Committee commends 
CDC's ongoing efforts to continue epidemiological studies on 
Crohn's disease and ulcerative colitis, known collectively as 
IBD, and to establish awareness and education activities for 
patients and healthcare professionals to produce improved time 
to diagnosis and optimal disease management, including in 
medically underserved populations. The Committee recognizes 
that health literacy is an important factor in an individual's 
ability to find, understand, and use information to inform 
health-related decisions and actions and that CDC has a leading 
role in improving health literacy. As CDC seeks to improve 
awareness of and education related to IBD, the Committee 
strongly encourages the agency to include health literacy 
activities within these activities and to work with multiple 
stakeholders to implement them.
    Kidney Disease.--The Committee provides $4,500,000 to 
support the Chronic Kidney Disease [CKD] program, which 
supports activities that identify risk factors for kidney 
disease, increase awareness, diagnosis, and treatment of [CKD] 
and improve health outcomes of people with CKD. The Committee 
encourages CDC to continue its ongoing Kidney Disease 
Surveillance System and enhance its capacity to track the 
progress of CKD prevention, detection, and management efforts. 
The Committee also supports activities that enhance health 
systems' capacity to identify, risk-stratify, and manage 
individuals with CKD with special emphasis on populations in 
low-income, geographically underserved areas, and communities 
with high burden of disease.
    Mississippi Delta Health Collaborative.--Within the funds 
provided for Chronic Disease Prevention and Health Promotion, 
the Committee encourages CDC to continue the Mississippi Delta 
Health Collaborative project and requests that CDC provide an 
update on these activities in the fiscal year 2025 CJ.
    Prostate Cancer.--The Committee is aware of the continued 
rise in prostate cancer deaths and supports CDC's work to 
promote public awareness of prostate cancer risks, screening, 
and treatment in high-risk men. The Committee provides 
$15,205,000 for CDC's prostate cancer activities, including for 
outreach and education initiatives among high-risk men, 
especially African American men.
    Psoriatic Disease.--The Committee recognizes that psoriatic 
disease impacts 8,000,000 Americans and presents a significant 
public health burden, including increased risk of co-occurring 
conditions such as depression, anxiety, diabetes, and 
cardiovascular disease, as well as social isolation, and the 
need for costly treatments. The Committee commends CDC for its 
work through the CDEA program to raise awareness of psoriatic 
disease among underserved populations to improve diagnosis, and 
to update epidemiology and surveillance tools. This work, as 
well as the addition of a psoriatic disease question in the 
National Health Interview Survey, presents new opportunities to 
mitigate the public health burden of psoriatic disease. The 
Committee encourages CDC to build upon and expand these 
activities on psoriatic disease, with a focus on developing and 
disseminating public health interventions for those living with 
psoriatic disease and other co-occurring conditions.
    Racial and Ethnic Approaches to Community Health [REACH].--
The Committee includes $68,950,000 to continue scaling this 
program to all States and territories, and to support grantees 
in building capacity for collaboration and disseminating 
evidence-based strategies in communities. REACH is a vital 
initiative to help eliminate healthcare disparities in minority 
communities. The Committee's recommended level includes 
$24,000,000 for Good Health and Wellness in Indian Country.
    Safe Motherhood/Infant Health.--The Committee 
recommendation builds upon the commitment made in the fiscal 
year 2023 bill by providing an increase of $2,500,000 for this 
portfolio of programs to improve health outcomes during and 
after pregnancy, including to reduce disparities in maternal 
and infant health outcomes. Maternal mortality continues to 
rise at an unacceptable rate in the United States, which 
reached 1,205 maternal deaths in 2021, a forty percent increase 
from 2020. The Committee continues to direct CDC to expand the 
Maternal Mortality Review Committees [MMRCs] and Perinatal 
Quality Collaboratives [PQCs] to additional States and 
territories and for increased support to current States and 
territories, as well as to increase support for other programs, 
including Sudden Unexplained Infant Death [SUID]. State MMRCs 
are working to collect complete data on pregnancy and delivery-
related deaths, but more must be done to ensure the accuracy 
and completeness of the data. The Committee encourages CDC to 
prioritize funding to help MMRCs build stronger data systems 
and improve data collection at the State level to create 
consistency in data collection, analysis and reporting across 
State MMRCs. The Committee requests CDC to provide a briefing 
to the Committees on Appropriations within 90 days of enactment 
of this act on barriers to effective and consistent data 
collection and opportunities to improve coordination among 
State MMRCs. The Committee requests an update on the expansion 
of PQCs beyond the States currently funded, as well as any 
barriers to expansion. Finally, the Committee continues to 
support the SUID and Sudden Death in the Young Registry to 
expand the number of States and jurisdictions participating in 
monitoring and surveillance to improve data collection. This 
data works to identify, develop, and implement best practices 
to prevent infant death, including practices to improve safe 
sleep, in coordination with appropriate nonprofits.
    Skin Cancer Education and Prevention.--The Committee is 
concerned with the growing number of people diagnosed with 
preventable forms of skin cancer, which is now the most 
commonly diagnosed cancer in the United States. The Committee 
provides $5,000,000 for skin cancer education and prevention 
and encourages CDC to increase its collaboration and 
partnership with local governments, business, health, 
education, communities, nonprofit, and faith-based sectors.
    Social Determinants of Health [SDOH].--The Committee 
recognizes the important impact of SDOH on outcomes and health 
inequities in communities. The Committee provides $8,000,000 
for SDOH activities. These activities should include expanding 
and implementing accelerator plans and providing grants for 
implementation of SDOH activities. CDC should award grants to 
improve the capacity of governmental and non-governmental 
public health organizations and community organizations to 
address SDOH in communities; support and conduct research on 
best practices; and improve health outcomes and reduce health 
inequities by coordinating SDOH activities across CDC. The 
Committee encourages CDC to continue efforts that support 
action plans and research into best practices that address 
SDOH.
    Sudden Cardiac Arrest.--The Committee recognizes that 
sudden cardiac arrest [SCA] is a leading cause of death among 
athletes at all ages and that timely access to automated 
external defibrillators [AEDs] can significantly improve 
survival rates. The Committee urges CDC to publish best 
practices for how to best deploy AEDs in sporting facilities, 
including schools, colleges, community centers, and stadiums. 
The best practices should include recommendations on optimal 
locations, maintenance, training, and coordination with 
emergency medical services, including the development of 
Emergency Action Plans for AED deployment. The Committee 
requests a report on its progress no later than 180 days after 
enactment of this act.
    Sudden Cardiac Arrest Registry.--The Committee encourages 
CDC to expand the Cardiac Arrest Registry to Enhance Survival 
[CARES] program to capture data from additional States. 
Registry data is critical to improving sudden cardiac survival 
rates in all States by allowing communities to measure the 
quality of patient care, establish performance goals, and 
analyze emergency response data to identify opportunities for 
improvement.
    Tobacco.--The Committee provides $246,500,000 so that CDC, 
States and territories can continue efforts to reduce tobacco 
use among disparate populations and in areas and regions with 
high tobacco prevalence and mortality and expand the highly 
successful and cost-effective Tips from Former Smokers media 
campaign. The Committee remains concerned that 3,000,000 youth 
currently use at least one tobacco product and encourages CDC's 
ongoing efforts to respond to and prevent youth use of e-
cigarettes and other tobacco products.
    Vision and Eye Health.--The Committee provides $2,500,000 
and encourages CDC to update national prevalence estimates on 
vision impairment and eye disease through use of the National 
Health and Nutrition Examination Survey. The Committee is aware 
that vision impairments and eye disease contribute to or 
complicate many other serious and costly chronic health 
conditions, including diabetes, depression and anxiety, 
cardiovascular disease, and cognitive decline. Data on risk of 
vision loss and existence of vision loss in the United State is 
necessary to inform state and community partnerships that 
emphasize early detection and intervention and to address the 
biggest challenges in access to eye care that can prevent eye 
disease from progressing to permanent vision loss.

     NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, 
                         DISABILITY AND HEALTH

Appropriations, 2023....................................    $205,560,000
Budget estimate, 2024...................................     222,560,000
Committee recommendation................................     206,060,000

    The Committee recommendation for the activities of the 
National Center on Birth Defects, Developmental Disabilities, 
Disability and Health [NCBDDD] is $206,060,000.
    This Center improves the health of children and adults by 
preventing birth defects, developmental disabilities, and 
complications of hereditary blood disorders, and by promoting 
optimal child development and health and wellness among 
children and adults living with disabilities.
    Within the total provided, the following amounts are 
available for the following activities:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Child Health and Development........        71,300,000        71,300,000
    Other Birth Defects.............        19,000,000        19,000,000
    Fetal Death.....................           900,000           900,000
    Fetal Alcohol Syndrome..........        11,500,000        11,500,000
    Folic Acid......................         3,150,000         3,150,000
    Infant Health...................         8,650,000         8,650,000
    Autism..........................        28,100,000        28,100,000
Health and Development for People           85,910,000        86,410,000
 with Disabilities..................
    Disability and Health...........        45,500,000        45,500,000
    Tourette Syndome................         2,500,000         2,500,000
    Early Hearing Detection and             10,760,000        10,760,000
     Intervention...................
    Muscular Dystrophy..............         7,500,000         8,000,000
    Attention Deficit Hyperactivity          1,900,000         1,900,000
     Disorder.......................
    Fragile X.......................         2,000,000         2,000,000
    Spina Bifida....................         7,500,000         7,500,000
    Congenital Heart................         8,250,000         8,250,000
Public Health Approach to Blood             10,400,000        10,400,000
 Disorders..........................
Hemophilia CDC Activities...........         3,500,000         3,500,000
Hemophilia Treatment Centers........         5,100,000         5,100,000
Thalassemia.........................         2,100,000         2,100,000
Neonatal Abstinence Syndrome........         4,250,000         4,250,000
Surveillance for Emerging Threats to        23,000,000        23,000,000
 Mothers and Babies.................
------------------------------------------------------------------------

    Autism.--The Committee includes $28,100,000 for the Autism 
Developmental Disabilities Monitoring [ADDM] Network and to 
continue surveillance of cerebral palsy to reach nearly all of 
its 16 ADDM Network sites.
    Blood Clots.--The Committee is concerned about the enormous 
toll of blood clots on patients and the healthcare system, 
particularly for pregnant women, Black Americans, and cancer 
patients. The Committee again urges CDC to develop a 
comprehensive, nationwide blood clot education and awareness 
campaign for the general public focused on the treatment and 
prevention of blood clots and education and training of 
healthcare professionals about the signs and symptoms of blood 
clots.
    Diversity and Expansion of Blood Supply.--The current pool 
of donors to the Nation's blood supply does not reflect the 
diversity of the population at large. To better serve the needs 
of those who require blood transfusions, diversifying and 
expanding the blood donor pool is crucial. Red blood cells 
carry markers that determine blood type beyond the common O, A, 
B and AB designation. Some blood types are more common among 
people of similar racial or ethnic backgrounds. Diversifying 
and expanding the blood supply decreases the chance of 
transfusion-related complications, especially among individuals 
who require regular transfusion, such as many with thalassemia 
or sickle cell disease. The Committee encourages the creation 
of strategies and campaigns aimed at creating a blood supply 
that more adequately reflects the diverse population of the 
United States and better meets the needs of the blood 
transfusion population.
    Congenital Heart Disease [CHD].--The Committee includes 
$8,250,000 for surveillance, research, and awareness activities 
authorized by the Congenital Heart Futures Reauthorization Act 
(Public Law 115-342), including to support additional 
longitudinal surveillance sites, survey activities on long-term 
outcomes and patient needs, engagement with healthcare 
providers, and analysis of healthcare claims and clinical data.
    Duchenne and Becker Muscular Dystrophy.--The Committee 
includes $8,000,000 to enhance Muscular Dystrophy research and 
disease surveillance initiatives, including the evaluation of 
the impact of incorporating the care considerations as 
identified in the recent report to the Committee, into the 
standards of care for Duchenne Muscular Dystrophy patients. In 
addition, the Committee encourages CDC to collaborate with 
stakeholders on an initiative to integrate the care 
considerations into electronic health records to improve care, 
understand disease outcomes, and model disease progression.
    Hemophilia Treatment Centers [HTC].--The Committee 
recognizes the importance of the Community Counts Hemophilia 
Data Collection program and its role in identifying blood-borne 
infections and improvements in the care and treatment of 
individuals living with Hemophilia.
    Neonatal Abstinence Syndrome [NAS] Surveillance.--The 
Committee includes $4,250,000 to address the rise in NAS 
resulting from the overuse of opioids and other related 
substances during pregnancy. Funding should be used to conduct 
research on the use of opioids and other substances during 
pregnancy and related adverse outcomes from infancy through 
childhood, and identify best practices for care, evaluation, 
and management to help children.
    Physical Activity for People with Disabilities.--The 
Committee includes funding to strengthen existing programs that 
address healthy athletes.
    Public Health Approach to Blood Disorders.--The Committee 
provides $10,400,000 for the Public Health Approach to Blood 
Disorders program and encourages CDC to implement innovative 
activities dedicated to supporting patients with immune 
thrombocytopenia and other rare platelet disorders, in a manner 
similar to programming and activities available for sickle cell 
and hemophilia.
    Sickle Cell Disease [SCD].--The Committee recommendation 
includes $6,000,000 for the sickle cell disease data collection 
program to allow for data collection and analysis in States 
currently participating in the program and encourages expansion 
to additional States. The Committee encourages CDC to provide 
technical assistance to additional States with a higher 
prevalence of SCD, so that they can successfully participate in 
this grant program to better identify affected individuals in 
their States and better meet their needs.
    Stillbirth.--Stillbirth rates remain unacceptably high, 
affecting thousands of families each year. The Committee 
appreciates the findings and recommendations included in the 
March 2023 Stillbirth Task Force report and encourages CDC to 
implement the recommendations including improved recordkeeping, 
data collection, and analysis about stillbirths, addressing 
disparities in stillbirth risk, and provide better support for 
families after a stillbirth occurs.
    Surveillance for Emerging Threats to Mothers and Babies 
Network [SET-NET].--The Committee includes $23,000,000 for SET-
NET. The program supports CDC's collaboration with State, 
Tribal, territorial, and local health departments to monitor 
the impact of emerging health threats, including COVID-19, on 
pregnant people and their babies and inform public health and 
clinical decision-making to improve the health of pregnant and 
postpartum people and infants.
    Thalassemia.--The Committee supports funding for 
thalassemia, a rare genetic blood disorder that requires 
lifelong blood transfusions, thus requiring chelation to remove 
excess iron, particularly from the heart and liver. The 
Committee is aware of the critical work done by the thalassemia 
program at CDC in identifying thalassemia patients and 
connecting them to services and to life-saving treatment 
centers. Thalassemia patients experience serious comorbidities 
that can impact almost every aspect of their lives. The 
Committee urges CDC to continue and strengthen this 
collaboration among thalassemia treatment centers, non-profit 
organizations, and patients and their families.
    Tourette Syndrome.--The Committee provides $2,500,000 and 
directs CDC to continue to educate physicians, educators, 
clinicians, allied professionals, and the general public about 
the disorder and to improve scientific knowledge on prevalence, 
risk factors, and co-occurring conditions of Tourette Syndrome.

                 PUBLIC HEALTH AND SCIENTIFIC SERVICES

Appropriations, 2023....................................    $754,497,000
Budget estimate, 2024...................................     961,564,000
Committee recommendation................................     739,497,000

    The Committee recommendation for Public Health Scientific 
Services is $739,497,000.
    This funding supports the work of all of the CDC Centers. 
In particular, these activities compile statistical information 
to inform public health policy; assure the accuracy and 
reliability of laboratory tests; apply digital information 
technology to help detect and manage diseases, injuries, and 
syndromes; support public health workforce development 
programs; and develop and inform the public health community on 
sound public health surveillance, laboratory protocols, and 
epidemiological practices.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Health Statistics...................       187,397,000       187,397,000
Surveillance, Epidemiology, and            298,100,000       298,100,000
 Informatics........................
Advancing Laboratory Science........        23,000,000        23,000,000
Public Health Data Modernization....       175,000,000       160,000,000
Public Health Workforce.............        71,000,000        71,000,000
------------------------------------------------------------------------

    Community Health Workers and Community Health.--The 
Committee recognizes the importance of the community health 
workforce in reaching underserved communities, preventing 
illness, and reducing related healthcare costs. The Committee 
urges CDC to encourage the use of community health workers in 
communities, including Tribal communities, to support the 
delivery of person-centered care.
    Epidemiology and Laboratory Capacity [ELC] Program.--The 
Committee includes $23,000,000 and recognizes the need to 
provide flexibility to State, territorial, and large local 
[STL] health departments to address gaps that are not funded by 
the disease specific sections of the ELC cooperative agreement. 
The ELC program provides critical foundational support for STL 
health departments to fund epidemiology, surveillance, 
laboratory, and data science staff positions that provide the 
backbone for STL public health programs. This program allows 
STL health departments to build the public health workforce and 
infrastructure that will allow them to be better prepared to 
respond to emerging threats more quickly.
    Familial Hypercholesterolemia [FH].--The Committee 
continues to encourage CDC to address FH as a public health 
concern in order to improve diagnosis and care delivery and 
prevent heart disease. The Committee is concerned that many in 
the United States who are affected with FH are completely 
unaware of their condition. The Committee encourages the 
National Center for Chronic Disease Prevention and Health 
Promotion to work collaboratively with CDC's Office of Genomics 
and Precision Public Health to address FH as a public health 
concern in order to improve diagnosis and care delivery and 
prevent heart disease.
    Health Data Utilities [HDUs].--The Committee urges CDC to 
encourage States to coordinate with ONC to designate existing 
neutral, trusted, and nonprofit health information exchange(s) 
[HIEs] to be the State's HDU. HDUs will build upon CDC's 
current work to create modern, integrated, and real-time public 
health infrastructure by building out a highly collaborative 
public utility infrastructure to facilitate State-wide 
electronic health data sharing across the healthcare ecosystem. 
A State-designated HDU will drive better health outcomes and 
more informed population health management programs and payment 
models. The CDC may use appropriated funding through the Data 
Modernization Initiative to support the development of HDUs. 
The Committee urges CDC to issue policy guidelines or best 
practices to support the establishment of HDUs across the 
country.
    National Center for Health Statistics.--The Committee 
provides $187,397,000 for the National Center on Health 
Statistics, which includes the National Health Interview 
Survey. The Committee intends this funding to support 
intersectional analyses of healthcare access, chronic health 
conditions, including Long COVID, and mental health status.
    Native Hawaiian and Pacific Islander National Health 
Interview Survey.--The Committee recognizes that it has been 10 
years since the Native Hawaiian and Pacific Islander National 
Health Interview Survey. The Committee directs the National 
Center for Health Statistics to provide the Committee a report 
within 90 days of enactment on the feasibility, advisability, 
and costs to re-issue this survey, as well as methods to ensure 
the inclusion of Native Hawaiian and Pacific Islanders in the 
annual National Health Interview Study.
    National Neurological Conditions Surveillance System.--The 
Committee includes $5,000,000 within Surveillance, 
Epidemiology, and Informatics to continue efforts on the two 
initial conditions-multiple sclerosis and Parkinson's disease.
    Public Health Data Modernization Initiative [DMI].--The 
Committee commends CDC's work to advance public health data 
modernization and acknowledges that efforts to enhance public 
health data system capabilities will result in fast and more 
reliable data sharing. The Committee provides $160,000,000 for 
CDC to continue bringing together State, Tribal, local and 
territorial public health jurisdictions and public and private 
sector partners with the goal of establishing modern, 
interoperable, and real-time public health data and 
surveillance systems to protect the American public. This 
funding level reflects a shift of $15,000,000 to Public Health 
Preparedness and Response for the Ready Response Enterprise 
Data Integration Platform. The Committee encourages CDC to 
create an advisory council or a sub-unit to an existing 
advisory council to formalize its engagement with 
representatives from State and local public health departments, 
healthcare providers, and the private sector toward the 
development and implementation of enterprise level public 
health data systems that will benefit all public health 
programs at all levels of the government for all diseases and 
conditions. Electronic birth and death registration systems are 
essential tools to monitor public health and fight waste, 
fraud, and abuse in Federal programs. The Committee recommends 
CDC ensure that funding from DMI is allocated to jurisdictions 
through the National Center for Health Statistics to support 
necessary upgrades to their vital statistics systems to enable 
more, better, and faster vital records data. The Committee 
requests a briefing within 90 days of enactment of this act on 
the progress and plans for programs and activities supported by 
DMI funding.
    Public Health Workforce.--The Committee includes 
$71,000,000 and urges CDC to invest in fellowship and training 
programs to rebuild the public health workforce that includes, 
but is not limited to, epidemiologists, contact tracers, lab 
scientists, community health workers, data scientists, 
behavioral scientists, disease intervention and prevention 
specialists, occupational health specialists, public health 
physicians, veterinarians, nurses, informaticians, program 
managers, economists, policy and evaluation experts, and 
communicators who can help protect the Nation's communities.

                          ENVIRONMENTAL HEALTH

Appropriations, 2023....................................    $246,850,000
Budget estimate, 2024...................................     420,850,000
Committee recommendation................................     246,850,000

    The Committee recommendation for the National Center for 
Environmental Health is $246,850,000. The Committee 
recommendation includes $17,000,000 in transfers from the PPH 
Fund.
    The National Center for Environmental Health addresses 
emerging pathogens and environmental toxins that pose 
significant challenges to public health. The Center conducts 
surveillance and data collection to determine which substances 
in the environment are found in people and to what degree. The 
Center also determines whether, and at what level of, exposure 
to these substances are harmful to humans.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Environmental Health Laboratory.....        70,750,000        70,750,000
    Newborn Screening Quality               21,000,000        21,000,000
     Assurance Program..............
    Newborn Screening for SCID......         1,250,000         1,250,000
    Other Environmental Health......        48,500,000        48,500,000
Environmental Health Activities.....        52,600,000        52,600,000
    Safe Water......................         8,600,000         8,600,000
    Amyotrophic Lateral Sclerosis           10,000,000        10,000,000
     Registry.......................
    Trevor's Law....................         3,000,000         3,000,000
    Climate and Health..............        10,000,000        10,000,000
    All Other Environmental Health..        21,000,000        21,000,000
Environmental and Health Outcome            34,000,000        34,000,000
 Tracking Network...................
Asthma..............................        33,500,000        33,500,000
Childhood Lead Poisoning............        51,000,000        51,000,000
Lead Exposure Registry..............         5,000,000         5,000,000
------------------------------------------------------------------------

    Amyotrophic Lateral Sclerosis [ALS] Registry.--The 
Committee encourages CDC to continue its investment in research 
that will reduce incidence and prevalence of ALS in the United 
States. The Committee urges CDC to provide reports to the 
public that include State-by-State data on the incidence and 
prevalence of ALS. The Committee encourages CDC to continue its 
efforts to evaluate, update, and improve the National ALS 
Registry program, by ensuring that the most up to date 
information is provided to researchers, and ALS patients are 
connected with clinical trials, treatments, and resources in a 
timely manner. The Committee supports continued ALS prevalence 
reports, and urges CDC to publish these reports in a timely 
manner and provide updates regarding these prevalence reports. 
Additionally, the Committee urges CDC to collaborate with the 
Departments of Defense and Veterans Affairs to provide a 
publicly available report on the incidence and prevalence of 
ALS among military veterans. The Committee requests this report 
within 1 year of enactment, and requests the inclusion of a 
strategy to develop and test risk reduction strategies that 
will lower the incidence of ALS among active-duty personnel and 
veterans.
    Asthma.--The Committee includes $33,500,000 for the 
National Asthma Control Program [NACP] so CDC can work with 
States to improve health outcomes for people living with 
asthma. As the number and severity of wildfires increases, the 
Committee also directs the NACP to continue its efforts to 
develop public health interventions aimed at protecting people 
with asthma from wildfire smoke.
    Childhood Lead Poisoning.--The Committee includes 
$51,000,000 to improve health equity by building capacity to 
better prevent and mitigate childhood lead exposure and expand 
the data capabilities of the program to rapidly identify and 
address emerging threats in communities with elevated risk of 
exposure to lead. CDC is expected to support local capacity to 
improve the health of children through efforts to eliminate 
lead from their environment.
    Climate and Health.--The Committee includes $10,000,000 for 
the program to provide guidance, data, and technical assistance 
to all States, local health departments, and additional 
assistance to Tribes and territories, to identify possible 
health effects associated with a changing climate and implement 
health adaptation plans. Communities across the country are 
vulnerable to health effects from increasingly common events 
such as heatwaves, wildfires, floods, droughts, and extreme 
storms. The Committee expects CDC to aid in the development and 
implementation of State-specific action plans to protect health 
from these threats.
    Per and Polyflouroalkyl Substances [PFAS].--The Committee 
remains concerned that extended exposure to PFAS is associated 
with decreased antibody response, dyslipidemia, decreased 
infant and fetal growth, and increased risk of kidney cancer. 
CDC should work expeditiously to update its clinical guidance 
to advise clinicians to offer PFAS blood testing to patients 
who are likely to have a history of elevated exposure.
    Preventing Harmful Exposure to Phthalates.--The Committee 
is concerned that despite action by the Consumer Product Safety 
Commission to limit chemicals known as ortho-phthalates 
(phthalates) in 2018 from children's toys and other children's 
items in addition to the three phthalates banned by Congress in 
2008, several phthalates continue to be used in food packaging 
and food contact equipment. The Committee requests a briefing 
within 180 days of enactment of this act outlining trends in 
human exposure for the 13 phthalates measured in CDC's National 
Exposure Report, including CDC's efforts to measure human 
exposure to phthalates.
    Vessel Sanitation Program.--The Committee includes 
$4,000,000 to support the critical public health functions of 
the vessel sanitation program. The Committee requests 
additional information in the fiscal year 2025 CJ on the 
program budget, including user fee and no-year funding 
balances, estimated user fee collections, and the anticipated 
workload.

                     INJURY PREVENTION AND CONTROL

Appropriations, 2023....................................    $761,379,000
Budget estimate, 2024...................................   1,351,669,000
Committee recommendation................................     761,879,000

    The Committee recommendation for the National Center for 
Injury Prevention and Control is $761,879,000.
    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 nonoccupational injuries including those caused by fires and 
burns, poisoning, drowning, violence, and traffic accidents.
    The Committee recommendation includes funding for the 
following activities:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Intentional Injury..................       164,550,000       164,550,000
    Domestic Violence and Sexual            38,200,000        38,200,000
     Violence.......................
        Child Maltreatment..........         7,250,000         7,250,000
        Child Sexual Abuse                   3,000,000         3,000,000
         Prevention.................
    Youth Violence Prevention.......        18,100,000        18,100,000
    Domestic Violence Community              7,500,000         7,500,000
     Projects.......................
    Rape Prevention.................        61,750,000        61,750,000
    Suicide Prevention..............        30,000,000        30,000,000
    Adverse Childhood Experiences...         9,000,000         9,000,000
National Violent Death Reporting            24,500,000        24,500,000
 System.............................
Unintentional Injury................        13,300,000        13,300,000
    Traumatic Brain Injury..........         8,250,000         8,250,000
    Elderly Falls...................         3,050,000         3,050,000
    Drowning Prevention.............         2,000,000         2,000,000
Other Injury Prevention Activities..        29,950,000        29,950,000
Opioid Overdose Prevention and             505,579,000       506,079,000
 Surveillance.......................
Injury Control Research Centers.....        11,000,000        11,000,000
Firearm Injury and Mortality                12,500,000        12,500,000
 Prevention Research................
------------------------------------------------------------------------

    Adolescent Mental Health.--The Committee is aware that the 
United States is facing a crisis in adolescent and youth mental 
health. The Committee commends CDC for standing up a new 
Behavioral Health Coordinating Unit [BHCU] to coordinate and 
leverage existing CDC activities related to mental health, with 
a particular focus on adolescent mental health activities, 
including prevention and early intervention. The BHCU will 
identify opportunities for a streamlined, coordinated, and 
collaborative approach to CDC's mental health activities to 
amplify the impact across the agency. The Committee encourages 
CDC to begin to develop a national strategy and establish goals 
to improve adolescent mental health, including linkages between 
adolescent mental health and substance use and overdose, 
adverse childhood experiences, suicide, and other areas that 
impact mental wellbeing. This effort is expected to include 
convening of key experts, in and out of government, with 
special considerations to ensure the voices of underserved 
communities and populations are represented. CDC is also 
encouraged to provide technical assistance, including through 
grants to partner organizations, to support collaborations and 
connections between multiple sectors in communities such as 
public health, education, community mental health organizations 
and other community-based organizations, youth serving 
organizations, parents, and social services providers to 
strengthen mental health prevention and promotion and improve 
mental health, well-being, and resilience in communities.
    Adverse Childhood Experiences [ACEs].--The Committee 
provides $9,000,000 for ACEs surveillance, research, and 
prevention efforts. The Committee commends CDC's Injury 
Prevention Center for funding States and localities, including 
those with high rates of trauma, violence, and overdoses, to 
conduct surveillance on exposure to ACEs and target community-
based interventions related to exposure to childhood trauma, 
ACEs, addiction, and violence. The Committee urges CDC to 
improve upon its previous ACEs research by focusing on building 
a diverse sample of participants, identifying the relative 
strength of risk and protective factors as well as community 
factors, understanding the impact of social and economic 
conditions on well-being, and measuring the intensity and 
frequency of specific ACEs and their effect on health outcomes.
    Child Sexual Abuse Prevention.--The Committee includes 
$3,000,000 in recognition of the severe and often life-long 
physical, cognitive, and emotional impact of child sexual abuse 
and commends CDC's work in child sexual abuse prevention 
research. CDC is encouraged to improve surveillance systems and 
data collection, increase the understanding of risk and 
protective factors, and develop and disseminate effective 
prevention efforts.
    Community and Youth Violence Prevention.--The Committee 
commends CDC for its work to prevent youth and community 
violence through technical assistance, research, and 
partnerships between community organizations, schools, law 
enforcement, faith-based organizations, and academia to 
evaluate effective interventions to reduce violence. The 
Committee encourages CDC to scale up existing partnerships with 
organizations that have demonstrated success in reducing 
community violence and its risk factors, including those 
involving healthcare and community outreach organizations, as 
well as supporting academic-community collaborations and 
research to advance the science and practice of violence 
prevention, while reducing inequities from which such violence 
stems.
    Additionally, as incidents of trauma continue to rise, the 
Committee urges CDC to develop innovative approaches to reduce 
the incidence of re-injury and re-incarceration caused by 
intentional violent trauma. Efforts may include facilitating 
the creation and expansion of comprehensive hospital-based 
violence intervention and prevention programs that focus on 
individuals at the highest risk for experiencing community 
violence. This may be done through partnerships with trauma 
centers and non-profit entities, such as community-based 
violence prevention programs, providing technical assistance, 
and facilitating or conducting research of hospital-based 
violence prevention programs.
    Core State Injury Prevention Program [Core SIPP].--The 
Committee includes $29,950,000 for the Core SIPP to enhance 
efforts to identify and respond to injury threats with data-
driven public health actions.
    Domestic Violence and Sexual Violence.--The Committee 
provides $38,200,000 for CDC to collect data on the connection 
between brain injuries and domestic and sexual violence, and 
implement a data collection project that follows up on and 
operates under CDC's National Intimate Partner and Sexual 
Violence Survey and asks questions about the prevalence and 
circumstances surrounding brain injuries.
    Drowning Prevention.--The Committee continues $2,000,000 to 
prevent fatal drownings. This funding will allow CDC to 
implement proven drowning prevention programs with national 
organizations working with underserved and diverse youth to 
support State drowning surveillance efforts, as well as to 
develop and begin implementation of a national plan on water 
safety.
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes $12,500,000 to conduct research on firearm 
injury and mortality prevention. Given violence and suicide 
have a number of causes, the Committee recommends CDC take a 
comprehensive approach to studying these underlying causes and 
evidence-based methods of prevention of injury, including crime 
prevention. All grantees under this section will be required to 
fulfill requirements around open data, open code, pre-
registration of research projects, and open access to research 
articles consistent with the National Science Foundation's open 
science principles. The Director of CDC is to report to the 
Committees within 30 days of enactment of this act on 
implementation schedules and procedures for grant awards, which 
strive to ensure that such awards support ideologically and 
politically unbiased research projects.
    Injury Control Research Centers.--The Committee includes 
$11,000,000 for awards for multi-disciplinary research on the 
causes, outcomes, and prevention of injuries and violence.
    National Violent Death Reporting System [NVDRS].--The 
Committee encourages CDC to support enhanced data linkage 
opportunities between NVDRS and emergency department data. The 
Committee recognizes the initial Linking ESSENCE and Death 
Surveillance initiative piloted across six health departments 
proved successful and should be expanded to additional sites to 
strengthen violence-related data linkage activities.
    Opioid Prescribing Guidelines.--The Committee applauds 
CDC's release of the 2022 Clinical Practice Guideline for 
Prescribing Opioids for Pain, which updates and replaces the 
2016 CDC prescribing guideline. The Committee directs CDC to 
continue its work educating patients and providers, and to 
encourage uptake and appropriate use of the Guidelines. The 
Committee urges CDC to continue coordination with other 
agencies including the VA, IHS, DoD and HRSA in implementation 
and related updates in safe prescribing practices to ensure 
consistent, high-quality care standards across the Federal 
Government.
    Opioid or Other Drug Use and Overdose Prevention.--The 
Committee continues to encourage CDC to ensure that funding for 
opioid and stimulant use and overdose prevention, as well as 
other emerging substances and threats, reaches local 
communities to advance local understanding of the opioid 
overdose epidemic and to scale-up prevention and response 
activities. Additionally, CDC is directed to continue expansion 
of case-level syndromic surveillance data, improvements of 
interventions that monitor prescribing and dispensing 
practices, better timeliness and quality of morbidity and 
mortality data, as well as the enhancement of efforts with 
medical examiners and coroner offices.
    Public Safety Officer Suicide Reporting Module.--The 
Committee continues funding for CDC to maintain its Public 
Safety Officer Suicide Reporting Module to collect data on the 
suicide incidence among public safety officers. These data will 
inform and aid in the development of prevention efforts to 
reduce suicide among public safety officers as described in the 
Helping Emergency Responders Overcome Act of 2020.
    Rape Prevention.--The Committee includes $61,750,000 to 
support rape prevention and education programs. In granting 
funds to States, the Secretary shall set forth procedures 
designed to ensure meaningful involvement of the State or 
territorial sexual assault coalitions and representatives from 
underserved communities in the application for and 
implementation of funding.
    Suicide Prevention.--The Committee is concerned about data 
that show suicide rates increased in 2021 after 2 years of 
decline, and that in 2021, suicide was one of the leading 
causes of death for people aged 10-14 and 25-34. The Committee 
recognizes that suicide is a serious public health problem 
requiring strategic programming, especially among 
disproportionately impacted populations. The Committee also 
recognizes that suicide prevention requires a public health 
approach that addresses multiple risk factors at the 
individual, community, and societal levels. States, tribes, and 
territories are well positioned to lead a comprehensive public 
health approach to suicide prevention, which involves 
coordinating with multisector partners to take a data-driven, 
evidence-based process to address the broad range of risk and 
protective factors associated with suicide. The Committee 
directs CDC to prioritize funding to State public health 
departments to expand the Comprehensive Suicide Prevention 
program nationwide, and to help tribes and territories build 
capacity and implement strategies to prevent suicide.
    Traumatic Brain Injury.--The Committee provides $8,250,000 
to initiate concussion surveillance, particularly among 
children and youth. The Committee appreciates CDC's work to 
better understand the burden of concussions in the United 
States. Gaps still exist in capturing youth sports concussion, 
therefore a national concussion surveillance system is needed 
to accurately determine the incidence of all concussions among 
youth ages 5 to 21. CDC is encouraged to continue efforts to 
track traumatic brain injury, concussion mortality, and 
morbidity, particularly among youth.

                     OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2023....................................    $362,800,000
Budget estimate, 2024...................................     362,800,000
Committee recommendation................................     362,800,000

    The Committee recommendation for the National Institute for 
Occupational Safety and Health [NIOSH] programs is 
$362,800,000. The Committee recognizes that 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 is implemented by conducting basic 
and applied scientific research and translating the knowledge 
gained into products and services that impact workers in 
settings from corporate offices to construction sites to coal 
mines. Further, the Committee acknowledges that NIOSH continues 
to protect American workers through its work-related illness 
and injury research. The Committee encourages NIOSH to continue 
its objectivity so as to ensure the highest professional and 
ethical standards are maintained.
    The Committee recommendation includes funding for the 
following activities at the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
National Occupational Research             119,500,000       119,500,000
 Agenda.............................
Agriculture, Forestry, Fishing (non--       29,000,000        29,000,000
 add)...............................
Education and Research Centers......        32,000,000        32,000,000
Personal Protective Technology......        23,000,000        23,000,000
Mining Research.....................        66,500,000        66,500,000
National Mesothelioma Registry......         1,200,000         1,200,000
Firefighter Cancer Registry.........         5,500,000         5,500,000
Other Occupational Safety and Health       115,100,000       115,100,000
 Research...........................
------------------------------------------------------------------------

    Agriculture, Forestry, and Fishing Program.--The Committee 
includes $29,000,000 for efforts to protect workers in this 
sector by providing leadership in applied research, disease and 
injury surveillance, education, and prevention. NIOSH is 
directed to provide a briefing to the Committee not later than 
90 days after the date of enactment of this act on the 
execution of the Commercial Fishing Safety Research and 
Training program and grants since the program's inception in 
Public Law 113-281.
    Coal Workers' Health Surveillance Program Mobile Medical 
Unit.--The Committee is concerned about the prevalence of coal 
workers' pneumoconiosis, also known as black lung, and the 
recent increase in progressive massive fibrosis, the most 
severe stage of black lung, among younger miners. According to 
NIOSH, one in 10 underground coal miners who have worked in 
mines for at least 25 years were identified as having black 
lung. Coal miners in central Appalachia are disproportionately 
affected with as many as one in five having evidence of black 
lung-the highest level recorded in 25 years. Early screening 
and detection of black lung can improve health outcomes and 
reduce mortality. However, a NIOSH report has identified 
several potential barriers to screening for miners--including 
the ability to participate in screening. To improve access to 
screening for miners, the Committee encourages CDC NIOSH to 
prioritize funds for the purchase of an additional mobile 
medical unit.
    Education and Research Centers [ERCs].--The Committee 
includes $32,000,000 for ERCs in recognition of their important 
work to improve workplace safety and health by translating 
scientific discoveries into practice through effective 
education, training, and outreach. The Committee applauds the 
work of NIOSH to implement innovative approaches, and its 
translational research. The agency's priorities and efforts 
have included work on the protection of workers from heat 
hazards as well as the effects of the COVID-19 pandemic on the 
workplace, including the mental and emotional health impact on 
workers. The Committee directs NIOSH to increase support for 
new and existing ERCs to support education and training 
programs for undergraduate and graduate students, particularly 
in Environmental and Industrial Hygiene, Occupational Health 
Nursing, Occupational Medicine Residency, and Occupational 
Safety and Health Engineering.
    Heat Stress and Worker Illnesses and Injuries.--The 
Committee recognizes that working under high heat conditions 
causes symptoms of heat illness, including fatigue, loss of 
balance, nausea, headache, loss of physical and mental 
capacity, heavy sweating, muscle cramps, and other symptoms 
that cause or contribute to workplace injuries and illnesses. 
Injuries incurred may be minor, serious, life-threatening, 
illnesses, or fatal and may result in long-term injuries or 
permanent disabilities. The Committee directs the CDC, in 
collaboration with appropriate partners, to research the 
relationship between heat stress and workplace illnesses and 
injuries and to identify means for more accurate data 
collection, including the recording and reporting of heat 
related injuries and illnesses, in outdoor and indoor 
workplaces.
    National Firefighter Registry for Cancer.--The Committee 
includes $5,500,000 as the registry recruits and enrolls 
participants.
    Potential PFAS Exposure Source for Firefighters.--The 
Committee is committed to advancing research on occupational 
exposure of firefighters to PFAS. NIOSH is directed to engage 
with the National Institute of Standards and Technology on 
their ongoing study to identify a firefighter's relative risk 
of exposure to PFAS released from their protective gear.
    Ryan White Act Emergency Responder Notification Compliance 
Program.--The Committee encourages CDC to implement Part G of 
the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public 
Law 111-87), which is intended to establish and facilitate a 
notification process for emergency response employees who may 
have been exposed to certain potentially life-threatening 
infectious diseases while attending, treating, assisting, or 
transporting victims of emergencies.
    Total Worker Health Program.--The Committee continues 
funding for the Total Worker Health program, which supports and 
conducts ground-breaking research to advance the overall 
safety, health, and well-being of U.S. workers. This funding 
supports critical priorities, including addressing the Nation's 
mental health, suicide, and substance use disorder crises, in 
the context of work design and employment.

         ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2023....................................     $55,358,000
Budget estimate, 2024...................................      55,358,000
Committee recommendation................................      55,358,000

    The Committee recommendation for the Energy Employees 
Occupational Illness Compensation Program Act [EEOICPA] (Public 
Law 106-398) is $55,358,000. This mandatory funding supports 
NIOSH scientists who reconstruct radiation dose levels to 
inform compensation decisions.

                             GLOBAL HEALTH

Appropriations, 2023....................................    $692,843,000
Budget estimate, 2024...................................     764,843,000
Committee recommendation................................     692,843,000

    The Committee recommends $692,843,000 for global health-
related activities at CDC.
    CDC's global efforts promote health security and prevent 
disease in the United States and abroad through rapid detection 
and response to emerging and re-emerging health threats.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Global HIV/AIDS Program.............       128,921,000       128,921,000
Global Tuberculosis.................        11,722,000        11,722,000
Global Immunization Program.........       230,000,000       230,000,000
    Polio Eradication...............       180,000,000       180,000,000
    Measles and Other Vaccine               50,000,000        50,000,000
     Preventable Diseases...........
Parasitic Diseases and Malaria......        29,000,000        29,000,000
Global Public Health Protection.....       293,200,000       293,200,000
------------------------------------------------------------------------

    Global Health Protection.--The Committee includes 
$293,200,000 and recognizes CDC's unique role in supporting 
public health capacity development through scientific and 
technical leadership both domestically and globally, to ensure 
that disease threats anywhere are prevented, detected early and 
responded to robustly through a coordinated, multisectoral 
approach. The Committee supports the creation of a deputy 
director for global health within the director's office to 
oversee and unify CDC's global health activities. CDC is a 
leader in global health research on infectious diseases and in 
developing and validating tools to detect, prevent, and respond 
to infectious diseases that are used in U.S. bilateral and 
multilateral global health and global health security programs. 
The Committee applauds the global health research and related 
partnerships led by the Global Health Center, the National 
Center for Immunization and Respiratory Diseases, and the 
National Center for Emerging and Zoonotic Infectious Diseases. 
In addition, the Committee urges CDC in its international 
engagements to emphasize the importance of research and 
development to global health security.
    Malaria and Parasitic Diseases.--The Committee provides 
$29,000,000, recognizing the important role CDC plays in the 
fight against malaria and parasitic disease, particularly 
providing parasitic lab capabilities for the United States. CDC 
provides life-saving services and expertise in research, 
diagnosis, treatment, surveillance, consultation, and education 
of parasitic diseases to States and countries, U.S. government 
agencies, and other public health partners. The Committee 
encourages further support for these activities so CDC can 
enhance its parasitic diseases laboratory, close the gap on 
parasitic disease-related health inequity in the United States, 
and advance global control and elimination of malaria and 
targeted neglected tropical diseases.
    Polio Eradication.--The Committee includes $180,000,000 to 
support CDC activities related to wild poliovirus and vaccine-
derived polio surveillance, vaccine procurement, and outbreak 
response. CDC is urged to continue to provide technical 
assistance to countries for polio immunization campaigns, 
conduct environmental surveillance of polio viruses to ensure 
prompt detection and to prevent potential outbreaks of 
paralytic polio disease.
    Population-based Surveillance Platforms.--The Committee 
continues $7,000,000 to continue to support longitudinal 
integrated population-based infectious disease surveillance 
platforms that enable comparative analysis between urban and 
rural populations in Africa.
    Soil Transmitted Helminth and Related Diseases of 
Poverty.--The Committee includes $1,500,000, for currently 
funded CDC projects aimed at surveillance, source remediation 
and clinical education to reduce soil transmitted helminth 
infection.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2023....................................    $883,200,000
Budget estimate, 2024...................................     943,200,000
Committee recommendation................................     898,200,000

    The Committee recommendation for CDC's Preparedness and 
Response activities is $898,200,000.
    CDC's preparedness and response mission is to build and 
strengthen national preparedness for public health emergencies 
including natural, biological, chemical, radiological, and 
nuclear incidents. This funding supports national response 
programs, as well as grants to States and localities to enhance 
preparedness efforts across the country.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Public Health Emergency Preparedness       735,000,000       735,000,000
 Cooperative Agreement..............
Academic Centers for Public Health           9,200,000         9,200,000
 Preparedness.......................
All Other CDC Preparedness..........       139,000,000       139,000,000
------------------------------------------------------------------------

    Centers for Public Health Preparedness and Response.--The 
Committee includes $9,200,000 and understands that despite 
unprecedented efforts to address the COVID-19 pandemic, many 
questions remain about which evidence-informed or evidence-
based practices may reduce the spread of SARS-COV-2 and its 
variants to improve public health preparedness and response. 
The Committee encourages CDC to consider equitable distribution 
across geographical regions when designating and funding 
Centers for Public Health Preparedness and Response as 
authorized in Public Law 117-328.
    Public Health Emergency Preparedness Cooperative 
Agreements.--The Committee includes $735,000,000 to support 
State and local health departments to quickly detect, monitor, 
and respond to health threats. Public health system investments 
serve as the backbone for disaster and outbreak response in 
every State and the pandemic has shown that increased funding 
for preparedness is necessary for a baseline of consistent 
protection. The Committee continues to request a State 
distribution table in the fiscal year 2025 CJ, which should 
also include information about how funding is being allocated 
to local health departments and how States are determining 
these allocations.
    Ready Response Enterprise Data Integration [RREDI] 
Platform.--The Committee provides $15,000,000 for RREDI and is 
aware of the unprecedented challenge recent public health 
emergencies, such as MPox, RSV, influenza, and COVID-19, pose 
to Federal, State, and local governments' ability to collect 
and share data in a meaningful way to ensure informed policy 
and operational decisionmaking. This platform, the next 
generation of HHS Protect, the platform used in the COVID-19 
response, has proven vital to allow for a common operating 
picture to collect, integrate and analyze enormous amounts of 
data for situational awareness and decisionmaking regarding 
public health response resources. The Committee recognizes the 
investment the U.S. government has made into this platform and 
includes funding for CDC to continue to maintain this 
capability to ensure preparedness for future public health 
emergencies.

                        BUILDINGS AND FACILITIES

Appropriations, 2023....................................     $40,000,000
Budget estimate, 2024...................................      40,000,000
Committee recommendation................................      40,000,000

    The Committee recommendation for Buildings and Facilities 
is $40,000,000.
    CDC-Owned Buildings and Facilities.--The Committee 
continues funding to make progress on reducing CDC's backlog of 
maintenance and repairs at its campuses nationwide, including 
its Atlanta headquarters. The Committee acknowledges that in 
order to protect Americans from health threats and to rapidly 
respond to public health emergencies, CDC needs a safe, secure, 
and fully operational infrastructure in the form of its own 
laboratories, buildings, and facilities. COVID-19 and other 
recent public health emergencies have required urgent action 
and demonstrated that CDC laboratories and facilities need to 
be ready to respond quickly and comprehensively. The Committee 
supports the completion of the CDC Masterplan Build Out, 
including continued progress with the Atlanta Masterplan Build 
Out.
    Mine Safety Research Facility.--The Committee requests the 
continuation of quarterly updates on progress in the 
construction of the new mine safety research facility and 
laboratory, costs incurred, and unanticipated challenges which 
may affect timeline or total costs until completion of the 
facility.

                          CDC-WIDE ACTIVITIES

Appropriations, 2023....................................    $723,570,000
Budget estimate, 2024...................................   1,038,570,000
Committee recommendation................................     693,570,000

    The Committee provides $693,570,000 for public health 
leadership and support activities at CDC.
    The recommendation includes $160,000,000 in transfers from 
the PPH Fund.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Preventive Health and Health               160,000,000       160,000,000
 Services Block Grant...............
Public Health Leadership and Support       128,570,000       128,570,000
Infectious Diseases Rapid Response          35,000,000        10,000,000
 Reserve Fund.......................
Public Health Infrastructure and           350,000,000       350,000,000
 Capacity...........................
Center for Forecasting and Outbreak         50,000,000        45,000,000
 Analytics..........................
------------------------------------------------------------------------

    Center for Forecasting and Outbreak Analytics [CFA].--The 
Committee includes funding for the CFA to facilitate the use of 
data, modeling, and analytics to improve preparedness and 
response. The Committee urges CDC to continue to work with 
schools of public health and other academic institutions to 
engage the Nation's expertise in disease modeling, public 
health data analysis, research, and training to build workforce 
capacity in this emerging field. As an interagency resource for 
early warnings related to emerging infectious disease threats, 
the Center will support the public health system in detecting, 
responding to, and eventually preventing future epidemics and 
outbreaks.
    Infectious Diseases Rapid Response Reserve Fund [IDRRRF].--
The Committee includes $10,000,000 for IDRRRF. The IDRRRF 
provides an immediate source of funding to ensure that funds 
are available when an emerging infectious disease crisis is 
detected. Funds are available until expended. CDC is expected 
to provide updates to the Committees on Appropriations as 
outlined in the Joint Explanatory Statement accompanying Public 
Law 117-328.
    Local Public Health Departments.--The Committee notes that 
Federal funding intended for both State and local health 
departments does not consistently reach local health 
departments beyond those directly-funded. The Committee 
encourages CDC to require States to fund local health 
departments when programmatically appropriate.
    Office of Rural Health [ORH].--The Committee is encouraged 
by efforts from the agency to establish the ORH. The Committee 
directs the agency to ensure that the established ORH will 
guide the CDC's rural health leadership across the entire 
agency. This includes developing purposeful public health 
guidance for rural health departments, analyzing and developing 
initiatives to expand the rural public health workforce, 
coordinating with the Federal Office of Rural Health Policy 
under HRSA, and otherwise serving as a resource and technical 
assistance hub for public health in rural communities. The 
Committee includes $5,000,000 for the continued efforts to 
establish the ORH.
    Public Health Infrastructure and Capacity.--The Committee 
includes $350,000,000 in public health funding that is not 
segmented by disease, condition, activity. Rather, it is 
provided for cross-cutting, core public health infrastructure 
needs, including but not limited to workforce, health 
information and data systems, public health policy and 
communications, equity, financial management, community 
partnership development, and organizational capacity. By 
providing maximum flexibility, this funding will allow public 
health agencies to determine and address their greatest needs 
and build core capabilities that will strengthen and support 
new and existing programmatic functions. The Committee again 
directs that no less than 70 percent of this funding be awarded 
to health departments. The Committee encourages CDC to 
strengthen infrastructure in local health departments by 
continuing to directly award funds to local health departments, 
and by urging State health department recipients to allocate 
resources to local health departments. The Committee urges CDC 
to publicly track and report to the Committee how funds 
provided to State health departments are passed through to 
local health departments.
    Public Health Leadership and Support.--The Committee 
includes $128,570,000 to support CDC's foundational public 
health activities and to facilitate partnerships. The Committee 
commends CDC for its commitment to the development of a diverse 
healthcare and public health workforce. The Committee continues 
funding for the John R. Lewis CDC Undergraduate Public Health 
Scholars Program.

                     National Institutes of Health

    The Committee provides $49,224,000,000, an increase of 
$943,000,000, for the National Institutes of Health [NIH].
    Within the total appropriation, the Committee provides 
$407,000,000 in budget authority authorized in the 21st Century 
Cures Act (Public Law 114-255). Per the Cures Act, $86,000,000 
is transferred to the National Institute of Neurological 
Disorders and Stroke [NINDS] and $86,000,000 to the National 
Institute of Mental Health [NIMH] for the BRAIN Initiative; and 
$235,000,000 to the Office of the Director [OD] for the All of 
Us precision medicine initiative. The total also includes 
$1,412,482,000 in transfers available under section 241 of the 
PHS Act (Public Law 78-410 as amended).
    More than 80 percent of NIH's appropriated budget is 
awarded for extramural research each fiscal year. This funding 
supports more than 58,000 meritorious grants to more than 2,700 
academic universities, hospitals, small businesses, and other 
organizations throughout the United States and internationally. 
This investment has allowed NIH to continue its mission to seek 
fundamental knowledge about the nature and behavior of living 
systems and the application of that knowledge to enhance 
health, lengthen life, and reduce illness and disability.
    As in previous years, the Committee has targeted NIH 
funding in areas of promise of scientific advancement and 
urgency, while allowing NIH to maintain flexibility to pursue 
unplanned scientific opportunities and address unforeseen 
public health needs. The Committee increases support for mental 
health research by $100,000,000, provides an increase of 
$100,000,000 for research on Alzheimer's disease and 
Alzheimer's disease-related dementias research, increases 
support for cancer research by $60,000,000, and increases 
support for diabetes research by $10,000,000. The bill also 
includes an increase of $20,000,000 for the Helping to End 
Addiction Long-term or HEAL Initiative, $12,000,000 for a new 
palliative care research program, and an increase of 
$10,000,000 for the Implementing a Maternal health and 
Pregnancy Outcomes Vision for Everyone [IMPROVE Initiative] to 
combat recent alarming rates of maternal mortality. Finally, 
the bill provides $1,500,000,000 for the Advanced Research 
Projects Agency for Health [ARPA-H], the President's bold and 
promising proposal to accelerate the pace of breakthroughs in 
medicine using the Defense Advanced Research Projects Agency as 
a model.
    The Committee directs NIH to include updates on the 
following research, projects, and programs in the fiscal year 
2025 Congressional Justification: metastatic breast cancer; 
future goals for each of the deadliest cancers (brain, 
esophagus, liver, lung, ovary, pancreas, stomach and 
mesothelioma); the link between obesity and endometrial cancer; 
melanoma; neuroblastoma; pediatric immunotherapy clinical 
trials; congenital heart disease; kidney transplant 
disparities; lower urinary tract symptoms; celiac disease; 
Maternal-Fetal Medicine Units Network; pelvic organ prolapse; 
Usher syndrome; indoor pollutants; amyloidosis; Childhood Post-
Infectious Neuroimmune Disorders/Pediatric Acute-Onset 
Neuropsychiatric Syndrome [PANS]/Pediatric Autoimmune 
Neuropsychiatric Disorders Associated with Streptococcus 
[PANDAS]; Congenital Cytomegalovirus; Native Hawaiian Early 
Career Development; Von Hippel-Lindau Disease; NCI's plans to 
update the Surveillance, Epidemiology, and End Results 
Registry; pulmonary fibrosis; cellular immunity; and 
opportunities to enhance childhood cancer research efforts, 
including coordinating efforts already underway through the 
Trans-NIH Pediatric Research Consortium.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2023....................................  $7,104,159,000
Budget estimate, 2024...................................   7,820,159,000
Committee recommendation................................   7,380,159,000

    The Committee recommendation includes $7,380,159,000 for 
the National Cancer Institute [NCI]. Of this amount, 
$30,000,000 is available for repairs and improvements to the 
NCI facility in Frederick, Maryland.
    Alaska Native Colorectal Cancer.--The Committee is 
concerned the Alaska Native people are twice as likely to be 
diagnosed with colorectal cancer as the White population. A 
recent study shows that Alaska Natives have the world's highest 
rate of colorectal cancer. Colorectal cancer often has no 
symptoms until later stage, but screenings help detect growth 
at earlier stages. These high rates have led the Alaska Native 
Tribal Health Consortium and the Alaska Native Medical Center 
to amend their guidelines to lower the screening age from 45 to 
40 in order to detect early onset colorectal cancer. The 
Committee encourages NCI to expand research efforts to reduce 
Alaska Native cancer disparities and improve outreach.
    Childhood Cancer Data Initiative [CCDI].--The Committee 
includes no less than $50,000,000 for the CCDI, including to 
support continued enhancement of the CCDI Molecular 
Characterization Initiative.
    Childhood Cancer STAR Act.--The Committee includes 
$30,000,000, the same as the fiscal year 2023 enacted level, 
for continued implementation of the Childhood Cancer 
Survivorship, Treatment, Access, and Research [STAR] Act to 
expand existing biorepositories for childhood cancer patients 
enrolled in NCI-sponsored clinical trials to collect and 
maintain relevant clinical, biological, and demographic 
information on all children, adolescents, and young adults with 
cancer. The Committee has also included sufficient funding to 
carry out childhood cancer survivorship research and programs 
as authorized in the STAR Act, such as supporting research to 
inform best practices for the treatment of late effects of 
childhood cancers, research to improve collaboration among 
providers so that doctors are better able to care for this 
population as they age, and research to inform innovative 
models of care for childhood cancer survivors. This amount also 
includes $2,000,000 provided for the CDC's ongoing efforts to 
enhance cancer registry case capture efforts for childhood and 
adolescent cancers.
    Clinical Research Workforce Training.--The Committee is 
concerned that a shortage of staff who are qualified to support 
and administer cancer clinical trials has reached a crisis 
point and is slowing our Nation's progress in developing new 
treatments. In some cases, trials have been delayed or even 
abandoned because the sponsor or cancer center conducting the 
trial could not hire enough staff to run them. The shortage is 
especially acute in trials involving cellular therapies, such 
as CAR-T, which are customized for each individual patient. 
Specialized skills are required to run trials that involve 
extracting a patient's cells, re-engineering them in the lab, 
and infusing them back into the patient. Therefore, the 
Committee urges the NCI to address the shortage of clinical 
research staff by working with the academic community to 
support the training of highly specialized clinical research 
staff, including in the area of cellular therapy.
    Deadliest Cancers.--The Recalcitrant Cancer Research Act 
[RCRA] of 2012 (Public Law 112-239) focuses on cancers with a 
5-year survival rate below 50 percent, which account for over 
40 percent of all U.S. cancer deaths. While advances in some 
cancers have made it possible to reduce the overall rate of 
cancer deaths over the last several decades, there has been 
limited progress reducing mortality for these diseases. In 
fiscal year 2020 (Public Law 116-94), Congress directed NCI to 
develop a scientific framework using the process outlined in 
the RCRA for stomach and esophageal cancers. In response, NCI 
formed a multi-disciplinary working group of its Clinical 
Trials and Translational Research Advisory Committee [CTAC] and 
has released a report listing suggested research focus areas. 
The Committee appreciates that NCI has transmitted its 
framework for gastric and esophageal cancers to Congress, 
emphasizing the important research efforts underway, as well as 
future opportunities. The Committee requests to be kept 
informed of NCI's efforts on the pancreatic, lung, 
glioblastoma, esophageal and stomach cancer frameworks and 
directs NCI to start a similar process for primary liver 
cancer, including cholangiocarcinoma. Finally, given the 
devastating toll of all recalcitrant cancers and the lack of 
diagnostic and treatment resources currently available, the 
Committee urges NCI to identify future goals for each of the 
deadliest cancers (brain, esophagus, liver, lung, ovary, 
pancreas, stomach and mesothelioma) in the fiscal year 2025 CJ.
    Endometrial Cancer and Obesity.--Endometrial cancer is the 
most common gynecologic cancer, and the fourth most common 
malignancy among women in the United States trailing only 
breast, lung, and colorectal. In fact, in 2023, it is estimated 
that 66,200 new cases of uterine cancer will be diagnosed, and 
about 13,030 women will die from the disease. Obesity is the 
strongest known risk factor for the most common type of 
endometrial cancer, and the disease is more than three times as 
common in people with obesity. The Committee recognizes that 
obesity is a growing public health issue, and as rates of 
obesity continue to increase, the number of women diagnosed 
with endometrial cancer is also expected to rise. Therefore, 
the Committee requests an update in the fiscal year 2025 CJ on 
collaborative research efforts across NIH, other NIH-supported 
extramural research projects, and research efforts focusing on 
the link between obesity and endometrial cancer.
    Geriatric Cancers.--As our population ages and cancer 
treatments improve, more patients with cancer are living long 
into their late decades. Adults aged 65 and older currently 
account for 67 percent of cancer survivors but are projected to 
account for 73 percent by 2040. Survivorship programs, however, 
have primarily focused on the late effects of cancer diagnosed 
at younger ages rather than supporting older adults. In 
addition, older adults with cancer remain significantly 
underrepresented in clinical trials, making treatment of these 
patients challenging for oncologists. The Committee urges NCI 
to continue to support funding opportunities across the 
geriatric oncology research continuum. Investments in this area 
will allow clinicians to provide a higher quality of care to 
this vulnerable and growing cancer patient population.
    Glioblastoma [GBM].--GBM is a cancer with less than a 5 
percent 5-year relative survival rate. The average survival 
time from diagnosis has improved by only 6 months over the last 
30 years. To date, only five drugs and one medical device have 
been approved by the FDA for treating GBM. With prior 
Congressional investment in NCI programs, glioblastomas have 
been molecularly characterized, resulting in a new and 
promising understanding of these tumors, including identifying 
potential clinical strategies and agents, trial designs, and 
imaging and pathology technologies. The Committee commends NCI 
for its establishment and implementation of the GBM 
Therapeutics Network [GTN] and requests an update on the status 
of the program's implementation and progress. The GTN's cross-
cutting teams' capabilities to conduct pre-clinical studies and 
early-phase clinical trials enable the careful evaluation of 
potential treatments, including small molecule drugs, 
immunotherapies, radiation, and devices. The overall goal of 
the GTN is advancing progress towards future cures and improved 
quality of life for GBM patients. The Committee urges NCI to 
continue to support the GTN so that this program can rapidly 
launch clinical trials that speed access to promising qualified 
treatments to patients consistent with NCI's Glioblastoma 
Working Group recommendations in 2019.
    Helping Cancer Patients Quit Smoking.--The Committee is 
concerned that not all cancer patients who smoke and are 
treated at NCI designated cancer centers are being offered 
tobacco cessation services. Research indicates that smoking 
cessation can lead to improved cancer treatment outcomes for 
all cancers. The Committee commends NCI for identifying this 
gap and launching the Cancer Center Cessation Initiative with 
the long-term goal of helping cancer centers and other 
hospitals build and implement tobacco cessation treatment 
programs for cancer patients. The Committee is eager to read 
new findings and publications from the pilot program and urges 
NCI's continued support for this initiative to ensure its 
sustainability. The Committee also is aware that tobacco use 
and lung cancer rates are higher in rural areas. The Committee 
encourages NCI to provide input on Agency for Healthcare 
Research and Quality efforts to develop model tobacco cessation 
programs for cancer patients in rural hospitals to improve 
health outcomes.
    Liver Cancer.--The Committee applauds NCI for seeking input 
on how best to address the need to prioritize early detection, 
screening, and prevention sciences for primary liver cancer. 
Primary liver cancer has a dismal 5-year survival rate of only 
18 percent, is the third most common cause of cancer death in 
the U.S., and unlike most cancers the rate of liver cancer 
mortality continues to increase. The Committee urges NCI to 
continue to support a robust research portfolio in early 
detection, screening, and prevention of liver cancer. The 
Committee applauds the NCI for its Early Detection of Liver 
Cancer consortia initiatives as a means of fostering progress 
and collaboration. The Committee encourages NCI to continue 
such programs as well as Program Projects, R01 and U01 
Cooperative Research to advance progress against liver cancer. 
Also, as hepatitis B is estimated to cause up to 60 percent of 
the cases of liver cancer, the Committee applauds NCI for its 
collaboration to implement the Strategic Plan for Trans-NIH 
Research to Cure Hepatitis B.
    Maternal and Child Cancer Risks.--The Committee is 
concerned about knowledge gaps regarding the risk and impact of 
exposure to environmental carcinogens associated with common 
cancers in women and children, particularly in understudied and 
highly impacted populations such as communities of color and 
low-income populations. Additional research is needed to 
understand the windows of exposure and the relationships 
between multiple exposures to environmental contaminants and 
intermediate cancer risk to develop effective prevention 
programs for environmentally mediated cancers and address 
health inequities. The Committee encourages NCI to continue to 
support research to understand the impact of multiple exposures 
to environmental chemicals, pollutants, and social stressors 
across a diverse population of pregnant women and children.
    Melanoma.--The Committee encourages NCI to continue support 
for research on mutagenesis, early detection and treatment. 
Continued study of gene expression profiling in melanoma and 
its precursors is needed to define patient subsets by their 
risk of melanoma and their prognosis, which will be able to 
guide management of early-stage disease as has been the case in 
breast cancer. Melanoma research over the last decade has 
produced groundbreaking advances in targeted therapy and 
immunotherapy that have not only led to a decline in melanoma 
mortality, but have been the foundation for advances in many 
other cancer types. The Committee encourages NCI to continue to 
support research on mechanisms of primary and secondary drug 
resistance, new drug targets and validation of predictive 
biomarkers that will allow selection of optimal therapy. Basic 
and translational goals should be facilitated through 
development and use of ever-improving models of human melanoma, 
including those involving rare subtypes. In addition, the 
Committee encourages NCI to explore opportunities for 
multicenter trials that will determine whether shorter courses 
of therapy will decrease toxicity while maintaining benefit, 
refine adjuvant therapies, and continue to develop neoadjuvant 
therapies. The Committee also encourages NCI to continue to 
further rare melanoma research through the use of patient data 
and biospecimen banks where populations are not adequate for 
randomized trials. The Committee requests an update on melanoma 
research efforts in the fiscal year 2025 CJ.
    Neuroblastoma.--The Committee encourages NCI to continue to 
support research on high-risk neuroblastoma, including 
continued support for an innovative treatment consortium that 
tests new therapies for relapsed and refractory patients in 
early phase clinical trials. The Committee requests an update 
on neuroblastoma research efforts in the fiscal year 2025 CJ.
    Pediatric Cancer Immunotherapy.--The Committee encourages 
NCI to continue to support pediatric immunotherapy 
translational and clinical research. The Committee is aware of 
the transition from the Pediatric Immunotherapy Discovery and 
Development Network to the Pediatric Immunotherapy Network. The 
Committee requests an update on progress made in ensuring the 
continuation of multi-site pediatric immunotherapy clinical 
trials in the fiscal year 2025 CJ.
    Surveillance, Epidemiology, and End Results [SEER] 
Program.--The Committee recognizes NCI for recent efforts to 
modernize the SEER registry and bolster data collection, 
including innovative activities to better capture the 
prevalence and progression of metastatic cancers. NCI is 
directed to further support SEER modernization activities in a 
meaningful way, and to continue to update the Committee on 
progress and unmet needs in this area in the fiscal year 2025 
CJ.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2023....................................  $3,982,345,000
Budget estimate, 2024...................................   3,985,158,000
Committee recommendation................................   3,982,345,000

    The Committee recommendation includes $3,982,345,000 for 
the National Heart, Lung, and Blood Institute [NHLBI].
    Community Engagement Alliance Against COVID-19 Disparities 
[CEAL] Initiative.--The Committee includes $30,000,000 for the 
CEAL initiative, consistent with the fiscal year 2023 enacted 
level. CEAL connects researchers with community organizations 
to foster trust in science, to conduct research and increase 
participation of people from underrepresented communities in 
clinical trials for treatments, vaccines, and research on 
critical areas of public health need.
    Congenital Heart Disease [CHD].--The Committee commends 
NHLBI for its continued work to better understand causation, 
improve treatments and outcomes, support the growth of the 
clinical and research workforce, and integrate registry data 
and research datasets to facilitate research on congenital 
heart disease across the lifespan, including through the 
Pediatric Heart Network and the Pediatric Cardiac Genomics 
Consortium. The Committee encourages NHLBI to prioritize CHD 
activities outlined in its strategic plan, including improving 
understanding of outcomes and co-morbidities, improving 
treatment options across the lifespan, and accelerating 
discovery, analysis, and translation by leveraging CHD 
registries and networks. The Committee requests NHLBI include 
in its fiscal year 2025 CJ a report on steps being taken to 
close these research gaps.
    Lung Health Research.--The burden of chronic lung diseases 
continues to rise. In order to accelerate progress in 
addressing these challenges for the approximately 15 million 
Americans diagnosed with chronic obstructive pulmonary disease 
[COPD] and other airway diseases such as non-cystic fibrosis 
bronchiectasis, the Committee encourages NHLBI to support 
critical research on these conditions including: (1) 
development of complex tissue and cellular systems to mimic the 
disease process in the lung to help identify molecular pathways 
of disease; (2) research to promote earlier diagnosis; (3) 
clinical research of early disease to identify appropriate 
targets to modulate disease progression before irreversible 
tissue damage has occurred; and, (4) proof-of-concept clinical 
trials including translational and experimental medicine 
studies. The Committee directs NHLBI to provide a report to the 
Committee within 180 days of enactment on the current and 
planned activities in these areas.
    Pulmonary Fibrosis.--Many pulmonary fibrosis [PF] patients 
wait more than a year for diagnosis after symptom onset, and 
patients with some types of PF have a life expectancy of only 
three to 5 years. Therefore, the Committee encourages NHLBI to 
support research into biomarkers that can aid in earlier, safer 
diagnosis of PF, as well as tools that can help predict which 
patients will experience disease progression. The Committee 
commends NHLBI for hosting a Pulmonary Fibrosis Stakeholders 
Summit in November 2022 to develop a blueprint for PF-related 
research priorities over the next 5 years, and requests an 
update on the plan's implementation in the fiscal year 2025 CJ. 
The plan's priorities include a focus on early disease 
detection and improved diagnosis and innovative clinical trial 
designs. The Committee urges NHLBI to support the development 
of advanced research models and integrate these models into 
preclinical studies in order to facilitate faster drug 
development. The Committee also hopes the PF plan will lead to 
increased support for related research and coordination to 
address this deadly disease.
    Rare Blood Disorders.--The Committee is encouraged by new 
leadership and emerging vision for the Division of Blood 
Diseases and Resources. NHLBI is encouraged to sustain its 
focus in immune thrombocytopenia, warm autoimmune hemolytic 
anemia and other rare blood disorders, including through 
community collaborations and partnerships with other Institutes 
and Centers, to sustain scientific progress in this important 
area.
    Sleep Disorders.--The Committee applauds NHLBI and other 
NIH Institutes and Centers for the ongoing commitment to sleep 
and circadian research, and notes the wealth of opportunities 
for further progress in specific sleep disorders and the 
promotion of sleep health. The Committee encourages the 
National Center for Sleep Disorders Research [NCSDR] to advance 
the blueprint for ongoing and emerging activities outlined 
through the recent NIH Sleep Research Plan and to advise the 
Committee of any resources, infrastructure, or innovation 
needed to facilitate further progress.
    Thalassemia.--Donated blood has a relatively short ``shelf 
life'' and is generally stored for only 42 days. However, 
stored blood begins to degrade before the end of that 42-day 
period, with possible stiffening of cell membranes as early as 
after 21 days. For patients in need of emergency blood 
transfusions, that degradation may not be significant; however, 
studies are needed to determine the impact of older red blood 
cells on patients who require chronic transfusion, such as 
those with thalassemia, especially in terms of iron loading in 
the heart and internal organs. The Committee urges NHLBI to 
continue to support research initiatives focused on this issue.
    Valvular Heart Disease Research.--Many people in the U.S. 
have heart valve defects or disease but do not have symptoms. 
For some, the condition remains the same throughout their lives 
and does not cause significant or life-threatening problems. 
Unfortunately, about 25,000 people die each year in the U.S. 
from heart valve disease, primarily due to underdiagnoses and 
under-treatment of the condition. The Committee strongly 
supports more research into the causation of and risk factors 
for valvular heart disease. Such research should focus on the 
use of advanced technological imaging and other relevant 
methods to generate data related to valvular heart disease, and 
assessing potential risk factors for sudden cardiac arrest or 
sudden cardiac death from valvular heart disease. Additionally, 
the Committee supports efforts by NIH to convene a workshop of 
subject matter experts and stakeholders to identify research 
needs and opportunities to develop recommendations for the 
identification and treatment of individuals with mitral valve 
prolapse, including individuals who may be at risk for sudden 
cardiac arrest or sudden cardiac death.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2023....................................    $520,163,000
Budget estimate, 2024...................................     520,138,000
Committee recommendation................................     520,163,000

    The Committee recommendation includes $520,163,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR].
    Dental Care.--The Committee reaffirms that dental care is 
integral to the medical management of numerous diseases and 
medical conditions and that the lack of medically necessary 
oral healthcare heightens the risk of costly medical 
complications. The Committee appreciates NIH's support for 
research that has demonstrated that dental care is closely 
linked to and crucial to the clinical success of other covered 
medical services. The Committee urges NIH to fund additional 
research in this area and conduct trials to determine which 
oral care interventions are most effective for improving 
medical management and reducing the prevalence of malignant 
oral cancers, preventing pneumonia in hospitals, and lowering 
hospitalization and emergency department admission rates for 
nontraumatic oral conditions.
    Dental, Oral and Craniofacial Tissue Regeneration 
Consortium.--The Committee commends NIDCR for establishing a 
multidisciplinary Dental, Oral and Craniofacial Tissue 
Regeneration Consortium [DOCTRC] that will develop effective 
clinically-applicable strategies for regeneration of functional 
tissues of the human dental, oral and craniofacial complex. The 
goal of DOCTRC is to develop technologies based on cells, 
biologics, devices, combination products and associated 
protocols ready for the initiation of clinical trials and to 
prepare them for submission for FDA approval.
    Oral Health in America Report.--The Committee commends 
NIDCR for publishing its 2021 report Oral Health in America: 
Advances and Challenges documenting 20 years of progress since 
the first Oral Health Report in 2000. The Committee encourages 
NIDCR to prioritize funding the research gaps that were 
identified in the report.
    Temporomandibular Disorders [TMD].--The Committee 
encourages NIDCR to maintain a patient-centered approach in the 
implementation of the TMD-IMPACT Concept. The Committee is 
encouraged by NIDCR's collaboration with agencies and 
institutes, and encourages further collaboration with other 
government agencies and Institutes, Centers, and Offices within 
NIH with appropriate scientific expertise. The Committee 
directs NIH to provide an update within 90 days of enactment on 
efforts to implement the next phase of the initiative including 
the recruitment of other NIH ICs as partners, the role of the 
patient perspective, and NIDCR's use of the National Academies 
of Sciences, Engineering, and Medicine [NASEM] Report on TMDs 
and the TMJ Patient-led Roundtable.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2023....................................  $2,300,721,000
Budget estimate, 2024...................................   2,303,098,000
Committee recommendation................................   2,310,721,000

    The Committee recommendation includes $2,310,721,000 for 
the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK].
    Diabetes.--The Committee commends the efforts of NIDDK to 
prioritize the discovery and validation of biomarkers and urges 
NIDDK to continue to prioritize this important work that will 
accelerate the designing and conducting of clinical trials to 
prevent, treat, and cure type 1 diabetes. Given the growing 
prevalence of diabetes, the Committee provides an additional 
$10,000,000 for diabetes related research. The Committee is 
concerned that additional research is needed to determine how 
to improve the treatment of a common complication, diabetic 
foot ulcers to reduce amputations, and urges NIDDK to support 
such efforts. Further, given the aging population, the 
Committee urges NIDDK to work with the National Institute on 
Aging to explore the relationship between diabetes and 
neurocognitive conditions, such as dementia and Alzheimer's 
disease in racially and ethnically diverse populations.
    Hepatitis B.--The Committee applauds NIDDK efforts to 
create common resource services and materials for the research 
community and urges continued focus on clinical networks, data 
bank development and precision medicine approaches. The 
Committee further encourages the development of experimental 
animal and cell culture models to help advance cure research 
against the widest possible set of therapeutic targets and 
research focused on understanding the virology and immunology 
of people with low levels of HBsAg--a protein on the surface of 
the HBV virus--as this category of people are more responsive 
to therapy. The Committee is aware of the view within the 
scientific community that finding a cure for hepatitis B, as 
has been achieved for hepatitis C, is a winnable goal and is 
within reach in the near-term.
    Kidney Transplant Disparities.--The Committee appreciates 
the ongoing efforts of NIDDK's Health Disparities and Health 
Equity Working Group, particularly on disparities in the 
prevention, diagnosis, and treatment of kidney diseases through 
new studies to address disparities in kidney transplant care. 
The Committee reaffirms the importance of reducing health 
disparities and urges NIDDK to support health disparities 
research to improve kidney transplant care. The Committee 
requests an update on these efforts in the fiscal year 2025 CJ.
    Lower Urinary Tract Symptoms.--Lower urinary tract symptoms 
[LUTS] describe symptoms related to the storage and voiding of 
urine. Conditions associated with LUTS include overactive 
bladder, stress urinary incontinence, as well as neurogenic and 
non-neurogenic voiding dysfunction. The effectiveness of 
treatment for these conditions varies depending on patient 
characteristics and symptoms. Unfortunately, an established 
repository of patient phenotypes for LUTS does not exist. 
Knowledge in this area would enable the identification of 
symptom clusters to advance LUTS treatment. Therefore, the 
Committee urges NIDDK to conduct a workshop that will lead to 
the development of LUTS precision medicine approaches, 
including the characterization of LUTS clusters and their 
association to treatment responsiveness, identification of 
markers for phenotype clusters, development of functional and 
physiologic assessment measures specific to individual 
phenotype profiles to objectively correlate symptoms and 
treatment outcomes. The Committee requests an update on 
research activities to advance LUTS prevention and treatment in 
the fiscal year 2025 CJ.
    Pancreatitis.--The Committee applauds NIDDK for featuring 
research into pancreatitis and conditions of the pancreas 
prominently through the 2023 Recent Advances and Emerging 
Opportunities report. Due to the lack of effective treatment 
options for patients impacted by pancreatitis and a variety of 
access challenges, NIDDK is encouraged to facilitate additional 
scientific progress in this important area.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2023....................................  $2,813,925,000
Budget estimate, 2024...................................   2,739,418,000
Committee recommendation................................   2,849,925,000

    The Committee recommendation includes $2,849,925,000 for 
the National Institute of Neurological Disorders and Stroke 
[NINDS].
    Alzheimer's Disease and Alzheimer's Disease-Related 
Dementias [AD/ADRD].--The Committee includes an increase of 
$100,000,000 across NIH for AD/ADRD research, including an 
increase of $10,000,000 in NINDS and $90,000,000 in NIA.
    Brain Aneurysms.--The Committee remains concerned that an 
estimated 1 out of every 50 individuals in the United States 
has a brain aneurysm and an estimated 30,000 Americans suffer a 
brain aneurysm rupture each year, with little or no warning. 
Ruptured brain aneurysms are fatal in about 50 percent of 
cases. Despite the widespread prevalence of this condition and 
the high societal cost it imposes on our Nation, the Federal 
Government only spends approximately $2.08 per year on brain 
aneurysm research for each person afflicted with a brain 
aneurysm. The Committee encourages NINDS to increase its 
support for research focused on prevention and early detection 
of brain aneurysms.
    Frontotemporal Degeneration [FTD].--The Committee 
encourages NIH to continue to support research to identify and 
validate biomarkers for FTD and other neurodegenerative 
diseases among racially and ethnically diverse cohorts. The 
Committee also urges NIH to support efforts to better 
understand the social determinants of health that lead to 
inequity in access to diagnosis and care for FTD and other 
dementias so that new treatments and best practices in care 
will be available to all, regardless of age, racial, ethnic, 
cultural, socioeconomic and geographic background. Equally 
critical is the development of a data biosphere that enhances 
secure sharing of clinical and research data and biological 
samples for FTD. Broad sharing of datasets will enable the 
larger community of researchers to bring their expertise to 
bear on the challenge of treating and preventing FTD and other 
ADRDs. The Committee also encourages NIH to find ways to 
support more effective communication across researchers, and 
between clinical science and broader society, to ensure that 
the research advances driven by NIH can have maximum effect on 
improving health. FTD is rare and tends to occur at a younger 
age than other forms of dementia. This creates additional 
challenges for clinical trials and research. To overcome these 
challenges as well as recruitment and retention issues, the 
Committee urges NIH to continue to advance regulatory science 
and develop innovative clinical trial designs that recruit 
diverse populations so that potential therapies can be 
effectively tested.
    Opioids, Stimulants, and Pain Management.--The Committee 
provides no less than $290,295,000, an increase of $10,000,000, 
in NINDS for the HEAL Initiative. The Committee encourages 
NINDS to continue its efforts through the HEAL Initiative, with 
a focus on grant opportunities to support research and 
education for effective and non-addictive pain management to 
improve outcomes for people with pain in diverse settings 
across the United States.
    Pediatric-Onset Epilepsies Research.--The Committee is 
aware of the enormous economic cost and toll in human suffering 
resulting from epilepsies and considers research in this area a 
high priority. While there are approximately 470,000 children 
currently living with epilepsy, there are many different kinds 
of epilepsies, and the number of children with one specific 
disease type is relatively small. A number of these types of 
epilepsy do not respond to existing medications. To develop and 
test more effective therapies, studies must precisely classify 
children with the same type of epilepsy for clinical trials. 
Large numbers of patients are critical to ensuring that study 
results are meaningful and result in improved patient outcomes. 
Using a collaborative research model and enrolling patients 
from many hospitals in the same system greatly increases the 
ability to detect meaningful differences due to interventions, 
can significantly accelerate therapy development, and expedites 
translation of research findings into standard clinical care. 
Therefore, the Committee encourages NIH to continue to enable 
cooperative research studies, accelerate the development of 
knowledge about epilepsies, and rapidly advance therapeutic 
options and their implementation to improve treatments and 
healthcare outcomes. Additionally, to better facilitate 
implementation of translational research, the Committee urges 
NINDS to prepare and submit a report to the Committee on 
progress and incorporate key findings and planned actions 
resulting from convenings of the Curing the Epilepsies 
conference.
    Undiagnosed Diseases Network [UDN].--The Committee 
continues to provide $18,000,000 to fund UDN and directs the 
continuation of the coordinating center, all clinical sites, 
DNA sequencing core, central biorepository, model organisms 
screening center, and other necessary testing in the pursuit of 
diagnoses, including but not limited to: metabolomics, 
infectious and toxic exposures, and immune abnormalities.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2023....................................  $6,562,279,000
Budget estimate, 2024...................................   6,561,652,000
Committee recommendation................................   6,562,279,000

    The Committee recommendation includes $6,562,279,000 for 
the National Institute of Allergy and Infectious Diseases 
[NIAID].
    Celiac Disease.--The Committee commends NIH for issuing a 
Notice of Special Interest to spur additional research on the 
study of celiac disease. Today, the only known treatment is a 
gluten-free diet; however, recent public and private sector 
research confirms that such a ``treatment'' is insufficient for 
many who suffer from celiac disease. The Committee encourages 
NIH to devote focused research on the study of celiac disease 
and continues to urge NIH to: support new research on celiac 
disease; better coordinate existing research; and focus new 
research efforts toward causation, diagnosis, management, 
treatment, and, ultimately, a cure of this disease. The 
Committee directs NIH to include updates on research, projects, 
and programs for celiac disease in the fiscal year 2025 CJ.
    Centers for Research on Emerging Infectious Diseases 
[CREID].--NIAID works with partners in 30 countries to 
understand how and where viruses can emerge to develop 
diagnostic tests. The Committee urges NIAID to ensure the CREID 
Network is sufficiently supported to coordinate and conduct 
research on, and active surveillance for, emerging pathogens.
    Equipping NIH Research Programs to Target HIV/AIDS 
Hotspots.--The Committee directs the NIH Office of AIDS 
Research to coordinate NIH-wide resources to focus on areas 
with the highest prevalence of HIV/AIDS, for example, utilizing 
Centers for AIDS Research [CFARs] to develop targeted 
interventions that increase the use of pre-exposure prophylaxis 
[PrEP] and better protect those communities from HIV 
transmission and its consequences.
    Food Allergies.--The Committee recognizes the serious issue 
of food allergies which affect approximately 8 percent of 
children and 10 percent of adults in the United States. The 
Committee commends the ongoing work of NIAID in supporting a 
total of 17 clinical sites for this critical research, 
including seven sites as part of the Consortium for Food 
Allergy Research [CoFAR]. The Committee encourages CoFAR to 
expand its clinical research network, identify new research 
centers, and conduct new, larger, and in-depth clinical trials 
and observational studies.
    Gonorrhea.--The Committee continues to be concerned with 
recent reports from the World Health Organization [WHO] and 
U.S. public health officials, that antimicrobial resistant 
gonorrhea continues to increase, reducing the treatment 
options. The Committee commends NIAID for their continued 
efforts to develop new antibiotics to combat the bacterium that 
causes this disease and encourages NIAID to accelerate work to 
find new diagnostic tools and treatments for these new strains 
of bacterium.
    Hepatitis B.--The Committee applauds NIAID for leading the 
effort to update the Strategic Plan for Trans-NIH Research to 
Cure Hepatitis B, so it remains a robust road map to find a 
cure. The Committee is aware of the widely held view in the 
scientific community that finding a cure for hepatitis B, as 
has now been achieved for hepatitis C, is a winnable goal and 
is within reach in the near-term. For these reasons, the 
Committee urges that research, based on the needs as identified 
in the updated Plan, be funded in fiscal year 2024 and beyond. 
The Committee urges NIAID to expand the use of Program 
Projects, R01 and U01 Cooperative Research Agreements, as was 
successfully used to discover cures for hepatitis C, as well as 
cooperative research programs modeled after the Martin Delaney 
Collaborations and applauds the success of the point of Care 
Technologies Research Network [POCTRN] and Rapid Acceleration 
of Diagnostics [RADx] programs and urges more use of these 
programs for development of point of care tests for HBV, HDV 
and the cancers caused by these viruses. Finally, the Committee 
understands that research to enhance the human immune system to 
control and cure hepatitis B is promising and the continued use 
of animal models is a research tool that needs to be continued.
    Metabolism of Infectious Disease.--The Committee recognizes 
that research to understand how metabolic responses are altered 
by infection and connected with the immune response and 
comorbidities is increasingly important due to the prevalence 
of emerging and reemerging infectious diseases. As such, the 
Committee urges NIAID to fund as many meritorious proposals as 
possible.
    Neglected Disease Research.--The Committee strongly 
supports NIAID's neglected disease research programs. NIH is 
the world's single largest funder of neglected disease research 
and has supported the development of high-impact technologies 
for health areas that receive little attention from industry. 
Many innovation gaps persist, and so these programs should 
remain a priority for NIAID leadership.
    Regional Biocontainment Laboratories [RBLs].--The Committee 
continues to provide $52,000,000 to the 12 RBLs to support core 
and shared resources for BSL-3 containment enabling them to 
develop and maintain the research resources, facilities and 
personnel needed to meet national, regional and local 
biodefense and emerging infectious diseases research needs in 
the event of a bioterrorism or infectious disease emergency. Of 
this amount, the Committee directs that no less than $1,000,000 
shall be provided to each of the 12 RBLs to support training 
and maintaining a capable research workforce with broad, 
relevant biomedical, technological, veterinary, and regulatory 
expertise, developing and contributing to an organizational 
structure to ensure the RBL network is prepared to respond 
effectively to national needs, and supporting operations, 
facilities, and equipment purchase costs. The Committee directs 
that the remaining funding shall go to the 12 RBLs to support: 
(1) research on biodefense, emerging infectious disease agents, 
and other infectious disease threats to global health; (2) 
training new researchers, including in biosafety level 3 
practices; (3) maintaining a workforce skilled in BSL-3 
research; and (4) establishing best practices for the safe, 
effective, and efficient conduct of research in BSL-3 
facilities.
    Research on Antimicrobial Resistance [AMR].--The Committee 
provides no less than $565,000,000 to fund NIAID research to 
combat AMR and the training of new investigators to improve AMR 
research capacity as outlined in the 2020-2025 National Action 
Plan to Combat Antibiotic Resistant Bacteria.
    Syphilis.--The Committee continues to be concerned with the 
rising syphilis rates, and correlation with the syphilis 
increase in women of childbearing age, which often leads to 
congenital syphilis. The Committee commends NIAID for their 
continued work in developing new diagnostic tests for both 
adults and newborns and encourages acceleration of vaccine 
development and new treatment options.
    Universal Flu Vaccine.--The Committee includes $270,000,000 
to support efforts to develop universal influenza vaccines that 
provides long-lasting protection against numerous flu strains, 
rather than a select few. Such vaccines would eliminate the 
need to update and administer the seasonal flu vaccine each 
year or could provide protection against newly emerging flu 
strains, potentially including those that could cause a flu 
pandemic.
    Viral Pathogen Research.--The Committee supports 
investments in research on highly pathogenic zoonotic viruses 
with pandemic potential including filoviruses, flaviviruses, 
paramyxoviruses, and bunyaviruses. The Committee notes that 
research on high consequence zoonotic viruses requires high-
containment BSL-4 labs. High-containment BSL-4 labs enable 
researchers to diagnose and investigate these types of 
pathogens, and develop rapid and reliable diagnostics, novel 
antiviral therapeutics and vaccines, without endangering the 
staff or population at large. Additional investments in BSL-4 
infrastructure for research in highly pathogenic zoonotic 
viruses is critical.
    Warm Autoimmune Hemolytic Anemia [wAIHA].--The Committee 
recognizes that wAIHA is a prototypical autoimmune disorder 
where the body's immune system attacks healthy red blood cells 
and little is known about underlying causes or effective 
treatment beyond the use of immunosuppressive therapies. NIH is 
encouraged to advance wAIHA research and to consider key 
partnerships among Institutes and Centers that have an interest 
in or have shown progress in this area, such as NHLBI, NIAID, 
and the Office of Autoimmune Disease Research [OADR].

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2023....................................  $3,239,679,000
Budget estimate, 2024...................................   3,239,679,000
Committee recommendation................................   3,239,679,000

    The Committee recommendation includes $3,239,679,000 for 
the National Institute of General Medical Sciences [NIGMS], 
which includes $1,412,482,000 in transfers available under 241 
of the PHS Act (Public Law 104-73 as amended).
    Increasing Diversity in Biomedical Research.--The Committee 
strongly supports opportunities for the Nation's next 
generation of researchers and efforts to enhance diversity in 
biomedical research. Early-stage researchers, particularly 
women and racial and ethnic minorities, spend longer periods of 
time in postdoctoral positions with lower salaries, receive 
inadequate mentorship, and are offered fewer opportunities for 
professional advancement, resulting in lower retention rates 
for those groups. Even with these obstacles, many early-stage 
researchers tackle riskier projects and have contributed to 
research that has generated positive outcomes for the benefit 
of society. Grant programs offering support and opportunities 
for researchers at key career transition points requiring 
little or no preliminary data, are critical to ensuring 
innovative scientists from diverse backgrounds succeed in 
biomedical research. The Committee urges NIGMS to expand the 
Maximizing Opportunities for Scientific and Academic 
Independent Careers [MOSAIC] program and the Minority Access to 
Research Careers undergraduate programs that train the next 
generation of scientists while enhancing the diversity of the 
biomedical research workforce and enabling promising scientists 
to pursue high-risk, high-reward research.
    Institutional Development Award [IDeA].--The Committee 
recognizes the importance of the IDeA program in enhancing 
geographical representation across NIH's research portfolio, 
and provides no less than $425,956,000 for the program. In 
order to ensure that research investments from IDeA programs 
provide maximum benefit, the Committee urges NIH to examine 
ways to increase NIH IDeA state participation in major grant 
programs across NIH's portfolio, including those that support 
biomedical research facilities, instrumentation, and training. 
The Committee notes the Biomedical Research Workforce Working 
Group report and supports growing the IDeA funding level to its 
minimum recommended level, which will allow NIH to take 
advantage of the full diversity of the Nation's assets: 
diversity of individuals, diversity of institutions, and 
diversity of geography. Finally, the Committee opposes any 
efforts within NIH to change eligibility for the IDeA program 
to a system that would be based on States' populations or to 
limit the number of awards per State. Currently eligible States 
have historically had low aggregate success rates for grant 
applications to NIH and rely on the IDeA program to help build 
a research infrastructure and enhance research capacity at 
institutions in those States.
    Minority Serving Institutions.--Congress recognizes the 
importance of highly trained physician-scientists to serve 
diverse communities, decrease health disparities, and enhance 
the biomedical research workforce. The Committee encourages 
NIGMS to support medical scientist training at Minority Serving 
Institutions as defined in title III of the Higher Education 
Act. Such efforts should support dual degree programs that 
train students in medicine and biomedical research.

  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN 
                              DEVELOPMENT

Appropriations, 2023....................................  $1,749,078,000
Budget estimate, 2024...................................   1,747,784,000
Committee recommendation................................   1,759,078,000

    The Committee recommendation includes $1,759,078,000 for 
the Eunice Kennedy Shriver National Institute of Child Health 
and Human Development [NICHD].
    Andrological Health.--The Committee strongly supports 
translational and clinical research into andrological health, 
and urges NICHD to prioritize and expand these research 
programs.
    Autism Research.--The Committee encourages NICHD to 
increase support for and prioritization of collaborations to 
build the methodological base and infrastructure for large 
scale longitudinal neuroimaging studies of autistic individuals 
with linkages to clinical data and outcomes. Projects supported 
by this investment could include proof of concept multicenter 
approaches to address major challenges for collaborative 
groups, such as linking longitudinal neuroimaging data with 
measures of behavioral change and outcomes, including 
information from clinical records, and to aggregate the 
resulting information into usable datasets that are harmonized 
across study sites and clinical centers. The Committee further 
encourages NICHD to support studies that allow for data to be 
collected across wide ranges in age.
    Congenital Syphilis [CS].--The Committee continues to be 
concerned with the continued rise in the rates of congenital 
syphilis. CS can lead to life-long deformities and 
disabilities, but with preventative care and treatment, these 
outcomes can be avoided. The Committee encourages NICHD to 
coordinate efforts with NIAID on new testing, diagnosis, and 
treatment efforts.
    Endometriosis.--The Committee is aware that endometriosis 
is a chronic disease originating in the female reproductive 
system affecting 10 percent of women of reproductive age 
worldwide and it has been linked to ovarian cancer. The 
Committee also recognizes that endometriosis is the third-
leading cause of female infertility in the United States. The 
Committee encourages NIH to advance research to increase 
earlier detection, develop more accurate diagnostics and for 
education to inform healthcare providers and their patients 
regarding diagnosis and treatment of endometriosis.
    Implementing a Maternal Health and Pregnancy Outcomes 
Vision for Everyone [IMPROVE] Initiative.--The Committee 
provides no less than $53,400,000 for this activity.
    Maternal Fetal Medicine Units.--The Committee appreciates 
NICHD's continued support of research focused on improving 
maternal and infant health outcomes. A critical part of this 
work is the Maternal-Fetal Medicine Units Network [MFMU]. Since 
1986, the MFMU Network has been performing multi-site clinical 
research focused on gathering data needed to ensure obstetric 
patients across the country and the world are receiving 
evidence-based and cost effective care. The Committee was 
pleased to see NICHD release a request for applications in 2022 
for a new funding cycle for the MFMU Network that maintains the 
Network's existing infrastructure, ensuring high-quality, high-
impact multi-site clinical studies continue. However, unlike 
the prior funding cycles, clinical study proposals for the MFMU 
Network will now undergo NIH peer review to assure greater 
rigor and transparency. In addition, the Network infrastructure 
will now be made available to the entire community of 
researchers. The Committee requests an update in the fiscal 
year 2025 CJ on the total funding for MFMU Network supported 
clinical trials awarded in each of fiscal years 2010--2022. 
This update should detail amounts spent on clinical trials and 
separately account for base funding for the MFMU Network 
clinical sites and data coordinating center. Further, NICHD 
should include in the update plans to ensure that NIH will 
continue to fund clinical research conducted by the MFMU at the 
appropriate levels based on scientific need.
    Pelvic Organ Prolapse.--Pelvic organ prolapse [POP] occurs 
when the pelvic floor muscles and connective tissue supporting 
the pelvic organs no longer support these organs, causing one 
or more of the pelvic organs to fall downward into the vagina. 
POP is a common problem, with 1 out of 8 women undergoing 
surgery for prolapse at some point in their life. Symptomatic 
POP is associated with urinary incontinence, depression, 
anxiety, sleep disturbance, sexual dysfunction, deteriorating 
physical function and diminished socialization. No effective 
preventative strategies for POP have been identified and the 
development of novel preventative strategies related to 
pregnancy is needed. Therefore, the Committee urges the NICHD 
to convene a workshop to assess peripartum, intrapartum, and 
postpartum preventative strategies for POP including ways to 
decrease pelvic floor trauma/denervation during delivery, with 
the goal of reducing the risk of subsequent POP and its 
complications. The Committee requests an update on this issue 
and on research activities to advance POP prevention and 
treatment in the fiscal year 2025 CJ.
    Population Research.--The Committee commends NICHD for 
fulfilling its statutory authority by supporting a robust 
population research portfolio that includes population 
representative longitudinal surveys, research centers and 
networks, training programs, and grant mechanisms. Over the 
decades, these investments have yielded numerous scientific 
advances regarding the causes and consequences of population 
change on human and child development, maternal health, and the 
health and well-being of individuals across the life course. 
Most recently, the Baby's First Years Study and Panel Study of 
Income Dynamics Child Supplement Survey provided key insights 
into the impact of COVID mitigation strategies and economic 
relief measures on infant and child development. The Committee 
encourages NICHD to enhance its support of these and its other 
large-scale longitudinal surveys to help, among other things, 
elucidate the pandemic's impacts on child and adolescent 
development. In addition, the Committee commends NICHD for 
supporting initiatives that facilitate collaborations and 
resource sharing between the Population Dynamics Research 
Centers and outside institutions and for funding the innovative 
Data Sharing for Demographic Research data repository, which 
makes high-quality demographic data widely available to the 
scientific research community.
    Reproductive Medicine Network [RMN].--Infertility, defined 
as the inability to conceive within 1 year of unprotected 
intercourse, affects an estimated 19 percent of reproductive 
aged couples. In addition, about 26 percent of women have 
difficulty getting pregnant or carrying a pregnancy to term. 
The RMN, which has since been replaced by the Consortia for 
Infertility and Reproductive Medicine [ConFIRM] Clinical Trial 
Program of linked R01s, had a proven track record of supporting 
infertility research by providing a single hub that supported 
multiple substudies and secondary analyses. Most importantly, 
it informed major changes to clinical practice and supported 
the training of young investigators in the field. While the 
Committee understands that NICHD has moved away from the U01/
U10 mechanism the RMN utilized, it is noted that the ConFIRM 
Clinical Trial Program may not be supporting coordination or a 
pipeline of young investigators in this field in the same 
manner as the RMN. The Committee urges NICHD to report on its 
plans to support clinical trials on infertility within 180 days 
of enactment.
    Women's Reproductive Health Research [WRHR] Program.--The 
Committee encourages NICHD to fund additional scholars, with 
the goal of increasing the diversity of the scholars, sites, 
and research supported by the program. The Committee recognizes 
the effectiveness of the WRHR program, which provides an 
opportunity for obstetrician/gynecologists who recently 
completed postgraduate clinical training to further their 
training in basic, translational and clinical research.
    Youth Tobacco Cessation Research.--The Committee recognizes 
that despite two million youth using at least one tobacco 
product, there are no FDA-approved tobacco cessation therapies 
for people ages 17 and under and few well-studied, evidence-
based behavioral interventions for youth tobacco use. The 
Committee encourages NIH to continue to support research on 
effective tobacco cessation modalities for youth under age 18, 
including pediatric studies of the safety and effectiveness of 
cessation treatments currently approved for adults. Studies 
should account for the broad range of tobacco products used by 
youth, including cessation options for individuals interested 
in quitting cigarettes, e-cigarettes, smokeless tobacco, and 
cigars. The Committee urges NIH to consider research 
recommendations published by the U.S. Preventive Services Task 
Force.

                         NATIONAL EYE INSTITUTE

Appropriations, 2023....................................    $896,549,000
Budget estimate, 2024...................................     896,136,000
Committee recommendation................................     896,549,000

    The Committee recommendation includes $896,549,000 for the 
National Eye Institute [NEI].
    Usher Syndrome.--The Committee encourages NIH to enhance 
and prioritize Usher syndrome research at NEI. The Committee 
requests an update in the fiscal year 2025 CJ. The update 
should include efforts to stimulate the field and to accelerate 
viable human treatment options for those with Usher syndrome.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2023....................................    $913,979,000
Budget estimate, 2024...................................     938,807,000
Committee recommendation................................     913,979,000

    The Committee recommendation includes $913,979,000 for the 
National Institute of Environmental Health Sciences [NIEHS].
    Disaster Research Response Program.--The Committee urges 
NIEHS to support research and community engagement activities 
related to the health of individuals affected by the train 
derailment in East Palestine, Ohio, including first responders 
and local residents in both Ohio and Pennsylvania.
    Environmental-related Health Conditions.--The Committee 
urges NIEHS to expand efforts to support and coordinate 
research on the rise in and exacerbation of a wide range of 
health conditions related to the environment, which may include 
infectious disease, injury and trauma, chronic conditions such 
as asthma, mental health, and health disparities. Such research 
may include evaluation of both preventative and intervention 
strategies for such conditions.
    Environmental exposures and Cancer in Firefighters.--The 
Committee encourages NIH and CDC/NIOSH to continue their 
efforts to better understand the cancer risks firefighters may 
experience, including efforts to measure environmental 
exposures in firefighters and determine the mechanisms that 
lead to increased cancer incidence, morbidity, and mortality. 
The Committee also encourages NIH to continue to support 
research to improve health equity among firefighters to 
evaluate potential differences and exposure risk.
    Indoor Air.--Health outcomes from the use of combustion 
indoors depend on individual health characteristics, the fuel 
used, and mitigations. The Committee encourages NIEHS to 
research and collaborate with appropriate partners to 
understand effects of indoor emissions on health and the degree 
to which mitigation strategies reduce exposures and other 
impacts. Research should include the impacts of other indoor 
pollutants to fully understand the indoor air landscape. The 
Committee requests an update on these activities in the fiscal 
year 2025 CJ.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2023....................................  $4,407,623,000
Budget estimate, 2024...................................   4,412,090,000
Committee recommendation................................   4,509,623,000

    The Committee recommendation includes $4,509,623,000 for 
the National Institute on Aging [NIA].
    Alzheimer's Disease/Alzheimer's Disease-Related Dementias 
[AD/ADRD].--Since fiscal year 2015, Congress has increased 
research funding for AD/ADRD by more than 500 percent, making 
it the largest expenditure of its kind in NIH. By 2050, the 
cost to treat and care for those suffering from Alzheimer's 
disease is expected to rise to as high as $1,100,000,000,000 a 
year. Without a medical breakthrough to prevent, slow, or stop 
the disease, Medicare- and Medicaid-related costs could rise 
more than four-fold. NIH-funded research offers hope for 
finding solutions to manage this disease successfully in the 
future. Therefore, the Committee continues to support 
Alzheimer's disease research, including multi-disciplinary 
approaches into the basic science and pathology of the disease, 
which builds upon the funding goals needed to prevent and 
effectively treat Alzheimer's by 2025 identified in the 
National Plan required by the National Alzheimer's Project Act 
(Public Law 111-375). The Committee previously directed NIA to 
collaborate with NINDS and NASEM to pinpoint research 
priorities for preventing and treating AD/ADRD, including 
identifying barriers to advancing large-scale precision 
medicine approaches in this space. Of the approximately 6.5 
million Americans over age 65 with AD, more than half have 
genetic risk variants linked to glial cell function, which 
makes them a key target for precision therapeutics. The 
Committee encourages NIA to increase support for research 
focused on mitigating immune dysfunction with precision 
inspired therapeutics for AD/ADRD and directs NIA and NINDS to 
provide a joint report to the Committee within 120 days on its 
progress in advancing these efforts.
    Clinical Trials.--Although Alzheimer's disease and other 
dementias disproportionately affect Black Americans, Hispanic 
Americans, Asian American and Pacific Islanders, and Native 
Americans, they continue to be underrepresented in AD/ADRD 
clinical trials. The Committee directs NIA to work with the 
Alzheimer's Disease Research Centers and other organizations to 
promote participation in clinical trials within 
underrepresented populations and, to the maximum 
scientifically-feasible extent, reduce the burden of 
participating. These efforts should include expanding community 
engagement and outreach to these populations, incentivizing 
trial locations in areas of unmet need, encouraging the 
diversity of clinical trial staff, allowing appropriate 
flexibility in trial design and inclusion and exclusion 
criteria, and utilizing technology like remote patient 
monitoring, where appropriate, to facilitate clinical trial 
participation and retention.
    Geroscience.--Recent advances in geroscience suggest it may 
be possible to prevent or treat a wide range of adult-onset 
health concerns, including functional declines such as frailty 
and lost resilience, and overt diseases such as Alzheimer's 
Disease, cancer, cardiovascular diseases and many others. This 
could be achieved by slowing or reversing certain genetic, 
molecular and cellular hallmarks of aging discovered through 
research on the basic biology of aging. The Committee strongly 
urges NIA to prioritize funding for geroscience research. The 
Committee also understands that the enormous promise of this 
field is limited by a shortage of investigators with expertise 
in the biology of aging and the clinical translation of basic 
research findings. Therefore, NIA should increase support for 
early career investigators, especially postdoctoral researchers 
and junior faculty, to help attract, retain, and develop top 
talent in the field of geroscience. Finally, the Committee 
encourages NIA to increase funding for basic and translational 
research in aging to provide more options and test more 
treatments as quickly as possible.
    Palliative Care Research.--Palliative care is specialized 
medical care for people living with a serious illness and is 
focused on treating the discomfort, symptoms, and stress of 
such illness. Palliative care has the potential to improve 
patient care, patient-clinician communication, and patient-
centered outcomes while decreasing unwanted and/or burdensome 
treatments and enhancing quality of life for people with 
serious illness, their loved ones, and their care partners. The 
Committee provides $12,500,000 for NIA to implement a trans-
Institute, multi-disease strategy to focus, expand, and 
intensify national research programs in palliative care. NIH is 
directed to establish a comprehensive multi-Institute and 
multi-Center initiative aimed at a wide variety of palliative 
care research, training, dissemination, and implementation of 
projects to intensify the strategic coordination of palliative 
care research efforts. Funding is provided to establish an 
extramural-based palliative care research consortium with no 
less than three sites to provide technical assistance, pilot 
and exploratory grant funding, research dissemination, data 
repositories, data analytics, and career development support 
for interdisciplinary palliative care. NIH shall prioritize 
grantees with a recognized expertise and leadership in 
palliative care. The Committee encourages NIH to fund several 
multi-year, early-career development grants modeled after NIA's 
GEMSSTAR program. Appropriations provided in fiscal year 2024 
for training are expected to cover 2 years of funding for 
career development awards. The Committee requests a briefing 
within 120 days of enactment on how this strategy will be 
established and implemented, including timelines on when 
funding opportunities will be issued and when funding will be 
awarded.
    Population Research.--NIA supports a rigorous population 
aging research portfolio that includes research grants, 
centers, networks, and population representative longitudinal 
surveys examining how demographic, social, and economic factors 
impact the health and well-being of older adults over the life 
course. The Committee is pleased to learn that in fiscal year 
2024 NIA will be renewing several transdisciplinary research 
networks devoted to studying issues such as rural aging, 
psychosocial stress measurement, and social genomics. The 
Committee encourages the NIA to stimulate additional research 
projects addressing high priority areas such as rising midlife 
mortality rates, socioeconomic disparities, and the unique 
impacts of climate change on older individuals. Further, the 
Committee urges the Institute to explore how multidisciplinary 
nationally representative studies, such as the Health and 
Retirement Study, can improve the representation of Asian 
American subpopulations.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2023....................................    $685,465,000
Budget estimate, 2024...................................     687,639,000
Committee recommendation................................     685,465,000

    The Committee recommendation includes $685,465,000 for the 
National Institute of Arthritis and Musculoskeletal and Skin 
Diseases [NIAMS].
    Musculoskeletal Regenerative Medicine.--The Committee 
recognizes the increasingly fundamental role that extracellular 
vesicles [EVs] play as a mechanism of communication between 
cells, organs, organ systems, and organisms in providing a 
snapshot of a wide range of disease processes including 
musculoskeletal disorders. The Committee also understands that 
the field of regenerative medicine is in the early stage of 
exploring the potential of EVs to help treat patients, 
including veterans, living with significant musculoskeletal 
injuries such as osteoarthritis, tendon, and ligament diseases. 
The Committee therefore encourages support for research to 
optimize regenerative medicine through analyzing EVs and other 
approaches through partnerships that bring together scholars, 
creators, and entrepreneurs to work in a collaborative space to 
discover and deliver solutions that utilize the body's healing 
capacity to improve the lives of those living with 
musculoskeletal disorders.
    Thalassemia.--Individuals with thalassemia frequently 
develop low bone mass issues, often several decades earlier 
than is typical in the general population. Most currently 
recognized treatment options for low bone mass issues have been 
developed for populations that develop these issues at an older 
age than in thalassemia, and which may not have the same 
characteristics as those with thalassemia. More research in 
treatments for and prevention of low bone mass for this 
population may be warranted.

    NATIONAL INSTITUTE OF DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2023....................................    $534,333,000
Budget estimate, 2024...................................     534,330,000
Committee recommendation................................     534,333,000

    The Committee recommendation includes $534,333,000 for the 
National Institute of Deafness and Other Communication 
Disorders [NIDCD].

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2023....................................    $197,693,000
Budget estimate, 2024...................................     197,671,000
Committee recommendation................................     197,693,000

    The Committee recommendation includes $197,693,000 for the 
National Institute of Nursing Research [NINR].
    Health Disparities Research.--The Committee continues to 
provide $10,000,000 for NINR to support research related to 
identifying and reducing health disparities.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2023....................................    $595,318,000
Budget estimate, 2024...................................     596,616,000
Committee recommendation................................     595,318,000

    The Committee recommendation includes $595,318,000 for the 
National Institute on Alcohol Abuse and Alcoholism [NIAAA].
    Alcohol and Polysubstance Use.--The Committee is pleased to 
see NIH supporting research on alcohol and polysubstance use, 
and urges NIH to increase research in this area through more 
comprehensive centers across the United States. The Committee 
is concerned by the high rates of alcohol misuse and alcohol-
related morbidity and mortality in the United States, 
particularly in Indigenous, frontier, and rural communities. 
The Committee encourages NIH to support studies, and form 
multi-tier prevention programs for R1 Research Centers, that 
focus on rural and minority communities with high rates of 
alcohol and polysubstance use mortality. These centers could 
develop, test, and implement prevention programming to reduce 
alcohol misuse, including through social media as well as web-
based and mobile applications. These programs could also train 
community health providers in delivering person-centered brief 
interventions to help reduce alcohol misuse and alcohol-related 
harms.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2023....................................  $1,662,695,000
Budget estimate, 2024...................................   1,663,365,000
Committee recommendation................................   1,672,695,000

    The Committee recommendation includes $1,672,695,000 for 
the National Institute on Drug Abuse [NIDA].
    Barriers to Research.--The Committee is concerned that 
restrictions associated with Schedule I of the Controlled 
Substances Act effectively limits the amount and type of 
research that can be conducted on certain Schedule I drugs, 
especially opioids, psychedelics, marijuana or its component 
chemicals, and new synthetic drugs and analogs. At a time when 
we need as much information as possible about these drugs and 
antidotes for their harmful effects, we should be addressing 
regulatory and other barriers to conducting this research. The 
Committee appreciates NIDA's completion of a report on the 
barriers to research that result from the classification of 
drugs and compounds as Schedule I substances including the 
challenges researchers face as a result of limited access to 
sources of marijuana, including dispensary products.
    Cocaine.--The Committee remains concerned about the drug 
addiction public health crisis and the surge in overdose deaths 
involving stimulants, including cocaine. The Committee 
recognizes that NIDA is prioritizing research and development 
of treatments which can rapidly reverse cocaine toxicity and 
reduce mortality rates, addressing the severe gap in this unmet 
medical need. Due to the unavailability of an FDA-approved 
cocaine overdose reversal medication, the Committee encourages 
NIDA to continue prioritization of additional research and 
development to advance a life-saving treatment for overdoses 
caused by cocaine.
    Investments in Basic Research.--The Committee is aware that 
basic research is the foundation for clinical research, both of 
which pave the way to new or improved treatments for substance 
use disorders. Basic research can focus on the causal 
mechanisms underlying the functioning of the human body and 
provides a critical understanding of the short- and long-term 
impacts of drug use. The discoveries that are made through 
basic research can be translated directly into improved patient 
care, including novel medications, fewer drug-related 
fatalities, and science-based methods for preventing addiction. 
The Committee encourages NIDA's continued investments in 
investigator-initiated grants in basic research and support for 
training of young investigators to ensure a healthy and growing 
population of researchers.
    Medication for Methamphetamine Use Disorder.--The Committee 
is concerned with the rise in methamphetamine use and addiction 
in the United States. While there are currently approved 
medication treatments for alcohol and opioid addiction there 
remains no approved medication for methamphetamine addiction. 
The Committee urges the Institute to continue their ongoing 
trials in order to expeditiously find and approve a medication 
for methamphetamine.
    Methamphetamine and Other Stimulants.--The Committee is 
concerned that, according to predicted provisional data 
released by CDC, overdose deaths involving drugs in the 
categories that include methamphetamine and cocaine increased 
by 41 and 40 percent respectively between 2021 and 2022. The 
sharp increase has led some to refer to stimulant overdoses as 
the ``fourth wave'' of the current drug addiction crisis in 
America following the rise of opioid-related deaths involving 
prescription opioids, heroin, and fentanyl-related substances. 
No FDA-approved medications are available for treating 
methamphetamine, cocaine, and other stimulant use disorders. 
The Committee continues to support NIDA's efforts to address 
the opioid crisis, has provided continued funding for the HEAL 
Initiative, and supports NIDA's efforts to combat the growing 
problem of methamphetamine and other stimulant use disorders 
and related deaths.
    Opioid Initiative.--The Committee continues to be concerned 
about the high mortality rate due to the opioid overdose 
epidemic and appreciates the important role that research plays 
in the various Federal initiatives aimed at this crisis. 
Approximately 174 people die each day in this country from drug 
overdose (over 100 of those are directly from opioids), making 
it one of the most common causes on non-disease-related deaths 
for adolescents and young adults. The Committee is also aware 
of increases in opioid deaths from 2020 to 2021, with the 
primary driver being the increased overdose deaths involving 
synthetic opioids, primarily fentanyl. More research is needed 
to find new and better agents to prevent or reverse the effects 
caused by this class of chemicals and to provide improved 
access to treatments for those with addiction to these drugs. 
To combat this crisis, the Committee has provided within NIDA's 
budget no less than $365,295,000, an increase of $10,000,000, 
for the Institute's share of the HEAL Initiative and in 
response to rising rates of stimulant use and overdose. The 
Committee encourages NIDA to support research on the 
development of safe and effective medications and new 
formulations and combinations to treat substance use disorders 
and prevent or reverse overdose, and to support research on 
comprehensive care models in communities nationwide to prevent 
opioid misuse, expand treatment capacity, enhance access to 
overdose reversal medications, and enhance prescriber practice; 
test interventions in justice system settings to expand the 
uptake of medication treatment and methods to scale up these 
interventions; and develop evidence-based strategies to 
integrate screening and treatment for opioid use disorders in 
emergency department and primary care settings. The Committee 
has included language expanding the allowable use of these 
funds to include research related to stimulant use and 
addiction.
    Overdose Analogs.--Recognizing the increasing severity of 
the National opioid crisis and the need to better our options 
for responding to, treating, and preventing overdoses, the 
Committee encourages NIDA to prioritize research to expedite 
treatments for and prevention of overdose from fentanyl and 
related analogs. Grant recipients should be able to develop and 
advance additional treatment and overdose prevention options 
such as a human IgG1 monoclonal antibody specific for fentanyl 
and structurally related fentanyl analogs to be delivered by 
intravenous, subcutaneous, and/or intramuscular (i.e., auto-
injection) routes of administration.
    Raising Awareness and Engaging the Medical Community in 
Drug Use and Addiction Prevention and Treatment.--Education is 
a critical component of any effort to curb drug use and 
addiction, and it must target every segment of society, 
including healthcare providers (doctors, nurses, dentists, and 
pharmacists), patients, and families. Medical professionals 
must be in the forefront of efforts to curb the opioid crisis. 
The Committee continues to be pleased with the NIDAMED 
initiative, targeting physicians-in-training, including medical 
students and resident physicians in primary care specialties 
(e.g., internal medicine, family practice, emergency medicine, 
and pediatrics). The Committee encourages NIDA to continue to 
provide clinical resources to providers to help identify and 
treat patients with substance use disorder.
    Youth E-Cigarette Use.--The Committee understands that 
electronic cigarettes (e-cigarettes) and other vaporizing 
equipment remain popular among adolescents, and requests that 
NIDA continue to fund research on the use and consequences of 
using these devices. The Committee is pleased that NIDA 
continues to support the Monitoring the Future survey and 
Population Assessment of Tobacco and Health studies, which 
provide timely data on tobacco products and other drug use. 
Finally, with more than 4 million young people using e-
cigarettes, there is a greater need for research into 
therapeutic options for nicotine cessation among youth who have 
developed addiction to nicotine. The Committee encourages NIDA 
to support research to develop therapies, including both 
pharmacologic and behavioral therapies, to combat nicotine 
addiction in pediatric populations.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2023....................................  $2,337,843,000
Budget estimate, 2024...................................   2,455,653,000
Committee recommendation................................   2,437,843,000

    The Committee recommendation includes $2,437,843,000 for 
the National Institute of Mental Health [NIMH].
    Autism Spectrum Disorder [ASD].--The Committee encourages 
NIH to support greater investment in research on autism, 
particularly in areas outlined in the Interagency Autism 
Coordinating Committee's [IACC] Strategic Plan for ASD. The 
Committee urges NIMH to work in close partnership with the 
other Institutes that serve on the IACC to provide an update on 
the level of research investment for each of the priority areas 
outlined in the IACC Strategic Plan for ASD. While significant 
progress has been made in the understanding of autism, large 
gaps remain in the ability to improve outcomes and access to 
services for autistic individuals across their life span. 
Research has shown that autistic individuals have higher rates 
of some co-occurring physical and mental health conditions, 
impacting quality of life and increasing medical utilization 
and costs. Additionally, there are significant unaddressed 
racial, ethnic, and socioeconomic health equity challenges 
experienced by autistic individuals across their life span and 
by their families. As such, the Committee encourages NIMH to 
work collaboratively with NIMHD to support research on the 
socioeconomic, racial, and ethnic health disparities associated 
with ASD, and to work collaboratively with other institutes 
including NIA, NIEHS, and NINDS to support research on the 
impact of neurological, social, and environmental factors 
leading to co-occurring health conditions.
    Cost of Serious Mental Illness [SMI].--Despite increased 
spending on mental health services, the prevalence of SMI has 
grown by almost fifty percent since 2008. In response to 
Congressional direction included with the Consolidated 
Appropriations Act, 2023, NIH developed a professional 
judgement budget setting the stage for near- and intermediate-
term improvements in mental healthcare to address the Nation's 
growing mental health crisis. The agenda outlines a 15-year 
vision for four independent but complementary projects that 
will address different needs in the prevention, diagnosis, and 
treatment of SMI. To develop this budget, NIMH considered input 
from the National Academy of Medicine Fora on Mental Health and 
Substance Abuse and Neuroscience; the National Advisory Mental 
Health Council; and NIMH-sponsored convenings over the past 3 
years. The Committee urges NIMH to launch the four projects 
proposed under the initiative, and NIMH is directed to brief 
the House and Senate Committees on Appropriations on how these 
time-limited, goal-driven investments will accelerate emerging 
science and support high-risk/high-reward research.
    Mental Health Research.--In recognition of the country's 
unprecedented mental health crisis, the Committee provides a 
$100,000,000 increase for mental health research. This funding 
is provided to support research focused on developing targeted 
prevention of and treatment for mental illness. The Committee 
expects this funding will be used to accelerate better 
diagnostics, improved therapeutics and behavioral treatments, 
and enhanced precision of mental healthcare; develop a new 
Precision Psychiatry Initiative; and support studies of social 
media's impact on mental health. The Committee supports NIMH 
efforts to launch a new depression biomarker development effort 
to guide treatment decisions for major depression and identify 
research gaps and opportunities for understanding relationships 
among social media behavior, social media engagement, and youth 
mental health. These initiatives will combine innovative 
physiological and behavioral methods to better predict patient 
prognosis and optimize treatment.
    Suicide Prevention.--The Committee is concerned by alarming 
rates of suicide, particularly among youth between the ages of 
10 and 24 year old, which climbed to the highest point in more 
than 20 years during the pandemic. Data show that the groups 
that experience higher rates of suicide or suicide attempts 
include veterans, people who live in rural areas, sexual and 
gender minorities, middle-aged adults, people of color, and 
Tribal populations. Suicide is complex, and multiple factors-
biological, psychological, social, and environmental-play a 
role. The Committee encourages NIMH to direct additional 
attention to suicide prevention research across all of these 
areas, as well as the application of novel measurement 
techniques, statistical analysis, digital initiatives and 
information systems. The Committee also encourages NIMH to 
promote greater collaboration with other NIH Institutes and 
Centers supporting research in areas that can contribute to 
suicide prevention, including NIA, NICHD, NHGRI, NIAAA, NIDA 
and NINDS.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2023....................................    $663,200,000
Budget estimate, 2024...................................     660,510,000
Committee recommendation................................     663,200,000

    The Committee recommendation includes $663,200,000 for the 
National Human Genome Research Institute [NHGRI].
    Proteomics.--The Committee recognizes the promise of 
research into the proteome in the study of biological systems. 
The ability to effectively and efficiently analyze protein 
patterns and their changes over time has potential to provide 
valuable insights into a person's real-time state of health 
including identifying existing disease, understanding the 
biological drivers of that disease, predicting near-term health 
events, and guiding effective therapeutic interventions. The 
Committee urges NHGRI to utilize existing resources to engage 
with academia and domestic industry partners to expand its 
research into this cutting-edge field.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2023....................................    $440,627,000
Budget estimate, 2024...................................     440,625,000
Committee recommendation................................     440,627,000

    The Committee recommendation includes $440,627,000 for the 
National Institute of Biomedical Imaging and Bioengineering 
[NIBIB].

        NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2023....................................    $170,384,000
Budget estimate, 2024...................................     170,277,000
Committee recommendation................................     170,384,000

    The Committee recommendation includes $170,384,000 for the 
National Center for Complementary and Integrative Health 
[NCCIH].
    Pain Management.--The Committee includes $5,000,000 to 
support research into non-pharmacological treatments for pain 
management and urges NCCIH, along with DOD and VA, to continue 
to support research, including comorbidities such as opioid 
misuse, abuse, and disorder among military personnel, veterans, 
and their families. The Committee urges NIH, VA, and DOD to 
expand research on non-pharmacological treatments for veterans 
and service members.

      NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2023....................................    $524,395,000
Budget estimate, 2024...................................     525,138,000
Committee recommendation................................     524,395,000

    The Committee recommendation includes $524,395,000 for the 
National Institute on Minority Health and Health Disparities 
[NIMHD].
    Research Centers at Minority Institutions [RCMI] Program.--
The Committee encourages NIMHD to continue investing in this 
program to provide more opportunities for health professions 
institutions with historical missions and precedence of serving 
minorities and building research infrastructure to conduct 
minority health and health disparities research.
    Research Endowment Program.--The Committee is pleased with 
NIMHD's reinvigoration of the Research Endowment Program and 
has provided $12,000,000 for fiscal year 2024 to implement the 
revitalized program. The Committee urges NIMHD to work swiftly 
on its implementation to expand and assist eligible 
institutions receiving grants with this additional funding 
through a competitive process.

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

Appropriations, 2023....................................     $95,162,000
Budget estimate, 2024...................................      95,130,000
Committee recommendation................................      95,162,000

    The Committee recommendation includes $95,162,000 for the 
Fogarty International Center [FIC].
    Fogarty International Center [FIC].--The Committee 
recognizes the need to support resources for FIC for its work 
in strengthening health research systems, training infectious 
disease researchers, and improving pandemic preparedness in 
low- and middle-income countries [LMICs]. These programs 
improve national and global health security and produce health 
interventions that can improve public health and reduce costs 
in low-resource settings everywhere, including in the United 
States. The Committee supports expanding FIC's role in pandemic 
preparedness and research capacity building, including by 
strengthening international coordination, increasing capacity 
for computational modeling and outbreak analytics, and 
supporting research to reduce health disparities and improve 
implementation of health interventions in low-resource 
settings.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 2023....................................    $497,548,000
Budget estimate, 2024...................................     495,314,000
Committee recommendation................................     497,548,000

    The Committee recommendation includes $497,548,000 for the 
National Library of Medicine [NLM].

          NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2023....................................    $923,323,000
Budget estimate, 2024...................................     923,323,000
Committee recommendation................................     923,323,000

    The Committee recommendation includes $923,323,000 for the 
National Center for Advancing Translational Sciences [NCATS].
    Addressing All Rare Diseases.--The Committee directs NCATS 
to host a public workshop convening rare disease expert 
stakeholders including scientists, Federal agency 
representatives including FDA, patient advocacy leaders, 
clinicians, therapy and diagnostics developers, and regulators. 
Developing a therapy for conditions occurring in very small 
populations involves overcoming unique regulatory and research 
hurdles due to their small patient populations. The workshop 
will address current research and treatment efforts for rare 
diseases, including focusing on commonalities across diseases 
and therapeutic platforms, the outcome of which would also be 
applicable for rare diseases with small patient populations, 
and rare diseases with no path to commercialization.
    Clinical and Translational Science Awards [CTSA] Program.--
The Committee provides $629,560,000 for the CTSA program. The 
Committee once again emphasizes that allocated resources shall 
be used to provide additional support to CTSA hubs and further 
enhance ongoing activities. The Committee maintains its strong 
support for the CTSA program and reaffirms previous language 
preserving the size, scope, and historic mission of the CTSA 
program, including the direction that no competitively funded 
hub shall receive less than 95 percent of the resources that 
were provided prior to fiscal year 2022. The CTSA program has 
helped modernize the Nation's approach to effective and 
efficient medical research and will continue to be fully 
supported to facilitate further scientific progress through 
this critical infrastructure. Finally, the CTSA program is 
encouraged to catalyze emerging opportunities in AI, big data, 
and other areas, while maintaining the commitment to critical 
activities, such as training the next generation of cutting-
edge physician scientists.
    Collaboration with Business Incubators.--The Committee 
urges NCATS to continue proactive outreach to redouble its 
efforts to leverage its mission by exploring opportunities or 
potential collaborations with business incubators that host 
small to midsize science, research and pharmaceutical companies 
that use service-based approaches to nurture and guide their 
member companies to success.
    National Clinical Cohort Collaborative [N3C].--The 
Committee continues to support NCATS N3C's open-science 
privacy-preserved data-sharing platform to accelerate 
biomedical research and discovery. N3C combines electronic 
health record data with imaging, mortality, viral genome 
sequences, and Medicare and Medicaid data from CMS to answer 
key research questions on a variety of diseases. The Committee 
encourages NCATS to expand use of its virtual data research 
infrastructure to accelerate research and cures for a variety 
of diseases through re-use of NCATS repositories, other NIH 
repositories including clinical trial data, and readily 
available real-world data including Federal agency data such as 
CMS claims data.
    Rare Disease Research.--The Committee encourages NCATS to 
leverage the investments made in NCATS rare disease research to 
accelerate the development of new treatments for the 95 percent 
of rare diseases with no approved treatment, to strengthen the 
innovation of diagnostics to shorten the average 6.3 year-long 
diagnostic odyssey, and to lower the nearly $1,000,000,000,000 
annual economic burden of rare diseases. The Committee urges 
NCATS to increase funding for rare disease research, helping to 
grow the newly created Division of Rare Diseases Research 
Innovation.

                         OFFICE OF THE DIRECTOR

Appropriations, 2023....................................  $2,655,514,000
Budget estimate, 2024...................................   2,903,379,000
Committee recommendation................................   2,834,514,000

    The Committee recommendation includes $2,834,514,000 for 
the Office of the Director [OD]. Within this total, 
$722,401,000 is provided for the Common Fund, and $12,600,000 
is included for the Gabriella Miller Kids First Research Act 
(Public Law 113-94).
    ADRD Clinical Trial Diversity/Health Equity.--The Committee 
recommends that NIH fund or conduct Black/African American-, 
Latino/Hispanic- and women- only research studies to better 
understand the underlying etiology of cognitive impairment and 
dementia in these groups that have disproportionately higher 
prevalence of disease.
    ALS Research, Treatments, and Expanded Access.--The 
Committee continues to provide funding for ALS research to 
reduce the burdens of people with ALS as quickly as possible. 
It is crucial for people living with ALS and people diagnosed 
with ALS in the future, that NIH dramatically grows its ALS 
portfolio and the research workforce with additional grant 
funding and increases its focus on research that will lead to 
measurable changes in the lives of people living with ALS. The 
Committee directs NIH to handle funding of expanded access 
grants as authorized by the Accelerating Access to Critical 
Therapies [ACT] for ALS (Public Law 117-79) as separate, not 
competitive with, funding for other research on ALS and 
includes $75,000,000 for this purpose. Expanded Access Grants 
support scientific research utilizing data from expanded access 
to investigational drugs for people with ALS who are not 
eligible for clinical trials. The Committee requests NINDS 
include ALS clinics across the country in an ALS Clinical 
Research Network to increase capacity for research utilizing 
data from expanded access and other clinical research at 
geographically distributed sites. The Committee continues to 
direct NINDS and OD to brief the Committees prior to any 
execution of expanded access grants or programmatic funding. 
Once awards are announced, the Committee directs NINDS and OD 
to provide the Committees with an explanation of the funded 
grants, including a clear breakdown of what the funding is to 
be used for. Furthermore, after the review and awards of 
meritorious applications under Section 2, the Committee directs 
NIH to apply any unused funds to programs authorized under ACT 
for ALS including Section 3 public-private research 
partnership. Finally, if sufficient eligible applications are 
not received, or NINDS and OD have any reason to believe any 
funding should lapse, the ICs are directed to notify the 
Committees prior to notifications of awards. This notification 
shall include: (1) a detailed explanation as to why 
applications cannot be funded; (2) the technical assistance 
provided to applicants to assist them in submitting eligible 
grant applications; and (3) a proposed plan to award funding 
for other ALS research identified by the NIH ALS Strategic 
Priorities prior to the end of the fiscal year.
    Amyloidosis.--The Committee urges NIH to expand its 
research efforts in amyloidosis, a group of rare and often 
fatal diseases. Amyloidosis is characterized by abnormally 
folded protein deposits in tissues. Federal and foundation 
support over the past years has given hope for successful new 
treatments. However more efforts are needed to accelerate 
research and awareness of the disease and to help patients with 
amyloidosis related multi-organ dysfunction. The Committee 
directs NIH to provide an update in the fiscal year 2025 CJ on 
the steps NIH has taken to expand research into the causes of 
amyloidosis and the measures taken to improve the diagnosis and 
treatment of this devastating group of diseases.
    Artificial Intelligence/Machine Learning [AI/ML].--The 
Committee provides $135,000,000 to support NIH's efforts to 
build capacity to leverage AI, ML and data science to 
accelerate the pace of biomedical innovation. The Committee 
supports NIH's efforts to build AI-based analytical tools to 
help NIH optimize investments in biomedical research by 
identifying emerging topics and predicting which ones will 
produce transformative breakthroughs. To build upon NIH's 
progress in this area, the Committee encourages NIH to continue 
expanding the application of AI, ML, and data science across 
its research portfolio, with a particular emphasis on 
activities that bring together research grants and the Office 
of Data Science [ODSS] as it implements the NIH Strategic Plan 
for Data Science. To increase AI, ML, and data science 
expertise on NIH review panels, the Committee encourages ODSS 
to partner with the Center for Scientific Review to increase 
outreach to the AI, ML, and data science community. Finally, 
the Committee continues to support collaboration between NIH 
and the Department of Energy [DOE] to bring together biomedical 
scientists with computer scientists, computational scientists 
and other data science experts. The Committee directs NIH to be 
consistent with the ODSS policies regarding use of AI/ML in 
biomedical and behavioral sciences research when carrying out 
AI/ML initiatives. The Committee requests an update within 180 
days of enactment on NIH-wide ethical standards when biomedical 
research utilizes AI/ML.
    Autoimmune and Immune Mediated Diseases.--The Committee 
recognizes the important role the new Office of Autoimmune 
Disease Research within the Office of Research on Women's 
Health will play in coordinating and fostering collaborative 
research across Institutes and Centers. As the office develops 
a strategic research plan, the Committee strongly encourages it 
to seek input from external stakeholders particularly patient 
advocacy organizations that represent the populations affected 
by autoimmune and immune-mediated diseases.
    Biosecurity in Synthetic Nucleic Acid Synthesis.--The 
Committee urges NIH to develop additional policies to advance 
the adoption of strong biosecurity practices for synthetic 
biology technologies. Specifically, NIH should explore 
approaches to encourage grantees receiving NIH research dollars 
to prioritize the purchase of domestically produced synthetic 
genetic materials and tools from companies that have 
implemented appropriate biosecurity practices, including but 
not limited to the 2010 HHS Screening Framework Guidance for 
Providers of Synthetic Double-Stranded DNA or when available, 
an updated version of this guidance. In creating and 
implementing any such approaches, the Committee encourages NIH 
to coordinate with the Administration for Strategic 
Preparedness and Response.
    Brain Research through Advancing Innovative 
Neurotechnologies [BRAIN] Initiative.--The Committee continues 
to support the BRAIN Initiative which is revolutionizing our 
understanding of the brain and fostering discoveries, 
collaborations, and partnerships that will lead to treatments 
and cures for brain diseases, disorders and injuries. The 
Committee provides $680,000,000 for the BRAIN Initiative. The 
Committee requests the BRAIN Initiative to communicate about 
the progress and achievements of the key projects and studies 
it is supporting with these funds by reporting on their 
objectives and anticipated/actual outcomes within 90 days of 
enactment.
    Cannabis Research.--The Committee is concerned that 
marijuana policies on the Federal level and in the States 
(medical marijuana, recreational use, etc.) are being changed 
without the benefit of scientific research to help guide those 
decisions. The Committee recognizes the increased interest and 
need to study cannabis and its constituent cannabinoids. The 
Committee encourages NIH to expand its current research agenda 
across its Institutes and Centers, including additional 
research on higher potency THC, alternative cannabis 
formulations and extracts, and additional minor cannabinoids. 
The Committee also encourages NIH to expand research on the 
potential medical uses of cannabis, such as for chronic pain, 
appetite stimulation, immune diseases, cancer, metabolic and 
digestive disorders, epilepsy, glaucoma, MS, sleep disorders, 
and a variety of mental health conditions such as anxiety and 
PTSD. The Committee encourages NIH to continue to take an 
integrated approach to cannabis research across its Institutes 
and Centers. Finally, the Committee encourages NIH to continue 
supporting a full range of research on the health effects of 
marijuana and its components, including research to understand 
how marijuana policies affect public health.
    Cephalopod Research.--The Committee recognizes that there 
are no federally required welfare standards for the use of 
cephalopods in federally-funded research because all 
invertebrate animals are excluded from the Public Health 
Service [PHS] Policy on the Humane Care and Use of Laboratory 
Animals, which provides certain welfare standards for 
vertebrate animals. The Committee acknowledges that other 
countries have established oversight requirements for 
cephalopods when used in government-funded research. Due to 
cephalopods' current exclusion in Federal regulations, there is 
limited oversight of their involvement in research. The 
Committee recognizes that researchers must still justify their 
use and numbers when proposing research seeking NIH funding. As 
interest in the welfare of these animals in research is 
increasing, the Committee encourages the NIH to consider 
developing guidance for the humane care and use of cephalopods 
in NIH-supported research, including possibly expanding the 
current definition of ``animal'' in the PHS Policy.
    Childhood Post-Infectious Neuroimmune Disorders/PANS/
PANDAS.--The Committee is concerned that although NIH supports 
research on Pediatric Acute-Onset Neuropsychiatric Syndrome 
[PANS] and Pediatric Autoimmune Neuropsychiatric Disorders 
Associated with Streptococcus [PANDAS], significantly more 
needs to be done to fully understand causes, diagnosis, and 
treatment of these devastating disorders. Research and 
physician education are essential to early identification and 
intervention, thereby reducing the risk of chronic illness and 
associated costs to families, school systems, healthcare 
systems, and insurers. The association between neuropsychiatric 
illness and infections has become even more evident because of 
SARS CoV-2 and provides increasing opportunities for 
breakthroughs in research and treatment. The Committee 
encourages NIH to increase prioritization of research in this 
area, and report to the Committee in the fiscal year 2025 CJ on 
the progress being made on the understanding of the causes, 
diagnostic criteria, and treatment of these conditions.
    Chimera Research.--The Committee supports NIH's funding 
limitation regarding the introduction of human pluripotent 
cells into non-human vertebrate animal pre-gastrulation stage 
embryos. The Committee takes seriously the bioethical 
considerations regarding the creation of human-animal chimeras 
and the continuation of research using these cells.
    Congenital Cytomegalovirus [cCMV].--cCMV is the most common 
viral infection infants are born with in the United States and 
the leading non-genetic cause of hearing loss. cCMV can cause 
stillbirth or miscarriage, visual impairment, developmental 
delays, and other health complications. Current anti-viral and 
prevention strategies for cCMV that have been clinically 
studied are based on outdated innovations. The Committee 
encourages NIH to support research on the development of lower-
cost and high-sensitivity prenatal (fetal) diagnosis and 
newborn screening technologies; the design, evaluation, and 
acceleration of clinical trials for vaccines; strategies to 
prevent CMV-related stillbirth and miscarriages; cCMV 
disparities research; effectiveness studies of risk reduction 
measures during pregnancy; treatment trials for those who are 
pregnant to reduce transmission and fetal disease; and 
intervention trials to assist those infants born with CMV. The 
Committee directs NIH to submit an update in the fiscal year 
2025 CJ on the development of this research.
    Common Fund.--The Gabriella Miller Kids First Research Act 
authorized $126,000,000 for a 10-year Pediatric Research 
Initiative. These funds are used to advance research for 
pediatric birth defects and childhood cancer. As authorized by 
the act, $12,600,000 is provided to support pediatric research.
    Common Data Elements [CDEs].--The Committee recognizes the 
continued need to develop CDEs in disease areas where they 
currently do not exist, particularly in complex autoimmune and 
immune-mediated conditions. The Committee encourages the Office 
of Data Science Strategy [ODSS] to collaborate with the Office 
of Research on Women's Health and Institutes and Centers that 
oversee research on autoimmune and immune-mediated conditions 
to prepare a roadmap for developing CDEs for these conditions. 
The Committee encourages ODSS to engage outside stakeholders, 
including professional societies and patient organizations, in 
this work, as appropriate.
    Compensation for Trainees and Early Career Researchers.--
The Committee appreciates that the future of U.S. economic 
competitiveness and our Nation's ability to address national, 
economic, and health security threats depends on sustaining a 
robust STEM workforce. Ensuring individuals from communities 
that are under-represented in the STEM field can enter and 
sustain a career as part of the STEM workforce is essential to 
strengthening the research workforce going forward. The 
Committee is deeply concerned that entrenched financial 
barriers are increasingly deterring graduate and postdoctoral 
students, particularly those from underrepresented communities, 
from pursuing STEM careers. The lack of Cost-of-Living 
Adjustments [COLAs] can make it financially unrealistic for 
postdoctoral students to accept positions, particularly in 
high-cost areas; areas in which academic medical centers are 
located. The Committee is aware of NIH's concerns about 
instituting COLAs for postdoctoral students, however, the 
Committee believes attracting and retaining New and Early-Stage 
Investigators and increasing diversity in biomedical science 
are paramount goals. The Committee directs NIH to evaluate the 
adequacy of compensation for trainees and early career 
researchers, including COLAs, supported through fellowships, 
training grants, and research awards. Within 180 days of 
enactment, the Committee directs NIH to provide a report on 
this analysis, and such a report shall include the estimated 
budgetary needs of instituting COLAs for postdoctoral students.
    Creutzfeldt-Jakob Disease.--The Committee encourages NIH to 
continue to fund projects investigating Creutzfeldt-Jakob 
Disease [CJD] and other prion diseases, which are rapidly 
progressive and fatal neurodegenerative diseases, including 
projects that are also relevant to Alzheimer's Disease and 
Related Dementias [ADRD]. CJD is caused by the abnormal folding 
of the prion protein in the brain, and closely resembles ADRDs.
    Developmental Delays.--The Committee continues to provide 
$10,000,000 for research on developmental delays, including 
speech and language delays in infants and toddlers, 
characterizing speech and language development and outcomes in 
infants and toddlers through early adolescence. The Committee 
urges NIH to support research including longitudinal studies, 
translation of research into clinical practice, and novel 
approaches to study children with speech and language delays to 
provide parents, teachers, pediatricians, and other caregivers 
with the information they need to help late talking children 
grow and thrive in school and other social environments.
    Diet and Chronic Disease Research.--The Committee 
recognizes the importance of ongoing activities to better 
understand the impact of food and diet on the development of 
mucosal immunity and the relevance of this topic to Crohn's 
disease and ulcerative colitis and to other digestive and 
autoimmune or immune-mediated diseases. The Committee 
encourages NIH to convene a scientific workshop, supported by 
multiple Institutes, Centers or Offices, including the Office 
of Nutrition Research, and to report to the Committee the 
outcomes of the workshop, including possible future research 
opportunities.
    Duchenne and Becker Muscular Dystrophy.--The Committee 
supports the research conducted by the Wellstone Muscular 
Dystrophy Research Network Centers of Excellence program 
established in 2003. The Committee directs NIH to provide a 
report to Congress and the public on the key scientific 
accomplishments of the Centers to date and their current 
activities. The NIH also should use this information to update 
its website content regarding the program.
    Eating Disorders.--The Committee commends NIH for 
supporting multi-Institute research on the chronic, serious, 
and fatal mental illness of eating disorders impacting nearly 
30 million Americans during their lifetimes. More than seventy 
percent of people with eating disorders have comorbid mental 
health conditions including anxiety disorders, mood disorders, 
and trauma-related symptoms. Lifetime prevalence of comorbid 
substance use disorder among individuals with eating disorders 
was recently reported as 27.9 percent. The Committee remains 
concerned about the lack of research surrounding binge-eating 
disorder, the most common eating disorder in the United States 
and encourages NIH to increase eating disorder research across 
all sub-types to better reflect the U.S population, including 
historically underrepresented populations. The Committee 
requests an update within 180 days of enactment on steps NIH is 
taking to diversify research across all eating disorder sub-
types and resources needed to address gaps in genetics, 
prevention, diagnosis, and treatment of eating disorders.
    Encouraging Innovation and Experimentation.--The Committee 
recognizes that there are many ideas for how NIH could improve 
its operations and funding models-such as lotteries for funding 
mid-range proposals, funding the person rather than the 
project, and more-yet there is not enough evidence to directly 
mandate any of these ideas. The Committee urges NIH to examine 
how best to create or empower a team that would engage in NIH-
wide experimentation with new ideas regarding peer review, 
funding models, and others, so as to enhance NIH's operations 
and ultimately to improve biomedical progress. The Committee 
directs NIH to provide a report within 1 year on these efforts.
    Endotoxemic Septic Shock.--The Committee encourages NIH to 
convene a stakeholder workshop to discuss research needs to 
inform the development of diagnostic criteria for 
characterizing endotoxemic septic shock in recognition of 
clinical advances in knowledge and emerging medical 
technologies to assess and treat this condition.
    Environmental Influences on Child Health Outcomes [ECHO].--
The Committee includes $180,000,000, for the ECHO program. ECHO 
currently funds the Navajo Birth Cohort Study. The Committee 
encourages expanding the study to include a larger 
representation of Navajo children in the cohort to allow for a 
better understanding of the impacts of environmental exposure 
in the Navajo Nation.
    Expanding Support for Young Investigators.--NIH has been 
criticized for funding too many late career scientists while 
funding too few early career scientists with new ideas. The 
Committee is concerned that the average age of first-time R01 
funded investigators remains 42 years old. More than twice as 
many R01 grants are awarded to investigators over 65 than to 
those under 36 years old. The Committee appreciates NIH's 
efforts to provide support for early-career researchers through 
several dedicated initiatives, including the NIH Director's New 
Innovator Award, Next Generation Researchers Initiative, 
Stephen Katz award, and the NIH Pathway to Independence Award. 
The Committee encourages NIH to continue supporting these 
important initiatives and to expand support for early career 
researchers by increasing the number of award recipients for 
these programs in future years. Finally, to better understand 
what is needed to advance these efforts, the Committee directs 
NIH to provide a report within 180 days of enactment on its 
full range of programs for early career scientists including 
the annual cost per program over the last five fiscal years and 
the average number of recipients per year by award. Such report 
shall include a ``professional judgement'' budget to estimate 
the additional funding needed to grow and retain the early 
career investigator pool, accelerate earlier research 
independence, and ensure the long term sustainability of the 
biomedical research enterprise.
    Firearm Injury and Mortality Prevention.--The Committee 
provides $12,500,000 to conduct research on firearm injury and 
mortality prevention. Given violence and suicide have a number 
of causes, the Committee recommends NIH take a comprehensive 
approach to studying these underlying causes and evidence-based 
methods of prevention of injury, including crime prevention. 
All grantees under this section will be required to fulfill 
requirements around open data, open code, pre-registration of 
research projects, and open access to research articles 
consistent with the National Science Foundation's open science 
principles. The Director is to report to the Committees within 
30 days of enactment of this act on implementation schedules 
and procedures for grant awards, which strive to ensure that 
such awards support ideologically and politically unbiased 
research projects.
    Foreign Influence.--To support NIH's efforts to 
expeditiously complete grant compliance reviews, the Committee 
continues to include $2,500,000 for this activity within the 
Office of Extramural Research. The Committee directs NIH to 
provide biannual briefings on compliance, oversight, and 
monitoring reviews where non-compliance has been identified.
    Full Spectrum of Medical Research.--The Committee 
recognizes the growing importance of supporting the full 
spectrum of medical research at NIH, to ensure breakthroughs in 
basic science are translated into innovative therapies, 
diagnostic tools, and health information with a tangible 
benefit to the patient and professional communities. The 
Committee encourages NIH to support the flagship CTSA program 
and to catalyze emerging opportunities in AI, big data, and 
other areas, while maintaining the commitment to critical 
activities, such as training the next generation of cutting-
edge physician-scientists.
    Fund the Person, Not the Project.--While many labs are 
funded by R01-equivalent grants, the R35 mechanism arguably 
allows scientists more flexibility and freedom to pursue the 
best possible science. At present, only NIGMS uses the R35 to a 
significant extent (more than four times as often as the rest 
of NIH put together), with its Maximizing Investigators' 
Research Award [MIRA] program. The Committee directs NIH to 
convene an expert panel on expanding the R35/MIRA grant type 
such that is more widely used across NIH Institutes and 
Centers, and to report back to the Committee within 1 year on 
NIH's plans for expanding the R35 along with its plans for 
evaluating the impact on scientific progress.
    Funding Replication Experiments and/or Fraud Detection.--
The Committee recognizes that many biomedical research studies 
have turned out to be irreproducible or even outright 
fraudulent. The recent Reproducibility Project in Cancer 
Biology showed that cancer biology studies in top journals 
often failed to be replicable, and a prominent line of 
Alzheimer's studies was recently found to be based on an 
allegedly fraudulent study funded by NIH in the early 2000s. 
Given the importance of detecting both reproducibility and 
fraud, the Committee provides $10,000,000 to establish a 
program to fund replication experiments on significant lines of 
research, as well as attempts to proactively look for signs of 
academic fraud. The Committee directs NIH to brief the 
Committee within 180 days of enactment on the establishment, 
staffing and plans for this effort in fiscal years 2024 and 
2025.
    Genomic Data.--The Committee encourages NIH to support 
development of technology that would allow biomedical 
researchers to manage and analyze genomic clinical data for 
research, in a user-friendly way, independent of 
bioinformaticians in an environment for users without coding 
skillsets.
    Harassment Policies.--The Committee is concerned by recent 
reports that despite being disciplined for sexual harassment 
against multiple trainees and co-investigators, NIH allowed the 
transfer of a principle investigator from one academic 
institution to another, where he continued to harass trainees, 
and was later awarded an additional $2,500,000 grant from NIH. 
The Committee directs NIH to provide a full reporting of this 
incident to the Committees, including an update on how NIH will 
rectify this particular case. In addition, NIH is directed to 
provide an update to the Committees on how it intends to 
prevent enabling ``pass the harasser'' in the future, and make 
clear to institutions and researchers that harassment is not 
acceptable and that both institutions and researchers will be 
held accountable, including through the loss of Federal 
funding, for such incidents.
    HEALing Community Study.--The Committee supports the goals 
of the HEALing Communities study to test the integration of 
prevention, overdose treatment, and medication-based treatment 
to combat the opioid crisis, and encourages NIH to continue 
funding the study to completion.
    Health Impacts on Children of Technology and Social Media 
Use.--The Committee remains concerned about the impacts of 
technology use and media consumption on infant, children, and 
adolescent development. The Committee appreciates NIH's ongoing 
engagement on this important topic and encourages NIH to 
prioritize research into the cognitive, physical, and 
socioemotional impacts of young people's use of technologies as 
well as long-term developmental effects on children's social, 
communication, and creative skills. The Committee also 
encourages NIH to study potential correlations between 
increased use of digital media and technologies and suicidal 
thoughts and ideation among children. The Committee encourages 
NIH to consider different forms of digital media and 
technologies, including mobile devices, smart phones, tablets, 
computers, and virtual reality tools, as well as social-media 
content, video games, and television programming. The Committee 
encourages collaboration between NIMH and NICHD for these 
activities.
    Improving Clinical Trials.--The clinical trial enterprise 
has been criticized for conducting too many clinical trials 
where small size may lead to the production of limited evidence 
relevant to clinical outcomes. The Committee directs NIH to 
convene an independent panel (at least 51 of whom must be non-
Federal employees) in order to assess the rate at which NIH-
funded clinical trials are not of sufficient size or quality to 
be informative. The panel should randomly sample at least 300 
NIH-funded trials from each of the years between 2010 and 2020, 
and should make recommendations as to how to fund fewer non-
informative trials in the future. The Committee directs NIH to 
provide a report within 1 year as to the independent panel's 
findings.
    INCLUDE Initiative.--The Committee includes no less than 
$90,000,000, the same as the fiscal year 2023 enacted level, 
within OD for the INCLUDE Initiative. The Committee encourages 
NIH to make further investments in health equity-focused 
research and care for African Americans and other 
underrepresented groups with Down syndrome. The Committee 
remains pleased with a focus on large cohort studies across the 
lifespan, novel clinical trials, and multi-year, NIH-wide 
research driving important advances in understanding immune 
system dysregulation, Alzheimer's disease, and leukemia that is 
contributing to improvements in the health outcomes and quality 
of life of individuals with Down syndrome as well as millions 
of typical individuals. The Committee requests that NIH provide 
an updated plan within 60 days of enactment of this act that 
includes a timeline and description of potential grant 
opportunities and deadlines for all expected funding 
opportunities so that young investigators and new research 
institutions may be further encouraged to explore research in 
this space. This plan should also incorporate and increase 
pipeline research initiatives specific to Down syndrome.
    Kleine-Levin Syndrome.--The Committee commends NIH for its 
December 2021 publication of the Sleep Research Plan. The 
Committee encourages the inclusion of Kleine-Levin Syndrome 
[KLS], a complex neurological disorder characterized by long, 
recurring episodes of excessive sleep and derealization, as a 
sleep disorder requiring attention and study in the next 
publication of the Sleep Research Plan. The cause of KLS is 
still unknown, and there are no known treatments. Because KLS 
shares symptoms with other sleep disorders and mental health 
conditions, the Committee encourages NIH to expand its support 
for research about KLS, which could provide the KLS community 
and many others with critical information and answers.
    Low-Code Application Development.--The Committee encourages 
NIH to continue to utilize commercially available tools to 
expand Low-Code Application Development and that NIH also seek 
to bring that increased efficiency and effectiveness to the 
entire NIH enterprise with the intent to improve cybersecurity 
posture, reduce Operation and Maintenance costs associated with 
legacy applications, reduce open-ended reliance upon external 
services vendors, and train and empower personnel to create 
solutions that can be replicated at lower cost by other users 
across the enterprise, utilizing Low-Code Application 
development technologies.
    Lyme Disease and Related Tick-Borne Illnesses.--The 
Committee urges NIH to develop new tools that can more 
effectively prevent, diagnose, and treat Lyme disease, 
including its long-term effects, and other tick-borne diseases. 
The Committee encourages the promotion and development of 
potential vaccine candidates for Lyme disease and other tick-
borne diseases. The Committee urges NIH to conduct research to 
better understand modes of transmission for Lyme and other 
tick-borne diseases, including vertical transmission. The 
Committee encourages NIH to incentivize new investigators to 
enter the field of Lyme disease and other tick-borne disease 
research. The Committee encourages NIH to coordinate with CDC 
including through the HHS Tick-borne Disease Working Group on 
publishing reports that assess diagnostic advancements, methods 
for prevention, the state of treatment, and links between tick-
borne disease and psychiatric illnesses.
    Mitochondrial Disease Research.--The Committee is aware of 
the efforts by NIH to advance research on mitochondrial 
disorders and translate advances in mitochondrial research to 
therapies for mitochondrial disorders and their secondary 
diseases, such as Alzheimer's disease, Parkinson's disease, 
muscle myopathies, and cancer. It is noteworthy progress that 
the first treatment for a primary mitochondrial disease--
Freidereich's Ataxia--was very recently approved by the FDA. 
The Committee is also aware of considerable evidence 
implicating the impairment of mitochondrial function resulting 
from infection with SARS-CoV-2 in the causation of so-called 
``Long COVID'' disease. Accordingly, the Committee encourages 
NIH to promote interest in primary mitochondrial disease 
research, continue its ongoing outreach and collaboration with 
FDA related to research that may lead to future mitochondrial 
disease-related drug approvals, ensure that support for Long 
COVID research includes opportunities for studies to explore 
the role of mitochondrial impairment, and fund collaborative 
research on mitochondrial disease to centralize a critical mass 
of research, clinical care, and provider education.
    National Primate Research Centers.--The Committee includes 
$30,000,000 in funding to expand, remodel, renovate, or alter 
existing research facilities or construct new research 
facilities for non-human primate resource infrastructure, as 
authorized under 42 U.S.C. section 283k.
    Native Hawaiian Early Career Development.--The Committee 
acknowledges the underrepresentation of Native Hawaiian health 
research-related activities across the agency and within the 
Native Hawaiian community. The Committee encourages NIH to 
continue to explore NIH-wide early career development awards 
that provide support for early-career investigators from 
populations underrepresented in the U.S. research enterprise, 
including Native Hawaiian investigators, and encourages 
outreach to entities with a proven track record of working 
closely with Native Hawaiian communities. The Committee 
requests an update on progress in the fiscal year 2025 CJ.
    National Security.--The Committee believes that NIH should 
consider relevant national security issues when developing and 
executing the NIH-Wide Strategic Plan.
    Near-Misses.--The Committee recognizes that in many cases, 
top biomedical scientists (even Nobel winners) attest that they 
struggled to get NIH funding for the work leading up to their 
major discoveries. The failure of the NIH peer review process 
to recognize and award groundbreaking science is separate from 
the issue of hypercompetition, and warrants investigation. The 
Committee urges NIH to fund a major, independent study of how 
often this phenomenon happens, the possible reasons behind it, 
and potential reforms that could alleviate the problem in the 
future.
    Neurofibromatosis [NF].--The Committee supports efforts to 
increase funding and resources for NF research and treatment at 
multiple Institutes, including NCI, NINDS, NIDCD, NHLBI, NICHD, 
NIMH, NCATS, and NEI. Children and adults with NF are at 
elevated risk for the development of many forms of cancer, 
deafness, blindness, developmental delays and autism. The 
Committee encourages NCI to continue to support a robust NF 
research portfolio in fundamental laboratory science, patient-
directed research, and clinical trials focused on NF-associated 
benign and malignant cancers. The Committee also encourages NCI 
to continue to support preclinical research and clinical 
trials. Because NF can cause blindness, pain, and hearing loss, 
the Committee urges NINDS and NIDCD to continue to support 
fundamental basic science research on NF relevant to restoring 
normal nerve function. Based on emerging findings from numerous 
researchers worldwide demonstrating that children with NF have 
a higher chance of developing autism, learning disabilities, 
motor delays, and attention deficits, the Committee encourages 
NINDS, NIMH, and NICHD to continue their support of research in 
these areas. Since NF2 accounts for some genetic forms of 
deafness, the Committee encourages NIDCD to expand its 
investment in NF2-related research. NF1 can cause vision loss 
due to optic gliomas. The Committee encourages NEI to expand 
its investment in NF1-focused research on optic gliomas and 
vision restoration.
    NIH Support for Pediatric Research.--The Committee commends 
NIH for its efforts to coordinate pediatric research across its 
Institutes and Centers through the recently established Trans-
NIH Pediatric Research Consortium. The Committee understands 
NCI participates in the Consortium, and that childhood cancer 
research is an important part of the pediatric research 
portfolio across NIH. The Committee requests an update in the 
fiscal year 2025 CJ on efforts underway through the Trans-NIH 
Pediatric Research Consortium to enhance pediatric research 
across NIH, including efforts to strengthen the pediatric 
research workforce. The Committee desires NIH to maintain a 
robust pediatric research portfolio spanning basic, 
translational and clinical research, to adequately support 
researchers at all career stages, particularly early career 
investigators focused in pediatrics, and to ensure pediatric 
components are included within larger NIH research priorities. 
The Committee includes $1,500,000 for the National Academies of 
Science, Engineering, and Medicine to assess the current NIH 
pediatric research portfolio and structure, including how 
projects are categorized as pediatrics, how pediatric 
components have been included or excluded from larger NIH 
initiatives, structural or process impediments to pediatric 
applicants, how pediatric research priorities are established, 
and how pediatric research activity is coordinated across 
Institutes and Centers and to make recommendations to address 
deficiencies and improve NIH's overall support of child health 
research.
    Office of the Chief Officer for Scientific Workforce 
Diversity [COSWD].--The Committee continues to provide 
$22,415,000 to the Office of COSWD.
    Office of Nutrition Research [ONR].--The Committee 
recognizes that understanding the complex factors that affect 
the nutritional needs of older adults is critical to informing 
the Dietary Guidelines for Americans, which serves as the 
foundation for Federal food assistance and meal programs, 
including the Older Americans Act Nutrition Program, which 
serves millions of older adults each year. However, there is 
limited research examining older adult nutrition. The Committee 
encourages ONR and NIA to coordinate and to study the 
nutritional needs of older adults, particularly those ages 85 
and older. Bolstering older adult nutrition research will 
support older adults in adequately meeting their dietary needs, 
which can contribute to improved health outcomes and quality of 
life and reduce the need for long-term care services and 
supports. In addition, the Committee encourages ONR and NIA to 
review all research currently underway at the NIH as it 
pertains to older adult nutrition and submit a report on the 
status of such research, as well as gaps in research, to the 
Committees on Appropriations no later than 270 days after 
enactment.
    Office of Research on Women's Health [ORWH].--The Committee 
notes bill language that was included in the Consolidated 
Appropriations Act, 2022 that funding for ORWH be made 
available for direct grant making to address women's health 
research needs that are not being addressed by Institutes and 
Centers. The Committee provides $76,480,000 for ORWH. This 
Office ensures women's health research and research on the 
biological and sociocultural influence of sex and gender are 
included within the NIH scientific framework. Congress 
recognizes ORWH's critical leadership in promoting women's 
health research and spearheading research programs like the 
Building Interdisciplinary Research Careers in Women's Health 
[BIRCWH] program, which aims to increase the number and skills 
of investigators who conduct research on sex and gender 
influences on health and disease, and the Specialized Centers 
of Research Excellence on Sex Differences, a program designed 
to expedite the development and application of new knowledge to 
human diseases that affect women, to learn more about the 
etiology of these diseases, and to foster improved approaches 
to treatment and/or prevention. The Committee recognizes 
persistent gaps remain in the knowledge of women's health. 
Within the total for ORWH, the Committee provides $7,000,000, 
an increase of $2,000,000 above the fiscal year 2023 enacted 
level, to expand the BIRCWH program. ORWH is encouraged to 
support additional researchers focused on women's health and 
sex differences, including research focused on cancer and 
maternal health.
    Osteopathic Medical Schools.--The Committee recognizes that 
osteopathic medicine is one of the fastest growing healthcare 
professions in the country and osteopathic medical schools 
educate 25 percent of all medical students. The Committee 
understands that osteopathic medical students receive 200 hours 
of additional training in the musculoskeletal system and learn 
the value of osteopathic manipulative treatment as a non-
pharmacological alternative to pain management. Over half of 
osteopathic physicians' practice in the primary care 
specialties of family medicine, internal medicine, and 
pediatrics, and a disproportionate share of osteopathic medical 
graduates locate in rural and underserved areas. Osteopathic 
research is needed to enhance primary care and improve 
healthcare for rural and underserved populations. Over the past 
5 years, osteopathic medical school applications have seen 
similar success rates as seen in NIH overall. The Committee 
recognizes that increased access to research funding for the 
osteopathic profession will significantly bolster NIH's 
capacity to support robust recovery from the COVID-19 pandemic, 
address health disparities in rural and medically-underserved 
populations, and advance research in primary care, prevention, 
and treatment. The Committee urges NIH to consider how best to 
incorporate colleges of osteopathic medicine into research 
activities and involvement of their researchers on NIH National 
Advisory Councils and study sections to have better 
representation of the osteopathic medicine field.
    Pain and Addiction.--The Committee commends NIH, NIDA, and 
NINDS for their focus on addressing addiction and developing 
alternatives to opioids for safe and effective pain management 
strategies that reduce reliance on opioids. In particular, NIDA 
and NINDS' commitment to research on improved pain management 
and prevention or recovery from opioid addiction as part of 
NIH's HEAL Initiative continues to help fuel the next 
generation of scientists and clinicians focused on mitigating 
chronic pain with nonaddictive therapies and prevention and 
treatment of drug addiction. The Committee encourages NIH, 
NIDA, and NINDS to continue their efforts through the HEAL 
Initiative in fiscal year 2024, with a focus on grant 
opportunities to support research and education to improve 
outcomes for people with both chronic pain and addiction in 
diverse settings across the United States, particularly those 
located in areas with high incidence of people living with 
chronic pain.
    Peripheral Neuropathy.--The Committee is concerned about 
the lack of research funding for peripheral neuropathy, a 
condition that affects 30 million Americans and can cause 
considerable pain and disability in those diagnosed with the 
disease. The Committee encourages NIH to develop a coordinated 
approach to better understand the causes of and find potential 
new treatments for peripheral neuropathy. Among other things, 
research could focus on developing a natural history database, 
collecting serial blood biomarkers and creating a tissue bank, 
and identifying genetic risk factors and other strategies to 
facilitate the diagnosis and treatment of various types of 
peripheral neuropathy. The Committee also encourages NIH to 
support research on idiopathic peripheral neuropathy, which 
affects 10 million Americans.
    Polycystic Ovary Syndrome [PCOS].--PCOS is a common female 
endocrine disorder that affects women across the lifespan. The 
Committee recognizes the significant and pervasive health and 
economic burden of PCOS, which may have reproductive, 
metabolic, cardiovascular, maternal, and mental health effects. 
Therefore, the Committee encourages NIH to continue to 
prioritize PCOS research and to devote additional resources to 
support research on cardiometabolic, endocrine, and other 
comorbidities that impact the health and quality of life of 
patients with PCOS such as insulin resistance, hirsutism and 
dermatologic conditions, cardiovascular diseases and their risk 
factors, mental health disorders, stroke, and cancer; as well 
as resources on research focused on ethnic and racial 
differences. The Committee directs NIH to submit an update to 
the Committee within 180 days of enactment on the findings from 
the 2021 NIH workshop on the cardiovascular risks across the 
lifespan in PCOS and the recommendations and plans to address 
identified gaps.
    Postural Orthostatic Tachycardia Syndrome [POTS].--The 
Committee requests an update within 90 days of enactment on the 
NIH's work to establish a new multi-institute Notice of Special 
Interest to spur new research on POTS as directed in fiscal 
year 2023.
    Psychedelic Research.--The Committee recognizes the 
increased interest and need to study psychedelics, including 
MDMA, ketamine, and psilocybin, and their potential therapeutic 
effects. The Committee encourages NIH to expand its current 
research agenda across its Institutes and Centers, potentially 
by forming a cross-Institute research group, and to encourage 
psychedelic research at the NIH Clinical Center. The Committee 
also encourages NIH to work with FDA in developing and 
supporting public-private collaborations to advance all forms 
of psychedelic research for therapeutic purposes.
    Research on Enhanced Potential Pandemic Pathogens 
[ePPPs].--The Committee supports the recommendations outlined 
the March 2023 National Science Advisory Board for Biosecurity 
[NSABB] Report on Proposed Biosecurity Oversight Framework for 
the Future of Science. Periodic reassessment of NIH's biosafety 
and biosecurity oversight ensures that the agency effectively 
addresses existing and emerging safety and security concerns 
surrounding the research it funds while preserving scientific 
progress and innovation. In accordance with the NSABB 
recommendations, NIH is directed to articulate specific roles, 
responsibilities, and expectations for investigators and 
institutions in the identification, review, and evaluation of 
research for potential involvement of ePPPs in its terms and 
conditions of awards. NIH is urged to prioritize resources for 
the independent review of such research identified by 
institutions that receive NIH support for life sciences 
research either directly or indirectly, and ensure that the 
conduct of ePPP research at international institutions 
receiving NIH support is subject to oversight requirements that 
are equivalent to domestic U.S. policies and procedures. 
Finally, in preparation for the Office of Science and 
Technology Policy's updated December 2023 Federal policy 
governing the review and oversight of ePPP research, the 
Committee provides $1,000,000 for NIH to establish an 
implementation office to serve as a resource for the research 
community. The implementation office shall serve as the main 
point of contact within NIH that provides technical assistance 
for research institutions regarding the ePPP policy. The office 
shall also develop tools and training guidance for the 
extramural research community to strengthen risk-assessment, 
safety, security, and ethical considerations surrounding 
proposed ePPP research at research institutions. NIH is 
directed to provide an update on the implementation of these 
activities within 120 days of enactment. Finally, NIH is 
directed to deliver with the fiscal year 2025 CJ a professional 
judgement budget on the funding required to support facilities 
and administration costs, including additional inspections and 
review of policies and procedures, at its high containment 
laboratories in addition to the grant funding it provides. This 
budget should estimate additional funding needed to support 
biosafety training and safeguard research involving pathogens 
to protect laboratory workers, public health, and national 
security.
    Research with Non-Human Primates.--The Committee recognizes 
the critical role of non-human primate [NHP] research in 
virtually all areas of biomedical research. Research with 
unique animal models makes irreplaceable contributions to 
understanding the biological processes that cause disease, 
which is necessary for the development, safety and efficacy 
testing of new therapeutics before clinical trials. NHP 
research will be vital to studying both the underlying 
mechanisms and potential cures for costly and emergent 
diseases. The Committee is concerned about the condition and 
availability of critical Federal research assets outlined in 
the 2023 National Academies report on the State of the Science 
and Future Needs for Nonhuman Primate Models in Biomedical 
Research. In particular, the Committee is alarmed that NIH has 
no central data management or reporting structure for tracking 
the number of NHPs required to meet current and future research 
needs. The Committee directs NIH to develop a strategic 
management plan for NHP research resources to bolster 
cooperative efforts, data sharing, purposeful planning, and 
data-driven care and management methods. The Committee urges 
NIH to award funding to meritorious research proposals using 
NHPs to study neurological diseases as well as research into 
preventing the next pandemic. NIH is also encouraged to 
continue the development and validation of new approach 
methodologies that reduce the need for, enhance the utility of, 
and mitigate shortages and costs of NHP models in the future.
    Research Transparency.--As demonstrated over the past 
several years, the Committee remains committed to funding NIH 
research and ensuring that our Nation's researchers, 
particularly our early career scientists, have the support to 
make the scientific breakthroughs that may transform 
healthcare. However, it is critical that NIH can ensure funds 
are used for the best possible research that fulfill the core 
research mission of NIH. NIH is encouraged to justify, in 
writing made available on a publicly accessible website, that 
each grant or agreement promotes efforts to seek fundamental 
knowledge about the nature and behavior of living systems and/
or the application of that knowledge to enhance health, 
lengthen life, and reduce illness and disability.
    Sex as a Biological Variable [SABV] Policy.--The 
appropriate analysis and reporting of data by sex can enhance 
the rigor and applicability of preclinical biomedical research. 
The NIH SABV Policy was necessary because historical research 
data that only uses one sex has been misleading and 
ungeneralizable to another sex. Furthermore, studying only one 
sex may lead to false conclusions due to hidden sex-specific 
effects that, left unreported, can have serious health 
consequences. To track and analyze NIH's progress in 
integrating SABV into biomedical research across its Institutes 
and Centers, the Committee encourages NIH to explore options 
for assessing policy implementation and how well studies are 
satisfactorily incorporating SABV into research designs, 
analyses, and reporting.
    Spinal Muscular Atrophy.--The Committee remains committed 
to continued NIH research into spinal muscular atrophy [SMA], a 
neuromuscular disease that causes degenerative nerve damage and 
results in severe muscle loss and impaired motor function. Past 
SMA research at NIH, particularly through NINDS, has led to 
disease-modifying SMA treatments and greater knowledge of the 
nervous system, which has benefited other neurological and 
neuro-muscular disorders. While current SMA treatments slow or 
stop future degeneration, they do not cure SMA. Individuals 
with SMA, particularly adults, face significant challenges in 
muscle weakness and fatigue due to degeneration that occurred 
prior to treatment. Individuals treated prior to clinical 
symptoms onset may also display unmet needs, such as bulbar 
impairment and gait abnormalities. The Committee urges NIH to 
address the significant unmet need that exists across all ages 
and disease stages of SMA by supporting new SMA research into 
the role and function of survival motor neuron [SMN] protein, 
investigation into non-SMN pathways and targets capable of 
modifying disease, and research into how to best combine SMN-
enhancing and non-SMN approaches for optimal therapeutic 
outcomes.
    Reducing the Administrative Burden on Researchers.--The 
Committee recognizes that according to a national survey by the 
Federal Demonstration Partnership, federally-funded researchers 
report spending 44 percent of their research time on 
bureaucracy, including the time to prepare proposals and 
budgets, post-grant reporting of time and effort, ethical 
requirements, and other compliance activities. Although NIH and 
other agencies tasked with reducing administrative burden 
conducted extensive consultations with the research community 
that resulted in a 2019 final report on their implementation 
plans, the Committee is concerned about the status of the 
implementation by NIH and any plans to evaluate the outcome. 
The Committee directs NIH to form a Board on reducing 
administrative burden, with at least 75 percent representation 
from non-Federal organizations and at least 25 percent 
representation from early-career researchers (including post-
docs). Within 1 year of enactment, the Board is directed to 
provide a report that includes an evaluation of current efforts 
to reduce administrative burden and to provide recommendations 
aiming to reduce the administrative burden on researchers by 25 
percent over the next 3 years. The Committee strongly 
encourages NIH to put recommendations into effect as soon as 
practicable. The Committee requests a briefing on this effort 
90 days from the enactment. The report recommendations shall be 
made available to the public on the agency website.
    Scientific Management Review Board.--The Committee 
recognizes that under the NIH Reform Act of 2006 (Public Law 
109-482), a Scientific Management Review Board [SMRB] was 
created with the specific mission of reviewing the overall 
``research portfolio'' of NIH, and advising on the ``use of 
organizational authorities,'' such as abolishing Institutes or 
Centers, creating new ones, and reorganizing existing 
structures. Yet this Board has not met or issued a report since 
2015, despite the obligation to do so every 7 years. The NIH 
Advisory Committee to the Director [ACD] does not have the 
statutory authority or mandate to serve as a substitute for the 
SMRB, and the Committee rejects any efforts to assign the ACD 
to undertake these efforts. The Committee directs NIH to 
reconvene the SMRB within 1 year of enactment in order to 
fulfill its statutory duty to advise Congress, the Secretary, 
and the NIH Director on how best to organize biomedical 
research funding.
    Term Limits.--Congress' decision to limit ARPA-H managers 
to a maximum of two 3-year appointments (4 years for the ARPA-H 
Director) is a break from NIH's longstanding practice of 
allowing its top officials to effectively serve indefinitely. 
The Committee believes that a healthy degree of turnover in 
leadership is critical for sustaining the vitality of NIH. It 
also provides the opportunity for leading scientists across the 
Nation to leave their positions for a set period of time and 
come to NIH to provide effective leadership to critical 
elements of the Nation's biomedical enterprise. The Committee 
supports the recommendations outlined in the 2003 Institute of 
Medicine report Enhancing the Vitality of the National 
Institutes of Health: Organizational Change to Meet New 
Challenges. Specifically, the Committee supports Recommendation 
10, to set term limits for IC Director appointments to two 5-
year terms. The Committee believes regular replacement of IC 
Directors following a maximum of two terms would be an overall 
benefit to medical research by ensuring the periodic 
introduction of fresh perspectives. The Committee provides 
$500,000 and directs NIH to begin the planning process for 
implementing this policy, and to report to the Committees 
within 180 days of enactment on these efforts.
    Thalassemia.--Nutrition can be an important tool in the 
management of rare diseases. Currently, there is no guidance on 
nutrition approaches for the management of thalassemia, which 
occurs most often in people of Mediterranean, Chinese, South 
Asian, and Southeast Asian descent. In addition to the 
possibility that thalassemia itself creates nutritional 
deficits, there is concern that necessary iron chelation 
therapy may create additional deficits. Research is needed to 
provide practitioners with evidence-based advice for patients, 
both on diets that would help improve and manage their 
condition, and those that may be harmful. The Committee 
encourages NIH to study the impact of nutrition on disease 
management and improving clinical understanding.
    The HEALthy Brain and Child Development [HBCD] Study.--The 
Committee recognizes and supports the NIH HBCD Study, which 
will establish a large cohort of pregnant individuals and 
follow them and their children up to age 10 to characterize the 
influence of a variety of factors on neurodevelopment and long-
term outcomes. The study aims to enroll approximately 7,500 
participants through 27 sites across the United States, 
including regions of the country significantly affected by the 
opioid crisis. The study cohort will comprise participants that 
reflect the U.S. population but will oversample for individuals 
that have used substances sometime during their pregnancy and a 
matching cohort with similar characteristics but no substance 
exposure during the pregnancy. Multimodal data collection will 
include neuroimaging, behavioral and cognitive assessments as 
well as collection of biospecimens and brain activity 
measurements [EEG]. Knowledge gained will be critical to help 
predict and prevent some of the known impacts of pre- and 
postnatal exposure to drugs and environmental influences, 
including risks for future illicit substance use, mental 
disorders, and other behavioral and developmental problems, as 
well as identify factors that contribute to resilience and 
opportunities for intervention. The Committee recognizes that 
the HBCD Study is supported in part by the NIH HEAL Initiative, 
and NIH Institutes, Centers, and Offices [ICOs], including 
OBSSR, ORWH, NEI, NIMHD, NIBIB, NIEHS, NICHD, NINDS, NIAAA, 
NIMH, and NIDA, and encourages additional NIH support for this 
important study.
    Von Hippel-Lindau [VHL] Disease.--The Committee recognizes 
that finding a treatment and cure for VHL disease, in which the 
VHL tumor suppressor gene is damaged or nonexistent, is key for 
treating and curing not only the rare disease of VHL but also 
many other forms of cancer. The role of the VHL gene is central 
in how cells sense and adapt to oxygen and nutrient 
availability and how this mechanism leads to abnormal cell or 
cancer growth. As a result, nearly a dozen medications 
currently used to treat various forms of cancer are the direct 
result of research in VHL biology. The Committee encourages NIH 
to continue to support research on VHL disease and biology, 
seeking both pharmacological and gene therapy treatments for 
VHL and other cancer patients. The Committee requests an update 
on VHL research efforts in the fiscal year 2025 CJ.
    Wastewater Surveillance R&D.--The Committee recognizes the 
potential and importance of wastewater surveillance in public 
health surveillance, including its use during the pandemic to 
inform COVID-19 surveillance. The Committee encourages NIH to 
continue programs, including the Rapid Acceleration of 
Diagnostics [RADx] that support innovation in developing and 
improving wastewater surveillance capabilities.
    Women's Health Clinical Research Network.--The Committee 
directs NIH to expand and more formally coordinate its support 
women's health clinical research by leveraging the CTSA 
program. The Committee urges NCATS and CTSA awardees to focus 
on women's health within its efforts to modernize the 
translation of research into health benefits across the full 
spectrum of medical research. The Committee directs NCATS to 
collaborate with ORWH to evaluate how to better promote 
research and collaborations that address the distinctive 
medical and health needs of women and advance the dissemination 
and implementation of research results. The Committee requests 
an update on these activities with 120 days of enactment.

              ADVANCED RESEARCH PROJECTS AGENCY FOR HEALTH

Appropriations, 2023....................................  $1,500,000,000
Budget estimate, 2024...................................   2,500,000,000
Committee recommendation................................   1,500,000,000

    The Committee includes $1,500,000,000 for the Advanced 
Research Projects Agency for Health [ARPA-H], the same level as 
fiscal year 2023. The Committee continues to believe ARPA-H 
requires a different culture and mission than NIH's other 27 
Institutes and Centers. The Committee continues to direct ARPA-
H to provide quarterly briefings to the Committee on its 
establishment process, hiring, and scientific priorities and 
progress. The Committee expects such briefings to address how 
ARPA-H's activities are designed to advance biomedical research 
and development and the mission to create breakthrough 
technologies, as well as how to balance long-term trans-
disciplinary scientific challenges with short-term research 
goals.
    Amyotrophic Lateral Sclerosis [ALS].--The Committee urges 
ARPA-H to consider funding ALS research that prioritizes time 
to beneficial impacts on people living with ALS and their 
families.
    Geroscience.--Geroscience research is a revolutionary way 
to approach health and aligns well with the mission of ARPA-H 
to identify and invest in high-risk, high-reward research 
projects that have the potential to transform healthcare and 
improve public health. By uncovering new insights into the 
underlying causes of age-related diseases, geroscience research 
could lead to treatments and therapies that offer the 
possibility of improving people's ``healthspan,'' so they 
remain healthier longer, and address the growing burden of age-
related diseases on society. The Committee urges ARPA-H to 
prioritize two areas of geroscience research that could advance 
the field dramatically: biomarkers and epigenetic 
reprogramming. Discovering and validating biomarkers for aging 
would significantly improve the efficacy of interventions, 
while epigenetic reprogramming of cellular age could slow down 
or even reverse the aging process and thereby prevent or delay 
the entire panoply of age-related diseases.
    Mission and Independence.--The Committee recognizes that 
ARPA-H plays a unique role in the U.S. science and technology 
enterprise. Modeled after the Defense Advanced Research Agency 
[DARPA] but singularly focused on improving health outcomes, 
ARPA-H is expected to pursue transformative advances in health 
beyond the scope of other public or private efforts. U.S. 
citizens and interests can be threatened by endemic and 
emerging diseases in any part of the world. The Committee 
expects ARPA-H to contribute in unique ways to combating 
existing and emerging health threats here and abroad, and to 
strengthen U.S. science and technology capacity, 
competitiveness, and leadership. While the Committee supports 
the structure of ARPA-H as an independent entity within NIH, it 
understands that ARPA-H will utilize many of NIH's 
administrative functions and will cover its appropriate share 
of the cost of these functions, like NIH's Institutes and 
Centers. In all other respects, where collaboration with other 
parts of NIH may occur, the Committee strongly encourages ARPA-
H and NIH to co-fund the collaboration following precedent of 
NIH projects co-funded with other government agencies. The 
Committee directs ARPA-H to report to the Committee within 180 
days of enactment with details on any scientific collaborations 
with NIH, including the allocation of costs.
    Recalcitrant Cancers.--Given the toll recalcitrant cancers 
exact on society and the lack of diagnostic and treatment 
resources currently available to help these patients, the 
Committee encourages ARPA-H to work with NIH and NCI to ensure 
that approved projects focus on the hardest problems and areas 
where medical practice will be dramatically changed, including 
the deadliest cancers.

                        BUILDINGS AND FACILITIES

Appropriations, 2023....................................    $350,000,000
Budget estimate, 2024...................................     350,000,000
Committee recommendation................................     292,000,000

    The Committee includes $292,000,000 for Buildings and 
Facilities. For the fourth time in as many years, the 
recommendation does not include authority for NIH to transfer 
up to 1 percent of its research funding to the Buildings and 
Facilities account. This is extraordinary authority for a 
Federal agency and NIH has yet to provide an explanation for 
why this mechanism would be appropriate. Funding provided for 
research should not be unilaterally transferred without a sound 
explanation and robust justification of need. The Committee 
commends the agency for continuing to develop a sound capital 
planning process and for keeping the Committee informed on such 
activities. These efforts have been supported by the Committee 
with modifications of section 216 of this act which permit NIH 
to use up to $100,000,000 of research funding for alterations 
and repairs. The Committee directs NIH to continue to provide 
quarterly updates of its efforts to develop best practices and 
its maintenance and construction plans for projects whose cost 
exceeds $5,000,000, including any changes to those plans and 
the original baseline estimates for individual projects. The 
Committee directs NIH to provide a detailed briefing on the 
proposed Center for Pediatric and Adult Diseases, including how 
the size and activities in the Center compare to the footprint 
and activities in the existing facilities that would be 
demolished to make way for it. Finally, the Committee also 
directs NIH to describe in its fiscal year 2025 and future CJs 
how the projects requested in its budgets tie to its capital 
planning process, including the Research Facilities Advisory 
Committee's role in determining which projects are selected for 
inclusion in the budget.

                   NIH INNOVATION ACCOUNT, CURES ACT

Appropriations, 2023....................................    $419,000,000
Budget estimate, 2024...................................     407,000,000
Committee recommendation................................     235,000,000

    The Committee recommendation includes $235,000,000 to be 
spent from the NIH Innovation Account for the All of Us 
precision medicine initiative. The Committee expects NIH to 
transfer funding shortly after enactment of this act.

       Substance Abuse and Mental Health Services Administration

    The Committee recommends $7,550,268,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA]. The 
recommendation includes $133,667,000 in transfers available 
under section 241 of the PHS Act (Public Law 78-410 as amended) 
and $12,000,000 in transfers from the PPH Fund.
    SAMHSA is the public health agency responsible for 
supporting mental health programs and behavioral healthcare, 
treatment, and prevention services throughout the country.
    The Committee recommendation continues bill language that 
instructs the Assistant Secretary of SAMHSA and the Secretary 
to exempt the Mental Health Block Grant [MHBG], the Substance 
Use Prevention Treatment, and Recovery Services Block Grant, 
and the State Opioid Response grant from being used as a source 
for the PHS evaluation set-aside in fiscal year 2024.

                             MENTAL HEALTH

Appropriations, 2023....................................  $2,788,546,000
Budget estimate, 2024...................................   4,529,395,000
Committee recommendation................................   2,850,546,000

    The Committee recommends $2,850,546,000 for mental health 
services. The recommendation includes $21,039,000 in transfers 
available under section 241 of the PHS Act (Public Law 78-410 
as amended) and $12,000,000 in transfers from the PPH Fund. 
Included in the recommendation is funding for Mental Health 
Programs of Regional and National Significance [PRNS], the 
MHBG, children's mental health services, Projects for 
Assistance in Transition from Homelessness [PATH], Protection 
and Advocacy for Individuals with Mental Illness [PAIMI], and 
the National Child Traumatic Stress Initiative.

Programs of Regional and National Significance

    The Committee recommends $1,077,453,000 for PRNS within the 
Center for Mental Health Services. The Committee recommendation 
includes $12,000,000 in transfers to PRNS from the PPH Fund. 
These programs address priority mental health needs by 
developing and applying evidence-based practices, offering 
training and technical assistance, providing targeted capacity 
expansion grants, and changing the delivery system through 
family, client-oriented, and consumer-run activities.
    Within the total provided for PRNS, the Committee 
recommendation includes funding for the following activities:

 
------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Seclusion & Restraint...........        $1,147,000        $1,147,000
    Project AWARE...................       140,001,000       140,001,000
    Mental Health Awareness Training        27,963,000        27,963,000
    Healthy Transitions.............        30,451,000        30,451,000
    Infant and Early Childhood              15,000,000        15,000,000
     Mental Health..................
    Interagency Task Force on Trauma         2,000,000         2,000,000
     Informed Care..................
    Children and Family Programs....         7,229,000         7,229,000
    Consumer and Family Network              4,954,000         4,954,000
     Grants.........................
    Project Launch..................        25,605,000        23,605,000
    Mental Health System                     3,779,000         3,779,000
     Transformation.................
    Primary and Behavioral Health           55,877,000        55,877,000
     Care Integration...............
    National Strategy for Suicide           28,200,000        28,200,000
     Prevention.....................
        Zero Suicide................        26,200,000        26,200,000
            American Indian and              3,400,000         3,400,000
             Alaska Native Set-Aside
    Mental Health Crisis Response           20,000,000        20,000,000
     Grants.........................
    988 Lifeline....................       501,618,000       519,618,000
    Garrett Lee Smith-Youth Suicide
     Prevention
        State Grants................        43,806,000        43,806,000
        Campus Grants...............         8,488,000         8,488,000
    American Indian and Alaska               3,931,000         3,931,000
     Native Suicide Prevention......
    Tribal Behavioral Grants........        22,750,000        22,750,000
    Homeless Prevention Programs....        33,696,000        33,696,000
    Minority AIDS...................         9,224,000         9,224,000
    Criminal and Juvenile Justice           11,269,000         7,269,000
     Programs.......................
    Assisted Outpatient Treatment...        21,420,000        21,420,000
    Assertive Community Treatment            9,000,000         9,000,000
     for Individuals with Serious
     Mental Illness.................
Science and Service:
    Garrett Lee Smith-Suicide               11,000,000        11,000,000
     Prevention Resource Center.....
    Practice Improvement and                 7,828,000         7,828,000
     Training.......................
    Consumer and Consumer Support            1,918,000         1,918,000
     Technical Assistance Centers...
    Primary and Behavioral Health            1,991,000         1,991,000
     Care Integration Technical
     Assistance.....................
    Minority Fellowship Program.....        11,059,000        11,059,000
    Disaster Response...............         1,953,000         1,953,000
    Homelessness....................         2,296,000         2,296,000
------------------------------------------------------------------------

    988 Suicide and Crisis Lifeline [Lifeline].--Suicide is a 
leading cause of death in the United States, claiming over 
48,000 lives in 2021. Suicide rates among youth and young 
adults between the ages of 10-24 reached a 20 year high in 
2021. The Committee provides $519,618,000 for the 988 Lifeline 
and Behavioral Health Crisis Services. This amount includes 
funding to continue to strengthen the National Suicide 
Prevention Lifeline [NSPL], which coordinates a network of more 
than 180 crisis centers across the United States by providing 
suicide prevention and crisis intervention services for 
individuals seeking help. The Committee requests a briefing 
within 90 days of enactment on the 988 Lifeline spend plan and 
related activities.
    This funding is intended to support local crisis center 
capacity including through partnerships in behavioral health 
crisis response and the centralized network functions necessary 
to respond to the anticipated increase in contacts in fiscal 
year 2024. The Committee encourages SAMHSA to use additional 
funding for 988 to expand existing intervention and suicide 
prevention hotline and web services, including texts, e-mails, 
photos, videos or other digital modes of communications and 
focus outreach to youth, teens, young adults and their 
families. Additionally, the Committee understands the 
importance of peer services, particularly for youth in crisis. 
The Committee recommends the inclusion and expansion of peer 
services as a component of the 988 Lifeline, which may include 
integrating training on youth peer services across contact 
centers within the Lifeline network, along with highly 
coordinated referrals and connections for youth peer-run 
support lines that are not formally embedded within the 988 
Lifeline.
    Behavioral Health Crisis and 988 Coordinating Office.--
Within the total for 988 and Behavioral Health Crisis Services, 
the Committee recommendation includes $7,000,000 to continue 
the office dedicated to the implementation of the 988 Lifeline 
and the coordination of efforts related to behavioral health 
crisis care across HHS operating divisions, including CMS and 
HRSA, as well as with external stakeholders. The Committee 
requests that the Secretary include a multi-year, crisis care 
system roadmap in the fiscal year 2025 CJ.
    988 Text and Chat-Based Capabilities.--Within the total for 
988 Suicide and Crisis Services, the Committee again includes 
$10,000,000 for specialized services for Spanish speakers 
seeking access to 988 services through texts or chats. SAMHSA 
shall make this funding available to one or more organizations 
with the capacity and experience to offer culturally competent, 
Spanish language text and chat services for mental health 
support and crisis intervention.
    Specialized Services for LGBTQ+ Youth.--The Committee 
understands that LGBTQ+ youth are four times more likely to 
attempt suicide than their peers. Within the total for the 988 
Lifeline, the Committee includes $33,100,000 which shall be 
used to provide specialized services for LGBTQ+ youth, 
including training for existing counselors in LGBTQ+ youth 
cultural competency and the establishment and operation of an 
Integrated Voice Response [IVR] to transfer LGBTQ+ youth to a 
specialty organization. This funding shall be awarded through a 
competitive process to an organization with experience working 
with LGBTQ+ youth and with the capacity and infrastructure to 
handle calls, chats, and texts from LGBTQ+ youth through IVR 
technology and other technology solutions where appropriate.
    Depression.--The Committee notes that depression and 
bipolar disorder afflict a growing number of Americans and are 
one of the most costly medical conditions in the United States. 
The Committee encourages the establishment of a national 
Depression Center of Excellence to help translate academic 
treatment advances into clinical care. This Center will help 
address the need for earlier clinical detection of depression 
and new strategies to prevent recurrences of depressive 
illnesses, as well as ways of reducing their length and 
severity.
    Garrett Lee Smith Youth Suicide Prevention.--The Committee 
recommends $43,806,000 for Garrett Lee Smith Suicide Prevention 
programs, which will support the development and implementation 
of early intervention programs and youth suicide prevention 
strategies. Additionally, the Committee recommends $11,000,000 
for the Garrett Lee Smith Youth Suicide Prevention Resource 
Center.
    Garrett Lee Smith Campus Suicide Prevention Grant 
Program.--The Committee recognizes the importance of addressing 
mental health and suicide prevention on college campuses, 
including at institutions of higher education that are 
traditionally under-resourced. To help meet these growing needs 
and address disparities in access to mental health services, 
the Committee directs the Secretary to waive the requirement of 
matching funds for minority-serving institutions and community 
colleges as defined by the Higher Education Act of 1965. The 
Secretary may continue to waive such requirement with respect 
to an institution of higher education not covered by those 
definitions, if the Secretary determines that extraordinary 
need at the institution justifies the waiver.
    Healthy Transitions.--The Committee includes $30,451,000 
for the Healthy Transitions program, which provides grants to 
States and tribes to improve access to mental healthcare 
treatment and related support services for young people aged 16 
to 25 who either have, or are at risk of developing, a serious 
mental health condition.
    Infant and Early Childhood Mental Health.--The Committee 
provides $15,000,000 for grants to entities such as State 
agencies, Tribal communities, universities, or medical centers 
that are in different stages of developing infant and early 
childhood mental health services. These entities should have 
the capacity to lead partners in systems-level change, as well 
as building or enhancing the basic components of such early 
childhood services, including an appropriately trained 
workforce. Additionally, the Committee recognizes the 
importance of early intervention strategies to prevent the 
onset of mental disorders, particularly among children. Recent 
research has shown that half of those who will develop mental 
health disorders show symptoms by age 14. The Committee 
encourages SAMHSA to work with States to support services and 
activities related to infants and toddlers, such as expanding 
the infant and early childhood mental health workforce; 
increasing knowledge of infant and early childhood mental 
health among professionals most connected with young children 
to promote positive early mental health and early 
identification; strengthening systems and networks for 
referral; and improving access to quality services for children 
and families who are in need of support.
    Interagency Task Force on Trauma Informed Care.--The 
Committee recommends $2,000,000 to continue the Interagency 
Task Force on Trauma-Informed Care as authorized by the SUPPORT 
Act (Public Law 115-271). The Committee supports the Task 
Force's authorized activities, including the dissemination of 
trauma-informed best practices and the promotion of such models 
and training strategies through all relevant grant programs and 
the Task Force is encouraged to collaborate with the National 
Child Traumatic Stress Network.
    Mental Health Awareness Training.--The Committee provides 
$27,963,000 to continue existing activities, including Mental 
Health First Aid. Mental Health Awareness Training and Mental 
Health First Aid have allowed Americans as well as first 
responders to recognize the signs and symptoms of common mental 
disorders. In addition to the funding made available in this 
bill, the Bipartisan Safer Communities Act included 
$120,000,000 for Mental Health Awareness Training over 4 fiscal 
years, with $30,000,000 made available each fiscal year through 
September 30, 2025, to support mental health awareness 
training. In continuing competitive funding opportunities, 
SAMHSA is directed to include as eligible grantees local law 
enforcement agencies, fire departments, and emergency medical 
units with a special emphasis on training for crisis de-
escalation techniques. SAMHSA is also encouraged to allow 
training for college students, veterans, armed services 
personnel, and their family members and broaden applicable 
settings for trainings to include non-educational and non-
healthcare settings where appropriate within the Mental Health 
Awareness Training program.
    Mental Health Crisis Response Grants.--The Committee 
understands the significant need for crisis services in order 
to divert people experiencing a mental health crisis away from 
the criminal justice system and into mental health treatment. 
The Committee continues $20,000,000 for communities to create 
or enhance existing crisis response programs that may include 
teams of mental health professionals, law enforcement, 
emergency medical technicians, and crisis workers to provide 
immediate support and stabilization to those in crisis.
    Minority Fellowship Program.--The Committee includes 
$11,059,000 to support grants that will increase the number of 
culturally competent behavioral health professionals who teach, 
administer, conduct services research, and provide direct 
mental illness services for underserved minority populations. 
The Committee understands the importance of increasing the pool 
of culturally competent pediatric mental health professionals, 
including child and adolescent psychiatrists, to address the 
Nation's youth mental health crisis. The Committee encourages 
SAMHSA to prioritize and increase the number of pediatric 
behavioral health treatment providers, including child and 
adolescent psychiatrists, selected to participate in the 
minority fellowship program and requests a report within 1 year 
showing the number and type of primary care, physician 
specialists and subspecialists, and other mental health 
professionals participating in the program and describing how 
the program is working to support youth mental health across 
communities.
    National Strategy for Suicide Prevention.--The Committee 
includes $28,200,000 for suicide prevention programs. Of the 
total, $26,200,000 is for the implementation of the Zero 
Suicide model, which is a comprehensive, multi-setting approach 
to suicide prevention within health systems.
    Additionally, suicide is often more prevalent in highly 
rural areas and among the American Indian and Alaskan Native 
populations. According to the CDC, American Indian/Alaska 
Natives [AI/AN] have the highest rates of suicide of any racial 
or ethnic group in the United States. In order to combat the 
rise in suicide rates among this population, the Committee 
recommends $3,931,000 for the AI/AN Suicide Prevention 
Initiative.
    Outreach in Underserved Communities.--The Committee directs 
SAMHSA to conduct outreach, provide technical assistance and 
give priority in awarding cooperative agreements and grants to 
underserved States and communities. Underserved States and 
communities disproportionately suffer from a high prevalence of 
substance use disorders, high suicide rates, and high poverty 
rates, combined with severe mental health provider shortages of 
rates less than half the National benchmark for full-time 
equivalent mental health providers, psychologists, and 
psychiatrists. The Committee urges SAMHSA to work with these 
communities to better develop a mental health workforce. The 
Committee requests a report, not later than 180 days of 
enactment of this act, on best practices and strategies to 
attract healthcare and mental healthcare practitioners to these 
underserved communities.
    Primary and Behavioral Health Care Integration Grants and 
Technical Assistance.--The Committee notes that Congress 
recently enacted changes to the Primary and Behavioral Health 
Care Integration Grant program, with the goal of improving 
patient access to bidirectional integrated care services. The 
Committee provides $55,877,000 for the program, and $1,991,000 
for technical assistance and directs SAMHSA to fund the 
psychiatric collaborative care model implemented by primary 
care physician practices as authorized under section 1301(i)(2) 
of division FF of Public Law 117-328.
    Project AWARE.--The Committee provides $140,001,000 for 
Project AWARE. This program increases awareness of mental 
health issues and connects young people who have behavioral 
health concerns and their families with needed services. The 
Committee encourages SAMHSA to continue using funds to provide 
mental health services in schools and for school-aged youth, 
and provide an update on these efforts in the fiscal year 2025 
CJ.
    In addition to the funding made available in this bill, the 
Bipartisan Safer Communities Act included $240,000,000 for 
Project AWARE over 4 fiscal years, with $60,000,000 made 
available each fiscal year through September 30, 2025, to 
support mental health services for youth.
    Of the amount provided for Project AWARE, the Committee 
directs SAMHSA to use $17,500,000 for discretionary grants to 
support efforts in high-crime, high-poverty areas and, in 
particular, communities that are seeking to address relevant 
impacts and root causes of civil unrest, community violence, 
and collective trauma. These grants should maintain the same 
focus as fiscal year 2023 grants. SAMHSA is encouraged to 
continue consultation with the Department of Education in 
administration of these grants. The Committee requests a report 
on progress of grantees 180 days after enactment of this act.
    Trauma Support Services in Educational Settings.--The 
Committee recognizes the increased need for school and 
community-based trauma services for children, youth, young 
adults, and their families. The Committee also recognizes the 
need to support school staff with training in trauma-informed 
practices. Within the total for Project AWARE, the Committee 
directs $12,000,000 for student access to evidence-based, 
culturally relevant, trauma support services and mental 
healthcare through established partnerships with community 
organizations as authorized by section 7134 of the SUPPORT Act 
(Public Law 115-271).

Community Mental Health Services Block Grant

    The Committee recommends $1,042,571,000 for the Mental 
Health Block Grant [MHBG]. The recommendation includes 
$21,039,000 in transfers available under section 241 of the PHS 
Act (Public Law 78-410 as amended). In addition to the funding 
made available in this bill, the Bipartisan Safer Communities 
Act included $250,000,000 over 4 fiscal years, with $62,500,000 
made available each fiscal year through September 30, 2025, to 
support the MHBG.
    The MHBG distributes funds to 59 eligible States and 
territories through a formula based on specified economic and 
demographic factors. Grant 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.
    The Committee recommendation continues bill language 
requiring that at least 10 percent of the funds for the MHBG 
program be set-aside for evidence-based programs that address 
the needs of individuals with early serious mental illness, 
including psychotic disorders. The Committee continues to 
direct SAMHSA to include in budget justifications a detailed 
table showing at a minimum each State's allotment, name of the 
program being implemented, and a short description of the 
program.
    Crisis Set-Aside.--The Committee continues the 5 percent 
set-aside within the MHBG for States to implement evidence-
based, crisis care programs to address the needs of individuals 
in crisis including those with serious mental illnesses and 
children with serious mental and emotional distress. The 
Committee directs SAMHSA to continue to use the set-aside to 
fund, at the discretion of eligible States and Territories, 
some or all of a set of core crisis care elements including 24/
7 mobile crisis units, local and Statewide call centers with 
the capacity to respond to distressed or suicidal individuals, 
and other programs that allow the development of systems where 
individuals can always receive assistance during a crisis.

Children's Mental Health Services

    The Committee recommends $130,000,000 for the Children's 
Mental Health Services program. This program provides grants 
and technical assistance to support comprehensive, community-
based systems of care for children and adolescents with serious 
emotional, behavioral, or mental disorders. Grantees must 
provide matching funds and services must be coordinated with 
the educational, juvenile justice, child welfare, and primary 
healthcare systems. The Committee continues to include a 10 
percent set-aside for an early intervention demonstration 
program with persons not more than 25 years of age at clinical 
high risk of developing a first-episode psychosis.

Projects for Assistance in Transition from Homelessness [PATH]

    The Committee recommends $66,635,000 for PATH, which 
addresses the needs of individuals with serious mental illness 
who are experiencing homelessness or are at risk of 
homelessness. Funds are used to provide an array of services, 
such as screening and diagnostic services, emergency 
assistance, case management, and referrals to the most 
appropriate housing environment.

Protection and Advocacy for Individuals with Mental Illness [PAIMI]

    The Committee recommends $40,000,000, for PAIMI. This 
program helps ensure that the rights of mentally ill 
individuals are protected while they are patients in all public 
and private facilities or while they are living in the 
community, including in their own homes. Funds are allocated to 
States according to a formula based on population and relative 
per capita incomes.

National Child Traumatic Stress Initiative

    The Committee recommends $93,887,000 for the National Child 
Traumatic Stress Initiative, which develops and promotes 
effective treatment and services for children and adolescents 
exposed to a wide array of traumatic events. In addition to the 
funding made available in this bill, the Bipartisan Safer 
Communities Act included $40,000,000 for the National Child 
Traumatic Stress Network over 4 fiscal years, with $10,000,000 
made available each fiscal year through September 30, 2025, for 
trauma services for youth.
    The Committee supports the National Child Traumatic Stress 
Network for building, evaluating, disseminating, and delivering 
evidence-based best practices, including through universities, 
hospitals, and front-line providers, to prevent and mitigate 
the impact of exposure to trauma among children and families. 
The Committee directs SAMHSA to ensure the network maintains 
its focus on collaboration, data collection, and the provision 
of direct services, and that the NCTSN mission or grant 
opportunities not be limited to training only.

Certified Community Behavioral Health Clinics [CCBHC]

    The Committee includes $400,000,000, an increase of 
$15,000,000. The CCBHC expansion program allows communities to 
improve access to mental health and substance use disorder 
treatment services.
    The Committee continues to direct SAMHSA to prioritize 
resources to entities within States that are able to quickly 
stand-up a CCBHC, including those part of the demonstration 
authorized by section 223(a) of the Protecting Access to 
Medicare Act of 2014 [PAMA] (Public Law 113-93).

                       SUBSTANCE ABUSE TREATMENT

Appropriations, 2023....................................  $4,157,298,000
Budget estimate, 2024...................................   5,463,087,000
Committee recommendation................................   4,219,298,000

    The Committee recommends $4,219,298,000 for substance use 
disorder services and treatment programs, including PRNS and 
the substance use prevention and treatment block grant to the 
States. The recommendation includes $81,200,000 in transfers 
available under section 241 of the PHS Act (Public Law 78-410 
as amended).

Programs of Regional and National Significance

    The Committee recommends $576,219,000 for PRNS within the 
Center for Substance Abuse Treatment. The recommendation 
includes $2,000,000 in transfers available under section 241 of 
the PHS Act (Public Law 78-410 as amended).
    PRNS include activities to increase capacity by 
implementing service improvements using proven evidence-based 
approaches, as well as science-to-services activities that 
promote the identification of practices thought to have 
potential for broad service improvement.
    Within the total provided for PRNS, the Committee 
recommendation includes funding for the following activities:

 
------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Opioid Treatment Programs/             $10,724,000       $10,724,000
     Regulatory Activities..........
    Screening, Brief Intervention,          33,840,000        33,840,000
     and Referral to Treatment
     [SBIRT]........................
        PHS Evaluation Funds........         2,000,000         2,000,000
    Targeted Capacity Expansion-           122,416,000       122,416,000
     General........................
        Medication Assisted                111,000,000       111,000,000
         Treatment..................
            Tribal Set-aside........        14,500,000        14,500,000
    Grants to Prevent Prescription          16,000,000        16,000,000
     Drug/Opioid Overdose...........
    First Responder Training........        56,000,000        57,000,000
        Rural Focus.................        31,000,000        32,000,000
    Pregnant and Postpartum Women...        38,931,000        38,931,000
    Recovery Community Services              4,434,000         4,434,000
     Program........................
    Children and Families...........        30,197,000        30,197,000
    Treatment Systems for Homeless..        37,114,000        37,114,000
    Minority AIDS...................        66,881,000        66,881,000
    Criminal Justice Activities.....        94,000,000        94,000,000
        Drug Courts.................        74,000,000        74,000,000
    Improving Access to Overdose             1,500,000         1,500,000
     Treatment......................
    Building Communities of Recovery        16,000,000        17,000,000
    Peer Support Technical                   2,000,000         2,000,000
     Assistance Center..............
    Comprehensive Opioid Recovery            6,000,000         6,000,000
     Centers........................
    Emergency Department                     8,000,000         8,000,000
     Alternatives to Opioids........
    Treatment, Recovery, and                12,000,000        12,000,000
     Workforce Support..............
    Youth Prevention and Recovery            2,000,000         2,000,000
     Initiatve......................
Science and Service:
    Addiction Technology Transfer            9,046,000         9,046,000
     Centers........................
    Minority Fellowship Program.....         7,136,000         7,136,000
------------------------------------------------------------------------

    Building Communities of Recovery and Peer Support 
Networks.--The Committee appreciates SAMHSA's implementation of 
new funding for community-based networks assisting individuals 
with substance use disorder recovery, and urges SAMHSA to 
promote the expansion of recovery support services and to 
reduce stigma associated with addictions. The Committee notes 
that peer support networks focus on long-term, sustainable 
recovery and incorporate a full range of services such as case 
management, counseling, and community supports. To further 
support these recovery community organizations, the Committee 
provides $2,000,000 for the National Peer Run Training and 
Technical Assistance Center to provide addiction recovery 
support to peer networks and recovery communities.
    Comprehensive Opioid Recovery Centers.--The Committee 
includes $6,000,000, to help ensure that people with substance 
use disorders can access proper treatment, as authorized by 
section 7121 of the SUPPORT Act.
    Confidentiality of Substance Use Disorder Patient 
Records.--The Committee appreciates SAMHSA and the Office for 
Civil Rights [OCR] developing proposed rules updating the 
Confidentiality of Substance Use Disorder Patient Records. This 
action holds the potential to reduce drug overdose rates and 
help coordinate treatment for those with substance use 
disorder. The Committee directs SAMHSA and OCR to complete the 
rulemaking process as soon as is practicable in order to 
improve treatment and save lives.
    Drug Courts.--The Committee recommends $74,000,000 for Drug 
Courts. The Committee continues to direct SAMHSA to ensure that 
all funding for drug treatment activities is allocated to serve 
people diagnosed with a substance use disorder as their primary 
condition. SAMHSA is further directed to ensure that all drug 
court recipients work with the corresponding State alcohol and 
drug agency in the planning, implementation, and evaluation of 
the grant. The Committee further directs SAMHSA to expand 
training and technical assistance to drug treatment court grant 
recipients to ensure evidence-based practices are fully 
implemented.
    Emergency Department Alternatives to Opioids.--The 
Committee includes $8,000,000 to award grants to hospitals and 
emergency departments to develop, implement, enhance, or study 
alternatives to opioids for pain management in such settings as 
authorized in section 7091 of the SUPPORT Act.
    First Responder Training.--The Committee provides 
$57,000,000 for First Responder Training grants. Of this 
amount, $32,000,000 is set aside for rural communities with 
high rates of substance use. In addition, $11,500,000 of this 
funding is provided to make new awards to rural public and non-
profit fire and EMS agencies to train and recruit staff, 
provide education, and purchase equipment (including 
medications such as naloxone and protective equipment) as 
authorized in the Supporting and Improving Rural EMS Needs Act, 
included in the Agriculture Improvement Act of 2018 (Public Law 
115-334). The Committee directs SAMHSA to ensure funding is for 
new awardees and allows awards in amounts less than the maximum 
award amount to ensure nationwide funding.
    Medication-Assisted Treatment.--The Committee includes 
$111,000,000 for medication-assisted treatment, of which 
$14,500,000 is for grants to Indian Tribes, Tribal 
organizations, or consortia. These grants should target States 
with the highest age adjusted rates of admissions, including 
those that have demonstrated a dramatic age-adjusted increase 
in admissions for the treatment of opioid use disorders. The 
Committee continues to direct the Center for Substance Abuse 
Treatment to ensure that these grants include as an allowable 
use the support of medication-assisted treatment and other 
clinically appropriate services to achieve and maintain 
abstinence from all opioids, including programs that offer low-
barrier or same day treatment options.
    Medications for Opioid Overdose Reversal and Treatment.--
The opioid epidemic remains a major concern for the Committee. 
Provisional data from CDC's National Center for Health 
Statistics indicate that there were an estimated 109,680 drug 
overdose deaths in the United States in 2022, the highest level 
ever recorded. Among these overdoses, there has been a dramatic 
increase of deaths due to illicit fentanyl, which is 
increasingly found mixed with xylazine in the illicit drug 
supply, putting users at an even higher risk of a fatal 
overdose. Opioid overdose reversal agents remain a key tool for 
law enforcement, first responders, and other community 
intervention organizations. The evolving nature of the epidemic 
and the increasing prevalence of synthetic opioids among 
overdose deaths have led to substantial innovation in reversing 
opioid overdoses. To ensure the availability of opioid overdose 
reversal agents throughout the country, including innovative 
technologies, the Committee urges the Secretary to include as 
an allowable use of funds all FDA approved medications for 
opioid use disorder and overdose reversal, and other clinically 
appropriate services to treat opioid use disorder.
    Minority Fellowship Program.--The Committee includes 
$7,136,000 to support grants that will increase the number of 
culturally competent behavioral health professionals who teach, 
administer, conduct services research, and provide direct 
substance use disorder treatment services for minority 
populations that are underserved.
    Opioid Use in Rural Communities.--The Committee is aware 
that response to the opioid misuse crisis continues to pose 
unique challenges for rural America. Rural areas can struggle 
with limited access to care and there is a lack of health 
professionals necessary for identifying, diagnosing, and 
treating patients with substance use disorders, as well as 
assisting individuals in recovery. As a result, responding to 
the opioid crisis in rural America requires a comprehensive 
approach, which may involve: an integrated approach to care; 
collaboration when appropriate with patients and their 
families; involvement of community partners and institutions; 
advancing competency and skills development for healthcare 
providers treating people with substance use disorders; 
training to provide care in a culturally responsive manner; the 
use of technologies to ensure improved access to medically 
underserved areas through the use of telehealth and the 
addition of treatment programs where feasible. The Committee 
encourages SAMHSA to support initiatives to advance these 
objectives, specifically focusing on addressing the needs of 
individuals with substance use disorders in rural and 
medically-underserved areas, as well as programs that emphasize 
a comprehensive community-based approach involving academic 
institutions, healthcare providers, and local criminal justice 
systems.
    Opioid Use Disorder Recurrence.--The Committee is concerned 
that relapse following withdrawal management from opioids is a 
contributing factor to the overdose crisis. The Committee 
appreciates SAMHSA's efforts to address this within the Federal 
grant population by emphasizing the potential benefits of 
withdrawal management for opioid use disorder followed by 
medication to prevent recurrence and encourages SAMHSA to 
disseminate and implement this policy in all settings where 
withdrawal management is offered, including opioid treatment 
programs, rehabilitation centers, and criminal justice 
settings.
    Pregnant and Postpartum Women Program.--The Committee 
includes $38,931,00 for the Pregnant and Postpartum Women 
program, which uses a family-centered approach to provide 
comprehensive residential substance use disorder treatment 
services for pregnant and postpartum women, their minor 
children, and other family members. The Committee encourages 
SAMHSA to prioritize States that support best-practice 
collaborative models for the treatment and support of pregnant 
women with opioid use disorders. A provision in the 
Comprehensive Addiction and Recovery Act authorizes SAMHSA to 
allocate a portion of these resources for a pilot program to 
State alcohol and drug agencies to support outpatient, 
intensive outpatient, and related services to pregnant and 
postpartum women using a family-centered approach. The 
Committee again encourages SAMHSA to fund an additional cohort 
of States above and beyond the pilots already funded.
    Substance Use Screening, Brief Intervention, and Referral 
to Treatment [SBIRT].--The Committee understands that substance 
use disorders, including opioid use, typically begin in 
adolescence, and that preventing early substance use is an 
effective strategy to prevent problems later in life. The 
Committee is also aware that SBIRT has been shown to be a cost-
effective model for reducing and preventing underage drinking 
and other substance use, but that many health providers, 
especially pediatricians and those in underserved communities, 
have not been trained to use the method effectively. The 
Committee encourages SAMHSA to use funds for the adoption of 
SBIRT protocols in primary care and other appropriate settings 
that serve youth 12 to 21 years of age, as well as for the 
adoption of system-level approaches to facilitate the uptake of 
SBIRT into routine healthcare visits for adults.
    Treatment Assistance for Localities.--The Committee 
recognizes the use of peer recovery specialists and mutual aid 
recovery programs that support medication-assisted treatment 
and directs SAMHSA to support evidence-based, self-empowering, 
mutual aid recovery support programs that expressly support 
medication-assisted treatment in its grant programs.
    Treatment, Recovery, and Workforce Support.--The Committee 
includes $12,000,000 for SAMHSA to continue implementation of 
section 7183 of the SUPPORT Act.

State Opioid Response [SOR] Grants

    The Committee provides $1,595,000,000 for grants to States 
to address the opioid crisis. Bill language provides 
$60,000,000 for grants to Indian Tribes or Tribal 
organizations. The Committee supports the 15 percent set-aside 
for States with the highest age-adjusted mortality rate related 
to substance use disorders, as authorized in Public Law 117-
328. Activities funded with this grant may include treatment, 
prevention, and recovery support services. States receiving 
these grants should ensure that comprehensive, effective, 
universal prevention, and recovery strategies are prioritized 
to account for comprehensive services to individuals. The 
Committee continues to direct SAMHSA to make prevention and 
treatment of, and recovery from, stimulant use an allowable use 
of these funds. The Committee directs SAMHSA to ensure funds 
reach communities and counties with the greatest unmet need. 
SAMHSA is also directed to provide State agencies with 
technical assistance concerning how to enhance outreach and 
direct support to providers and underserved communities. The 
Committee continues to direct SAMHSA to conduct a yearly 
evaluation of the program to be transmitted to the Committees 
on Appropriations of the House of Representatives and Senate no 
later than 180 days after enactment of this act. SAMHSA is 
directed to make such evaluation publicly available on SAMHSA's 
website. The Committee directs SAMHSA to continue funding 
technical assistance within the administrative portion of the 
appropriated amounts for the State Opioid Response grants, to 
provide locally based technical assistance teams as has been 
done through the Opioid Response Network. The Committee 
recognizes the importance and essential work currently being 
done by the Opioid Response Network in delivering technical 
assistance to State and Territory State Opioid Response 
grantees, sub-recipients and others addressing opioid use 
disorder and stimulant use disorder in their communities.
    SOR Funding Cliffs.--The Committee continues to direct 
SAMHSA to avoid significant cliffs between States with similar 
opioid mortality data and to prevent unusually large changes in 
a State's SOR allocation when compared to the prior year's 
allocation. In ensuring the formula avoids such cliffs, the 
Assistant Secretary may consider options including, but not 
limited to, expanding the number of States that are eligible 
for the 15 percent set aside and using multiple years of data 
to minimize the effect of temporary changes in overdose 
mortality rates. The Assistant Secretary is encouraged to apply 
a weighted formula within the set aside based on state ordinal 
ranking. SAMHSA shall submit to the Committees on 
Appropriations of the House of Representatives and the Senate a 
work plan of the proposed allocation of funds not later than 30 
days prior to awarding grants.

Substance Use Prevention, Treatment, and Recovery Services [SUPTRS] 
        Block Grant

    The Committee recommends $2,048,079,000 for the SUPTRS 
Block Grant. The recommendation includes $79,200,000 in 
transfers available under section 241 of the PHS Act (Public 
Law 78-410 as amended).
    The Committee recognizes the importance of the block grant 
given its flexibility to allow States to direct resources to 
address the most pressing needs. This funding stream is also 
critical in assisting States to address all substance use 
disorders, including, but not limited to, those related to 
alcohol, cocaine, and methamphetamine. The Committee also notes 
the importance of the block grant's 20 percent prevention set-
aside, which is a vital source of primary prevention funding. 
The block grant provides funds to States to support alcohol and 
drug use prevention, treatment, and rehabilitation services. 
Funds are allocated to States according to a formula.

                       SUBSTANCE ABUSE PREVENTION

Appropriations, 2023....................................    $236,879,000
Budget estimate, 2024...................................     245,738,000
Committee recommendation................................     236,879,000

    The Committee recommends $236,879,000 for the Center for 
Substance Abuse Prevention [CSAP], the sole Federal 
organization with responsibility for improving accessibility 
and quality of substance use prevention services.
    The Committee is concerned about SAMHSA's lack of emphasis 
and funding for primary substance use prevention to stop use 
and delay the age of initiation. SAMHSA has conflated mental 
health promotion with substance use prevention, thereby 
diluting the already scarce resources for actual substance use 
prevention in CSAP. The Committee instructs SAMHSA to ensure 
that all the funding provided to the Center for Substance Abuse 
Prevention, as well as the 20 percent prevention set aside in 
the Substance Use Prevention, Treatment, and Recovery Services 
Block Grant, be used only for evidence-based substance use 
prevention activities and not for any other purposes, to 
include mental health promotion and harm reduction. The 
Committee further requests a report to Congress within 120 days 
of enactment that includes how this guidance is being applied 
to all CSAP programs as well as in the guidance to the States 
and territories regarding the 20 percent prevention set aside 
in the SUPTRS Block Grant.

Programs of Regional and National Significance

    The Committee provides $236,879,000 for PRNS within the 
Center for Substance Abuse Prevention. These programs support 
the development of new practice knowledge on substance use 
prevention; identification of proven effective models; 
dissemination of science-based intervention information; State 
and community capacity building for implementation of proven, 
effective substance use prevention programs; and programs 
addressing new needs in the prevention system.
    Within the total provided for PRNS, the Committee 
recommendation includes funding for the following activities:

 
------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Strategic Prevention Framework/       $135,484,000      $135,484,000
     Partnership for Success........
        Strategic Prevention                10,000,000        10,000,000
         Framework Rx...............
    Federal Drug-Free Workplace.....         5,139,000         5,139,000
    Minority AIDS...................        43,205,000        43,205,000
    Sober Truth on Preventing               14,500,000        14,500,000
     Underage Drinking (STOP Act)...
            National Adult-Oriented          2,500,000         2,500,000
             Media Public Services
             Campaign...............
            Community Based                 11,000,000        11,000,000
             Coalition Enhancement
             Grants.................
            Interagency Coordinating         1,000,000         1,000,000
             Committee to Prevent
             Underage Drinking......
        Tribal Behavioral Health            23,665,000        23,665,000
         Grants.....................
    Science and Service:
        Center for the Application           9,493,000         9,493,000
         of Prevention Technologies.
        Science and Service Program          4,072,000         4,072,000
         Coordination...............
        Minority Fellowship Program.         1,321,000         1,321,000
------------------------------------------------------------------------

    Prevention Technology Transfer Centers [PTTC] Network.--The 
Committee supports the work of the PTTC Network and efforts 
related to certified prevention specialists and the Prevention 
Fellowship program.
    Strategic Prevention Framework.--The Committee recommends 
$135,484,000 for the Strategic Prevention Framework. Within the 
total provided, $125,484,000 is for the Strategic Prevention 
Framework-Partnerships for Success program, and $10,000,000 is 
for Strategic Prevention Framework-Rx. The Strategic Prevention 
Framework is designed to prevent the onset of substance misuse 
while strengthening prevention capacity and infrastructure at 
the State, community, and Tribal levels. The Committee intends 
that this program support comprehensive, multi-sector substance 
use prevention strategies to stop or delay the age of 
initiation of each State's top substance use issues for high-
risk youth as determined by the State's epidemiological data. 
The Committee directs SAMHSA to ensure that State alcohol and 
drug agencies remain eligible to apply along with community-
based organizations and coalitions. Finally, the Committee 
directs SAMHSA to issue a report to the Committees on 
Appropriations assessing the extent to which the work of local 
grantees complements and aligns with the primary prevention 
efforts led by the corresponding State alcohol and drug agency.
    Sober Truth on Preventing [STOP] Underage Drinking Act.--
The Committee provides $14,500,000 for the STOP Act. Of this 
funding, $11,000,000 is for community-based coalition 
enhancement grants, $2,500,000 is for the National media 
campaign, and $1,000,000 is for the Interagency Coordinating 
Committee on the Prevention of Underage Drinking.
    Substance Use Disorder Prevention Workforce Report.--The 
Committee appreciates SAMHSA's work to conduct a comprehensive 
national study regarding the substance use prevention workforce 
as directed in fiscal year 2022. The study will collect 
information on the existing availability of and access to data 
on prevention workforce size, salaries, and current challenges 
in maintaining support for an adequate workforce, a plan to 
address these challenges and potential Federal programming to 
help implement the plan. The Committee looks forward to a 
briefing from SAMHSA on the study's findings within 60 days of 
issuing the final report.
    Tribal Behavioral Health Grants.--SAMHSA has administered 
Tribal Behavioral Health Grants for mental health and substance 
use prevention and treatment for Tribes and Tribal 
organizations since fiscal year 2014. In light of the continued 
growth of this program, as well as the urgent need among Tribal 
populations, the Committee continues to urge the Assistant 
Secretary for SAMHSA to engage with Tribes on ways to maximize 
participation in this program.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2023....................................    $333,360,000
Budget estimate, 2024...................................     182,255,000
Committee recommendation................................     243,545,000

    The Committee recommends $243,545,000 for Health 
Surveillance and Program Support activities. The recommendation 
includes $31,428,000 in transfers available under section 241 
of the PHS Act (Public Law 78-410 as amended).
    This activity supports Federal staff and the administrative 
functions of the agency. It also provides funding to SAMHSA's 
surveillance and data collection activities, including national 
surveys such as the National Survey on Drug Use and Health.
    Within the total provided for Health Surveillance and 
Program Support, the Committee recommendation includes funding 
for the following activities:

 
------------------------------------------------------------------------
                                      Fiscal year 2023      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Health Surveillance.................       $50,623,000       $50,623,000
    PHS Evaluation Funds............        30,428,000        30,428,000
Program Support.....................        84,500,000        84,500,000
Performance and Quality Information         10,200,000        10,200,000
 Systems............................
Drug Abuse Warning Network..........        13,000,000        13,000,000
Public Awareness and Support........        13,260,000        13,260,000
Behavioral Health Workforce Data....         1,000,000         1,000,000
    PHS Evaluation Funds............         1,000,000         1,000,000
------------------------------------------------------------------------

    Block Grant Reporting Requirements.--The Committee 
acknowledges the important role of the Community Mental Health 
Services and Substance Use Prevention, Treatment, and Recovery 
Services Block Grants in supporting States' efforts to provide 
resources for expanded mental health and substance use disorder 
treatment and prevention services. The Committee is concerned 
with the lack of transparency and information that is provided 
to Congress and the public about how States are distributing 
those funds and what programs or services they are going 
toward. The Committee encourages SAMHSA to begin implementing 
public reporting on their existing block grants. The Committee 
directs SAMHSA to submit a report, 180 days after the enactment 
of this act, to identify any staffing, IT infrastructure, 
legislative policies, or funding barriers that would prevent 
grantees and SAMHSA from collecting and providing outcome data 
on their block grant programs.
    Congressionally Directed Spending.--Within the funds 
included in this account, $70,962,000 are for the projects, and 
in the amounts, specified in the table titled ``Congressionally 
Directed Spending Items'' at the end of this Committee Report.
    Data Collection for SUD Grants to States.--A December 2020 
GAO report [GAO 21-58] examining SUD grants to States found 
that SAMHSA does not have consistent, relevant, and timely data 
on the number of individuals provided treatment and recovery 
support through the SUPTRS Block Grant, State Targeted Response 
to the Opioid Crisis Grant, and SOR programs. The Committee 
recognizes the challenges the lack of data poses in evaluating 
the effectiveness of these grants and encourages SAMHSA to 
adopt GAO's recommendation to identify and implement changes to 
their data collection efforts to improve the consistency, 
relevance, and timeliness of data collected on the number of 
individuals who receive substance use disorder treatment and 
recovery support services with funding from the SUPTRS Block 
Grant and SOR programs.
    Drug Abuse Warning Network.--The Committee recommends 
$13,000,000 for the Drug Abuse Warning Network [DAWN]. 
Authorized by the 21st Century Cures Act, DAWN is a 
surveillance system to monitor emergency department visits in 
order to help public health workers, policy makers, and other 
stakeholders respond effectively to emerging substance use 
trends.
    Drug Testing.--The Committee recognizes that section 5402 
of the Fixing America's Surface Transportation [FAST] Act 
(Public Law 114-94) required the Secretary to ``issue 
scientific and technical guidelines for hair testing as a 
method of detecting the use of a controlled substance for 
purposes of section 31306 of title 49, United States Code'', 
which is the drug and alcohol testing program for operators of 
commercial motor vehicles. While more than seven years have 
passed since the enactment of the FAST Act, the Committee 
understands that HHS is currently considering hair testing as 
an alternative method of drug testing and issued proposed 
mandatory guidelines relating to hair testing in September 
2020, but has not issued final guidelines, as required by the 
FAST Act. Therefore, the Committee calls on HHS to produce 
guidelines for the use of hair testing as an alternative drug 
testing method for commercial motor vehicle operators, in 
accordance with section 5402 of the FAST Act.
    National Survey on Drug Use and Health [NSDUH].--Recent 
data from NSDUH indicates that LGBTQ+ adults are more likely to 
experience mental health conditions such as depression and 
suicidality. The Committee encourages SAMHSA to continue to use 
NSDUH to better understand how to support the LGBTQ+ community 
through mental health and substance use programs.
    Program Support.--The Committee recommends $84,500,000 for 
program support, to ensure SAMHSA has the resources and staff 
to further its mission.

               Agency for Healthcare Research and Quality

Appropriations, 2023....................................    $373,500,000
Budget estimate, 2024...................................     447,500,000
Committee recommendation................................     370,500,000

    The Committee provides $370,500,000 for the Agency for 
Healthcare Research and Quality [AHRQ]. This funding is 
combined with the $116,000,000 in mandatory funding from the 
Patient-Centered Outcomes Research Trust Fund. AHRQ's mission 
is to enhance the quality, appropriateness, and effectiveness 
of health services, as well as access to such services. AHRQ 
conducts, supports, and disseminates scientific and policy-
relevant research on topics, such as promoting high-quality 
care and patient safety, eliminating healthcare disparities, 
using information technology, and evaluating the effectiveness 
of clinical services.

                  HEALTH COSTS, QUALITY, AND OUTCOMES

    Health costs, quality, and outcomes [HCQO] research 
activity is focused upon improving clinical practice, 
strengthening the healthcare system's capacity to deliver 
quality care, and tracking progress toward health goals through 
monitoring and evaluation.
    Within the total provided for HCQO, the Committee 
recommendation includes funding for the following activities:
    Center for Primary Care Research.--The Committee includes 
no less than $2,000,000 for the Center for Primary Care 
Research authorized at 42 U.S.C. 299b-4(b). The center supports 
clinical primary care research as well as strategies to improve 
primary care delivery and advancing the development of primary 
care researchers. The Committee supports efforts to coordinate 
research in areas such as multiple chronic conditions, symptom 
syndromes such as Long COVID, behavioral and social health 
integration, telehealth in primary care, shared decision-
making, and patient experience of care. The areas of focus 
should include, but not be limited to, expanding research on 
persons with multiple co-morbid conditions and improving 
primary care in rural and underserved areas.
    Improving Maternal Health.--The Committee supports AHRQ 
efforts to address the complex challenges of ensuring safe and 
healthy pregnancies and childbirth, particularly for 
underserved women who are at substantially higher risk of 
complication and death.
    Long COVID Research.--The extensive incidence of 
individuals suffering from Long COVID (Post-Acute Sequelae of 
SARS CoV-2 COVID [PASC]) presents an ongoing challenge to the 
healthcare system, patients and their caregivers. The Committee 
recommendation includes $10,000,000 to support access to 
comprehensive, coordinated, and person-centered care, 
particularly for underserved, rural, vulnerable, or minority 
populations that are disproportionately impacted by the effects 
of Long COVID. This funding supports health-systems research 
that develops and implements new or improved care delivery 
models, expands access and services offered, and strengthens 
care coordination. The Committee expects AHRQ to coordinate 
these efforts on Long COVID health-systems research with HRSA 
and other Federal healthcare agencies.
    Nonalcoholic Fatty Liver Disease [NAFLD] Study.--The 
Committee acknowledges the public health burden of NAFLD and 
values having a comprehensive understanding of NAFLD. 
Therefore, the Committee encourages AHRQ, in collaboration with 
other relevant Federal agency stakeholders, to evaluate the 
prevalence, diagnoses, treatments, and complications associated 
with NAFLD. The Committee requests that such study: (1) assess 
the prevalence of NAFLD in the United States; (2) assess the 
costs associated with individuals diagnosed with NAFLD, 
including the costs to patients, families, and government 
programs; (3) assess the costs and impact on patients and the 
healthcare system if NAFLD is unaddressed and progresses to 
nonalcoholic steatohepatitis [NASH], liver failure, poor liver 
function, or liver transplant; (4) identify and address 
barriers to preventing, diagnosing, and treating NAFLD and 
NASH; and (5) include an analysis of any disparities in access 
to care and other outcomes, such as health status, among 
minority populations. The Committee requests that AHRQ provide 
an interim report on the findings of this study, if applicable, 
in the fiscal year 2025 Congressional Justification and to 
provide a final report, if applicable, in the fiscal year 2026 
Congressional Justification.
    Opioid Research.--The Committee continues to support the 
research AHRQ has undertaken to better equip practitioners with 
evidence-based interventions to treat opioid and multi-
substance misuse. The Committee expects AHRQ to continue its 
opioid-related research to include equitable access to 
treatment, management of substance use disorders with other co-
occurring chronic conditions, and how changes in service 
delivery could improve outcomes.
    Patient Safety.--The Committee continues to support AHRQ's 
research to address failures in the diagnostic process and to 
support Diagnostic Safety Centers of Excellence to develop 
systems, measures, and new technology solutions to improve 
diagnostic safety and quality.
    People with Disabilities.--The Committee continues to 
support AHRQ's work with stakeholders to develop a research 
agenda and report for dissemination on health promotion, 
disease prevention, and intervention strategies for people with 
disabilities.
    Telehealth.--The Committee notes that telehealth now 
represents a significant share of healthcare delivery. The 
Committee encourages AHRQ to issue guidance on effective 
strategies to engage individuals with disabilities and 
individuals with limited English proficiency, and to assess and 
publish the effectiveness of beneficiary telehealth readiness 
tools commonly used across the health system, such as digital 
navigators and provision of technology.

Unites States Preventive Services Task Force [USPSTF]

    The Committee recommends $11,542,000 for USPSTF, which 
works to improve the health of people nationwide by making 
evidence-based recommendations about clinical preventive 
services.
    Medical Innovations.--The Committee notes concerns with the 
USPSTF's ability to keep pace with medical innovation. Emerging 
and innovative screening modalities can further public health 
for all Americans and address health inequities by improving 
timely access to and compliance with USPSTF-recommended 
screenings. The Committee continues to encourage the USPSTF to 
utilize the Early Topic Update process described in the USPSTF 
procedure manual to review a recommendation on an enhanced 
timeframe upon a showing of new evidence. The Committee also 
continues to urge the USPSTF to prioritize review of any new 
screening test or preventive medication approved or cleared by 
the Food and Drug Administration that is a preventive strategy 
or modality pertaining to, but not included, in a previous 
USPSTF recommendation.
    USPSTF Public Engagement.--The Committee encourages the 
USPSTF to advance open processes that help ensure meaningful 
engagement by the public, including underrepresented groups.

                   MEDICAL EXPENDITURES PANEL SURVEYS

    The Committee recommends $71,791,000 for Medical 
Expenditure Panel Surveys [MEPS], which collect detailed 
information annually from households, healthcare providers, and 
employers regarding how Americans use and pay for healthcare. 
The data from MEPS are used to develop estimates of healthcare 
utilization, expenditures, sources of payment, and the degree 
of health insurance coverage of the U.S. population.

                            PROGRAM SUPPORT

    The Committee recommends $73,100,000 for program support. 
This activity funds the overall management of AHRQ, including 
salaries, benefits, and overhead costs.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2023....................................$367,357,090,000
Budget estimate, 2024................................... 406,956,850,000
Committee recommendation................................ 406,956,850,000

    The Committee recommends $406,956,850,000 in mandatory 
funding for Grants to States for Medicaid.
    The fiscal year 2024 recommendation excludes 
$197,580,474,000 in fiscal year 2023 advance appropriations for 
fiscal year 2024. As requested by the administration, 
$245,580,414,000 is provided for the first quarter of fiscal 
year 2025.
    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, and the U.S. 
territories. Federal funds for medical assistance are made 
available to the States according to a formula that determines 
the appropriate Federal matching rate for State program costs. 
This matching rate is based on the State's average per capita 
income relative to the National average and cannot be less than 
50 percent.

                   PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2023....................................$548,130,000,000
Budget estimate, 2024................................... 476,725,000,000
Committee recommendation................................ 476,725,000,000

    The Committee recommends $476,725,000,000 in mandatory 
funding for payments to healthcare trust funds.
    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.

                           PROGRAM MANAGEMENT

Appropriations, 2023....................................  $3,669,744,000
Budget estimate, 2024...................................   4,550,070,000
Committee recommendation................................   3,669,744,000

    The Committee recommends $3,669,744,000 for CMS program 
management, which includes funding for research and 
evaluations, program operations and demonstrations, survey and 
certification programs, and Federal administration.

Program Operations

    The Committee recommends $2,479,823,000 for the Program 
Operations account, which 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.
    Affordable Care Act Notifications.--The Committee continues 
bill language requiring the administration to provide detailed 
enrollment figures to the Committees on Appropriations not less 
than two full business days before any public release of the 
information.
    Alzheimer's Disease [AD].--The Committee remains 
disappointed about CMS' decision to restrict coverage of an 
FDA-approved monoclonal antibody treatment for Alzheimer's 
disease. That decision set a dangerous precedent that 
undermines FDA decision-making and may have far reaching 
consequences that extend well beyond Alzheimer's treatments. 
Even now that FDA has granted traditional approval for such a 
treatment, the Committee is concerned that CMS continues to 
create barriers to care by requiring Medicare patients be 
enrolled in a qualifying registry. Given the substantial new 
clinical evidence published since the national coverage 
decision was issued and the FDA's confirmation of clinical 
benefit in keeping with its traditional approval of a treatment 
in this class, the Committee expects CMS to reconsider the 
National Coverage Determination policy to provide full access 
for Medicare beneficiaries to these FDA-approved Alzheimer's 
treatments.
    AD Diagnostics.--AD is among the top 10 causes of death in 
the United States and disproportionately affects racial and 
ethnic minorities. CMS' rate-setting policies may discourage 
the use of advance diagnostics for AD in certain care settings. 
The Committee notes that CMS' bundled payment policy for 
advance radiopharmaceuticals in the hospital outpatient setting 
makes these diagnostic imaging services cost prohibitive for 
many hospitals and doctors, especially those providing care to 
racial and ethnic minorities, who already face more significant 
delays in obtaining a timely diagnosis. The Committee 
encourages CMS to review these rate-setting policies and the 
impacts these payment rules have on utilization of AD 
diagnostics among racial and ethnic minority groups. 
Furthermore, the Committee directs CMS to review the 
utilization of AD diagnostics and consider potential 
modifications that could make access to advanced imaging for AD 
more equitable.
    Biosimilars.--The Committee notes concerns about the lack 
of access to lower cost biosimilars for Medicare Part D 
enrollees, including the prevalence of formulary exclusions of 
lower priced biosimilars and the application of step therapy by 
some plans to require enrollees to use a higher-priced brand 
product before accessing a biosimilar. The Committee notes the 
potential savings for patients and taxpayers through swift 
inclusion of biosimilars on Medicare Part D formularies. The 
Committee therefore urges CMS to prioritize policies that 
accelerate the adoption of all biosimilars on Medicare 
Advantage and Part D formularies. In doing so, CMS should 
examine existing barriers to biosimilar adoption, including 
Part D plan practices that impede access to lower-priced 
products. CMS should also provide beneficiary-focused education 
on the availability of biosimilars on Medicare Plan Finder and 
real-time benefit tools, as well as ensure guidance and 
regulations for Part D formulary development and design 
appropriately encourage the adoption of biosimilars with lower 
list prices, given that beneficiaries often pay coinsurance as 
a percentage of a product's list price under the program.
    Birthing-Friendly Hospitals.--The Committee supports CMS' 
new Birthing-Friendly Hospital designation to assist consumers 
in choosing hospitals that have demonstrated a commitment to 
maternal health through the implementation of best practices 
that advance healthcare quality, safety, and equity for 
pregnant and postpartum patients. The Committee encourages CMS 
to explore expanding the criteria for which this designation 
would be awarded in the future and requests a briefing on 
additional steps to address maternal health outcomes and 
improve patient care within 120 days of enactment of this act.
    Cardiac Computed Tomography [CT].--The Committee notes that 
unstable and low Medicare payments for cardiac CT services 
contribute to significant disparities in access to services 
among minority and underserved populations. The Committee 
encourages CMS to review the reimbursement structure and to 
make appropriate adjustments.
    Cardiovascular Disease [CVD].--The Committee notes the 
economic and public health burden of CVD, including 
atherosclerotic CVD [ASCVD], which can lead to heart attack or 
stroke. More than 200 studies with over 2.0 million patients 
have broadly established that elevated low-density lipoprotein 
cholesterol [LDL-C] levels can cause ASCVD. The Committee 
encourages CMS to evaluate whether to add a quality measure of 
appropriate LDL-C testing as part of its Universal Foundation 
initiative.
    Certified Registered Nurse Anesthetists [CRNAs].--The 
Committee notes concerns about patient access to anesthesia 
services, particularly in rural areas, and is encouraged by 
some positive outcomes resulting from the suspended physician 
supervision requirements for CRNAs during the COVID-19 Public 
Health Emergency. The Committee urges CMS to use empirical data 
analysis and stakeholder input to consider whether permanently 
waiving the physician supervision requirement for CRNAs under 
Medicare Part A Conditions of Participation can increase access 
to safe and effective anesthesia services.
    Diabetes Self-Management Training.--Given the prevalence 
and cost of diabetes, particularly among communities of color, 
the Committee continues to be concerned that barriers to 
accessing the Medicare diabetes self-management training 
benefit have resulted in utilization by only 5 percent of newly 
diagnosed Medicare beneficiaries. The Committee encourages CMS 
to obtain additional feedback from stakeholders on the barriers 
to accessing the diabetes self-management benefit and to 
consider changes to address these barriers to the extent 
permitted by the statute. Within 120 days of enactment of this 
act, the Committee directs CMS to provide a report to the 
Committees on Finance and Appropriations of the Senate 
detailing the agency's efforts to address these barriers.
    Disproportionate Share Hospital [DSH] Payments.--The 
Committee recognizes that the Federal Medicaid statute 
generally requires DSH payments to hospitals treating large 
numbers of low-income patients in every State except Tennessee, 
whose DSH allotment is currently scheduled to cease after 
fiscal year 2025. The Committee encourages CMS to provide the 
necessary and adequate data to Congress to ensure a long-term 
Medicaid DSH allotment for Tennessee in the near future.
    Expanding Support for Screening and Diagnostic Testing in 
Cancer Treatment.--The Committee understands that the use of 
pre-treatment interventions, such as screening for signs of 
cancer or testing with a companion diagnostic to determine a 
specific cancer type, can help healthcare providers select 
treatment options with a greater probability of better outcomes 
for patients. The Committee also recognizes that the use of 
these interventions can reduce unnecessary costs in the 
healthcare system by avoiding ineffective treatments and that 
awareness of genetic risk factors can encourage preventive care 
and early diagnosis. The Committee urges CMS to identify ways 
to expand access to such screening and testing.
    Healthcare for People with Mobility Disabilities.--The 
Committee encourages CMS to require disability clinical care 
training and the availability of accessible medical and 
diagnostic equipment into its conditions of participation for 
Part A and Part B providers and suppliers.
    Health Insurance Exchange.--The Committee continues bill 
language that requires CMS to provide cost information for the 
following: Federal Payroll and Other Administrative Costs; 
Exchange related Information Technology [IT]; Non-IT Program 
Costs, including Health Plan Benefit and Rate Review, Exchange 
Oversight, Payment and Financial Management, Eligibility and 
Enrollment; Consumer Information and Outreach, including the 
Call Center, Navigator Grants and Consumer Education and 
Outreach; Exchange Quality Review; Small Business Health 
Options Program and Employer Activities; and Other Exchange 
Activities. Cost information should be provided for each fiscal 
year since the enactment of the Patient Protection and 
Affordable Care Act [ACA]. CMS is also required to include the 
estimated costs for fiscal year 2025.
    Home and Community Based Services.--The Committee is 
supportive of efforts to increase access to care in homes and 
communities, which includes support for family caregivers and 
direct care workers that provide essential care and services. 
Within existing resources, the Committee expects CMS to 
strengthen and expand access to HCBS, facilitate State 
planning, encourage innovative models that benefit the 
workforce and care recipients, and support quality and 
accountability.
    Hospice Respite Care.--The Committee requests an update in 
the fiscal year 2025 CJ on the current capacity and best 
practices for the provision of hospice respite care, including 
in the home. The update should assess and provide 
recommendations on what would be needed to ensure greater 
access to home respite care for hospice beneficiaries and their 
caregivers, including but not limited to changes to the current 
benefit to expand access to in-home respite. It should also 
evaluate the adequacy of the current five-day inpatient respite 
limit and make recommendations on parameters and situations in 
which an expanded eligibility definition and benefit duration 
might be appropriate.
    Hospital Wage Index.--The Committee encourages CMS to 
continue its low wage index policy, as established in the 
Fiscal Year 2020 Medicare Hospital Inpatient Prospective 
Payment System Final Rule, which helps many rural, low-wage 
hospitals attract and maintain a skilled workforce. This policy 
increases reimbursements for many vulnerable, rural hospitals 
while ensuring overall budget neutrality in order to avoid 
further depleting the already strained Medicare Hospital 
Insurance Trust Fund.
    Non-Emergency Medical Transportation [NEMT].--The Committee 
continues to monitor patient outcomes resulting from changes to 
NEMT policies. The Committee encourages CMS to evaluate 
existing State Medicaid NEMT access for beneficiaries and 
timeliness of services, and if appropriate, pursue alternative 
options to provide NEMT for partial dual eligible beneficiaries 
and to establish a data exchange between the Medicare 
Administrative Contractors and State Medicaid agencies to 
identify affected beneficiaries.
    Nursing Home Medical Directors.--The Committee continues to 
be concerned that post-acute and long-term care setting 
facility medical directors remain underutilized and invisible 
to most patients, families and others in the healthcare field. 
The Committee requests that CMS and the Secretary identify 
better ways for public health agencies to contact nursing 
facility medical directors with mechanisms like Care Compare or 
on data.cms.gov. This effort aligns with recent HHS proposed 
rule to increase the transparency of nursing home ownership and 
management through the administrative process.
    Nurse Staffing Levels for Patient Safety.--The Committee 
recognizes high-quality nursing staff are essential to patient 
safety and outcomes. As part of its accrediting oversight 
function, CMS is charged with ensuring that Medicare-
participating hospitals meet important patient safety 
standards, including meeting appropriate nurse staffing 
requirements. The Committee encourages CMS to work with 
stakeholders to support the post-acute workforce, including by 
ensuring burdensome requirements do not result in decreased 
access for patients.
    Osteoporosis.--The Committee notes that current Medicare 
payment policies may not be adequate to encourage comprehensive 
care to reduce osteoporosis-related bone fractures. As such, 
the Committee is pleased that CMS is considering implementing a 
care coordination payment mechanism for secondary prevention of 
osteoporotic fractures through future rulemaking. These 
services have the potential to reduce the rates of costly 
secondary fractures through improved screening, treatment and 
adherence, patient and caregiver education and counseling, and 
comprehensive fall prevention strategies.
    Pediatric Oral Health.--The Committee appreciates CMS' 
ongoing work to improve access to pediatric oral healthcare. 
However, as CMS and States work to meet Oral Health Initiative 
targets, the Committee urges CMS to continue to look towards 
innovative approaches to improve pediatric oral healthcare by 
coordinating with other agencies and programs that serve 
Medicaid and CHIP populations such as the Department of 
Agriculture's Women, Infants and Children [WIC] and 
Supplemental Nutrition Assistance Program [SNAP] programs. 
Efforts may include expanding programs to integrate care into 
different settings and increasing education for parents and 
families on the importance of oral healthcare for children 
throughout each stage of development.
    Prescription Digital Therapeutics.--The Committee is 
encouraged that a new cutting-edge medical modality of 
software-based, FDA-cleared products called prescription 
digital therapeutics [PDTs] is beginning to improve the lives 
of Americans living with serious diseases and conditions like 
substance use disorder, attention-deficit/hyperactivity 
disorder, insomnia, major depression, diabetes, stroke, 
schizophrenia, and cancer. The Committee directs CMS to explore 
coverage of PDTs in the Medicare and Medicaid programs under 
existing benefit categories until a distinct benefit category 
can be created for these products through legislation.
    Rare Disorders.--The Committee notes the limitations of 
bundled payments for rare and ultra- rare diseases. The 
Committee urges the HHS Inspector General to review bundled 
payment systems and quality reporting methodologies across care 
settings. The review should evaluate barriers to accessing 
treatments, diagnostics, clinicians, and specialists, as 
appropriate.
    Risk Corridor Program.--The Committee continues bill 
language to prevent the CMS Program Management appropriation 
account from being used to support risk corridor payments.
    Robotic Stereotactic Radiosurgery [SRS].--The Committee 
remains concerned that inadequate payments for robotic 
stereotactic radiosurgery and robotic stereotactic body 
radiation therapy [SBRT] may threaten patient access to this 
important treatment option for many types of cancer in both the 
hospital and freestanding cancer settings. CMS' statement in 
the 2023 Medicare Physician Fee Schedule Final Rule that the 
agency intends to review coding and payment policies for 
radiation therapy services, including possible adoption of 
revised CPT codes established in 2015. The Committee urges CMS 
and contractors to maintain existing G codes describing robotic 
SRS and robotic SBRT in order to protect Medicare beneficiary 
access to these services which safely deliver life-saving and 
life-changing cancer treatment in a timely and cost-efficient 
manner, improving patient compliance and reducing burdens on 
patients, providers, and the healthcare system.
    Rural Emergency Hospitals.--The Committee is encouraged by 
CMS' timely implementation of the Rural Emergency Hospital 
[REH] designation, as created by Public Law 116-260. The 
Committee urges CMS to continue working with stakeholders to 
ensure the regulatory geographic requirements for the REH 
designation are clear for interested parties, especially rural 
hospitals located in or near metropolitan statistical areas.
    Rural Hospital Closures.--The Committee notes that 135 
rural hospitals have closed in the past decade and many others 
are vulnerable to closure. The Committee continues to direct 
CMS to provide information to the Committees on Appropriations, 
Energy and Commerce, and Ways and Means of the House of 
Representatives and the Committees on Appropriations and 
Finance of the Senate on existing policies that provide support 
for struggling hospitals in rural and under-served communities.
    Tribal Health Care Reimbursements.--The IHS rate does not 
reimburse Tribal healthcare providers for the cost of 
chemotherapeutics provided by a physician in the office 
setting. This makes the provision of cancer treatment on Indian 
reservations unsustainable for Medicare patients and damages 
the ability of American Indians to access local cancer 
treatment. The Committee urges CMS to clarify reimbursement 
procedures and amounts for Part B oncology drugs dispensed at 
IHS facilities to ensure parity among IHS and non-IHS 
facilities.
    Whole Child Health Model.--The Committee is aware that 
social determinants of health influence health outcomes, 
particularly for children and youth. The Committee commends CMS 
for establishing the Integrated Care for Kids Model and for 
supporting State flexibility to address social drivers of 
health through recent guidance and waivers. The Committee 
encourages CMS to issue a report on options for a whole child 
health demonstration centered in primary care settings that 
would build state capacity to address youth mental health 
through sustainable payment and delivery models. Options 
included in such report would address the mental, developmental 
and social factors affecting children served by Medicaid and 
CHIP through pediatric value-based care models and locally 
driven strategies, to align financial incentives and resources 
across Medicaid and other programs. The Committee directs CMS 
to provide an update to the Committees on Energy and Commerce 
and Appropriations of the House of Representatives and the 
Committees on Finance and Appropriations of the Senate within 
180 days of enactment of this act on options for benefit 
designs, including cost estimates for implementation.

State Survey and Certification

    The Committee recommends $397,334,000 for State Survey and 
Certification activities, which 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.
    Annual Reports.--The Committee directs CMS to provide, in 
the fiscal year 2025 Congressional Justification, a report to 
the Committees regarding operational milestones and funding 
activities under this heading. Such reports shall, at a 
minimum, include quarterly obligations, unobligated balances 
(including a breakdown of committed and uncommitted balances), 
and expenditures of current year discretionary budgetary 
authority by originating statute. Such reports shall also 
include operational metrics, such as those found on pages 78 
and 80 of the fiscal year 2024 Congressional Justification, 
regarding the numbers and rates of survey and complaint visits 
by provider type for the applicable quarter.

Federal Administration

    The Committee recommends $772,533,000 Federal 
Administration, which funds the majority of CMS' staff and 
operating expenses for routine activities, such as planning, 
implementing, evaluating, and ensuring accountability in the 
programs administered by CMS.

                   HEALTHCARE FRAUD AND ABUSE CONTROL

Appropriations, 2023....................................    $893,000,000
Budget estimate, 2024...................................     937,000,000
Committee recommendation................................     915,000,000

    The Committee recommends $915,000,000, to be transferred 
from the Medicare trust funds, for Health Care Fraud and Abuse 
Control activities. The Committee recommendation includes a 
discretionary base amount of $311,000,000 and an additional 
$604,000,000 in resources through a budget cap adjustment, in 
alignment with the parameters set forth in the Fiscal 
Responsibility Act of 2023. Proactively identifying healthcare 
waste, fraud, and abuse continues to be a priority for the 
Committee.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 2023....................................  $2,883,000,000
Budget estimate, 2024...................................   3,309,000,000
Committee recommendation................................   3,309,000,000

    The Committee recommendation includes $3,309,000,000 in 
fiscal year 2024 mandatory funds for Child Support Enforcement 
and Family Support programs. In addition, the Committee 
recommends $1,400,000,000 in advance funding for the first 
quarter of fiscal year 2025.
    These funds support States' efforts to promote the economic 
security of low-income families, including administrative 
expenses, matching funds, and incentive payments to States for 
child support enforcement; grants to States to help establish 
and administer access and visitation programs between 
noncustodial parents and their children; payments to 
territories for benefits to certain aged, blind, or disabled 
individuals; and temporary benefits for certain repatriated 
citizens.

               LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2023....................................  $4,000,000,000
Budget estimate, 2024...................................   4,111,000,000
Committee recommendation................................   4,075,000,000

    The Committee recommendation includes $4,075,000,000 for 
the Low Income Home Energy Assistance Program [LIHEAP], which 
is $75,000,000 over the fiscal year 2023 enacted level. LIHEAP 
provides home heating and cooling assistance to low-income 
households. In addition to funding made available in this bill, 
the Infrastructure Investment and Jobs Act (Public Law 117-58) 
provided $500,000,000 in LIHEAP funding, with $100,000,000 
available each fiscal year through September 30, 2026, for home 
energy assistance.
    Sudden, significant, and unexpected decreases in annual 
funding for States, even when based in part on changes in home 
energy costs or other formula factors, can be difficult for 
States to manage. Accordingly, the Committee recommendation 
continues to limit year-to-year fluctuations in allocations to 
States.
    Technical Assistance and Program Administration.--Within 
the total, the Committee recommendation continues to include up 
to $9,600,000 for program integrity and oversight efforts. A 
portion of this funding is intended to support ongoing efforts 
to implement a formula system, which will allow ACF to provide 
estimates more readily when requested by the Committee. Once 
such a system is in place, the Committee instructs HHS to work 
collaboratively with the Committee to promptly respond to 
requests for estimates and to ensure no request shall be 
outstanding for longer than 10 calendar days. The Committee 
requests a briefing on the progress that has been made on a 
formula system within 90 days of enactment of this act.

                     REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2023....................................  $6,427,214,000
Budget estimate, 2024...................................   7,258,755,000
Committee recommendation................................   6,427,214,000

    The Committee recommends $6,427,214,000 in base 
discretionary funding for Refugee and Entrant Assistance [REA] 
programs. These programs provide a variety of benefits and 
services to refugees, asylees, Cuban and Haitian entrants, 
immigrants arriving on Special Immigrant Visas [SIV], 
trafficking victims, and torture victims (collectively referred 
to below as ``refugees''). These programs also provide 
temporary care and services for unaccompanied children 
apprehended by the Department of Homeland Security [DHS] or 
other law enforcement agencies, who have no lawful immigration 
status in the United States until they can be placed with a 
parent, guardian, or other sponsor while awaiting adjudication 
of their immigration status.
    The Committee recommendation continues the directive to 
provide monthly updates to the Committees on Appropriations of 
arrivals each month by category, including refugees, asylees, 
Cuban and Haitian Entrants, SIVs, and unaccompanied children. 
Such updates shall include any changes in estimated funding 
needs as a result of changing trends. The Committee notes that 
ORR has consistently relied on supplemental funding to address 
funding needs in this program, and the Committee will continue 
to work closely with HHS to evaluate and address fiscal year 
2024 funding needs.
    The Committee believes that the U.S. Refugee Admissions 
Program [USRAP] serves as a reflection of U.S. humanitarianism 
as well as the Nation's strategic interests. In times of 
changes in the pace and projections of refugee arrivals, the 
Committee encourages HHS, to the extent practicable, to ensure 
that resettlement agencies are able to maintain their 
infrastructure and capacity at a level to continue to serve new 
refugees, previously arrived refugees, and other populations of 
concern who remain statutorily eligible for integration 
services, and to ensure that there is capacity for future 
arrivals to be adequately served.
    Community Engagement and Quarterly Consultation.--The 
Committee recognizes that quarterly consultations and regular 
community engagement are critical to support refugee 
integration and encourages HHS to pursue efforts to ensure 
robust participation in regular community consultations.
    Coordination with DHS and DOJ.--The Committee notes that 
not all refugees (including all populations eligible for ORR-
funded services) receive ORR-funded services. The Committee 
encourages ORR to better coordinate with DHS and the Department 
of Justice to improve the referral process for eligible 
arrivals.
    Mental Health and Trauma Informed Care.--The Committee 
recognizes that mental health is an important component of 
ORR's work. Many of the individuals that ORR serves have 
endured torture, war, loss of homes and loved ones, and other 
traumatic events. The Committee encourages ORR to partner with 
an outside organization to evaluate the mental healthcare needs 
of ORR-eligible populations and any ongoing gaps and challenges 
in current mental health provision across populations ORR 
serves. This should also include recommendations for enhancing 
programming or additional investments needed to address any 
gaps and for ensuring that mental health services are trauma-
informed and culturally appropriate. The Committee also 
encourages ORR to assess the need for training for ORR staff 
who regularly engage with potential trauma survivors, 
including: training on recognizing signs of trauma exposure, 
understanding culturally specific behaviors of people exposed 
to trauma, and sensitive or trauma-informed principles for 
interacting; and secondary trauma and resilience training and 
support.

Transitional and Medical Services

    The Committee recommendation includes $564,000,000 for 
Transitional and Medical Services. This program provides grants 
to States and nonprofit organizations to provide cash and 
medical assistance to arriving refugees, as well as foster care 
services to unaccompanied minors.
    Matching Grant Program.--The Committee continues to support 
the Matching Grant [MG] program and strongly encourages HHS to 
expand the program, including increasing the number and 
percentage of eligible arrivals served by the program; 
increasing the government's per capita contribution to respond 
to inflation and cost of living; and easing the burden of the 
match requirement. The Committee also strongly encourages HHS 
to give matching grant organizations flexibility in 
administering their programs, including, when justified, 
carrying over unexpended funding and slots and extending 
exemptions to the 31-day enrollment period. The Committee also 
encourages HHS to continue permitting flexibilities in 
dispersing MG funds, such as continuing to separate direct 
assistance and administrative portions, and encourages HHS to 
create a plan to expand case management for MG enrollees. 
Finally, the Committee encourages HHS to work with resettlement 
sites to ensure continuity of MG enrollments and services 
during the transition from one fiscal year to the next.

Refugee Support Services

    The Committee recommendation includes $307,201,000 for 
Refugee Support Services [RSS]. This program provides a 
combination of formula and competitive grants to States and 
nonprofit organizations to help refugees become self-sufficient 
and address barriers to employment.
    The Committee strongly encourages ORR to the greatest 
extent possible allocate RSS funding based on best data 
available that reflects actual needs of providing services to 
newly arrived refugees. The Committee directs ORR to include 
information in its fiscal year 2025 CJ on what flexibilities 
ORR has applied in allocating funding to better reflect needs, 
and any ongoing limitations in doing so.
    Preferred Communities.--The Committee recognizes that the 
increase in refugee arrivals projected for fiscal year 2024 
requires expanded capacity among the resettlement network and 
the Preferred Communities program is an important part of that. 
The Committee directs HHS to include information in its fiscal 
year 2025 CJ on the Preferred Communities program, including an 
estimate of funding to be spent on the program and funding 
needed to maintain Preferred Communities programming at all 
resettlement sites.
    Intensive Case Management.--The Committee recognizes the 
importance of expanding intensive case management [ICM] and 
virtual case management, particularly in locations where 
expanded resettlement capacity relies on remote placement. The 
Committee encourages HHS to expand the availability of virtual 
case management to provide ICM services, particularly in 
locations without existing resettlement sites nearby. The 
Committee directs HHS to include information in its fiscal year 
2025 CJ on such efforts, including an assessment of the use of 
virtual ICM services.

Victims of Trafficking

    The Committee recommendation includes $30,755,000 for 
Victims of Trafficking programs. These programs support a 
national network of organizations that provide a variety of 
services-including case management, counseling, benefit 
coordination, and housing assistance-for victims of commercial 
sex and forced labor trafficking.
    Within this amount the Committee recommendation includes no 
less than $5,000,000 for the National human trafficking 
hotline. The Committee notes concern with reports that the 
hotline has not consistently and promptly reported tips, when 
appropriate and consistent with Federal and State law, of 
trafficking of adults to law enforcement. The national 
trafficking hotline is authorized to assist victims of severe 
forms of trafficking in persons in communicating with service 
providers. It is critical that that the hotline maintain a 
person-centered approach focused on the victim's well-being. 
The Committee also notes that hotline plays an important role 
in notifying law enforcement of potential trafficking when that 
is appropriate. Accordingly, the Committee directs ACF to 
ensure the National trafficking hotline is complying with 
applicable laws and policies regarding the operation of the 
hotline, assisting victims of severe forms of trafficking in 
persons, and referring potential cases of trafficking to law 
enforcement.

Unaccompanied Children

    The Committee recommendation includes $5,506,258,000 for 
the Unaccompanied Children [UC] program. The UC program 
provides temporary care for children who have no lawful 
immigration status in the United States and who have been 
apprehended by DHS without a parent or a guardian. HHS provides 
care for children until they can be placed with a parent or 
other sponsor living in the United States pending resolution of 
their immigration status.
    Bond Hearings and Placement Reviews.--The Committee expects 
HHS to approach placement review and Flores bond requests with 
expediency, fairness, child-centered procedures, and trauma-
informed approaches prior to and during Flores bond hearings 
and placement review panel adjudications.
    Influx Care Facilities [ICFs].--The Committee appreciates 
that ORR has significantly reduced the need for ICFs in fiscal 
year 2023, but has significant concerns that the administration 
has not been aggressive enough in reducing capacity in ICFs and 
closing them when they are no longer needed. The Committee 
expects that ICFs will only be used in the future when 
absolutely necessary and directs ORR to include in its fiscal 
year 2025 CJ estimates of how much it will spend on ICFs, its 
estimated capacity needs, the methodology it uses and factors 
it considers when estimating ICF capacity needs, and in what 
specific circumstances it will activate capacity in ICFs. The 
Committee also expects that if ICFs are needed in the future, 
HHS will continue to improve the quality of care provided in 
ICFs, including ensuring they have the physical infrastructure 
to provide developmentally appropriate care for children, 
including appropriate space for education services, and 
confidential space for the provision of healthcare, mental 
healthcare, and legal services.
    Maintaining Family Contact.--The Committee strongly 
encourages ORR to work with its care providers to ensure that 
children have as much access as possible via telephone and 
video calls to their parents, family members, and caregivers 
while maintaining appropriate child welfare safeguards.
    Mental Health and Related Services for Children in ORR-
Care.--The Committee appreciates the steps ORR has taken to 
improve mental health services for children in their care, and 
encourages ORR to continue to expand such services and ensure 
that they are developmentally appropriate, trauma-informed, 
culturally competent, and provided in the most integrated, 
least restrictive setting. This should also include in-person 
training for ORR and ORR-contracted staff on trauma and trauma-
informed care. The Committee also expects ORR to work with 
residential care providers, disability experts, and child 
welfare experts to ensure adherence to Federal, State, and 
local laws related to standards of care for children with 
disabilities. ORR should also work with protection and advocacy 
organizations to support monitoring visits and access to 
information. Finally, the Committee recognizes that 
unaccompanied children often share extensive personal 
information to case managers, clinicians, or other adults while 
in ORR care, and expects ORR and its grantees and contractors 
to protect sensitive personal information, behavioral health 
records, and mental health records consistent with all 
applicable child welfare laws, regulations, and licensing 
requirements. The Committee directs ORR to include information 
in its fiscal year 2025 CJ on these efforts.
    Office of the Ombudsperson.--The Committee strongly 
supports efforts to increase independent oversight of the UC 
program. Accordingly, the Committee supports the establishment 
of an Office of the Ombudsperson, to provide independent child-
welfare focused recommendations to ORR and the Secretary 
regarding the care of unaccompanied children, including on 
policies to ensure children are safe, cared for, and receive 
the services they need both while in HHS custody and after they 
have been released to a sponsor. The Committee strongly 
encourages HHS to establish the Office of the Ombudsperson as 
soon as possible. The Ombudsperson shall monitor, including by 
making site visits, for compliance with all applicable laws and 
standards relating to unaccompanied children. The Committee 
directs the Ombudsperson to submit a report to Congress no less 
than once each fiscal year including a summary of activities 
carried out during the preceding fiscal year, as well as 
recommendations for improving the UC program and a description 
of the priorities for the subsequent fiscal year.
    Post-Release Services, Legal Services/Access to Counsel, 
and Child Advocates.--The Committee recommendation includes no 
less than the fiscal year 2023 funding level for post-release 
services; legal services and access to counsel; and child 
advocates. The Committee expects that HHS will continue to 
expand child-welfare focused post-release services to increase 
the number of children and families receiving services, and 
improve the types of services they receive, including case 
management assistance with school enrollment, and access to 
legal services, healthcare, mental health, and community 
services. These post-release services are critical to ensuring 
that children are in safe and appropriate homes after they have 
been released from ORR's care and that children and families 
have access to the services they need. The Committee encourages 
ORR to engage with current family reunification service 
providers, post-release service providers, and recently 
released children and sponsors to discuss needed services, the 
length of services, and how to improve coordination between 
shelters, providers, and other community services providers, to 
help evaluate the current program and to identify new risks and 
opportunities for improvement. In addition to children already 
designated under law or policy to receive such services, the 
Committee encourages ORR to ensure that all pregnant or 
parenting teens and children whose primary language is neither 
English nor Spanish are referred for post-release services. 
Finally, the Committee supports ORR's plans to provide tiered 
levels of services, and strongly encourages ORR to prioritize 
post-release services for children released to category 2 and 3 
sponsors.
    The Committee also expects these funds will be used to 
provide access to counsel, consistent with the goals of the 
Trafficking Victims Protection Reauthorization Act of 2008 for 
all children to have access to counsel in their immigration 
proceedings. The Committee understands the supply of service 
providers may be constrained in some areas, and encourages ORR 
to allow grantees to use flexibilities in contracting expenses, 
to the extent practicable, to build the capacity to ensure the 
necessary legal requirements are met to provide expanded 
services to children. The Committee also expects ORR to ensure 
in-person Know Your Rights presentations and legal screenings 
for every child in ORR custody and access to legal counsel for 
any child in prolonged ORR-care. The Committee expects that 
legal services will be in person absent exigent circumstances 
and that ORR will ensure that there is sufficient confidential 
space available for legal services at all facilities, including 
emergency or influx facilities. When services are provided 
remotely, ORR must make sufficient technology and confidential 
space available for communication via video whenever possible, 
and telephone if necessary.
    The Committee directs ORR to include information in its 
fiscal year 2025 CJ on how children are prioritized for post-
release services, legal services, and child advocate services, 
and the number and percentage of children that have and are 
estimated to receive services annually, including broken out by 
specific types and levels of services.
    Prioritization of Small-Scale, Community- and Family Based 
Placements.--The Committee continues to direct ORR to 
prioritize the placement of children in small-scale, community- 
and family-based care providers, including transitional foster 
care, small group homes, and long-term foster care. The 
Committee directs ORR to pursue efforts to expand capacity in 
such programs, which are both more appropriate for children, 
and reduce the need for ICFs. This should include predictably 
posting funding opportunity announcements, providing technical 
assistance to both existing and potentially new providers, and 
working with providers to address any staffing-related issues 
that limit their capacity. Finally, the Committee directs ORR 
to include information in its fiscal year 2025 CJ on its actual 
and planned capacity by program type and a review of past 
funding opportunity announcements. This review should include 
any challenges or barriers with expanding capacity in such 
programs, including detailed explanations of why applicants 
were unsuccessful and what ORR has done to address such 
barriers and challenges as well as steps taken to improve 
technical assistance for and communication with both current 
and potential new providers.
    Special Education.--The Committee strongly encourages ORR 
to conduct a study on the education support needs of children 
with disabilities in its care, identify any gaps or challenges 
in addressing such needs, and take steps as necessary to 
address them.
    Spend Plan.--The Committee directs ORR to continue to 
provide quarterly spend plans with actual and estimated 
obligations by major category, at the same level of detail has 
been provided in previous years. The Committee further expects 
at least this level of detail to be included in future budget 
justifications.
    Sponsor Suitability Determination Policies.--The Committee 
directs ORR to conduct targeted reviews of its sponsor 
suitability determination policies and procedures. This should 
include reviews of a sampling of cases of children released to 
different categories of sponsors during fiscal year 2023 to 
evaluate specific policies for how they promote the welfare of 
all children referred to their care, and ensure that children 
are placed with safe and appropriate sponsors. The Committee 
requests a briefing within 180 days of enactment on these 
reviews.
    Trusted Adult Relatives.--The Committee recognizes efforts 
to co-locate ORR staff at the border in designated locations to 
verify family relationships, screen out risks of trafficking, 
and otherwise conduct sponsor suitability determinations for 
children travelling with a close adult relative. This allows 
children, when it's determined to be appropriate, safe, and in 
the best interest of the child, to be quickly released to the 
care and custody of a close relative, avoiding unnecessary 
trauma from separation. This also has the potential to decrease 
ORR shelter capacity and funding needs, as such children would 
otherwise be in ORR care for a longer period of time, in some 
cases significantly longer. The Committee requests information 
be included in the fiscal year 2025 CJ on any such efforts.
    Youth Aging Out of ORR Care.--The Committee directs ORR to 
have developed a concrete post-18 plan for every 17-year-old 
unaccompanied child in ORR care at least 30 days in advance of 
their 18th birthday to ensure that an appropriate placement has 
been identified and arranged for the child, along with any 
necessary social support services, prior to discharge from ORR. 
The Committee directs ORR to ensure that it is complying with 
its obligation to protect children's private and confidential 
information in fulfilling its obligation to engage in post-18 
planning for children aging out of ORR care.

Victims of Torture

    The Committee recommendation includes $19,000,000 for the 
Victims of Torture program to provide support to non-profit 
organizations providing direct support to torture survivors and 
their families.

   PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2023....................................  $8,021,387,000
Budget estimate, 2024...................................   9,000,000,000
Committee recommendation................................   8,721,387,000

    The Committee recommends $8,721,387,000, an increase of 
$700,000,000 for the Child Care and Development Block Grant 
[CCDBG], a formula grant to States that provides financial 
assistance to families to help pay for child care, and 
otherwise improve the quality of child care programs.

                      SOCIAL SERVICES BLOCK GRANT

Appropriations, 2023....................................  $1,700,000,000
Budget estimate, 2024...................................   1,700,000,000
Committee recommendation................................   1,700,000,000

    The Committee recommends $1,700,000,000 for the Social 
Services Block Grant [SSBG], a flexible source of funding that 
allows States to provide a diverse array of services to low-
income children and families, the disabled, and the elderly in 
order to reduce poverty.
    The Committee continues to note that SSBG funding can be 
used for a wide-range of activities and encourages HHS to 
ensure that States are aware that funding can be used to 
support child support programs by providing job training and 
employment services for non-custodial parents.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2023.................................... $14,618,437,000
Budget estimate, 2024...................................  16,139,665,000
Committee recommendation................................  14,801,100,000

    The Committee recommends $14,801,100,000 for Children and 
Families Services programs. These funds support a variety of 
programs for children, youth, and families; Native Americans; 
survivors of child abuse, neglect, and domestic violence; and 
other vulnerable populations.

Head Start

    The Committee recommendation includes $12,271,820,000 for 
Head Start. Head Start provides grants directly to local 
organizations to provide comprehensive early childhood 
education services to children and their families, from before 
birth to age 5.
    Within the total, the Committee recommendation includes a 
$275,000,000 cost of living adjustment for all Head Start 
grantees to help keep up with rising costs, to recruit and 
retain highly qualified staff, and to continue to provide high-
quality services to children and families.
    American Indian and Alaska Native [AIAN] and Migrant and 
Seasonal Head Start [MSHS] Eligibility.--The Committee 
recognizes the efforts OHS has made to ensure AIAN and MSHS 
programs are aware of the flexibilities that exist for 
determining eligibility under these programs. Nevertheless, 
AIAN and MSHS programs continue to face difficulty enrolling 
families who are functionally very low income due to high costs 
and wage inflation in some parts of the country. To address 
this issue, the Committee includes bill language allowing 
flexibility for AIAN and MSHS providers to enroll families at 
their discretion.
    Designation Renewal System [DRS].--The Committee continues 
to encourage HHS to consider the unique challenges faced by 
Head Start grantees in remote and frontier areas when reviewing 
such grantees' compliance with health and dental screening 
requirements as part of the DRS.
    Facility Improvement Funding.--The Committee continues to 
strongly encourage ACF to ensure that all Head Start grantees 
are aware of any funding opportunities, or funding otherwise 
available, for making capital improvements to their facilities. 
Further, the Committee continues to encourage ACF to 
standardize this process so all grantees have equal opportunity 
to apply and are aware of priorities and eligible uses of such 
funds.
    Tribal Colleges and Universities-Head Start Partnership 
Program.--The Committee recommendation continues $8,000,000 for 
the Tribal Colleges and Universities-Head Start Partnership 
Program.

Preschool Development Grants

    The Committee recommendation includes $310,000,000 for 
Preschool Development Grants. This program, as authorized in 
the Every Student Succeeds Act (Public Law 114-95), provides 
competitive grants to States to improve the coordination, 
collaboration, and quality of existing early childhood 
programs; improve the transition from early childhood programs 
to kindergarten; implement evidence-based practices; improve 
professional development for early childhood providers; and 
generally improve educational opportunities for children.
    The Committee recommends ACF encourage States to consider 
how providing access to kindergarten preparedness services, 
including those that are innovative, technology-enabled for use 
in the home, and focused on parent engagement, could improve 
their birth through five systems.
    Duel Language Learners [DLL].--The Committee encourages ACF 
to support States that choose to develop high-quality and 
culturally competent dual immersion preschool programs through 
Preschool Development Grants. The Committee recommends a focus 
on training, professional development, and postsecondary 
education for all caregivers, teachers, and directors to meet 
the needs of DLLs through dual language acquisition, engaging 
culturally and linguistically diverse families, home language 
support, and culturally and linguistically appropriate 
assessment.

Consolidated Runaway and Homeless Youth Program

    The Committee recommendation includes $125,283,000 for the 
Consolidated Runaway and Homeless Youth program. This program 
supports the Basic Centers program, which provides temporary 
shelter, counseling, and after-care services to runaway and 
homeless youth under age 18 and their families; the 
Transitional Living Program, which provides longer-term shelter 
and services for older youth; and a national toll-free runaway 
and homeless youth crisis hotline.
    The Committee continues to support the ability of grantees 
to provide prevention services such as counseling and case 
management, regardless of their enrollment in residential 
services. The Committee urges ACF to advise grantees that they 
are not required to enroll youth in shelter or residential 
services, nor require the young person to physically travel to 
the grantee's location in order for an at-risk youth to receive 
prevention and supportive services.
    The Committee continues to encourage the program to notify 
applicants if grant applications are successful at least 30 
days before the grant begins or no less than 30 days before an 
existing grant is set to end.
    The Committee again strongly urges the program to ensure 
that service delivery and staff training comprehensively 
address the individual strengths and needs of youth, as well as 
language-appropriate, gender-appropriate interventions that are 
culturally sensitive and respectful of the complex social 
identities of youth. The Committee strongly believes that no 
runaway youth or homeless youth should be excluded from 
participation in, be denied the benefits of, or be subject to 
discrimination under, any program or activity funded in whole 
or in part under the Runaway and Homeless Youth Act, based on 
any of the conditions outlined in this paragraph.
    Child, Youth, and Family Homelessness.--The Committee is 
concerned about the impact of homelessness on the wellbeing and 
development of children, youth, and families, including the 
instability and overcrowding that accompany child, youth, and 
family homelessness. In light of this, the Committee urges ACF 
to assess the current state of child, youth, and family 
homelessness, including the strengths, barriers, and 
opportunities across ACF and HHS to provide two-generation 
services to end the cycle of homelessness. In particular, the 
Committee urges ACF to develop a plan to lead and coordinate 
efforts to provide holistic services to homeless children, 
youth, and families to break the cycle of homelessness, 
including by identifying existing resources and gaps. The 
Committee directs ACF to provide a report to Congress outlining 
progress on these efforts not later than 1 year after the date 
of enactment of this act.
    National Communications System, National Runaway 
Safeline.--The Committee remains concerned with the number of 
homeless children and youth and those at risk of homelessness 
and the ability of those youth and parents to access 
information that can help connect them with the needed 
services, resources, and support both at school and in the 
community. The Committee encourages ACF to coordinate with the 
Department of Education to increase outreach and raise 
awareness in school districts and community-based organizations 
of services and resources provided by the National Runaway 
Safeline.

Education and Prevention Grants to Reduce Sexual Abuse of Runaway Youth

    The Committee recommendation includes $21,000,000 for 
Education and Prevention Grants to Reduce Sexual Abuse of 
Runaway and Homeless Youth. This program provides competitive 
grants for street-based outreach and education services for 
runaway and homeless youth who are subjected to, or are at risk 
of being subjected to, sexual abuse or exploitation.

Child Abuse Prevention and Treatment State Grants

    The Committee recommendation includes $105,091,000 for the 
Child Abuse Prevention and Treatment State Grant program. This 
program provides formula grants to States to improve their 
child protective service systems.
    Infant Plans of Safe Care.--Within the total, the Committee 
recommendation includes $60,000,000 to help States continue to 
develop and implement plans of safe care as required by section 
106(b)(2)(B)(iii) of the Child Abuse Prevention and Treatment 
Act (Public Law 93-247). The Committee again urges HHS to 
support States in their implementation of the plans by 
providing specialized, non-punitive family support services for 
infants and their birth parents affected by substance use 
disorders to reduce the need for child welfare or foster care 
system involvement. The Committee continues to direct HHS to 
provide technical assistance to States on best-practices in 
this area to address the health, developmental, housing, and 
treatment needs of infants and their parents and to evaluate 
States' activities on plans of safe care. The Committee also 
encourages HHS to provide technical assistance to States on 
best practices for developing notification systems that are 
distinct and separate from the system used in the State to 
report child abuse and neglect in order to promote a public 
health response to infants affected by substance use disorders, 
and not for the purpose of initiating an investigation of child 
abuse or neglect. The Committee also encourages HHS to ensure 
such technical assistance includes an emphasis on the role of 
public health focused plans of safe care in reducing racial 
disproportionality in child protective services investigations 
and removals.

Child Abuse Discretionary Activities

    The Committee recommendation includes $36,000,000 for Child 
Abuse Discretionary Activities. This program supports 
discretionary grants for research, demonstration, and technical 
assistance to increase the knowledge base of evidence-based 
practices and to disseminate information to State and local 
child welfare programs.
    Child Abuse Hotline.--The Committee supports ongoing 
efforts to address and support youth and families impacted by 
child abuse and neglect. Within the total, the Committee 
includes $2,000,000 for broad, ongoing support for the existing 
national child abuse hotline in order to provide resources and 
intervention through multiple modalities, including chat, text, 
and call, to respond to the urgent needs of youth and concerned 
adults facing these challenges.

Community-based Child Abuse Prevention

    The Committee recommendation includes $70,660,000 for the 
Community-based Child Abuse Prevention program. This program 
provides formula grants to States that then disburse funds to 
local community-based organizations to improve local child 
abuse prevention and treatment efforts, including providing 
direct services and improving the coordination between State 
and community-based organizations.

Child Welfare Services

    The Committee recommendation includes $268,735,000 for 
Child Welfare Services. This formula grant program helps State 
and Tribal public welfare agencies improve their child welfare 
services with the goal of keeping families together. These 
funds help States and Tribes provide a continuum of services 
that prevent child neglect, abuse or exploitation; allow 
children to remain with their families, when appropriate; 
promote the safety and permanence of children in foster care 
and adoptive families; and provide training and professional 
development to the child welfare workforce.

Child Welfare Research, Training, and Demonstration

    The Committee recommendation includes $21,984,000 for child 
welfare research, training, and demonstration projects. This 
program provides grants to public and nonprofit organizations 
for demonstration projects that encourage experimental and 
promising types of child welfare services, as well as projects 
that improve education and training programs for child welfare 
service providers.
    Community Partnership Pilot Program.--The Committee urges 
ACF to carry out a community partnership pilot program to 
provide grants to non-profit organizations building 
partnerships between child welfare agencies and local community 
organizations, to leverage private dollars, goods, and human 
resources in the community to meet the needs of at-risk 
children and their families interacting with the child welfare 
system, which may include establishing the ability for child 
welfare agency employees to seek community support for the 
needs of children and families through an electronic portal.
    Emergency Relief for Foster Youth.--The Committee urges ACF 
to establish a demonstration program to provide emergency 
relief, including clothes and basic necessities, to youth 
entering the foster care system and improve pre-placement 
services offered by foster care stabilization agencies. 
Additionally, the Committee continues to be concerned by the 
high rates of homelessness among children who age-out of the 
foster care system. The Committee encourages HHS to support the 
development, implementation, and evaluation of innovative 
programs that effectively serve vulnerable populations of youth 
transitioning out of the foster care system.
    Strengthening State ICWA Compliance.--The Committee 
recognizes the important role State child welfare agencies play 
in ensuring the safety of Indian children who come into contact 
with the State child welfare system. The Committee appreciates 
the work of the Children's Bureau to support State compliance 
with the Indian Child Welfare Act [ICWA] through technical 
assistance and through grants to develop strong working 
relationships between States and tribes. The Committee provides 
$3,000,000 for State-Tribal partnership grants to build 
collaborations between States and tribes to better address the 
ongoing challenges Tribal communities face. Further, the 
Committee recommends ACF, in coordination with the relevant 
Federal agencies, develop guidance for States to better serve 
Indian children who come into contact with the child welfare 
system. This guidance may include best practices on the timely 
identification of Indian children and extended family members; 
timely notice to Tribes of State child custody proceedings; 
foster care or adoptive placements of Indian children; and case 
recordkeeping as it relates to transfers of jurisdiction, 
termination of parental rights, and insufficient active 
efforts, as defined by ICWA.

Adoption Opportunities

    The Committee recommends $51,000,000 for the Adoption 
Opportunities program. This program funds discretionary grants 
to help facilitate the elimination of barriers to adoption and 
provide technical assistance to help States increase the number 
of children adopted, particularly children with special needs.
    The Committee recognizes that adoption arrangements at risk 
of a disruption or dissolution that would result in a foster 
care placement are eligible for funding under the Family First 
Prevention Services Act. However, no programs expressly 
designed to meet the needs of these families have been approved 
by the Title IV-E Prevention Services Clearinghouse. The 
Committee directs not less than $2,000,000 for the evaluation 
of such programs that could qualify for funding under the 
Family First Prevention Services Act and aim to meet the 
evidence standards established by the Title IV-E Prevention 
Services Clearinghouse in accordance with the Family First 
Prevention Services Act. The Committee encourages ACF to 
prioritize the evaluation of programs with existing evidence 
and to support studies that can be completed as rapidly as 
possible while meeting the evidence standards of the Title IV-E 
Prevention Services Clearinghouse.
    The Committee recommendation includes $2,000,000 to 
continue the National Adoption Competency Mental Health 
Training Initiative. This initiative supports ongoing resources 
for a national organization with the capacity and expertise to 
continuously evaluate and update the training curriculums, and 
will provide all States, tribes, and territories the necessary 
technical assistance to ensure that the curriculums are 
appropriately used by State child welfare and mental health 
professionals. This funding should also be used to initiate the 
development of derivative trainings for courts and continuing 
medical education for medical professionals to ensure 
consistency across disciplines. The Committee again recommends 
the agency take steps to standardize the National Adoption 
Competency Mental Health Training Initiative's curriculum to 
provide consistent training in all State child welfare 
agencies.

Adoption and Legal Guardianship Incentive Payments

    The Committee recommends $70,000,000 for the Adoption and 
Legal Guardianship Incentive Payments program. This program 
provides formula-based incentive payments to States to 
encourage them to increase the number of adoptions of children 
from the foster care system, with an emphasis on children who 
are the hardest to place.

Social Services Research and Demonstration

    The Committee recommends $70,523,000 for Social Services 
Research and Demonstration. These funds support research and 
evaluation of cost-effective programs that increase the 
stability and economic independence of families and contribute 
to the healthy development of children and youth.
    Benefits Programs.--The Committee recommends the creation 
of a pilot program to align Federal assistance programs for 
low-income Americans into one application. The result of these 
improvements should expand access and enrollment in Federal, 
State, Tribal, and local benefits, such as SNAP, WIC, Medicaid, 
TANF, and the Housing Choice Voucher program, and improve 
coordination of critical services such as mental healthcare and 
childcare.
    Congressionally Directed Spending.--Within the funds 
included in this account, $40,011,000 shall be for the 
Congressionally Directed Spending projects, and in the amounts, 
as specified in the table titled ``Congressionally Directed 
Spending Items'' at the end of this Committee Report.
    Diaper Distribution Grant Demonstration.--The Committee 
recommendation continues $20,000,000 for the purposes of 
carrying out a diaper distribution grant program. The diaper 
distribution program will provide grants to social service 
agencies or other non-profit organizations specifically for 
diaper and diapering supply needs.
    Preventing Youth Homelessness.--The Committee includes 
$3,000,000 for a demonstration program to identify and 
implement strategies and services for youth between ages 12 and 
26 in order to prevent homelessness, including strategies 
designed to serve youth and young adult populations with a high 
likelihood of imminently experiencing homelessness, housing 
instability, or other forms of victimization such as human 
trafficking to include individuals transitioning out of foster 
care, the juvenile justice system, or a residential behavioral 
health system. Funds shall be made available to State agencies, 
tribes, counties, cities, or other unit of local government for 
demonstration grants to provide primary prevention services for 
youth at risk of homelessness and implement or improve cross-
system collaboration with key partners within the community 
that serve youth at risk of homelessness. Grantees shall show 
collaboration with youth with lived expertise in project design 
and implementation, including establishment of local youth 
advisory boards. The Committee requests a briefing 1 year after 
award of such grants on the initial findings of this 
demonstration program. Further, the Committee notes that this 
demonstration program is in addition to other, ongoing Family 
and Youth Services Bureau initiatives.

Native American Programs

    The Committee recommends $60,500,000 for Native American 
programs. These funds support a variety of programs to promote 
self-sufficiency and cultural preservation activities among 
Native American, Native Hawaiian, Alaska Native, and Pacific 
Islander organizations and communities.
    Native American Language Preservation.--Within the total, 
the Committee recommendation includes $15,000,000 for Native 
American language preservation activities, including no less 
than $6,000,000 for Native American language immersion 
programs, as authorized by section 803C(b)(7)(A)-(B) of the 
Native American Programs Act (Public Law 88-452).

Community Services Block Grant

    The Committee recommendation includes $765,000,000, for the 
Community Services Block Grant [CSBG]. CSBG is a formula grant 
to States and Indian tribes to provide a wide-range of services 
to alleviate causes of poverty in communities and to assist 
low-income individuals. States are required to pass on at least 
90 percent of these funds to local community-based 
organizations, the vast majority of which are community action 
agencies.

Community Economic Development

    The Committee recommendation includes $22,383,000 for the 
Community Economic Development program. Community Economic 
Development grants fund non-profit, Community Development 
Corporations that help communities address the needs of low-
income individuals and families by creating employment and 
business development opportunities.

Rural Community Facilities

    The Committee recommendation includes $12,000,000 for the 
Rural Community Facilities program. The Rural Community 
Facilities program provides grants to regional non-profit 
organizations to provide technical assistance to small, low-
income rural communities, that are not served by other similar 
Federal programs, to help manage, develop, and improve safe 
drinking and waste water facilities.

National Domestic Violence Hotline

    The Committee recommendation includes $20,500,000 for the 
National Domestic Violence Hotline. This national, toll-free 
hotline provides critical emergency assistance and information 
to victims of domestic violence 24 hours a day.
    The Committee recommendation includes continued support for 
the StrongHearts Native Helpline, which provides critical 
support and resources to meet the unique legal and cultural 
needs of American Indians and Alaska Natives affected by 
domestic violence.

Family Violence Prevention and Services

    The Committee recommendation includes $235,000,000 for 
Family Violence Prevention and Services programs. These funds 
support programs to prevent family violence and provide 
immediate shelter and related assistance for survivors of 
domestic violence and their dependents.
    Culturally Specific Services for Domestic Violence.--The 
Committee understands that women and girls of color are often 
disproportionally impacted by domestic violence and sexual 
assault yet often lack access to family violence prevention 
services in their communities that incorporate or reflect their 
specific needs. In order to foster programming for this 
community, the Committee continues $7,500,000 for culturally 
specific, community-based organizations to provide culturally 
specific services for survivors of domestic violence.
    Native Hawaiian Resource Center on Domestic Violence.--The 
Committee includes $2,000,000 for the Native Hawaiian Resource 
Center on Domestic Violence. This Resource Center will continue 
to build capacity to engage Native Hawaiian communities in 
developing local responses to domestic violence and support 
critical networking and coalition building between Native 
Hawaiian advocates across the State and the Nation.

Chafee Education and Training Vouchers

    The Committee recommendation includes $43,257,000 for the 
Chafee Education and Training Voucher program. This program 
supports vouchers to foster care youth to help pay for expenses 
related to postsecondary education and vocational training.

Disaster Human Services Case Management

    The Committee recommends $1,864,000 for Disaster Human 
Services Case Management. This program assists States in 
establishing the capacity to provide case management services 
in a timely manner in the event of a disaster. It ensures that 
States are able to meet social service needs during disasters 
by helping disaster victims prepare recovery plans, referring 
them to service providers and Federal Emergency Management 
Agency contacts to identify needed assistance, and providing 
ongoing support and monitoring through the recovery process.

Program Administration

    The Committee recommendation includes $218,500,000 for the 
Federal costs of administering ACF programs.

                   PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2023....................................    $431,515,000
Budget estimate, 2024...................................     451,000,000
Committee recommendation................................     417,515,000

    The Committee recommends $417,515,000 for the Promoting 
Safe and Stable Families program. The Committee recommendation 
includes $345,000,000 in mandatory funds authorized by the 
Social Security Act (Public Law 74-271) and $72,515,000 in 
discretionary appropriations.
    This program enables States to operate coordinated programs 
of family preservation services, time-limited family 
reunification services, community-based family support 
services, and adoption promotion and support services.
    Family First Clearinghouse.--The Committee includes 
$2,750,000 for the Family First Clearinghouse. The Committee 
continues to recognize the need to support research into 
programs that provide rigorous evaluations of established 
foster care prevention and family support programs within the 
child welfare population, including programs that support 
adoption arrangements at risk of a disruption or dissolution 
that would result in foster care placement, provide mental 
health prevention and treatment services, substance abuse 
prevention and treatment services, in-home parent skill-based 
programs, and kinship navigator programs.
    Kinship Navigator Programs.--The Committee recommendation 
includes $10,000,000 for Kinship Navigator Programs to improve 
services for grandparents and other relatives taking primary 
responsibility for children, particularly children and families 
affected by opioid addiction and substance use disorder. The 
Committee encourages HHS to encourage States to collaborate 
with agencies with experience serving kinship families both 
inside and outside foster care, and to demonstrate how they are 
preparing their navigator programs to meet evidence-based 
kinship navigator standards included in the Family First 
Prevention Services Act (Public Law 115-123).

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2023....................................  $7,606,000,000
Budget estimate, 2024...................................   8,594,000,000
Committee recommendation................................   8,594,000,000

    The Committee recommends $8,594,000,000 in mandatory funds 
for Payments for Foster Care and Permanency. In addition, the 
Committee recommends $3,400,000,000 in advance mandatory 
funding for the first quarter of fiscal year 2025. These funds 
support programs that assist States with the costs of 
maintaining eligible children in foster care, prepare children 
for living on their own, assist relatives with legal 
guardianship of eligible children, and find and support 
adoptive homes for children with special needs.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2023....................................  $2,565,487,000
Budget estimate, 2024...................................   3,055,322,000
Committee recommendation................................   2,524,592,000

    The Committee recommends $2,524,592,000 for the 
Administration for Community Living [ACL], which includes 
$27,700,000 to be transferred to ACL from the PPH Fund.
    ACL was created with the goal of increasing access to 
community support for older Americans and people with 
disabilities. It is charged with administering programs 
authorized under the Older Americans Act [OAA] (Public Law 116-
131) and the Developmental Disabilities Act (Public Law 106-
402), as well as promoting community living policies throughout 
the Federal Government for older Americans and people with 
disabilities. The Committee continues to fund the Senior 
Medicare Patrol Program through the Health Care Fraud and Abuse 
Control Account.

Home- and Community-Based Supportive Services

    The Committee recommends $410,000,000 for the Home and 
Community Based Supportive Services program. This program 
provides formula grants to States and territories to fund a 
wide-range of social services that enable seniors to remain 
independent and in their homes for as long as possible. State 
agencies on aging award funds to designated area agencies on 
aging that, in turn, make awards to local service providers. 
This activity supports services such as transportation, adult 
day care, physical fitness programs, and in-home assistance.
    Senior Centers.--Senior centers play an important role in 
providing programs to combat isolation and loneliness, which 
can be risk factors for depression, substance use disorder and 
even suicide. The Committee encourages ACL and the State and 
local agencies administering programs funded through the Older 
Americans Act to provide ample funding to senior centers to 
support their general operations and for programming that 
promotes the health and well-being of seniors, including 
fitness and falls prevention programs, nutrition classes and 
consultation, and foot clinics.

Preventive Health Services

    The Committee recommends $26,339,000 for Preventive Health 
Services. This program funds activities such as medication 
management and enhanced fitness and wellness programs. These 
programs help seniors stay healthy and avoid chronic disease, 
thus reducing the need for costly medical interventions. The 
Committee maintains bill language that requires States to use 
these funds to support evidence-based models that enhance the 
wellness of seniors.

Protection of Vulnerable Older Americans

    The Committee recommends $26,658,000 for grants to States 
for the Long-term Care Ombudsman program and 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 other long-term care facilities, 
while the elder abuse prevention program targets the elderly 
community at large.

National Family Caregiver Support Program

    The Committee recommends $210,000,000 for the National 
Family Caregiver Support program. Funds appropriated for this 
activity establish a multifaceted support system in each State 
for family caregivers, allowing them to care for their loved 
ones at home for as long as possible. States may use funding to 
provide information to caregivers about available services, 
assistance to caregivers in gaining access to services, 
caregiver counseling and training, respite care to enable 
caregivers to be temporarily relieved from their caregiving 
responsibilities, and limited supplemental services that fill 
remaining service gaps.
    National Family Caregiver Strategy.--The Committee notes 
the publication of the 2022 National Strategy to Support Family 
Caregivers [National Strategy], as required by the RAISE Family 
Caregivers Act. The National Strategy includes nearly 350 
commitments from over a dozen Federal agencies for actions to 
support family caregivers. It also includes more than 150 
recommended actions for State and local governments and the 
private sector to begin to build a system that ensures family 
caregivers have the resources they need to maintain their own 
health, well-being, and financial security while providing 
crucial support for those in their care. The Committee includes 
$5,000,000 to support demonstration grants that develop, test, 
and scale models that implement commitments and recommended 
actions from the National Strategy. The Committee directs ACL 
to provide a briefing for the Committee on Appropriations no 
later than 180 days after enactment of this act with an update 
on the implementation of this effort.
    Direct Care Worker Shortage.--The Committee notes worker 
shortages occurring in parts of the direct care sector, such as 
aging care and disability care. The Committee notes that such 
shortages may be driven by a host of factors, including wages, 
established workplace benefits and protections, increased 
prevalence of workplace violence, and competition from other 
employment sectors. These factors can make it difficult to 
recruit and retain qualified workers. The Committee is further 
concerned with the potential effects of worker shortages on 
increasing healthcare costs, such as emergency room visits and 
re-hospitalizations, as well as the costs to employers that 
need to hire and train new workers. Expanding access to 
quality, long-term care will become more urgent as the U.S. 
population of adults who are 65 and older will grow 
substantially in the coming decades.
    The Committee notes ACL's recent launch of the Direct Care 
Workforce [DCW] Capacity Building Center, which will serve as a 
hub to improve home and community-based services and enhance 
the direct care workforce. DCW will disseminate best practices 
for agency-based and consumer-directed care arrangements, as 
well as provide tools, resources, and training to assist state 
systems, service providers, and other key stakeholders to 
strengthen the direct care workforce. The Committee directs 
ACL, in coordination with DOL and CMS, to examine data on the 
potential impacts of worker shortages on long-term care 
affordability and accessibility. The agencies shall submit a 
report analyzing the above-mentioned data to the Committees on 
Appropriations not later than 120 days after enactment of this 
act.

Native American Caregiver Support Program

    The Committee recommends $12,000,000 to carry out the 
Native American Caregiver Support program. This program 
provides grants to Tribes for the support of American Indian, 
Alaskan Native, and Native Hawaiian families caring for older 
relatives with chronic illness or disability, as well as for 
grandparents caring for grandchildren.

Congregate and Home-Delivered Nutrition Services

    The Committee recommends $565,342,000 for congregate 
nutrition services and $381,342,000 for home-delivered meals. 
These programs address the nutritional needs of older 
individuals, thus helping them to stay healthy and reduce their 
risk of disability. Funded projects must make home-delivered 
and congregate meals available at least once per day, 5 days a 
week, and each meal must meet a minimum of one-third of daily 
dietary requirements. While States receive separate allotments 
of funds for congregate meals, home-delivered meals, and 
supportive services, they have flexibility to transfer funds 
between these programs.
    Nutrition Services Incentives Program [NSIP].--The 
Committee recommends $112,000,000 for NSIP, consistent with the 
budget request level. ACL expects that the reduction will be 
offset by State and private funding, as well as the Committee's 
recommended increases for the two primary nutrition programs. 
NSIP augments funding for congregate and home-delivered meals 
provided to older adults. States and Tribes may choose to 
receive all or part of their funding in the form of commodities 
from the U.S. Department of Agriculture.

Aging Grants to Indian Tribes and Native Hawaiian Organizations

    The Committee recommends $38,264,000 for grants to Native 
Americans. This program provides grants to eligible Tribal 
organizations for the delivery of nutrition and supportive 
services to Native Americans.

Aging Network Support Activities

    The Committee recommends $30,461,000 for Aging Network 
Support activities. These funds support activities that 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, and provide technical assistance to agencies that 
administer programs authorized by the OAA.
    Holocaust Survivor Assistance.--The Committee provides 
$8,500,000 for the Holocaust Survivor Assistance program, which 
provides supportive services for aging Holocaust survivors and 
their families, and to other older adult populations that have 
been exposed to and impacted by traumatic events, including 
aging military veterans, first responders, victims of childhood 
and domestic violence, and survivors of man-made or natural 
disasters.

Alzheimer's Disease Program

    The Committee recommends $16,800,000, including $14,700,000 
to be transferred from the PPH Fund, for the Alzheimer's 
Disease Program which includes Demonstration Grants to States 
and the Alzheimer's Disease Initiative. Within this funding, 
the Committee supports the continuation of the National 
Alzheimer's Call Center, which is available in all States, 24 
hours a day, 7 days a week, year-round, to provide expert 
advice, crisis counseling, care consultation and information 
referral services in at least 140 languages, for persons with 
Alzheimer's disease, their family members and informal 
caregivers. The Committee recommends no less than $2,000,000 to 
continue the National Alzheimer's Call Center.

Lifespan Respite Care

    The Committee recommends $11,500,000, an increase of 
$1,500,000, for the Lifespan Respite Care program. The Lifespan 
Respite Care program provides grants to States to expand 
respite care services to family caregivers, improve the local 
coordination of respite care resources, and improve access to 
and quality of respite care services, thereby reducing family 
caregiver strain.

Chronic Disease Self-Management Program

    The Committee recommends $8,000,000 to be transferred from 
the PPH Fund to ACL for the Chronic Disease Self-Management 
Program [CDSMP]. This program assists those with chronic 
disease with education to manage their conditions and improve 
their health status. Topics covered by the program include 
nutrition; appropriate use of medications; fitness; and 
effective communications with healthcare providers. Multiple 
studies have shown CDSMP to result in significant and 
measurable improvements in health and quality of life, as well 
as reductions in hospitalizations and emergency room visits.

Elder Falls Prevention

    The Committee recommends $7,500,000, including $5,000,000 
to be transferred from the PPH Fund, for Elder Falls Prevention 
activities at ACL. Preventing falls will help seniors stay 
independent and in their homes and avoid costly 
hospitalizations and hip fractures, which frequently lead to 
nursing home placement.

Elder Rights Support Activities

    The Committee recommends $33,874,000 for Elder Rights 
Support activities, which support programs that provide 
information, training, and technical assistance to legal and 
aging services organizations in order to prevent and detect 
elder abuse and neglect.

Aging and Disability Resource Centers

    The Committee recommendation includes $8,619,000 for Aging 
and Disability Resource Centers. These centers provide 
information, one-on-one counseling, and access for individuals 
to learn about their long-term services and support options 
with the goal of allowing seniors and individuals with 
disabilities to maintain their independence.

State Health Insurance Assistance Program

    The Committee recommends $55,242,000 for State Health 
Insurance Assistance Programs, which provide accurate and 
understandable health insurance information to Medicare 
beneficiaries and their families.

Paralysis Resource Center

    The Committee recommends $10,700,000 for the Paralysis 
Resource Center [PRC]. This program has long provided 
essential, comprehensive information, and referral services 
that promote independence and quality of life for the over five 
million people living with paralysis and their families. The 
Committee directs ACL to support the National PRC at not less 
than $10,000,000.

Limb Loss

    The Committee recommends $4,200,000 for the Limb Loss 
program, which supports programs and activities to improve the 
health of people with limb loss and promote their well-being, 
quality of life, prevent disease, and provide support to their 
families and caregivers. Maintaining these programs is critical 
to support independent living within the disability community 
across their life course.

Traumatic Brain Injury

    The Committee recommends $13,118,000 for the Traumatic 
Brain Injury program. The program supports implementation and 
planning grants to States for coordination and improvement of 
services to individuals and families with traumatic brain 
injuries. Such services can include pre-hospital care, 
emergency department care, hospital care, rehabilitation, 
transitional services, education, employment, long-term 
support, and protection and advocacy services.

Developmental Disabilities State Councils

    The Committee recommends $81,000,000 for State councils on 
developmental disabilities. These councils work to develop, 
improve, and expand the system of services and supports for 
people with developmental disabilities at the State and local 
level. Councils engage in activities such as training, 
educating the public, building capacity, and advocating for 
change in State policies with the goal of furthering the 
inclusion and integration of individuals with developmental 
disabilities in all aspects of community life.
    Technical Assistance.--The Committee recommends that ACL to 
provide not less than $800,000 for technical assistance and 
training for the State Councils on Developmental Disabilities. 
In addition, the Committee encourages ACL to consult with 
Developmental Disabilities Assistance and Bill of Rights Act 
[DD Act] stakeholders prior to announcing opportunities for new 
technical assistance projects and to notify the Committee prior 
to releasing new funding opportunity announcements, grants, or 
contract awards with technical assistance funding.

Developmental Disabilities Protection and Advocacy

    The Committee recommends $45,000,000 for protection and 
advocacy programs for people with developmental disabilities. 
This formula grant program provides funds to States to 
establish and maintain protection and advocacy systems that 
protect the legal and human rights of persons with 
developmental disabilities who are receiving treatment, 
services, or rehabilitation.
    Proper Settings of Care.--The Committee encourages ACL 
consider the needs and desires of patients, families, 
caregivers, legal representatives, and other stakeholders, as 
well as the need to provide proper settings for care, in its 
enforcement of the DD Act.

Voting Access for Individuals with Disabilities

    The Committee recommends $10,000,000 to improve voting 
access for individuals with disabilities. This program provides 
grants to protection and advocacy organizations to ensure that 
individuals with disabilities have the opportunity to 
participate in every step of the electoral process, including 
registering to vote, accessing polling places, and casting a 
vote.

Developmental Disabilities Projects of National Significance

    The Committee recommends $12,250,000 for projects of 
national significance to assist persons with developmental 
disabilities. This program funds grants and contracts that 
develop new technologies and demonstrate innovative methods to 
support the independence, productivity, and integration into 
the community of persons with developmental disabilities.

University Centers for Excellence in Developmental Disabilities

    The Committee recommends $43,119,000 for the University 
Centers for Excellence in Developmental Disabilities [UCEDDs] 
to continue to meet their obligations under the DD Act. UCEDDs 
provide training, technical assistance, service, research, and 
information dissemination to people with disabilities, their 
families, State and local government agencies, and providers, 
to build the capacity of communities and create improvements in 
the service delivery system for people with I/DD and other 
disabilities, including those from underrepresented 
populations. The funding also will support technical assistance 
to strengthen and support the National network of UCEDDs as 
they disseminate research, training, and practices nationwide.

Independent Living

    The Committee recommends $128,183,000 for the Independent 
Living Program, which helps ensure that individuals with 
disabilities can live productive and independent lives in 
society. Funding helps States sustain, improve, and expand 
independent living services and establish and support a network 
of centers for independent living.

National Institute on Disability, Independent Living, and 
        Rehabilitation Research [NIDILRR]

    The Committee recommends $119,000,000 for the NIDILRR, 
which supports research and activities that help to maximize 
the full potential of individuals with disabilities in 
employment, independent living, and social activities. NIDILRR 
is the only government entity charged to focus on the whole 
person with a disability and their ability to function 
independently and maintain a high quality of life among all 
personal, societal and environmental factors. The 
recommendation continues funding to support the Traumatic Brain 
Injury Model Systems National Data and Statistical Center 
[NDSC].

Assistive Technology

    The Committee recommends $40,000,000 for Assistive 
Technology [AT]. AT provides States with funding to support 
individuals with disabilities of all ages to obtain devices and 
services that will increase, maintain, or improve their 
functional capabilities. With the reauthorization of the 21st 
Century Assistive Technology Act last Congress, the Committee 
supports implementation to meet the increased demand for access 
to assistive technology for people with disabilities and older 
adults. In doing so, the Committee eliminates the alternative 
financing program that duplicates resources already available 
under the 21st Century Assistive Technology Act.

Program Administration

    The Committee recommends $47,813,000 for program 
administration at ACL. These funds support salaries and related 
expenses for program management and oversight activities.
    Congressionally Directed Spending.--The Committee includes 
$29,268,000 for aging and disability services projects, as 
specified in the explanatory statement accompanying this act.

         Administration for Strategic Preparedness and Response

    The Committee recommends $3,673,677,000 for the 
Administration for Strategic Preparedness and Response [ASPR]. 
This appropriation supports the activities of ASPR and other 
components within the Office of the Secretary to prepare for 
the health consequences of bioterrorism and other public health 
emergencies, including pandemic influenza.
    Department of Defense Coordination.--The Committee 
understands the critical role of the Department of Defense 
[DoD] in the larger U.S. Government and private sector efforts 
to address chemical, biological, radiological, and nuclear 
[CBRN] threats as well as emerging infectious diseases. The DoD 
possesses unique capabilities that contribute to interagency 
efforts to prevent, detect, and respond to outbreaks of 
infectious disease worldwide. The Committee encourages 
prioritizing and aligning investments in medical 
countermeasures among all Federal stakeholders to ensure that 
effective countermeasures are developed to meet both military 
and civilian needs, and to prevent potential duplication of 
efforts. The Committee urges ASPR and DoD to coordinate to 
leverage private industry expertise to meet these needs.
    Public Health Emergency Medical Countermeasures Enterprise 
[PHEMCE].--The Committee recognizes the importance of the 
PHEMCE in ensuring the Nation's preparedness for CBRN and 
emerging infectious disease threats. The Committee directs ASPR 
to continue to partner with PHEMCE interagency partners in the 
execution of those functions. The Committee further directs 
ASPR, working with PHEMCE and intelligence community partners, 
to provide an annual classified threat briefing to the 
Committee, and as situations arise that may materially impact 
our medical countermeasure enterprise. Finally, in accordance 
with the recommendations outlined in the National Academies of 
Sciences, Engineering and Medicine November 2021 report, 
Ensuring an Effective PHEMCE, the Committee encourages ASPR to 
create an advisory committee to the PHEMCE of rotating private 
sector and non-Federal partners and stakeholders. To the extent 
practicable, PHEMCE's strategic planning and decision-making 
around stockpile needs, requirements, and interactions with 
other government agencies and the communication of such 
decisions should be made in concert with the advisory committee 
considering the inputs from private partners. ASPR is directed 
to report to the Committee within 120 days of enactment to 
provide an update on these activities.
    Reporting.--The Committee directs ASPR to brief the 
Committees on Appropriations monthly regarding activities 
funded by this act and other available appropriations. The 
agency shall notify the Committee at least 24 hours in advance 
of any obligation greater than $25,000,000 from any 
appropriation available to ASPR. Such notification shall 
include the source of funding, including the applicable 
legislative citation, and a description of the obligation. In 
addition, ASPR shall submit a monthly obligation report in 
electronic format summarizing the details of these obligations 
to the Committees on Appropriations. Such report shall be due 
not later than 30 days after the end of each month and shall be 
cumulative for the fiscal year with the most recent obligations 
listed at the top. Furthermore, the Secretary shall include in 
this monthly report the current inventory of COVID-19 vaccines 
and therapeutics, as well as the deployment of these vaccines 
and therapeutics during the previous month as reported by 
States and other jurisdictions until the inventory is expended.

                 RESEARCH, DEVELOPMENT, AND PROCUREMENT

Appropriations, 2023....................................  $3,062,991,000
Budget estimate, 2024...................................   3,215,123,000
Committee recommendation................................   3,056,991,000

    The Committee recommends $3,056,991,000 for ASPR's 
Research, Development, and Procurement activities. This 
appropriation supports the advanced research, development, 
regulatory approval, and procurement of life-saving medical 
products--drugs, vaccines, therapeutics, diagnostics, and 
medical devices--that are collectively known as medical 
countermeasures [MCMs]. These MCMs serve as life-saving 
technologies during public health emergencies involving CBRN 
threats and other emerging threats, while advancing the day-to-
day public health and medical capabilities. In addition to 
developing these products, this appropriation also supports 
ensuring certain qualifying MCMs and medical supplies are 
stockpiled to be ready to deploy when needed.

Biomedical Advanced Research and Development Authority [BARDA]

    The Committee recommendation includes $970,000,000, an 
increase of $20,000,000, for BARDA. BARDA supports the advanced 
development of vaccines, therapeutics, diagnostics and devices 
for potential serious public health threats, including 
chemical, biological, radiological, and nuclear threats, 
pandemic influenza, and emerging and re-emerging infectious 
diseases. BARDA played a critical role in the COVID-19 and Mpox 
outbreak responses, and swiftly acted in response to recent 
Marburg, Sudan, and Ebola Zaire outbreaks. The Committee 
encourages BARDA to expand its portfolio of partnerships for 
broader success.
    Antimicrobial Resistance [AMR].--The Committee continues to 
support advanced research and development of broad-spectrum 
antimicrobials, particularly for multi-drug resistant 
pathogens, and next-generation therapeutics that address the 
increasing incidence of antimicrobial resistance.
    Blood Supply.--The Committee remains concerned about the 
vulnerability of the blood supply after the peak COVID 
shortages and the HHS Advisory Committee on Blood and Tissue 
Safety and Availability report indicating that the blood supply 
faces significant threats and challenges. The Committee 
supports the report's recommendation to implement new 
technologies to improve the safety and reliability of the blood 
supply. The BARDA strategic objective to develop next 
generation blood products must go beyond treatment of radiation 
injuries and be expanded to include products that can be used 
regardless of the patient's blood group, expand availability to 
all hospitals, prevent shortages, and be suitable for use 
throughout the continuum of care including first responders. 
Suitable products that are in clinical trials should be 
considered a priority for funding. The Committee urges BARDA to 
rapidly expand the development of freeze-dried hemostatic 
products, especially platelet-derived products, to include a 
wide range of indications encompassing treatment of hemorrhagic 
disease, use in general surgery, obstetrics, and trauma. The 
Committee encourages the Secretary to consider a pilot project 
to expand manufacturing capacity such that a national inventory 
adequate to provide a national response capability can be 
established.
    CBRN Threats.--The Committee notes with concern the 
elevated risks posed by CBRN weapons across the globe and 
provides robust funding for BARDA's core national security 
mission to protect Americans against these deliberate, man-made 
or naturally occurring threats. The Committee urges ASPR to 
prioritize the development and stockpiling of critical CBRN 
vaccines, treatments, and diagnostics to ensure there is no 
disruption in the availability of these life-saving MCMs in the 
Strategic National Stockpile [SNS]. The Committee encourages 
ASPR to engage more frequently with private sector partners to 
speed the development of new MCMs and stockpiling of existing 
MCMs against CBRN threats.
    Infectious Diseases.--The Committee supports robust funding 
for BARDA's naturally occurring infectious disease programs, 
including emerging infectious diseases, AMR, and pandemic 
influenza. The Committee encourages BARDA to account for low-
resource settings and vulnerable populations, such as children 
and neonates, in its funding decisions to produce tools that 
have wide applicability for many geographies in the United 
States and globally that lack advanced health infrastructure. 
The Committee encourages ASPR to project it's spending on 
emerging infectious diseases, pandemic influenza, and AMR in 
its annual 5-year budget plan. The Committee requests that 
BARDA continue publicly updating its research portfolios and to 
include pathogen, product, phase, and funding data for all its 
programs, and to provide the underlying data in tabular form.
    Infectious Disease Outbreaks with Pandemic Potential.--The 
Committee supports robust funding for BARDA to support advanced 
research and development of innovative platform technologies 
and medical countermeasures focused on (but not limited to) 
vaccines, therapeutics, diagnostics, and other MCMs for 
emerging infectious diseases, including novel pathogens and 
priority viral families with pandemic potential. The Committee 
encourages ASPR to collaborate with the heads of other 
appropriate Federal departments, agencies, and offices as well 
as the private sector and other stakeholders to identify 
promising MCMs and platform technologies that can be leveraged. 
The Committee directs BARDA to prioritize expeditious 
development of such MCMs and innovative platform technologies. 
The Committee directs BARDA to allocate no less than 
$10,000,000 in fiscal year 2024 to create a Disease X Medical 
Countermeasure Program at BARDA for expeditious development of 
MCMs against priority viral families, including those effective 
against novel pandemic pathogens. The Committee requests a 
briefing within 90 days of enactment to provide an update on 
such efforts.
    Valley Fever.--The Committee is concerned by projections of 
the growing geographic spread of coccidioidomycosis, commonly 
known as Valley fever, throughout the western United States. 
The Committee is encouraged by recent progress toward a canine 
vaccine to prevent Valley fever and urges close collaboration 
between NIAID and BARDA to identify, facilitate, and engage in 
translational research and opportunities for public-private 
partnerships to advance a Valley fever vaccine for humans.

Project Bioshield Special Reserve Fund

    The Committee recommendation includes $820,000,000 for 
Project Bioshield. The Committee is committed to ensuring the 
Nation is adequately prepared against chemical, biological, 
radiological, and nuclear attacks. These funds support the 
acquisition of promising MCMs developed through BARDA contracts 
for the most serious public health threats.

Strategic National Stockpile

    The Committee includes $965,000,000, for the Strategic 
National Stockpile [SNS].
    Acute Radiation Syndrome [ARS].--The Committee notes ASPR 
has the responsibility of developing and procuring MCMs for 
naturally occurring and intentional threat agents while 
ensuring that these are quickly available in the event of an 
emergency, and that these threats include nuclear and 
radiological events. The Committee is concerned, however, that 
ASPR/SNS has only been able to meet 55 percent of their 
requirement to protect Americans from ARS. Considering the 
risks associated with international supply chains and recent 
geopolitical developments, the Committee urges ASPR/SNS to 
enter into agreements that will allow them to achieve the 
requirements for FDA-approved MCMs for ARS that reflect the 
expected conditions for their deployment and use. The Committee 
requests a report within 30 days of enactment that includes an 
update on ASPR's plans to ensure existing ARS products are 
maintained and secure the continued availability of a diverse 
set of domestically manufactured ARS countermeasures that will 
be effective under expected conditions of deployment and use.
    Improving Testing Protocols for Auto-Injectors.--The 
Committee is concerned shelf-life extension protocols for auto-
injector delivered drugs in the SNS only verify the life-cycle 
of the active pharmaceutical ingredients inside the auto-
injector, but there is no protocol to verify the mechanical and 
functional efficacy of the auto-injector's delivery device. The 
Committee requests a report within 120 days of enactment on the 
agency's plans, in coordination with FDA, to commence routine 
testing of auto-injector mechanisms for continued viability, 
along with active pharmaceutical viability.
    Made in America Strategic National Stockpile.--The 
Committee is concerned about the Nation's limited 
infrastructure to produce essential products such as medical 
devices, medical equipment, pharmaceuticals, and Personal 
Protective Equipment [PPE]. The Committee strongly urges ASPR 
to develop a long-term sustainable procurement plan that gives 
preference to and results in purchases directly from domestic 
manufacturers to the maximum extent practicable.
    Nerve Agent Countermeasures.--The Committee is concerned 
the Nation is not sufficiently prepared for the threats posed 
by chemical weapons and nerve agents, particularly threats to 
the American public. Anti-convulsant medicines provide a key 
means of treatment, yet the SNS currently stockpiles only 
diazepam auto-injectors, all of which received previous shelf-
life extensions that are set to expire in October 2023. The 
Committee is concerned the existing anti-convulsants will soon 
expire and no plan is in place to resupply the stockpile. The 
Committee directs ASPR to provide a report within 45 days of 
enactment on the agency's plans to begin the replacement of 
expiring diazepam auto-injectors with FDA approved anti-
convulsant medicines.
    Poxvirus Vaccine.--The Committee commends ASPR for their 
role in the successful campaign to stop the 2022 Mpox outbreak 
by deploying MCMs that were previously developed, purchased and 
stockpiled for smallpox preparedness. The Committee is 
concerned however that there may now be an insufficient supply 
of poxvirus vaccine for immunocompromised individuals in the 
stockpile, especially in light of the continued national 
security threat of an intentional or accidental release of 
smallpox. The Committee requests ASPR prioritize replenishment 
of medical countermeasures used during the Mpox outbreak and 
requests a briefing within 60 days of enactment on the 
stockpiling requirements for poxvirus vaccine as determined by 
the PHEMCE.
    Replenishing Influenza Antivirals.--The Committee remains 
concerned about the perennial threat of pandemic influenza. In 
addition to vaccines, antivirals are a critical medical 
countermeasure. The Committee supports the Department's multi-
year strategic initiative to supplement shelf-life extended flu 
antivirals in the stockpile with therapeutics that have not 
undergone extensions, in order to meet the full requirements. 
ASPR is encouraged to prioritize acquiring influenza antivirals 
to the full requirements that can be safely used during 
pregnancy and in children under 5. The Committee also strongly 
urges HHS to diversify and replenish its stockpile of emergency 
influenza antivirals to ensure the Nation has multiple current 
treatment options in the event of an influenza pandemic.
    Shelf-life Extension Program.--The Joint Explanatory 
Statement accompanying the fiscal year 2023 Consolidated 
Appropriations Act (Public Law 117-328) expressed concern that 
efforts to achieve cost savings through the Shelf-Life 
Extension Program [SLEP] could negatively impact the 
distribution of, patient adherence to, and ultimately consumer 
confidence in certain products in the SNS, particularly aged 
antivirals. It also required an audit of SLEP for antivirals in 
the SNS as well as inclusion of recommendations to safeguard 
SNS's ability to effectively respond to future severe influenza 
outbreaks, and the Committee expects delivery of those 
materials expeditiously. Moreover, additional MCMs in the SNS, 
which have been procured to support domestic readiness in the 
event of a biological event, are expired or approaching expiry 
but are not currently included in the SLEP. The Committee 
directs ASPR, in coordination with FDA, to develop an 
appropriate strategy to evaluate the potency and utility of 
these products in a public health emergency. ASPR is directed 
to update the Committee on these activities within 120 days of 
enactment.
    Supply Chain Risk Assessment.--The Committee urges ASPR, in 
coordination with FDA, to prioritize the identification of 
upstream pharmaceutical supply chain risks to reduce medicine 
supply disruptions while also providing evidence to inform 
public investment and policy reforms that build more 
resilience. This includes the ability to leverage integrated 
data analytics from a range of data sources to identify key 
risk indicators and improve both demand forecasting and 
capacity management. The Committee directs ASPR to identify 
opportunities to support the development of capabilities to 
continually assess the global supply chain for essential 
medicines, that covers source location, volume, and the number 
of facilities involved in the product of Active Pharmaceutical 
Ingredients [APIs] and Key Starting Materials [KSMs], finished 
dosage forms, and other required components. A special emphasis 
should be placed on drug shortages, particularly sterile 
injectable drugs, which were found to be the drugs most 
commonly in short supply in the FDA's report Drug Shortages: 
Root Causes and Potential Solutions.
    Domestic Supply Chain of Essential Medicines.--The 
Committee urges ASPR, in coordination with FDA, to identify 
opportunities to support the development of capabilities to 
produce essential medicines in the United States. Particular 
attention should be paid to the production of antibiotics, 
which are experiencing drug shortages and are found on FDA's 
List of Essential Medicines.

Pandemic Influenza Preparedness

    The Committee recommendation includes $327,991,000, for 
Pandemic Influenza Preparedness, which includes $26,000,000 in 
unobligated balances from pandemic influenza supplemental 
appropriations. This funding supports efforts to modernize 
influenza research and development of vaccines and next-
generation influenza medical countermeasures, preparedness 
testing and evaluation, as well as critical domestic vaccine 
manufacturing infrastructure. Of the total, $27,991,000 is 
provided in annual funding and $274,000,000 in no-year funding. 
The Committee expects the $26,000,000 in unobligated balances 
from pandemic influenza supplemental appropriations shall be 
provided to BARDA for pandemic influenza activities.

            OPERATIONS, PREPAREDNESS, AND EMERGENCY RESPONSE

Appropriations, 2023....................................    $566,686,000
Budget estimate, 2024...................................     656,790,000
Committee recommendation................................     541,686,000

    The Committee recommends $541,686,000 for ASPR's 
Operations, Preparedness, and Emergency Response activities. 
This appropriation supports the operations and logistics 
capabilities across ASPR's programs as well as the tools and 
resources necessary to support its emergency preparedness and 
response mission. This includes ASPR's financial management, 
acquisition, information technology, and its suite of 
integrated Federal medical response capabilities that is 
prepared to respond when disaster strikes.
    HHS Coordination Operations and Response Element [H-
CORE].--The Committee includes $50,000,000 to ensure the 
operational coordination and logistical support for the COVID-
19 response and other threats, as they arise.

Preparedness and Emergency Operations

    The Committee includes $31,154,000 for Preparedness and 
Emergency Operations. The Preparedness and Emergency Operations 
account funds the Office of Emergency Management, which 
supports the full spectrum of emergency management 
responsibilities, including planning, coordination, logistics, 
training, and responding to planned events and unplanned 
incidents.

National Disaster Medical System

    The Committee includes $96,904,000, for the National 
Disaster Medical System [NDMS] to improve the disaster 
readiness of the Nation by better coordinating existing assets 
with States and regions.
    Mission Zero.--The Committee includes $4,000,000, for 
civilian trauma centers to train and incorporate military 
trauma care providers and teams into care centers.
    Pediatric Disaster Care.--The Committee includes 
$7,000,000, to support the pediatric disaster care program.
    Public Health Preparedness Equipment.--The Committee 
continues to include $20,000,000 for ASPR to invest in next 
generation air mobility solutions that will ensure more cost-
effective health delivery systems. The Committee supports the 
establishment of a federally-funded research and development 
center, led by an academic medical center, to improve far-
forward medical response, training and innovation, specifically 
utilizing health information technology, unmanned aerial 
systems, countermeasure delivery, and remote patient assessment 
and triage.

Health Care Readiness and Recovery

    The Committee's recommendation includes $305,055,000 for 
Health Care Readiness and Recovery [HCRR], formerly the 
Hospital Preparedness Program. The HCRR portfolio includes 
critical programs and activities that strengthen healthcare 
sector readiness to provide innovative, coordinated, and 
lifesaving care in the face of emergencies and disasters. The 
Committee believes this funding should be carefully coordinated 
within communities to continue to provide our Nation's 
hospitals and emergency responders the necessary tools to 
respond quickly and collaboratively to public health 
emergencies. Within HCRR, the Committee includes $240,000,000, 
for cooperative agreements, critical support to State, local, 
and regional partners to advance healthcare system preparedness 
and response.
    Collaborative Learning Models.--The Committee notes the use 
of technology-enabled collaborative learning models, such as 
Project ECHO, during the COVID-19 pandemic and encourages ASPR 
to leverage these solutions in its healthcare emergency 
preparedness and response.
    EMS Preparedness and Response Workforce Shortage Program.--
The Committee urges ASPR to address the crippling EMS workforce 
shortage, including in underserved, rural, and Tribal areas 
and/or address health disparities related to accessing 
prehospital ground ambulance healthcare services, including 
critical care transport. The Committee encourages ASPR, in 
consultation with the National Highway Traffic Safety 
Administration's Office of EMS, to develop a national pilot 
program of grants to governmental and non-governmental EMS 
organizations to support the recruitment and training of 
emergency medical technicians and paramedics in underserved, 
rural, and Tribal areas and/or addressing health disparities 
related to accessing prehospital ground ambulance healthcare 
services.
    National Special Pathogen System [NSPS].--The Committee 
includes $7,500,000, to continue to support the National 
Emerging Special Pathogens Training and Education Center 
[NETEC], and $21,000,000 to continue to support existing 
Regional Emerging Special Pathogen Treatment Centers [RESPTCs] 
and Special Pathogen Treatment Centers [SPTCs] to prepare for 
future pandemic threats. Funding will support efforts to 
maintain and improve the Nation's preparedness against highly 
infectious pathogen threats. Funding will continue to be 
available to NETEC and RESPTCs for readiness to respond to 
outbreaks of infectious diseases, for additional treatment 
centers, for special pathogen medical transport and further 
establish the National Special Pathogen Systems of Care tier 
network.
    Regional Disaster Health Response System.--The Committee 
includes $7,000,000 to support ASPR's efforts to improve 
disaster readiness by better coordinating healthcare 
infrastructure and systems with States and across regions. The 
Committee urges ASPR to continue improving regional readiness 
efforts to increase regional ability to respond to threats, 
leverage local, State, and Federal healthcare assets across 
coalition and State lines, and improve communications and 
coordination among participating agencies.

Medical Reserve Corps

    The Committee recommendation includes $6,240,000 for the 
Medical Reserve Corps [MRC] program, which is a national 
network of local volunteer doctors, dentists, nurses, 
pharmacists, and other community members. The Committee 
appreciates that funding for MRCs has historically been 
provided to local units quickly and effectively, thereby 
allowing for grants to help build and sustain local 
communities' ability to prepare for and respond to emergencies. 
The Committee encourages ASPR to continue this locally-driven 
approach and to allocate this funding and any remaining funding 
from the American Rescue Plan Act via established mechanisms 
that provide funds directly to local MRC units, which are made 
up of representatives from their communities.

                      MANUFACTURING AND PRODUCTION

Appropriations, 2023....................................................
Budget estimate, 2024...................................    $400,000,000
Committee recommendation................................      75,000,000

    The Committee recommends $75,000,000 for ASPR's 
Manufacturing and Production and Pandemic Preparedness and 
Biodefense activities. This appropriation supports the 
permanent establishment of the Industrial Based Management and 
Supply Chain Office to ensure that critical supplies are 
manufactured in the United States. It also provides new 
resources to bolster pandemic preparedness and biodefense 
against new and emerging threats, which may include investments 
to accelerate advanced development of investigational vaccines, 
therapeutics and diagnostics; support emergency manufacturing 
of critical MCMs and ancillary supplies; and, to the extent 
feasible, invest in the expansion of the domestic medical 
supply chain.

Industrial Based Management and Supply Chain [IBMSC]

    The Committee directs that this funding shall be used to 
continue and expand ongoing work to build and validate advanced 
manufacturing processes and facilities capable of storing, 
producing, and deploying essential medicines and diagnostics in 
the event of a national health emergency.
    Active Pharmaceutical Ingredients.--The Committee is 
concerned with the National security risk of our increased 
reliance on foreign-based sources of APIs, their chemical 
components, and drug production. Key identified vulnerabilities 
in the essential medicine supply chain include the current lack 
of the ability to manufacture high-quality products for the 
U.S. market, need for diversification of the drug supply chain, 
and establishing redundancy in the supply chain, such as 
incentivizing the existence of multiple manufacturers for each 
product and its precursors. The Committee recognizes the 
importance of domestic drug manufacturing and onshore 
production of medicine and provided supplemental emergency 
funding in pandemic relief legislation to support increased 
U.S. based manufacturing capabilities. The Committee urges 
IBMSC to engage in public-private partnerships for U.S. based 
advanced manufacturing for APIs including their chemical 
precursors for the SNS. The Committee directs IBMSC to provide 
a report within 180 days of enactment detailing their efforts 
to promote domestic drug manufacturing, including efforts 
during the COVID-19 public health emergency, and 
recommendations for Congress to support onshore pharmaceutical 
production.
    Strengthening Domestic Manufacturing and Production.--The 
Committee commends ASPR for its support of industrial base 
management capabilities launched during the COVID-19 pandemic, 
including global supply chain situational awareness, market 
capabilities, rapid acquisition execution, and coordination of 
Defense Production Act [DPA] and Emergency Support Function 
[ESF]-8 authorities. This work has been essential to creating a 
secure and resilient domestic supply of quality and affordable 
essential medicines and PPE. These strategic investments in 
domestic technologies and industries ensure our Nation's health 
and biosecurity. However, the Committee remains concerned about 
the Nation's limited infrastructure to produce essential 
products such as medical devices, equipment, pharmaceuticals, 
and PPE. The Committee supports efforts by ASPR to expand upon 
the domestic industrial base to end the reliance on foreign 
sourced medical equipment, PPE, diagnostic tests, medical 
devices, and to secure the pipeline for critical medicines, 
including antibiotics. The Committee directs IBMSC to use 
available funds to continue and expand ongoing work to build 
and validate advanced manufacturing processes and facilities 
capable of storing, producing, and deploying essential 
medicines in the event of a national health emergency. IBMSC 
should seek opportunities to expand domestic manufacturing 
facilities with end-to-end capabilities to produce bulk drug 
substance, support platform technologies for MCMs, and provide 
fill-finish capacity. The Committee urges ASPR to use available 
funds to support manufacturers in building, expanding, 
upgrading, modifying, and/or recommissioning facilities in the 
U.S. to increase manufacturing capacity of critical medicines 
or their active pharmaceutical ingredients.
    Warm-Base Manufacturing for Diagnostics.--The Committee 
remains concerned the COVID-19 pandemic has demonstrated the 
need for warm-base manufacturing for U.S. domestic diagnostic 
companies. Warm-base manufacturing programs for diagnostics, 
like those established for vaccines, would be a significant 
benefit to the United States and global health. In addition, 
the pandemic highlighted the expansion and success of Over-the-
Counter [OTC] testing as a pivotal part of the Administration's 
Test-to-Treat program to address the public health emergency. 
The Committee encourages ASPR to continue to support the 
investments made during the pandemic for testing, supply chain, 
and surge capacity for U.S. diagnostic manufacturing to 
maintain U.S. readiness and future preparedness. Further, the 
Committee urges ASPR to promote policies for flexible 
contracting and the expansion of OTC tests, and tests 
appropriate for use in low resource settings, to improve public 
health surveillance beyond COVID-19.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2023....................................    $601,972,000
Budget estimate, 2024...................................     704,566,000
Committee recommendation................................     601,972,000

    The Committee recommends $601,972,000 for General 
Departmental Management [GDM]. The recommendation includes 
$64,828,000 in transfers available under section 241 of the PHS 
Act (Public Law 78-410 as amended).
    This appropriation supports activities that are associated 
with the Secretary's role as policy officer and general manager 
of the Department. It supports health activities performed by 
the Office of the Assistant Secretary for Health [OASH], 
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.
    Addressing Factors Related to Improving Health Outcomes.--
The Committee encourages the Secretary to support efforts to 
coordinate health and social services, enable information 
sharing on health and social services, and provide technical 
assistance and related support for entities engaging in efforts 
to better coordinate health and social services as authorized 
in Public Law 117-328.
    Adult Cellular Therapies.--The Committee encourages the 
Department to support collaborative evidence development in 
coordination with FDA, NIH, and HRSA, to fully operationalize 
an outcomes database for adult cellular therapies that are FDA-
approved or being administered under FDA Investigational New 
Drug or Investigational Device Exemption protocols. The 
Committee also encourages engagement of experts and 
stakeholders to define data types and standards necessary for 
such a database.
    Alzheimer's Advisory Council.--The Committee directs ASPE 
to fulfill the legislative objectives for the Advisory Council 
on Alzheimer's Research, Care, and Services, as created by the 
National Alzheimer's Project Act (Public Law 111-375).
    Antimicrobial Resistance [AMR].--The Committee continues to 
support the Administration's proposal to combat antibiotic-
resistant infections by strengthening national One Health 
surveillance efforts, encouraging the development of innovative 
diagnostic tests for resistant bacteria, and accelerating the 
development of new antibiotics, other therapeutics, and 
vaccines. The Committee directs OASH, NIH, ASPR, CDC, and AHRQ 
to jointly brief the Committee no later than 60 days after the 
enactment of this act detailing how HHS and its agencies are 
coordinating their AMR-related efforts, as well as domestic and 
international AMR trends.
    Artificial DNA Synthesis.--The Committee remains concerned 
about the potential for state actors or terrorist organizations 
to modify existing pathogens using DNA synthesis technologies 
to create dangerous biological agents that could be used as 
bioweapons. HHS, in collaboration with the Department of 
Homeland Security [DHS], is currently required to establish and 
regulate the list of biological agents and toxins that have the 
potential to pose a severe threat to public health and safety, 
referred to as ``Select Agents and Toxins.'' Current DNA 
synthesis technologies are enabling the production of Select 
Agents, as well as nontraditional Agents, that could pose a 
significant risk to National Security and may not be covered by 
current HHS select agent review or regulations. The Committee 
is concerned by the potential for commercial DNA synthesis 
providers to manufacture and distribute synthetic genetic 
material (directly or indirectly through providing synthesizing 
instruments) that could enable the production of infectious 
forms of agents with potential to cause serious intentional or 
unintentional harm. The Committee encourages the Secretary of 
HHS to consult with DHS on the current threat landscape and for 
the Secretary to evaluate the need for a regulatory framework 
for screening synthetic genetic material to prevent the 
mistaken or malicious production of biological agents.
    Barriers to Behavioral Health Care for Students.--The 
Committee encourages the Secretary to investigate barriers to 
continuity of behavioral healthcare due to State licensing 
agreements, particularly for students in higher education. The 
Committee is concerned that students who move or reside out-of-
State from their primary behavioral health provider may not be 
able to maintain access to their provider via telehealth. The 
Committee directs the Secretary to submit a report within 1 
year of enactment of this act on the circumstances under which 
providers may be eligible to deliver telehealth services to 
patients located out-of-State, with their informed consent, 
including follow up care for patients in higher education with 
an established therapeutic (patient-provider) relationship. The 
report should also provide recommendations on how to alleviate 
such barriers to care.
    Bio-Attribution.--The Committee is aware that there is a 
need to improve U.S. capacity to determine the origins of 
serious future epidemics or pandemics, referred to as bio-
attribution whether they come from a natural, accidental, or 
deliberate source. Having strong national bio-attribution 
capabilities to allow the identification of a pandemic could 
help to prevent further events. Developments in the 
complementary fields of genomics, proteomics, metabolomics, and 
data analytics provide opportunities for development of 
improved bio-attribution capabilities. The Committee encourages 
HHS to work with other government agencies towards the 
development, maturation, and implementation of new bio-
attribution technologies through both internal government 
scientific development programs, grants or contracts, as 
appropriate.
    Brain Aneurysm.--The Committee directs the Secretary to 
develop best practices on brain aneurysm detection and rupture 
for first responders, emergency room physicians, primary care 
physicians, nurses, and advanced practice providers.
    Breast Cancer Diagnostics.--The Committee remains concerned 
about access to breast cancer diagnostic and supplemental 
imaging for individuals with commercial insurance, including 
financial barriers to care, and the financial costs associated 
with delayed care. The Committee urges the Secretary to work 
with Congress, and stakeholders to ensure adequate access to 
diagnostic and supplemental breast imaging, which are integral 
services of breast cancer screening and early detection. The 
Committee also requests a report to Congress on existing 
barriers to breast cancer diagnostic and supplemental imaging, 
financial costs associated with delayed care relative to breast 
cancer screenings, actions the Secretary could take to address 
this issue, and recommendations to Congress on how to alleviate 
such barriers within 180 days of enactment of this act.
    Broadband Deployment.--The Committee notes that HHS has not 
submitted the report on broadband deployment as requested in 
the joint explanatory statement that accompanied Public Law 
117-328. HHS is directed to submit the report to the Committees 
on Appropriations detailing the progress it has made to date to 
coordinate with the Federal Communications Commission and carry 
outs its responsibilities to populate the Deployment Locations 
Map pursuant to section 60105 of the Infrastructure and Jobs 
Act (Public Law 117-58), including responsibilities not yet 
fulfilled.
    Children's Interagency Coordinating Council.--The 
Consolidated Appropriations Act of 2023 provided HHS with 
$3,000,000 to create a Children's Interagency Coordinating 
Council to foster greater coordination and transparency on 
child policy across agencies. The Committee requests that the 
Department provide a briefing for the House and Senate 
Committees on Appropriations on this effort within 90 days of 
enactment of this act.
    Continuous Manufacturing.--The Committee is concerned that 
the lack of clear standards and realistic quality assessment 
methods for continuous pharmaceutical manufacturing are 
creating unnecessary risk for capital investments in advanced 
manufacturing equipment. The Committee urges the Secretary to 
issue updated guidance that provides clear standards and 
realistic quality assessment methods for continuous 
pharmaceutical manufacturing, such as by creating a monitoring 
system for finished drug quality performance. Furthermore, the 
Committee urges the Secretary to hold industry forums with 
domestic pharmaceutical manufacturers and to make dedicated 
staff available to assist innovators and drug manufacturers in 
navigating the regulatory process for new and emerging advanced 
manufacturing practices and technologies.
    Dietary Guidelines.--The Committee notes that section 772 
of division A of the Consolidated Appropriations Act, 2023 
(Public Law 117-328) includes funding for the Secretary of 
Agriculture, in consultation with the Secretary of HHS, to 
enter into an agreement with the National Academies of 
Sciences, Engineering, and Medicine [NASEM] to conduct a study 
of the eight topics and scientific questions related to alcohol 
previously published by USDA and HHS, and other relevant 
topics. Section 772 further directs the Secretary of 
Agriculture to ensure the process for developing the 2025 
Dietary Guidelines includes recommendations that are based on 
the preponderance of scientific and medical evidence consistent 
with section 5341 of title 7 of the United States Code, and 
that it is fully transparent and includes a balanced 
representation of individuals who are unbiased and free from 
conflicts of interest. The Committee expects the Secretary of 
HHS will ensure the same, and requests a briefing within 120 
days of enactment on how HHS will incorporate the findings and 
recommendations of the NASEM study into the process for 
developing the 2025 Dietary Guidelines.
    Embryo Adoption Awareness Campaign.--The Committee includes 
funding for the Embryo Adoption Awareness Campaign to educate 
Americans about the existence of frozen human embryos 
(resulting from in-vitro fertilization), which may be available 
for donation/adoption to help other couples build their 
families. The Committee includes bill language permitting these 
funds also to be used to provide medical and administrative 
services to individuals adopting embryos, deemed necessary for 
such adoptions, consistent with the Code of Federal 
Regulations.
    Grants.gov.--Grants.gov, operated by HHS for all Federal 
agencies, allows Indian tribes, Tribal organizations, and 
Native Hawaiian organizations to search for Federal grants for 
which they are eligible. Alaska Native Corporations [ANCs], 
created by Congress, are not able to search for the funding 
opportunities for which they are eligible in the same manner. 
The Committee directs HHS to report within 120 days of 
enactment on how the Department is ensuring ANCs are aware of 
their eligibility through search functions on grants.gov.
    Ending the HIV Epidemic.--The Committee continues support 
for this initiative but is concerned by a lack of quantifiable 
data showing outcomes of a program started in 2019. Therefore, 
the Committee directs HHS to: (1) provide a spend plan to the 
Committees no later than 60 days after enactment of this act, 
to include resource allocation by State; (2) brief the 
Committees on the fiscal year 2024 plans no later than 90 days 
after enactment of this act; (3) provide the Committees an 
update on the program's performance data since the beginning of 
the initiative through the latest available data, making sure 
to address each of the initiative's goals and performance 
metrics, no later than 180 days after enactment of this act and 
updated annually throughout the life of the initiative.
    Evaluation of 211 Hotlines.--The Committee directs ASPE, in 
collaboration with ACF and ACL, and in consultation with State, 
local, and Tribal governments, to conduct a study on the usage, 
quality, shortcomings, and best practices of the 211 hotline 
and submit a report to the Committee within 1 year of enactment 
of this act on the findings of such study. The report shall 
include findings on the prevalence of 211 hotline usage, 
effectiveness of 211 referrals, any gaps in service coverage, 
modes of communication used to disseminate information, 
accuracy, timeliness, data protections, and satisfaction of 211 
users. The report should also provide recommendations for the 
improvement to the 211 hotline, including funding, technology, 
accessibility, quality of social service information, and 
measurement of outcomes.
    Global Health Research.--The Committee requests an update 
in the fiscal year 2025 CJ on how CDC, FDA, BARDA, NIH, 
including the Fogarty International Center, and other agencies 
jointly coordinate global health research activities with 
specific metrics to track progress and collaboration toward 
agreed upon health goals.
    Hepatitis B Initiatives.--The Committee encourages OASH to 
lead the development of a government wide coordinated effort to 
ensure the implementation of the Advisory Committee on 
Immunization Practices' [ACIP] recommendation that all adults 
between 19 and 59 be vaccinated for hepatitis B. The Committee 
requests a report, in partnership with CDC, to be prepared 
before the end of fiscal year 2024 on a government-wide 
coordinated effort needed to make progress to meet this 
vaccination goal. The Committee also urges HHS to take action 
on its Viral Hepatitis National Strategic Plan.
    Housing-Related Supportive Services.--Individuals who have 
serious and complex health challenges, including mental health 
and substance use disorders, and chronic medical conditions 
require additional supports to maintain stable housing. The 
Committee supports the effort underway in partnership with the 
Department of Housing and Urban Development, CMS, SAMHSA, ACL, 
and ASPE to provide direct technical assistance to communities 
leveraging programs, like Medicaid, to cover and provide 
housing-related supportive services and behavioral healthcare. 
The Committee directs HHS and HUD to jointly brief the House 
and Senate Committees on Appropriations on this effort within 
180 days of enactment of this act.
    Impairment after Mastectomy.--The Committee is aware of 
research demonstrating that long-term impacts after mastectomy 
can lead to both functional impairment and quality of life 
issues in breast cancer survivors. Impairment due to numbness, 
muscle weakness, and chronic swelling may occur. The Committee 
is aware that technological procedure advancements are now 
available to shift the focus of reconstructive breast surgery 
beyond cosmetic-only results to include the restoration of 
typical breast functions, such as sensation. The Committee 
requests that the Secretary, in collaboration with other 
relevant HHS agencies, explore technological advances impacting 
health outcomes after mastectomy. The Committee requests an 
update in the fiscal year 2025 CJ about this issue.
    Maternal Health.--The CDC recently released a new study on 
the maternal mortality crisis in the United States, finding 
that the rate has risen 40 percent since 2020, the highest 
numbers in almost 60 years. The Committee is concerned with 
these alarming statistics, and directs HHS to prioritize 
efforts to improve maternal health outcomes and reduce maternal 
mortality. The Committee directs HHS to focus on efforts to 
improve coordination across maternal health programs, expand 
the maternity care workforce, advance equity through the 
development of a maternal health quality outcomes measure, and 
enhance postpartum social supports for families.
    Mental Health Grants.--The Committee supports the continued 
efforts of the Federal Government in addressing the growing 
mental health crisis across the country. The Committee 
encourages the Secretary, in coordination with other Federal 
agencies, to establish an interactive online dashboard to allow 
the public to review information for Federal grant funding 
related to mental health programs across agencies in order to 
promote increased accessibility of Federal funding to 
effectively address mental health.
    Mental Health Parity.--The Committee encourages the 
Secretary to support State insurance departments for the 
implementation of mental health parity as authorized in Public 
Law 117-328.
    Nonrecurring Expenses Fund [NEF].--The Committee directs 
the Secretary to prioritize obligations from resources in the 
NEF for projects currently underway, including the CDC NIOSH 
facility in Cincinnati, Ohio. The Secretary should complete 
outstanding projects in a timely manner and prior to funding 
new projects.
    Obligation Reports.--The Committee directs the Secretary to 
submit electronically to the Committees an excel table 
detailing the obligations made in the most recent quarter for 
each office and activity funded under this appropriation not 
later than 30 days after the end of each quarter.
    Polycystic Ovary Syndrome [PCOS].--Research shows that the 
prevalence of PCOS, one of the most common endocrine disorders 
in women-reported in health systems data is significantly less 
than the population prevalence of PCOS. One potential factor in 
underdiagnoses is a lack of education and awareness about the 
disorder by healthcare professionals and patients. The 
Committee urges HHS to increase education about PCOS among 
medical and allied health providers within health systems and 
insurers and work in partnership with PCOS patient 
organizations to increase education and awareness among 
patients. The Committee urges HHS to investigate and report on 
gaps in care for PCOS patients regarding metabolic, 
cardiovascular, cerebrovascular, mental, reproductive, 
oncologic, maternal, and adolescent health, and any other 
identified care gaps.
    Programs of All-Inclusive Care for the Elderly.--The 
Committee notes that before the COVID-19 pandemic and during 
the COVID-19 Public Health Emergency, Programs of All-Inclusive 
Care for the Elderly [PACE] have been effective in keeping 
their medically complex, nursing home eligible population safe 
at home. Given the increasing demand for home and community 
based services by older adults and those living with 
disabilities, within 120 days of enactment of this act, the 
Committee directs the Secretary to submit a report providing 
details of an implementation plan for PACE-specific model tests 
that examine methods of increasing access and affordability for 
Medicare and Medicaid beneficiaries.
    Rare Kidney Disease Diagnostic Issues.--The Committee 
encourages the Secretary to convene a conference focused on 
rare kidney disease diagnostic issues. The Committee notes the 
need to analyze the impact of the decline of routine urinalysis 
on the timely diagnosis of rare kidney disease and on the 
quality of patient care as well as the quality and reliability 
of kidney biopsy in diagnosis of rare kidney disease. The 
Committee further encourages the Secretary to report to 
Congress on whether genetic and genomic testing may improve 
preventative care, precision medicine and health outcomes.
    Rare Kidney Disease Transplant and Dialysis.--The Committee 
notes the high costs of dialysis and transplant associated with 
rare kidney disease. The Committee encourages the Secretary to 
conduct experiments to evaluate methods for treating rare 
kidney disease, particularly those that would delay or 
eliminate the need for dialysis and transplant through a 
comprehensive study of methods to increase public awareness of 
rare kidney disease, including in communities of color. The 
Committee requests an update on these activities as part of the 
fiscal year 2025 CJ.
    Rural Media.--The Committee recognizes the critical role 
local media plays in delivering public health messages to small 
or rural communities. Therefore, the Committee directs the 
Secretary to ensure that local media in small or rural markets 
are part of the Federal public health advertising campaigns. To 
further this goal, the Committee directs the Secretary, in 
coordination with the Assistant Secretary for Public Affairs 
and their media buyer contractors, to prioritize local news 
media in rural areas for HHS Federal advertising campaigns to 
reach citizens in these communities with key health messages. 
Local media should include newspapers, including non-daily 
newspapers, television, and radio. The Committee directs the 
Office of the Secretary to provide to the Committee within 90 
days of enactment an update on the efforts of the Department to 
ensure that local media in rural areas are part of the 
Department's public health advertising campaigns, including a 
breakdown of money allocated to local media in rural areas for 
each of the health focused public affairs campaigns for fiscal 
year 2023.
    Staffing Reports.--The Committee includes a general 
provision requiring the Department to submit a biannual 
staffing report to the Committees. The Excel table shall 
include: the names, titles, grades, agencies, and divisions of 
all of the political appointees, special government employees, 
and detailees that were employed by or assigned to the 
Department during the previous 180 days.
    Stillbirth Working Group.--The Committee continues funding 
for implementation of the Stillbirth Working Group's 
recommendations across HHS, including at NIH and CDC.
    Voting-Related Activities.--The Committee directs the 
Secretary to brief the House and Senate Committees on 
Appropriations no later than 90 days after enactment of this 
act regarding any strategic plans developed by the Department 
over the three prior fiscal years outlining the ways that the 
Department has promoted voter registration, and voter 
participation.
    Wuhan Institute of Virology.--The Committee is encouraged 
with the action Referral Memorandum issued on July 17, 2023, 
with respect to the suspension and debarment of Wuhan Institute 
of Virology, Chinese Academy of Sciences Capital Construction 
from participating in the United States Federal Government 
programs. The Committee directs the Department to provide a 
report to the Committee within 30 days of enactment regarding 
compliance with the Memorandum and ways the Department is 
ensuring that Federal funds are not awarded to entities that 
are likely to have failed to comply with Federal biosafety 
requirements based on evidence that provides cause for 
suspension under 2 C.F.R Sec. 180.700(a)-(c).

Teen Pregnancy Prevention

    The Committee recommendation includes $101,000,000 for the 
Teen Pregnancy Prevention Program [TPPP]. This program supports 
competitive grants to public and private entities to replicate 
evidence-based teen pregnancy prevention approaches and develop 
and evaluate new and innovative approaches to prevent teen 
pregnancy and STIs among adolescents. In addition, the 
recommendation includes $6,800,000 in transfers available under 
section 241 of the PHS Act.
    TPPP.--The Committee includes $900,000 for ASPE to support 
the TPPP Evidence Review. The Evidence Review is an 
independent, systematic, rigorous review of evaluation studies 
that informs grant making and provides a clearinghouse of 
evidence-based programs for other Federal, State, and community 
initiatives.

Office of Minority Health

    The Committee recommends $74,835,000 for the Office of 
Minority Health [OMH]. The Office focuses on strategies 
designed to decrease health 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 identifying and disseminating 
innovative and effective approaches for improving health 
outcomes for racial and ethnic minority individuals.
    Achieving Equitable Maternal Health Outcomes.--The 
Committee continues $7,000,000 to support community-based and 
other eligible organizations located in geographic areas with 
high rates of adverse maternal health outcomes, particularly 
among racial and ethnic minority families. The Department 
should support activities that include but are not limited to 
identifying evidence-based and evidence-informed practices for: 
addressing social determinants of health; promoting evidence-
based health literacy, and pregnancy, childbirth, and parenting 
education programs; providing support from perinatal health 
workers; and providing culturally congruent, linguistically 
appropriate, and trauma-informed training to perinatal health 
workers.
    Center for Indigenous Innovation and Health Equity.--The 
Committee continues $4,000,000 to support the Center for 
Indigenous Innovation and Health Equity. The Committee 
recognizes the Center's efforts to partner with institutions of 
higher education with a focus on Indigenous health research and 
policy among American Indians and Alaska Natives, as well as 
institutions of higher education with a focus on Indigenous 
health policy and innovation among Native Hawaiians/Pacific 
Islanders. The Committee encourages the Center to both continue 
and expand these efforts.
    Promoting Language Access Services.--The Committee 
continues no less than $4,000,000 to support the development of 
methods of informing limited English proficient [LEP] 
individuals about their right to and the availability of 
language access services. The Committee supports the 
Department's efforts to improve external communications, which 
should include mediums such as television and radio, to reach 
LEP communities. However, the Committee encourages the 
Department to review communication practices and create uniform 
applications across all HHS agencies to strengthen 
communication practices to include digital, television, and 
radio advertising when working with LEP communities.

Minority HIV/AIDS

    The Committee includes $60,000,000 for the Secretary's 
Minority HIV/AIDS Fund to strengthen and expand services 
provided by minority-serving community-based organizations 
[CBOs] for HIV education and awareness campaigns, testing, 
prevention, linkage to care, and engagement in care to racial 
and ethnic minority individuals at risk for or living with HIV 
in order to address the decline in HIV testing and the 
challenges with linkage to and retention in care and treatment 
that occurred during the COVID-19 pandemic. Funding may be 
prioritized for minority-serving CBOs in the South, which has 
the highest burden of HIV of any region nationwide.

Office of Women's Health

    The Committee recommends $44,140,000 for the Office of 
Women's Health [OWH]. This office develops, stimulates, and 
coordinates women's health research, healthcare services, and 
public and healthcare professional education across the 
Department. It advances important crosscutting initiatives and 
develops public-private partnerships, providing leadership and 
policy direction to address the disparities in women's health.
    The Committee recommendation includes $10,100,000 to combat 
violence against women through the State partnership 
initiative. This program provides funding to State-level public 
and private health programs to partner with domestic and sexual 
violence organizations to improve healthcare providers' ability 
to help victims of violence and improve prevention programs. 
The Committee continues to recommend OWH create a State-level 
pilot program to incentivize substance use disorder treatment 
providers to be trained on intimate partner violence.
    Access to Lactation Support Services.--The Committee 
supports HHS' initiatives to improve access to lactation 
support services for all individuals who choose to breastfeed. 
The Committee notes that despite guidance from the HHS Women's 
Preventive Services Initiative recommending that families 
receive comprehensive lactation support services to optimize 
the successful initiation and maintenance of breastfeeding, 
many families struggle to gain access to quality lactation 
care. The Committee notes that the Consolidated Appropriations 
Act of 2023 (Public Law 117-328) included funding for HHS to 
enter into an agreement with NASEM to provide an evidence-
based, non-partisan analysis of the macroeconomic, health, and 
social costs of U.S. breastfeeding rates and national 
breastfeeding goals. The Committee expects that this analysis 
should also examine how health insurers have implemented 
comprehensive lactation services, the standards set to 
determine reimbursement rates for breastfeeding supplies and 
services, and the current best practices used to provide 
coverage to help women breastfeed.
    Women's Health Research Study.--To address the persistent 
gaps of knowledge of women's health and improve access to care, 
the Committee continues to expect the Secretary to coordinate 
with NIH and NASEM in support of research that explores the 
proportion of research on conditions that are more common or 
unique to women. This research should establish how these 
conditions are defined and ensure that it captures conditions 
across the lifespan, evaluates sex and gender differences and 
racial health disparities, and determine the appropriate level 
of funding that is needed to address gaps in women's health 
research at NIH and submit to Congress a report containing the 
findings and recommendations of the study no later than 18 
months after enactment of this act.

                OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2023....................................    $196,000,000
Budget estimate, 2024...................................     199,000,000
Committee recommendation................................     196,000,000

    The Committee provides $196,000,000 for the Office of 
Medicare Hearings and Appeals [OMHA]. This Office is 
responsible for hearing Medicare appeals at the Administrative 
Law Judge [ALJ] level, which is the third level of Medicare 
claims appeals. OMHA ensures that Medicare beneficiaries who 
are dissatisfied with the initial decisions about their 
benefits or eligibility can appeal and exercise their right to 
a hearing in front of an ALJ.

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriations, 2023....................................     $66,238,000
Budget estimate, 2024...................................     103,614,000
Committee recommendation................................      71,238,000

    The Committee makes available $71,238,000, in transfers 
available under section 241 of the PHS, to the Office of the 
National Coordinator for Health Information Technology [ONC]. 
ONC is responsible for coordinating Federal health information 
systems and collaborating with the private sector to develop 
standards for a nationwide interoperable health information 
technology infrastructure.
    Information Blocking Guidance.--The Committee recognizes 
that the ONC's rule to implement the interoperability and 
information blocking provisions of the 21st Century Cures Act 
took significant steps forward to give patients greater access 
to and improve the electronic flow of electronic health 
information across care settings. Given the significant 
penalties and other consequences for information blocking, the 
Committee urges ONC to provide regulated entities and other 
affected stakeholders with clear, practical guidance regarding 
foundational concepts in the rule. Guidance should clearly 
outline how regulated entities can evaluate their particular 
circumstances and scenarios against the rule's provisions, 
including how to identify and apply relevant exceptions to the 
information blocking definition.
    Health Information Exchanges [HIE].--The Committee 
recognizes the importance of electronic health data as a 
critical piece to address the health needs and care delivery 
challenges of diverse communities. The Committee strongly 
encourages HHS to work with States to designate existing 
neutral, trusted, and nonprofit HIEs to be the State's health 
data utility [HDU]. HDU models are designed and implemented in 
alignment with States' policies and priorities to address the 
needs of a broader health and healthcare ecosystem. An HDU can 
be defined as one or more entities, guided by a diverse 
stakeholder governance structure, that combine, enhance, and 
exchange disparate electronic health data sets for treatment, 
care coordination, quality improvement, population health, 
public health emergencies, and other public and community 
health purposes. The Committee recognizes that each State 
designated HDU is essential in establishing a national 
framework that fulfills a current gap in healthcare by 
implementing a comprehensive digital health infrastructure as a 
public utility that will support data sharing between public 
and private health data stakeholders. The Committee directs 
HHS, through ONC and other relevant Federal agencies, to 
leverage existing authorities, funds, and other resources to 
construct policy and regulations that strengthen existing HIE 
infrastructure to facilitate their transition into HDUs. If 
necessary, the Committee encourages the Secretary to issue 
policy guidelines, or best practices, to encourage each State 
to designate an HIE or HIEs to be a State's HDU.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2023....................................     $87,000,000
Budget estimate, 2024...................................     116,801,000
Committee recommendation................................      87,000,000

    The Committee recommends $87,000,000 for the HHS Office of 
Inspector General [OIG].
    OIG conducts audits, investigations, and evaluations of the 
programs administered by the Department's operating and staff 
divisions, including the recipients of the Department's grant 
and contract funds. In doing so, OIG addresses issues of waste, 
fraud, and abuse and makes recommendations to improve the 
efficiency and effectiveness of the Department's programs and 
operations.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2023....................................     $39,798,000
Budget estimate, 2024...................................      78,000,000
Committee recommendation................................      39,798,000

    The Committee recommends $39,798,000 for the Office for 
Civil Rights [OCR] in budget authority. OCR is responsible for 
enforcing civil rights-related statutes in healthcare 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, 2023....................................    $710,327,000
Budget estimate, 2024...................................     792,691,000
Committee recommendation................................     792,691,000

    The Committee provides an estimated $792,691,000 in 
mandatory funds for Retirement Pay and Medical Benefits for 
Commissioned Officers of the U.S. Public Health Service. This 
account provides for retirement payments to PHS officers who 
are retired due to age, disability, or length of service; 
payments to survivors of deceased officers; and medical care to 
Active Duty and retired officers, as well as their dependents.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2023....................................    $137,892,000
Budget estimate, 2024...................................     278,318,000
Committee recommendation................................     115,992,000

    The Committee recommends $115,992,000 for the Public Health 
and Social Services Emergency Fund [PHSSEF]. This appropriation 
supports the activities to prepare for, respond to, and recover 
from the consequences of a wide range of natural and man-made 
medical and public health security threats and includes the HHS 
Office of the Chief Information Officer Cybersecurity Program, 
the Office of National Security [ONS], the Office of Global 
Affairs [OGA], pandemic programs, and other HHS-wide 
preparedness activities.

Cybersecurity

    The Committee recommends $100,000,000 for information 
technology cybersecurity in the Office of the Chief Information 
Officer and HHS-wide to strengthen the Department's 
cybersecurity posture. These funds provide continuous 
monitoring and security incident response coordination for the 
Department's computer systems and networks.

Office of National Security

    The Committee recommends $8,983,000 for the Office of 
National Security to support strategic all-source information, 
intelligence, defensive counterintelligence, insider threat 
intelligence, enterprise supply chain risk management, security 
for classified information, and communications security support 
across the Department. These funds sustain the Department's 
security and threat awareness and its ability to respond 
swiftly and effectively to national and homeland security 
threats.

Office of Global Affairs

    The Committee recommends $7,009,000 for the HHS Office of 
Global Affairs to support its work to lead global health 
diplomacy and policy coordination efforts for HHS to strengthen 
U.S. health security and pandemic preparedness.

                   PREVENTION AND PUBLIC HEALTH FUND

    In fiscal year 2024, the level transferred from the PPH 
Fund after accounting for sequestration is $1,225,900,000. The 
Committee includes bill language in section 221 of this act 
that requires that funds be transferred within 45 days of 
enactment of this act to the following accounts, for the 
following activities, and in the following amounts:

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                                            Committee
             Account                      Program         recommendation
------------------------------------------------------------------------
Aging and Disability Services      Alzheimer's Disease       $14,700,000
 Programs.                          Prevention
                                    Education and
                                    Outreach.
Aging and Disability Services      Chronic Disease Self-       8,000,000
 Programs.                          Management.
Aging and Disability Services      Falls Prevention....        5,000,000
 Programs.
Immunization and Respiratory       Section 317               702,250,000
 Diseases.                          Immunization Grants.
Emerging and Zoonotic Infectious   Epidemiology and           40,000,000
 Diseases.                          Laboratory Capacity
                                    Grants.
Emerging and Zoonotic Infectious   Healthcare                 12,000,000
 Diseases.                          Associated
                                    Infections.
Chronic Disease Prevention and     Office of Smoking         125,850,000
 Health Promotion.                  and Health (Tobacco
                                    Prevention/Media &
                                    Quit Lines).
Chronic Disease Prevention and     Breast Feeding              9,750,000
 Health Promotion.                  Grants (Hospitals
                                    Promoting
                                    Breastfeeding).
Chronic Disease Prevention and     Million Hearts              5,000,000
 Health Promotion.                  Program.
Chronic Disease Prevention and     Heart Disease &            57,075,000
 Health Promotion.                  Stroke Prevention
                                    Program.
Chronic Disease Prevention and     Diabetes............       52,275,000
 Health Promotion.
Chronic Disease Prevention and     Early Care                  5,000,000
 Health Promotion.                  Collaboratives.
Environmental Health.............  Lead Poisoning             17,000,000
                                    Prevention.
CDC-Wide Activities..............  Preventive Health         160,000,000
                                    and Health Services
                                    Block Grants.
Mental Health....................  Suicide Prevention         12,000,000
                                    (Garrett Lee Smith).
------------------------------------------------------------------------

                           General Provisions

    Section 201. The bill continues a provision placing a 
$50,000 ceiling on official representation expenses.
    Section 202. The bill continues a provision limiting the 
use of certain grant funds to pay individuals more than an 
annual rate of Executive Level II or capping NIH investigator 
salaries.
    Section 203. The bill continues a provision restricting the 
Secretary's use of taps for program evaluation activities 
unless a report is submitted to the Committees on 
Appropriations of the House of Representatives and the Senate 
on the proposed use of funds.
    Section 204. The bill modifies a provision authorizing the 
transfer of up to 2.8 percent of PHS Act (Public Law 78-410) 
funds for evaluation activities.
    Section 205. The bill continues a provision restricting 
transfers of appropriated funds and requires a 15-day 
notification to the Committees on Appropriations of the House 
of Representatives and the Senate.
    Section 206. The bill continues a general provision 
allowing National Health Service Corps contracts to be canceled 
up to 60 days after award.
    Section 207. The bill continues a provision regarding 
requirements for family planning applicants.
    Section 208. The bill continues language which states that 
no provider of services under title X of the PHS Act (Public 
Law 78-410) may be exempt from State laws regarding child 
abuse.
    Section 209. The bill continues language that restricts the 
use of funds to carry out the Medicare Advantage Program if the 
Secretary denies participation to an otherwise eligible entity.
    Section 210. The bill continues a provision prohibiting the 
use of funds for lobbying activities related to gun control.
    Section 211. The bill continues a provision that limits the 
assignment of certain public health personnel.
    Section 212. The bill continues a provision that 
facilitates the expenditure of funds for international health 
activities.
    Section 213. The bill continues a provision permitting the 
transfer of up to 3 percent of AIDS funds among ICs by the 
Director of NIH and the Director of the Office of AIDS Research 
at NIH.
    Section 214. The bill continues language that requires that 
the use of AIDS research funds be determined jointly by the 
Director of NIH 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 ICs consistent with the 
AIDS research plan.
    Section 215. The bill continues a provision authorizing the 
Director of NIH to enter into certain transactions to carry out 
research in support of the NIH Common Fund.
    Section 216. The bill continues a provision permitting NIH 
to use up to $100,000,000 of IC funding for construction, 
improvements, and repairs of facilities.
    Section 217. The bill continues a provision that transfers 
funds from NIH to HRSA and AHRQ, to be used for National 
Research Service Awards.
    Section 218. The bill continues a provision that provides 
BARDA with authority to enter into a multiyear contract for up 
to 10 years and to repurpose unused termination costs to pay 
contract invoices.
    Sections 219. The bill continues a provision requiring the 
CJ to include certain FTE information with respect to the ACA.
    Section 220. The bill continues a provision related to ACA 
exchange funding transparency.
    Section 221. The bill continues a provision prohibiting 
funds for the Risk Corridor program.
    Section 222. The bill continues a provision requiring the 
Secretary to transfer Prevention and Public Health Fund 
resources within 45 days.
    Section 223. The bill continues a provision related to 
breast cancer screening recommendations.
    Section 224. The bill continues a provision on NIH indirect 
costs.
    Section 225. The bill continues a provision requiring 
Congressional notification prior to NIH transfers of opioid 
funds internally.
    Section 226. The bill continues a provision related to 
notifications for ACA enrollment and Community Health Centers 
awards.
    Section 227. The bill continues a provision related to 
Medicare administrative funds.
    Section 228. The bill continues a provision requiring 
staffing reports.
    Section 229. The bill continues a provision on HHS staff 
travel for medical care.
    Section 230. The bill continues a provision allowing 
private donations for the care of unaccompanied children.
    Section 231. The bill continues a provision limiting the 
use of funds for unlicensed shelters for unaccompanied 
children.
    Section 232. The bill continues a provision requiring 
Congressional notification prior to the use of influx 
facilities as shelters for unaccompanied children.
    Section 233. The bill continues a provision regarding 
Member access to unaccompanied children facilities.
    Section 234. The bill continues a provision requiring 
monthly reporting of unaccompanied children.
    Section 235. The bill continues a provision for CDC 
employees dependents' schooling of CDC employees stationed in a 
U.S. territory.
    Section 236. The bill includes a new provision related to 
eligibility criteria for certain Head Start enrollees.
    Section 237. The bill includes a new provision related to 
eligibility criteria for certain Head Start enrollees.
    Section 238. The bill includes a provision rescinding 
funding from the Nonrecurring Expenses Fund.

                               TITLE III

                        DEPARTMENT OF EDUCATION

    Any references in this title of the Committee Report to the 
``Secretary'' or the ``Department'' shall be interpreted to 
mean the Secretary of Education or the Department of Education, 
respectively, unless otherwise noted.

                    Education for the Disadvantaged

Appropriations, 2023.................................... $19,087,790,000
Budget estimate, 2024...................................  21,254,551,000
Committee recommendation................................  19,262,790,000

    The Committee recommends $19,262,790,000 for programs in 
the Education for the Disadvantaged account. Funds appropriated 
in this account primarily support activities in the 2024-2025 
school year.

Grants to Local Educational Agencies

    The Committee recommends $18,561,802,000 for the title I-A 
grants to local educational agencies [LEAs] program. Title I-A 
grants to LEAs provide supplemental education funding, 
especially in high-poverty areas, for LEAs to provide extra 
academic support to help raise the achievement of eligible 
students or, in the case of school-wide programs in which the 
vast majority of students participate in title I-A programs, 
help all students in high-poverty schools meet challenging 
State academic standards. Title I-A grants are distributed 
through four ESEA formulas in amounts provided by this act: 
basic, concentration, targeted, and the education finance 
incentive grant [EFIG].
    Of the funds available for title I-A grants to LEAs, up to 
$5,000,000 shall be available on October 1, 2023, for transfer 
to the Census Bureau for poverty updates; $7,715,625,000 will 
become available on July 1, 2024; and $10,841,177,000 will 
become available on October 1, 2024. The funds that become 
available on July 1, 2024, and October 1, 2024, will remain 
available for obligation through September 30, 2025.
    The fiscal year 2024 President's budget also proposes to 
reserve up to $100,000,000 from amounts available for EFIG and 
targeted grants to support voluntary activities to help school 
systems address inequities in school funding through voluntary 
State school funding equity commissions and voluntary local 
educational agency equity reviews. Given the limited allocation 
and necessity to invest in formula allocations needed to 
sustain investments that assist with academic recovery and 
student well-being, the Committee recommendation does not 
include this requested authority.
    School Improvement and Support.--The Committee appreciates 
the Department's targeted monitoring of implementation of ESEA 
requirements related to resource allocation reviews and 
resource inequities. The Committee also appreciates this 
summer's release of a dear colleague letter that shares 
recommendations for effectively implementing these 
requirements. The Department also must continue efforts to 
assist SEAs and LEAs with implementing all of the school 
improvement requirements of ESEA. The Committee is concerned 
the Department has not identified any actions or plans to 
implement direction in the explanatory statement accompanying 
last year's appropriations act which directed the Department to 
increase transparency on the amount reserved by each State for 
the school improvement set aside, method of distribution to 
eligible LEAs, and uses of such funds. The Committee directs 
the Department to provide a briefing on actions taken and 
planned to be taken to provide transparency for school 
improvement investments, including information required to be 
reported in State report cards.
    Students Experiencing Homelessness.--The Committee 
continues to be concerned by the challenges faced by students 
experiencing homelessness and the continued lack of compliance 
by LEAs with requirements intended to ensure such students 
receive necessary amounts required to be reserved under section 
1113(c)(3)(A) of the ESEA for a wide variety of services, 
including those not ordinarily provided with title I-A funds to 
other students served by title I-A programs such as all or part 
of the homeless liaison's salary, education-related fees, and 
other necessary items or services. The Department has taken 
important steps by recently revising its monitoring protocol 
and planning to work with SEAs to ensure they provide guidance 
on coordination between the LEA's title I and McKinney-Vento 
staff and provide training on methods for determining required 
set-aside amounts. The Committee looks forward to seeing the 
changes that result from these and other efforts and directs 
the Department to report in its fiscal year 2025 CJ the 
specific State policy changes resulting from these efforts. In 
addition, the Department should widely disseminate specific 
State policy changes resulting from monitoring findings and 
recommendations that produce more collaborative and transparent 
approaches to the determination of set-aside amounts under such 
section providing necessary resources to fulfill needs 
assessments conducted for students experiencing homelessness to 
meet State challenging academic standards and effectively take 
advantage of educational opportunities.
    In addition, as was noted in the explanatory statement 
accompanying last year's appropriations act, more must be done 
to improve transparency on amounts reserved by LEAs under 
section 1113(c)(3)(A). The Committee understands the Department 
is planning to analyze the variation of per-homeless-pupil 
amounts across LEAs within a State and take other steps to 
improve the quality of reported data. However, this must be 
accompanied with actions to provide transparency on amounts 
reserved and spent with funds available under such section, 
including effective technical assistance and support being 
provided to title I SEA and LEA leaders on the wide variety of 
services supported by these funds, implementation of an 
adequate needs assessment, and determination of a sufficient 
reservation under such section. The Committee requests a 
briefing on actions taken and planned on these issues not later 
than 45 days after enactment of this act.

Comprehensive Literacy State Development Grants

    The Committee recommendation includes $194,000,000 for the 
Comprehensive Literacy State Development Grants program. This 
program provides competitive grants to SEAs that then subgrant 
at least 95 percent of such funds to eligible entities to 
support efforts to improve the literacy skills of children and 
students from birth through 12th grade in high-need schools and 
early education programs in a State for each of several age 
bands through implementation of evidence-based practices and 
interventions. The fiscal year 2024 appropriation will support 
approximately 12 new and continuation State grant awards and 
funding reservations for Bureau of Indian Education schools, 
the outlying areas, and national activities, including 
evaluation.
    Evidence-based Instruction for Students with Language-based 
Learning Disabilities.--The Committee is aware ESEA requires 
the Secretary to prioritize applications proposing evidence-
based activities to develop or enhance comprehensive literacy 
instruction plans that ensure high-quality instruction and 
effective strategies in reading and writing for children from 
early childhood education through grade 12. In developing the 
notice inviting applications for this program consistent with 
the requirements of the ESEA, the Committee encourages the 
Department to consider applications that include activities 
designed to strengthen and enhance teacher training on the 
identification of language-based learning disabilities and 
evidence-based methods of literacy instruction for students 
with language-based learning disabilities.

Innovative Approaches to Literacy

    The Committee recommendation includes $30,000,000 for the 
Innovative Approaches to Literacy program. This program 
provides competitive grants to national not-for-profit 
organizations and school libraries for providing books and 
childhood literacy activities to children and families living 
in high-need communities.
    The Committee continues to direct the Department to reserve 
no less than 50 percent of funds under this program for grants 
to develop and enhance effective school library programs, which 
may include providing professional development to school 
librarians, books, and up-to-date materials to high-need 
schools. School library programs increase access to a wide 
range of print and electronic resources and provide learning 
opportunities for all students, particularly those who are less 
likely to have access to such materials at home. In addition, 
the Committee directs the Department to ensure that grants are 
distributed among eligible entities that will serve 
geographically diverse areas, including rural areas.

Migrant Education Program

    The Committee recommends $375,626,000 for the title I 
Migrant Education program. This funding supports grants to SEAs 
to ensure that migratory children receive full and appropriate 
opportunities to meet the same challenging State academic 
standards that all children are expected to meet and help such 
children overcome educational disruption and other factors that 
inhibit the ability of such children to succeed in school. 
Funding also supports activities to improve interstate and 
intrastate coordination of migrant education programs, as well 
as identify and improve services to the migrant student 
population.

Neglected and Delinquent

    The Committee recommends $49,239,000 for the Neglected and 
Delinquent program. This program, authorized under subpart 1 of 
title I-D of the ESEA, provides financial assistance to SEAs 
for education services to neglected and delinquent children and 
youth in State-run institutions and for juveniles in adult 
correctional institutions. States are authorized to set aside 
at least 15 percent, but not more than 30 percent, of their 
Neglected and Delinquent program 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. The 
Department is authorized to reserve up to 2.5 percent of the 
appropriation for national activities, including technical 
assistance. The Committee urges the Department to increase its 
direct and technical assistance support to further assist 
grantees in their efforts to improve and report on program 
outcomes.

Special Programs for Migrant Students

    The Committee recommends $52,123,000 for Special Programs 
for Migrant Students, which consist of the High School 
Equivalency Program [HEP] and the College Assistance Migrant 
Program [CAMP]. HEP projects are 5-year grants to institutions 
of higher education and other nonprofit organizations to 
recruit migrant students ages 16 and older and provide the 
academic and support services needed to help them obtain a high 
school equivalency credential and subsequently gain employment, 
attain admission to a postsecondary institution or a job 
training program, or join the military. CAMP projects are 5-
year grants to institutions of higher education and nonprofit 
organizations to provide tutoring, counseling, and financial 
assistance to migrant students during their first year of 
postsecondary education in order to support postsecondary 
education program completion.
    The bill does not include language proposed in the budget 
which allows the Secretary the ability to fund the highest 
quality HEP and CAMP applications regardless of the allocation 
requirements of the Higher Education Act.

                               Impact Aid

Appropriations, 2023....................................  $1,618,112,000
Budget estimate, 2024...................................   1,618,112,000
Committee recommendation................................   1,628,151,000

    The Committee recommends $1,628,151,000 for the Impact Aid 
program. Impact Aid provides financial assistance to LEAs 
affected by the presence of Federal activities and federally 
owned land. These LEAs face unique challenges because they must 
educate children living on federally owned land, such as 
military bases, while federally owned property is also exempt 
from local taxes, a primary source of revenue for LEAs. LEAs 
also enroll students residing on private property whose parents 
may be exempt from paying sales and income taxes, reducing the 
revenue available to support these LEAs.

Basic Support Payments

    The Committee recommends $1,477,000,000 for the Basic 
Support Payments program. 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 23 heavily impacted LEAs and providing any remaining 
funds for regular basic support payments.
    Student Weighting.--The Committee understands that this 
year one LEA benefitting from increased student weighting for 
serving a large total student and on-base military and civilian 
connected student population has experienced a decline in total 
student population that jeopardizes their eligibility for such 
student weighting. Such a change could cause a significant 
reduction in Impact Aid payment. The Committee notes there are 
other changes impacting LEAs eligibility for Impact Aid and 
understands the need for continued work to address these issues 
in a comprehensive manner that reflects the input of all 
stakeholders. The Department should be prepared to engage in 
these discussions and seamlessly implement changes.

Payments for Children With Disabilities

    The Committee bill includes $48,316,000 for Payments for 
Children With Disabilities. Under this program, additional 
payments are made for certain federally connected children 
eligible for services under the Individuals with Disabilities 
Education Act [IDEA].

Facilities Maintenance

    The Committee recommends $4,835,000 for Facilities 
Maintenance. This activity provides funding for emergency 
repairs and comprehensive capital improvements to certain 
school facilities owned by the Department and used by LEAs to 
serve federally connected military dependent students. Funds 
appropriated for this purpose are available until expended.

Construction

    The Committee recommends $19,000,000 for eligible LEAs for 
school construction activities allocated through the authority 
for formula grants to LEAs under section 7007(a) of the ESEA.

Payments for Federal Property

    The Committee recommends $79,000,000 for Payments for 
Federal Property. These payments compensate LEAs specifically 
for revenue lost due to the removal of Federal property from 
local tax rolls, regardless of whether any federally connected 
children attend schools in the LEA.

                      School Improvement Programs

Appropriations, 2023....................................  $5,810,642,000
Budget estimate, 2024...................................   5,890,278,000
Committee recommendation................................   5,820,642,000

    The Committee recommendation includes $5,820,642,000 for 
the School Improvement Programs account.

Supporting Effective Instruction State Grants

    The Committee recommends $2,190,080,000 for Supporting 
Effective Instruction State Grants. States and LEAs may use 
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, improving equitable access 
to effective teachers, and implementing teacher mentoring 
systems, evaluation and support systems, merit pay, and merit-
based performance systems. These funds may also be used by LEAs 
to hire teachers to reduce class sizes.
    The appropriation for this program primarily supports 
activities associated with the 2024-2025 academic year. Of the 
funds provided, $508,639,000 will become available on July 1, 
2024, and $1,681,441,000 will become available on October 1, 
2024. These funds will remain available for obligation through 
September 30, 2025.
    The Committee notes that title II, part A funds can be 
targeted toward effective preparation and professional 
development designs that enable teachers and school leaders to 
expand their knowledge and skills regarding the sciences of 
child and adolescent learning and development, including 
teaching challenging content, teaching diverse learners, and 
supporting social-emotional and academic development in 
culturally and linguistically responsive ways.

Supplemental Education Grants

    The Committee recommendation includes $24,464,000 for 
supplemental education grants to the Republic of Marshall 
Islands [RMI] and the Federated States of Micronesia [FSM]. 
This grant program was authorized by the Compact of Free 
Association Amendments Act of 2003 (Public Law 99-239). Under 
the Compact, funds were transferred from the Department to the 
Secretary of the Interior for grants to these entities. The 
Committee bill continues language requested in the budget and 
contained in previous appropriations acts that allows the 
Secretary of Education to reserve 5 percent of these funds to 
provide FSM and RMI with technical assistance.

Nita M. Lowey 21st Century Community Learning Centers

    The Committee recommends an appropriation of $1,329,673,000 
for the Nita M. Lowey 21st Century Community Learning Centers 
program. Funds are allocated to States by formula, which in 
turn, award at least 95 percent of their allocations to LEAs, 
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 to students who attend schools that are eligible 
to operate a school-wide program under title I of the ESEA or 
serve high percentages of students from low-income families.

State Assessments Grants

    The Committee recommends $380,000,000 for the State 
Assessments Grants program. This program provides formula 
grants to States for the development and implementation of 
standards and assessments required by the ESEA. This program 
may assist States and LEAs in carrying out audits of their 
assessment systems to eliminate low-quality or duplicative 
assessments. It also provides competitive grants to States, 
including consortia of States, to improve the quality, 
validity, and reliability of academic assessments. The 
recommendation includes nearly $11,000,000 more than the 
statutorily required amount for formula grants that would be 
available for new competitive grants for state assessments.
    The Committee recommendation does not include language 
proposed in the President's budget that would provide up to 
$100,000,000 in grants to LEAs for a new demonstration program 
that would develop, improve, or scale-up diagnostic and 
formative assessments.

Education for Homeless Children and Youth

    The Committee recommends $129,000,000 for carrying out 
education activities authorized by title VII, subtitle B of the 
McKinney-Vento Homeless Assistance Act. 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 children and 
youth experiencing homelessness, and to make subgrants to LEAs 
to support the education of those children and youth. Grants 
are made to States based on the total that each State receives 
in title I-A grants to LEAs. States must subgrant not less than 
75 percent of funds received to LEAs and may reserve remaining 
funds for State level activities. Under the McKinney-Vento 
Homeless Children and Youth Program, SEAs must ensure that 
children and youth experiencing homelessness have equal access 
to the same free public education, including a public preschool 
education, as is provided to other children and youth.
    The Committee recommendation includes new language 
providing an additional 12 months for educational agencies and 
institutions to obligate and expend EHCY funds provided last 
year and in this year's act.

Training and Advisory Services

    For Training and Advisory Services authorized by title IV 
of the Civil Rights Act (Public Law 88-352), the Committee 
recommends $6,575,000. The funds provided will support awards 
to operate regional equity assistance centers [EACs]. EACs 
provide services to LEAs, SEAs, and other customers upon 
request. Activities include disseminating information on 
successful practices and legal requirements related to 
nondiscrimination in educational programs on the basis of race, 
sex, religion, or national origin and evidence-based activities 
to improve equity and access to high-quality educational 
settings.

Native Hawaiian Education

    The Committee recommends $45,897,000 for the Education for 
Native Hawaiian program. In addition, the Committee bill 
continues a provision that clarifies the use of funds for 
administrative costs.
    The Committee recommendation provides $650,000 for the 
Native Hawaiian Education Council, which includes an increase 
of $150,000 for the Council to fulfill the statutory 
requirement for data collection.
    The Committee recommendation continues the set-aside 
established last year of funds made available for the Education 
for Native Hawaiians program for grants for construction, 
renovation, and modernization of any public elementary school, 
secondary school, or structure related to a public elementary 
school or secondary school, that serves a predominantly Native 
Hawaiian student body. The Committee intends increased funds 
above the prior year be used for this purpose, which shall be 
made competitively available to organizations in need of 
assistance with infrastructure improvement for increased 
capacity to serve a predominantly Native Hawaiian student body.

Alaska Native Education

    The Committee recommends $44,953,000 for the Alaska Native 
Education. These funds help address the unique educational 
needs of Alaska Native schoolchildren. Funds are used for the 
development of supplemental educational programs to benefit 
Alaska Natives.
    Use of Funds.--The Committee continues language that allows 
funding provided by this program to be used for construction 
and overriding the authorizing statute's requirement to make 
noncompetitive awards to certain organizations.
    Outreach and Program Responsiveness.--The Committee directs 
the Department to make every effort to ensure that grants are 
awarded well in advance of the school year, to maximize 
grantees' ability to hire the necessary staff and have their 
programs ready to go with the start of Alaska's school year in 
mid-August. The Committee continues to direct the Department to 
ensure that Alaska Native Tribes, Alaska Native regional non-
profits, and Alaska Native corporations have the maximum 
opportunity to successfully compete for grants under this 
program by providing these entities multiple opportunities for 
technical assistance in developing successful applications for 
these funds, both in Alaska and via various forms of 
telecommunications. The Committee also strongly encourages the 
Department to include as many peer reviewers as possible who 
are Alaska Natives or who have experience with Alaska Native 
education and Alaska generally on each peer review panel.

Rural Education

    The Committee recommends $220,000,000 for rural education 
programs. The Committee expects that rural education funding 
will be equally divided between the Small, Rural School 
Achievement Program, which provides funds to LEAs that serve a 
small number of students, and the Rural and Low-Income School 
Program, which provides funds to LEAs that serve concentrations 
of poor students, regardless of the number of students served.
    In 2020, the Department announced that some LEAs were using 
alternative poverty data to demonstrate eligibility for the 
Rural and Low-Income School Program in place of the U.S. Census 
Bureau's Small Area Income and Poverty Estimates, as required 
by section 5221(b)(1)(A)(i) of the ESEA. The Department had 
routinely accepted these data since the program was created in 
2002. In fiscal years 2021, 2022 and 2023, those LEAs that 
would have been eliminated abruptly from eligibility were held 
harmless at a declining rate that would continue to fall this 
fiscal year through fiscal year 2027. The Committee has also 
increased funding for the Rural Education Achievement Program 
in the fiscal year 2021 through 2023 bills and recommends an 
increase of $5,000,000 for this fiscal year. The Committee 
understands that changes to eligibility for funding received 
under this program create very significant challenges for 
several LEAs and States, at no fault of their own, and 
therefore includes bill language that will hold the affected 
LEAs harmless during this fiscal year.

Comprehensive Centers

    The Committee recommends $50,000,000 for the Comprehensive 
Centers program. These funds provide support to a network of 
comprehensive centers that are operated by research 
organizations, agencies, institutions of higher education, or 
partnerships thereof. Centers provide training and technical 
assistance identified in annual State service plans to build 
the capacity of SEAs and the Bureau of Indian Education [BIE], 
and through them LEAs, and schools, to provide a high quality 
education to all students.
    The Committee understands the Department is considering 
changes for the scheduled 2024 competition for regional and 
content centers. The Committee requests a briefing not later 
than 14 days prior to issuance of a notice of proposed 
priorities or notice inviting applications on how the 
assessments of the Regional Advisory Committees and other 
regional surveys are reflected in these notices.

Student Support and Academic Enrichment Grants

    The Committee recommendation includes $1,400,000,000 for 
Student Support and Academic Enrichment [SSAE] Grants. This 
program provides formula grants to States based on each State's 
share of title I-A grants, which then sub-grant to LEAs, to 
help support activities that provide students with a well-
rounded education, ensure safe and supportive learning 
environments, and use technology to improve instruction.
    Report on Use of Funds.--The Committee understands the 
Department is conducting an implementation study that will 
gather information on how LEAs determined the uses of SSAE 
grant funds, the primary services and activities implemented 
with such funds and the support from SEAs for implementation of 
the program. The Committee looks forward to the publication of 
the report in early 2024. In addition, the Department should 
continue to analyze and report on expenditures by statutory 
program areas and the percentage of LEAs spending funds in each 
of these areas.
    Technical Assistance and Capacity Building.--The Committee 
appreciates the information provided in the fiscal year 2024 CJ 
on expenditures for the 2 percent set-aside for technical 
assistance and capacity building from the fiscal year 2022 
appropriation. The reservation for technical assistance [TA] 
and capacity building should be used to support SEAs and LEAs 
in carrying out authorized activities under this program 
identified by SEAs and LEAs, which may include support for 
fostering school diversity efforts across and within school 
districts. The Committee continues to direct the Department to 
prioritize its TA and capacity building support for SEAs and 
LEAs seeking to address such school diversity needs. In future 
CJs, the Department shall continue to provide current and 
planned expenditures for this reservation and include a plan 
for how resources will be spent to provide TA and to build the 
capacity of SEAs and LEAs. Further, such information shall also 
describe how expenditures for this reservation have and will 
build upon efforts to foster school diversity across and within 
school districts, including efforts set out by the Department 
in the May 8, 2023 Notice Inviting Applications.

                            School Readiness

Appropriations, 2023....................................................
Budget estimate, 2024...................................    $500,000,000
Committee recommendation................................................

    The Committee does not include funds for a newly proposed 
School Readiness account.

Preschool Incentive Demonstration Program

    The Committee recommendation does not includes funds for 
this proposed demonstration program. The proposed program is 
intended to expand access to high-quality preschool for 
children eligible to attend title I schools through a mixed-
delivery model.

                            Indian Education

Appropriations, 2023....................................    $194,746,000
Budget estimate, 2024...................................     201,746,000
Committee recommendation................................     194,746,000

    The Committee recommends $194,746,000 for Indian Education 
programs.

Grants to Local Educational Agencies

    For grants to LEAs, the Committee recommends $110,381,000. 
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 
LEAs, schools supported and operated by the Department of the 
Interior/Bureau of Indian Education, and in some cases directly 
to Indian Tribes.

Special Programs for Indian Children

    The Committee recommends $72,000,000 for Special Programs 
for Indian Children. Funds are used for demonstration grants to 
improve Indian student achievement from early childhood 
education through college preparation programs, and for 
professional development grants for training Indians who are 
preparing to begin careers in teaching and school 
administration. The Committee continues support for the Indian 
Education Professional Development Program to effectively 
prepare and address the need for American Indian/Alaska Native 
teachers and administrators.
    In addition, the Department shall continue support for the 
teacher retention-initiative established in fiscal year 2023 to 
address the shortage of Native American educators and expand 
their impact on Native American students' education. The 
initiative should support teacher leadership models to increase 
the retention of effective, experienced Native American 
teachers.

National Activities

    The Committee recommends $12,365,000 for National 
Activities. Funds are used to expand efforts to improve 
research, evaluation, and data collection on the status and 
effectiveness of Indian education programs, and to continue 
grants to Tribal educational departments for education 
administration and planning. The President's budget includes 
appropriations language overriding the authorized funding level 
for this program. The Committee bill continues language, which 
allows the Secretary to make such awards for a period not to 
exceed 5 years.
    Native American Language Immersion Programs.--The 
recommendation includes not less than $2,885,000 for Native 
American Language Immersion Programs. If the Department makes 
new awards in fiscal year 2024, funds for the Native American 
Language Immersion program should continue to be allocated to 
all types of eligible entities, including both new and existing 
language immersion programs and schools, to support the most 
extensive possible geographical distribution and language 
diversity. Further, the Department should continue to give the 
same consideration to applicants that propose to provide 
partial immersion schools and programs as to full immersion, as 
the local Tribes, schools, and other applicants know best what 
type of program will most effectively assist their youth to 
succeed.
    The Committee notes that Hawaiian is a Native American 
language defined under the Native American Language Act, and 
that the Department website specifically lists Native Hawaiian 
organizations as eligible for funding under the Native American 
Language program. The Committee further notes that while almost 
half of the Native students enrolled in Native American 
language immersion schools or programs are taught in the medium 
of Hawaiian, there has not been a single Hawaiian language 
school or program grantee in the years the Department has 
administered this program. Therefore, the Committee is 
concerned the Department has failed to provide adequate notice 
of Native American Language program funding opportunities or to 
seek meaningful engagement with the Native Hawaiian community. 
The Committee directs the Department to provide parity in the 
treatment to American Indian, Alaska Native and Native Hawaiian 
language immersion schools and programs, including the 
development of a fair and equitable process to confer with 
Native Hawaiian organizations and Hawaiian language education 
stakeholders regarding implementation of the Native American 
Language program.
    Native American Language Resource Centers.--The Committee 
recognizes the importance of supporting the revitalization of 
such Native American languages, including by encouraging and 
supporting the use of Native American languages as a medium of 
instruction. In addition, the Committee recognizes the need to 
encourage and support elementary schools, secondary schools, 
and institutions of higher education to include Native American 
languages in the curriculum in the same manner as other world 
languages, including through cooperative agreements and 
distance education, and to grant proficiency in Native American 
languages the same full academic credit as proficiency in other 
world languages. To that end, the Committee provides $2,965,000 
to carry out the policy set forth in Public Law 117-335 and 
direction provided in fiscal years 2022 and 2023 to establish 
Native American Language Resource Centers. Furthermore, the 
Committee directs the Office of Indian Education to continue 
consulting with the Office of English Language Acquisition on 
the continued development, implementation, and support of the 
centers.

                       Innovation and Improvement

Appropriations, 2023....................................  $1,453,443,000
Budget estimate, 2024...................................   1,604,000,000
Committee recommendation................................   1,236,844,000

    The Committee recommends $1,236,844,000 for programs within 
the Innovation and Improvement account. This amount includes an 
additional $87,344,000 provided by a general provision at the 
end of this title of the bill.

Education Innovation and Research

    The Committee recommendation includes $240,000,000 for the 
Education Innovation and Research [EIR] program. This program 
supports the creation, development, implementation, 
replication, and scaling up of evidence-based, field-initiated 
innovations designed to improve student achievement and 
attainment for high-need students. EIR incorporates a tiered 
evidence framework that provides early-phase, mid-phase, and 
expansion and replication grants. This supports interventions 
throughout the pipeline, from smaller grants for early stage 
projects that are willing to undergo rigorous evaluation to 
test their efficacy to larger grants to scale-up proven-
effective interventions that have demonstrated significant 
impacts through at least one rigorous evaluation. The Committee 
recommendation supports a robust competition for new awards of 
approximately $225,000,000.
    Briefing Requirement.--The Committee requests the 
Department brief the Committees on the fiscal year 2024 funding 
opportunities available under this program, including any 
proposed priorities, not less than 14 days prior to publication 
in the Federal Register.
    Data Science Education.--The Committee encourages the 
Department to invite eligible applications that propose the 
development and implementation of effective interventions to 
support data science education.
    Grant Priorities.--The Committee notes there is significant 
demand from the field to test many types of strategies and to 
examine promising techniques that can be scaled-up in different 
settings. The Committee expects funds to continue to support 
diverse and field-initiated interventions, rather than a single 
nationwide program or award focused solely on one area of 
educational innovation. The Committee believes the Department 
should continue to support new awards to develop, validate and 
scale up evidence-based strategies that address the impact of 
the COVID-19 pandemic.
    Social and Emotional Learning.--The Committee expects the 
Department to continue prioritizing and funding quality 
applications for eligible social and emotional learning 
projects within both the early- and mid-phase evidence tiers.
    Rural Set-Aside.--The Committee supports the required 25 
percent set-aside within EIR for rural areas and encourages the 
Department to take steps necessary to ensure the set-aside is 
met and that EIR funds are awarded to diverse geographic areas. 
The Committee encourages the Department to invest in rural, 
high-need communities by ensuring grants are awarded to a 
diverse set of institutions, affecting varied geographic 
locations, including areas with substantial minority students, 
which have submitted high quality applications meeting EIR 
program requirements.

School Leader Recruitment and Support

    The Committee recommendation does not include funding for 
the School Leader Recruitment and Support [SLRS] program. The 
President's budget proposed $40,000,000 for SLRS. This program 
is authorized to provide competitive grants for improving the 
recruitment, preparation, placement, support and retention of 
effective principals and other school leaders in high-need 
schools.

Charter School Program

    The Committee recommends $440,000,000 for the Charter 
School Program [CSP]. This program supports the start-up, 
replication, and expansion of high-quality public charter 
schools prepared to effectively serve all students.
    Program Activities.--The Committee bill includes new 
language modified from last year's enacted bill to increase 
flexibility within the program to effectively respond to the 
changing needs of the sector and the likelihood that Federal 
funds will be invested in high-quality charter schools prepared 
to serve all students effectively. Both the authorizing statute 
and prior year appropriations bills dictated the use of the 
appropriation in ways that prevented the Department from 
allocating funds based on the number of high quality 
applications in grant competitions and emerging needs of the 
field. To facilitate this, the Committee expects the Department 
to run competitions for charter school programs on similar 
cycles and earlier in the fiscal year. The new language allows 
the Department to allocate not more than $140,000,000 for 
replication and expansion of high-quality charter schools 
through the Charter Management Organization [CMO] program 
established in ESEA. The Committee bill provides extended 
availability through March 31, 2025 for continuation grants for 
existing CMO grantees making substantial progress on their 
awards. The bill also allocates not less than $60,000,000 for 
Facilities Grants under section 4304, including the Credit 
Enhancement program. The bill also provides not more than 
$16,000,000 for national activities to provide technical 
assistance, disseminate best practices, and evaluate the impact 
of the charter school program. Finally, funds are available for 
use under 4305(a)(2) for Developer grants and under section 
4303 for State Entity grants. The Committee directs the 
Department to provide a briefing on its planned use of 
flexibility provided not later than 14 days prior to the 
announcement of any notice of proposed priorities, notice 
inviting applications for CSP activities, and announcement of 
grant awards.
    In addition, the Department is directed to continue to 
support and evaluate flexibility in the availability and 
effective use of CSP State Entity technical assistance 
resources; evaluate how such funds are used to ensure 
subgrantees are equipped to meet the needs of all students, and 
specifically students with disabilities and English learners as 
required by law; and, brief the Committees not later than 90 
days after enactment of this act on its actions and continued 
plans to effectively oversee the CSP program.
    The Committee takes no action on additional language 
proposed in the President's budget that would prohibit the 
Secretary from making new awards under Charter Schools Grants 
that support charter schools that are operated or managed by 
for-profit entities, including through contractual 
relationships. CSP applicants for State Entity, CMO, and 
Developer grant competitions must assure a charter school 
supported by CSP funds has not or will not enter into a 
contract with a for-profit management organization, including a 
nonprofit management organization operated by or on behalf of a 
for-profit entity, under which the management organization, or 
its related entities, exercises full or substantial 
administrative control over the charter school and, thereby, 
the CSP project. The Committee expects the Department to 
enforce the assurance and related transparency requirements for 
the reporting of contracts with for-profit entities.

Magnet Schools Assistance

    The Committee recommends $139,000,000 for the Magnet 
Schools Assistance program. This program supports grants to 
LEAs 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; salaries of instructional staff; 
transportation, as long as such expenses are sustainable beyond 
the grant period and not a significant portion of the grant; 
and the purchase of technology, educational materials, and 
equipment.
    Fiscal Year 2024 Priorities.--The Committee requests a 
briefing not later than 14 days prior to the publication of a 
notice of proposed priorities or notice inviting applications 
for fiscal year 2024 funds.

Teacher and School Leader Incentive Grants

    The Committee recommendation includes $120,000,000 for 
Teacher and School Leader Incentive Grants. At this level, the 
Department would have sufficient funding for all non-
competitive continuation awards and approximately $20,000,000 
for renewal awards. The Committee requests a briefing not later 
than 14 days prior to obligating funds for new activities, 
including renewal awards expected to be made at this funding 
level. This program provides competitive grants to eligible 
entities to develop, implement, improve, or expand human 
capital management systems or performance-based compensation 
systems in schools. Funds can be used for a wide-range of 
activities, including developing or improving evaluation and 
support systems that are based in part on student achievement; 
providing principals with necessary tools to make school-level 
decisions; implementing a differentiated salary structure based 
on a variety of factors; improving the recruitment and 
retention of effective teachers, principals, and other school 
leaders; and instituting career advancement opportunities that 
reward effective teachers, principals and other school leaders.

Ready-To-Learn Television

    The Committee recommendation includes $31,000,000 for the 
Ready-to-Learn Television program. This program is designed to 
facilitate student academic achievement by leveraging the power 
and reach of public television to develop and distribute 
educational video programming, and digital content, for 
preschool and elementary school children and their parents, 
caregivers, and teachers.

Arts in Education

    The Committee recommendation includes $30,000,000 for the 
Arts in Education program. The funding is used for a program of 
competitive awards for assistance for arts education, including 
professional development for arts educators, teachers and 
principals; developing and disseminating accessible 
instructional materials and arts-based educational programming; 
and for national and community outreach activities that 
strengthen relationships among LEAs, schools, communities and 
arts organizations. Funds also are used for evaluation and 
dissemination activities.

Javits Gifted and Talented Students

    The Committee recommendation includes $16,500,000 for the 
Javits Gifted and Talented Students Education program. Funds 
are used for awards to State and local educational agencies, 
institutions of higher education, and other public and private 
agencies for research, demonstration, and technical assistance 
activities designed to enhance the capability of elementary and 
secondary schools to meet the special educational needs of 
gifted and talented students. Under ESEA, the Department gives 
priority to making awards for projects that include evidence-
based activities or that develop new information to improve the 
capacity of schools to operate gifted and talented education 
programs or to assist schools in identifying and serving 
traditionally underserved students

Supporting Effective Educator Development

    The Committee recommendation includes $90,000,000 for the 
Supporting Effective Educator Development [SEED] program. SEED 
provides competitive grants to improve teacher and principal 
effectiveness by supporting pathways that help teachers, 
principals, or other school leaders with non-traditional 
preparation and certification obtain employment in underserved 
LEAs; providing evidence-based professional development; and 
making services and learning opportunities freely available to 
LEAs.
    Effective School Leaders.--The Committee recognizes the 
significant impact of effective school principals and other 
school leaders on student achievement and other student 
outcomes, and believes the SEED program provides important 
support for helping ensure that more highly trained school 
leaders are available for service in schools that have 
concentrations of students from low-income families. Therefore, 
the Committee directs the Secretary to continue to use a 
portion of funds made available for SEED for awards supporting 
the preparation of principals and other school leaders.

American History and Civics Education

    The Committee recommendation includes $23,000,000 for 
American History and Civics Education, including $3,000,000 for 
Presidential and Congressional Academies for American History 
and Civics and $20,000,000 for American History and Civics 
Education National Activities.
    Presidential Academies for the Teaching of American History 
and Civics offer residential workshops to elementary and 
secondary school teachers to strengthen their knowledge through 
instruction and interaction with primary scholars and 
accomplished teachers in these fields. The Congressional 
Academies for Students of American History and Civics provide 
similar workshops to students to enrich their understanding of 
American history and civics.
    The Committee recommendation only includes sufficient funds 
for continuation grants and does not include proposed language 
for Civics Participatory Learning and Engagement Grants.

Statewide Family Engagement Centers

    The Committee recommendation includes $20,000,000 for 
Statewide Family Engagement Centers. This program provides 
competitive grants to statewide organizations to promote and 
implement evidence-based family engagement activities in 
education programs, and provide training and technical 
assistance to SEAs, LEAs, schools, and other organizations for 
carrying out such activities.
    Parental and Family Engagement.--The Committee 
recommendation sustains the increased resources provided the 
past 2 years that has enabled the Department to support 20 
centers providing technical assistance to SEAs, LEAs and 
relevant organizations to increase parental and family 
engagement to improve educational outcomes. The Committee urges 
the Department to continue to support educators, principals, 
school leaders, specialized instructional support personnel, 
and other school staff in implementing evidence-based parental 
and family engagement activities to address chronic absenteeism 
and other urgent issues facing students, parents, and families, 
such as home visitation programs, effective professional 
development, afterschool and summer activities, and the 
provision of resources in the home languages of families.

Fostering Diverse Schools

    The budget includes $100,000,000 for the creation of a new 
Fostering Diverse Schools program. This new program would 
support competitive awards to address voluntary efforts to 
increase racial and socioeconomic diversity in preschool 
through 12th grade.
    While the Committee recommendation does not include 
requested bill language and funding for this proposal, the bill 
does include investments through a range of authorized programs 
that may be used to further racial and socioeconomic diversity 
in the Nation's public schools, including capacity building 
grants through the student support and academic enrichment 
grant program.

Fund for the Improvement of Education

    The bill includes a general provision providing an 
additional $87,344,000 for this account for projects and 
associated amounts and purposes identified in the table at the 
end of this Committee Report.

                 Safe Schools and Citizenship Education

Appropriations, 2023....................................    $457,000,000
Budget estimate, 2024...................................   1,075,000,000
Committee recommendation................................     437,000,000

    The Committee recommends a total of $437,000,000 for 
activities to promote safe schools, healthy students, and 
citizenship education.

Promise Neighborhoods

    The Committee recommendation includes $91,000,000 for the 
Promise Neighborhoods program. This program awards competitive 
grants to not-for-profit, community-based organizations for the 
development of comprehensive neighborhood programs designed to 
combat the effects of poverty and improve educational and life 
outcomes for children and youth, from birth through college. 
Each Promise Neighborhood grantee serves a high-poverty urban 
neighborhood or rural community. Grants are for up to 5 years, 
with the final 2 years of funding contingent on grantee 
performance against program- and project-level performance 
objectives. Further, grants may be extended an additional 2 
years beyond the 5-year project period contingent on grantee 
performance. The bill continues to provide extended 
availability of these funds, to allow the Department more 
flexibility for the timing of new awards and maximize the time 
for grantee planning activities.

School Safety National Activities

    The Committee recommendation includes $196,000,000 for 
School Safety National Activities, including up to $5,000,000 
as necessary for Project SERV, which provides assistance to 
schools and institutions of higher education to respond and 
recover in the aftermath of violent or traumatic events 
disrupting the learning environment. School Safety National 
Activities funding also supports several grant and technical 
assistance activities intended to improve the safety, health, 
and well-being of all students. At the recommended funding 
level, sufficient funding is available for continuation grants 
for grantees making substantial progress on their awards, and 
approximately $60,000,000 is available for new awards. The 
Committee requests a briefing not later than 14 days prior to 
the issuance of any notice inviting applications or notice of 
proposed priorities.
    Mental Health Service Professional Development Grant 
Program and School-Based Mental Health Services Grant 
Program.--The Committee encourages the Department to continue 
working to support SEAs, LEAs, and IHEs in addressing the 
shortage of school-based mental health professionals in our 
Nation's K-12 schools by expanding the pipeline of these 
professionals and improving districts' ability to recruit and 
retain these professionals. The Committee recommendation 
includes $44,000,000 for continuation awards for the 2022 
cohort of grantees under the Mental Health Services 
Professional Demonstration Grant Program and $56,000,000 for 
continuation awards for the 2022, 2021, and 2020 cohorts of 
grantees under the School-Based Mental Health Services Grant to 
increase the number of well-trained school counselors, school 
social workers, and school psychologists, or other mental 
health professionals qualified to provide school-based mental 
health services. The Bipartisan Safer Communities Act also 
provides $100,000,000 each for these programs for additional 
continuation grants in fiscal year 2024.
    The Committee recognizes the significant challenges facing 
some students, including LGBTQ+ students and students of color, 
in regards to bullying and harassment by their peers. The 
Committee understands that LGBTQ+ youth are four times more 
likely to attempt suicide than their peers. These funds can 
help reduce bullying and harassment, improve student well-
being, and ensure every student is able to attend school in a 
safe and welcoming environment.
    Project Prevent.--The Committee recommendation includes 
just more than $8,000,000 to continue existing Project Prevent 
grants. These grants are helping increase the capacity of LEAs 
in communities with high rates of violence to address the needs 
of students, including by supporting trauma-informed practices, 
and help break the cycle of violence.
    GAO Study of Substance Misuse Prevention.--The Committee is 
concerned about the increase of K-12 students using and abusing 
substances like opioids, tobacco, and vaping. The Committee 
appreciates GAO's work to evaluate and improve the Federal 
effort to improve drug prevention efforts. The Committee 
directs GAO to report on the extent to which States require the 
use of evidence-based drug education and prevention programs in 
schools. GAO shall also report on how the Federal Government 
helps address challenges schools face in implementing such 
programs, especially in rural areas, and make recommendations 
on best practices for incorporating educational materials on 
the harmful impacts of substance misuse and abuse. The 
Committee requests GAO provide a preliminary briefing not later 
than 200 days after the date of enactment of this act and to 
provide a full report on the findings of the review as 
determined at the briefing.

Full Service Community Schools

    The Committee recommendation includes $150,000,000 for 
Full-Service Community Schools. This program provides support 
for the planning, implementation, and operation of full-service 
community schools that improve the integration, accessibility, 
and effectiveness of services for children and families, 
particularly for children attending high-poverty schools, 
including high-poverty rural schools. The Committee appreciates 
the Department adopted a priority for State scaling grants for 
implementation of the program in fiscal year 2023. The 
Committee believes prioritizing commitments by States to 
sustain the Federal investment made by this program is a 
powerful way to leverage these funds and support the growing 
evidence base that this approach improves student outcomes and 
school performance.
    The Committee recommendation does not include language 
proposed in the President's budget allowing up to $10,000,000 
to be awarded as planning grants, $25,000,000 to be used for 
grants to LEAs to provide integrated student supports language, 
and up to 2 percent of Full-Service Community Schools funds to 
provide technical assistance to grantees.

                      English Language Acquisition

Appropriations, 2023....................................    $890,000,000
Budget estimate, 2024...................................   1,195,000,000
Committee recommendation................................     897,000,000

    The Committee recommends an appropriation of $897,000,000 
for the English Language Acquisition [ELA] program.
    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 authorizing statute requires 
that 6.5 percent of the appropriation 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; and a 
National Clearinghouse for English Language Acquisition and 
Language Instructional Programs. National activities funds 
shall be available for 2 years.
    National Clearinghouse for English Language Acquisition.--
The Committee does not adopt the President's budget proposal to 
increase to $4,000,000 the amount of funds that may be reserved 
for the National Clearinghouse for English Language Acquisition 
and expand the scope of the National Clearinghouse to include 
technical assistance and capacity building to support SEAs and 
LEAs.
    Multilingualism.--The Committee is concerned that the 
Office of English Language Acquisition has overemphasized 
English-only approaches for the education of English language 
learner students, to the detriment of bilingual and dual 
language approaches. These approaches have proven more 
effective in the teaching of English, as well as academic 
content such as reading, math, science, and social studies. The 
Committee supports initiatives to build multilingual teacher 
pipelines through Grow-Your-Own initiatives and provide 
professional development in multilingual education for existing 
school staff and teachers. The Committee also supports efforts 
for post-secondary fellowships to bolster the multilingual 
educator pipeline.

                           Special Education

Appropriations, 2023.................................... $15,453,264,000
Budget estimate, 2024...................................  18,179,373,000
Committee recommendation................................  15,661,764,000

    The Committee recommends an appropriation of 
$15,661,764,000 for special education programs.

Grants to States

    The Committee recommendation includes $14,368,704,000 for 
IDEA part B Grants to States. 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 LEAs, but may reserve some for program 
monitoring, enforcement, technical assistance, and other 
activities. The appropriation for this program primarily 
supports activities associated with the 2024-2025 academic 
year. Of the funds available for this program, $5,085,321,000 
will become available on July 1, 2024, and $9,283,383,000 will 
become available on October 1, 2024. These funds will remain 
available for obligation through September 30, 2025.

Preschool Grants

    The Committee recommends $420,000,000 for Preschool Grants. 
This program provides formula grants to States to assist them 
in making available special education and related services for 
children with disabilities aged 3 through 5. States distribute 
the bulk of the funds to LEAs. States must serve all eligible 
children with disabilities aged 3 through 5 and have an 
approved application under the IDEA.

Grants for Infants and Families

    The Committee recommends $560,000,000 for the Grants for 
Infants and Families program under part C of the IDEA. Part C 
of IDEA authorizes formula grants to States, outlying areas, 
and other entities to implement State-wide systems for 
providing early intervention services to all children with 
disabilities, ages 2 and younger, and their families. IDEA also 
gives States the option of extending eligibility for part C 
services to children 3 and older if they were previously served 
under part C and will continue to be served until entrance to 
kindergarten. The Committee bill does not include the policy 
proposals included in the President's budget.

State Personnel Development

    The Committee recommends $38,630,000 for the State 
Personnel Development program. Ninety percent of funds must be 
used for professional development activities. The program 
supports grants to SEAs 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.

Technical Assistance and Dissemination

    The Committee recommends $75,345,000 for Technical 
Assistance and Dissemination. 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 the IDEA.
    Special Olympics.--Within the total, the Committee 
recommendation includes $36,000,000 to support activities 
authorized by the Special Olympics Sport and Empowerment Act. 
This funding supports efforts to expand Special Olympics 
programs and the design and implementation of Special Olympics 
education programs that can be integrated into classroom 
instruction and are consistent with academic content standards.

Personnel Preparation

    The Committee recommends $134,500,000 for the Personnel 
Preparation 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 program 
is required to fund several other broad areas, including 
training leadership personnel and personnel who work with 
children with low-incidence disabilities, and providing 
enhanced support for beginning special educators. The Committee 
notes the critical role the Personnel Preparation program plays 
in helping to address the Nation's shortage of teachers for 
students with disabilities. Given the critical shortage of 
special education teachers, including the higher education 
special education faculty who prepare them, the Committee 
recommends that the Office of Special Education Programs 
prioritize additional investments in doctoral level personnel 
preparation in special education.

Parent Information Centers

    The Committee recommends $33,152,000 for Parent Information 
Centers. 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 $31,433,000 for Technology and 
Media Services. This program makes competitive awards to 
support the development, demonstration, and use of technology 
and educational media activities of value to children with 
disabilities.
    Education Materials in Accessible Formats for Students with 
Visual Impairments.--The Committee recognizes the ongoing 
progress made with the tools and services provided under the 
Educational Technology, Media and Materials program that have 
allowed more than 900,000 students with disabilities free 
access to more than 1.0 million books in digitally accessible 
formats while creating systemic change in the publishing 
industry by equipping publishers with tools and processes to 
make their products ``Born Accessible,'' ensuring all students 
can use the same educational materials.
    The Committee recognizes that to meet the educational needs 
of more students with print disabilities, new investments are 
required to develop technology and expand capacity so that the 
growing diversity of educational materials, such as teacher 
curated educational materials not included in standard 
textbooks, are also available to eligible students in a timely 
manner. Additionally, the Committee recognizes the benefit of 
making more accessible educational materials available to pre-K 
and postsecondary students in addition to the K-12 student 
population, which requires additional resources and greater 
capacity to process and convert a larger volume of educational 
materials into accessible formats. The Committee recommendation 
continues to include funding to make a broader range of 
educational materials available to students and to meet the 
needs of all eligible students, including pre-K and 
postsecondary students.

                        Rehabilitation Services

Appropriations, 2023....................................  $4,092,906,000
Budget estimate, 2024...................................   4,405,533,000
Committee recommendation................................   4,397,033,000

Vocational Rehabilitation State Grants

    The Committee recommends $4,253,834,000 in mandatory 
funding for Vocational Rehabilitation [VR] State Grants. State 
Grants assist States in providing a range of services to help 
persons with physical and mental disabilities prepare for and 
engage in meaningful employment.
    Disability Innovation Fund [DIF].--The Committee directs 
the Department to use a portion of DIF funds for competitive 
grants, to be awarded in coordination with the Office of 
Disability Employment Policy, to eligible entities in 
partnership with State VR agencies for innovative strategies 
that significantly increase competitive integrated employment 
of youth and adults with disabilities. The Committee expects 
this will focus on expanding the capacity and the State network 
of eligible entities providing employment supports in States, 
prioritizing States that have returned funds to RSA or States 
from the two lowest quintiles of labor force participation 
rates for people with disabilities.
    The Committee directs the Department to continue to brief 
the Committees on Appropriations; the Committee on Health, 
Education, Labor, and Pensions of the Senate; the Committee on 
Education and Labor of the House of Representatives; the 
Committee on Finance of the Senate; and the Committee on Ways 
and Means of the House of Representatives at least every 6 
months with updates on activities funded within DIF.

Client Assistance State Grants

    The Committee recommends $13,000,000 in discretionary funds 
for Client Assistance State Grants. This program funds State 
formula grants to help VR clients or client applicants 
understand the benefits available to them. States must operate 
client assistance programs to receive VR State Grant funds.

Training

    The Committee recommends $29,388,000 for training 
rehabilitation personnel. This program supports grants to 
provide training to new VR staff or upgrade the qualifications 
of existing staff.

Demonstration and Training Programs

    The Committee recommendation includes $5,796,000 for 
demonstration and training programs. These programs support 
activities designed to increase employment opportunities for 
individuals with disabilities by expanding and improving the 
availability and provision of rehabilitation and other 
services.

Protection and Advocacy of Individual Rights

    The Committee recommends $20,150,000 for the Protection and 
Advocacy of Individual Rights program. This program provides 
grants to agencies to protect and advocate for the legal and 
human rights of persons with disabilities who are ineligible 
for the protection and advocacy services available through the 
Developmental Disabilities Assistance and Bill of Rights Act 
(Public Law 106-402) or the Protection and Advocacy for 
Individuals with Mental Illness Act (Public Law 99-319).

Supported Employment State Grants

    The Committee recommendation includes $22,548,000 for the 
Supported Employment State Grants Program. This program 
provides grants to States to provide supported employment 
services for individuals with the most significant 
disabilities, including youth with disabilities.

Independent Living Services for Older Individuals Who Are Blind

    The Committee recommends $33,317,000 for Independent Living 
State Grants. This program supports assistance to individuals 
over age 55 to help them adjust to their blindness and continue 
to live independently, including daily living skills training, 
counseling, community integration information and referral, the 
provision of low-vision and communication devices, and low-
vision screening.

Helen Keller National Center

    The Committee recommends $19,000,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults. The Helen 
Keller National Center consists of a national headquarters in 
Sands Point, New York, with a residential training and 
rehabilitation facility where deaf-blind persons receive 
intensive specialized services; a network of 10 regional field 
offices that provide referral and counseling assistance to 
deaf-blind persons; and an affiliate network of agencies.

           Special Institutions for Persons with Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2023....................................     $43,431,000
Budget estimate, 2024...................................      43,431,000
Committee recommendation................................      43,431,000

    The Committee recommends $43,431,000 to help support 
American Printing House for the Blind [APH].
    APH provides educational materials to students who are 
legally blind and enrolled in programs below the college level. 
The Federal subsidy provides approximately 65 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, recorded form, and computer 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 
(Public Law 45-186).
    The Committee includes funding for APH to expand assistive 
technology training resources and regional partnerships into 
additional States to assist schools, teachers, parents, and 
students throughout the Nation. In addition, within amounts 
provided for APH, the Committee includes up to $5,000,000 to 
support additional field testing and initial production and 
distribution of an innovative braille and tactile display 
product developed by the Printing House and its partners.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2023....................................     $92,500,000
Budget estimate, 2024...................................      92,500,000
Committee recommendation................................      92,500,000

    The Committee recommends $92,500,000 for the National 
Technical Institute for the Deaf [NTID].
    NTID, located on the campus of the Rochester Institute of 
Technology in Rochester, New York, 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.
    Regional STEM Center.--The Committee recommendation 
includes up to $9,500,000 for NTID's Regional STEM Center 
[NRSC] program. The NRSC program expands NTID's geographical 
reach and improves access to postsecondary STEM education and 
employment for students who are deaf or hard of hearing in 
underserved areas. This has included professional development 
for teachers, developing relationships with business and 
industry to promote employment opportunities, and preparing 
students to be successful in STEM fields.

                          GALLAUDET UNIVERSITY

Appropriations, 2023....................................    $165,361,000
Budget estimate, 2024...................................     165,361,000
Committee recommendation................................     165,361,000

    The Committee recommends $165,361,000 for Gallaudet 
University.
    Gallaudet University is a private, not-for-profit 
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 and deaf. The university conducts basic and applied 
research related to hearing impairments and provides public 
service programs for the deaf community.
    This funding also supports the Model Secondary School for 
the Deaf, which serves as a laboratory for educational 
experimentation and development; disseminates curricula, 
materials, and models of instruction for students who are deaf; 
and prepares adolescents who are deaf for postsecondary 
academic or vocational education or the workplace. The 
university's Kendall Demonstration Elementary School develops 
and provides instruction for children from infancy through age 
15.
    Early Language Acquisition Project [ELAP].--Within the 
total, the Committee recommendation includes up to $8,500,000 
for ELAP, which supports early language acquisition for 
children from birth through age three who are deaf or hard of 
hearing. This program supports activities to improve early 
language acquisition training for early educators, caretakers, 
and other professionals and allows Gallaudet to expand and 
build on its current research in this area, and test and 
evaluate interventions in diverse geographic areas.

                 Career, Technical, and Adult Education

Appropriations, 2023....................................  $2,191,436,000
Budget estimate, 2024...................................   2,447,900,000
Committee recommendation................................   2,211,436,000

Career and Technical Education

    The Committee recommends $1,482,269,000 for Career and 
Technical Education [CTE] programs.
    State Grants.--The Committee recommends $1,469,848,000 for 
CTE State grants. Funds provided under the State grant program 
assist States, localities, and outlying areas to expand and 
improve their CTE program and help ensure equal access to CTE 
for populations with special needs. Persons assisted range from 
secondary students in pre-vocational courses through adults who 
need retraining to adapt to changing technological and labor 
market conditions. Per the authorization of the program, after 
reservations for required set-asides and small State minimums, 
funds are distributed to a baseline level of the amount awarded 
to each State in fiscal year 2018, with any remaining funds 
allocated 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 additional 
to what these groups receive under other provisions of the 
Perkins Act (Public Law 109-270).
    Of the funds available for this program, $678,848,000 will 
become available July 1, 2024, and $791,000,000 will become 
available on October 1, 2024. These funds will remain available 
for obligation until September 30, 2025.
    National Activities.--The Committee recommendation includes 
$12,421,000 for national activities, including up to $6,100,000 
for Innovation and Modernization grants.
    The Committee encourages the Department to work with the 
Departments of Defense, Labor, and Commerce to develop a pilot 
project to increase the quality of, and participation in, 
career and technical education programs related to the skills 
needed for new submarine construction.
    The Committee encourages the Department to support 
Innovation and Modernization grants for evidence-based school-
based mentoring programs focused on providing students with 
social-emotional and other skills and experiences needed to be 
successful in the workplace.
    The Committee encourages the Department to update and 
reissue the Beyond the Box guidance to support increased access 
to higher education for justice-involved individuals.

Adult Education

    The Committee recommends $729,167,000 for Adult Education 
programs.
    Adult Education State Grants.--The Committee recommendation 
includes $715,455,000 for Adult Education State Grants which 
provide funding for States for programs that assist adults in 
becoming literate and in obtaining the skills necessary for 
employment and self-sufficiency.
    National Leadership Activities.--The Committee recommends 
$13,712,000 for adult education national leadership activities.
    The Committee encourages the Department to support 
technical assistance that will help build the evidence-base of 
adult education programs, including supporting States in 
prioritizing rigorously evaluated programs and the development 
of rigorous evidence such as funding randomized control trials, 
quasi-experimental studies and other evaluation methods that 
provide for a causal understanding of the effects of programs.

                      Student Financial Assistance

Appropriations, 2023.................................... $24,615,352,000
Budget estimate, 2024...................................  26,415,352,000
Committee recommendation................................  24,595,352,000

    The Committee recommends an appropriation of 
$24,595,352,000 for programs under the Student Financial 
Assistance account.

Federal Pell Grant Program

    The Committee recommends $22,475,352,000 in current year 
discretionary funding for the Pell grant program.
    The Committee recommendation includes $6,585 for the 
discretionary portion of the maximum Pell grant award, an 
increase of $250. Combined with mandatory funding, under 
current law, this would provide a total maximum award of $7,645 
for the 2024-2025 award year.
    Pell Grant Restoration and Prison Education Program.--The 
Committee continues to recognize the significance of restoring 
Pell Grant access for incarcerated individuals and the impact 
that will have on reestablishing effective prison education 
programs across the country, and ultimately reducing recidivism 
rates and saving taxpayer dollars by reducing the overall cost 
of incarceration. Given that regulations for the new Prison 
Education Program are expected to be finalized during fiscal 
year 2024, the Committee directs the Department to continue the 
Second Chance Pell Pilot program as the Department finalizes 
implementation of the full Pell Grant reinstatement. The 
Committee encourages the Department to use the expertise and 
best practices from the Pilot to develop guidance and technical 
assistance for the new Prison Education Program. The Committee 
further directs the Department to work with Second Chance Pell 
Pilot sites as they transition to the requirements under the 
new Prison Education Program to ensure that incarcerated 
students do not experience a gap in their educational 
programming. In addition, the Committee strongly encourages the 
Department to notify institutions of higher education 
(particularly those that operate Second Chance Pell Pilot 
sites), the Bureau of Prisons, State departments of 
corrections, county and local jail administrators, and 
institutional accrediting agencies about the new Prison 
Education Program. Further, the Committee expects the 
Department will provide technical assistance and guidance to 
Second Chance Pell sites to ensure that they have enough time 
and information to prepare and apply for Prison Education 
Program approval.
    As a part of the new Prison Education Program, the 
Committee encourages the Department, in coordination with the 
Department of Justice, to develop and provide technical 
assistance and guidance to participating institutions of higher 
education on how to support formerly incarcerated students as 
they leave prison, reenter society, and reenroll in 
postsecondary education. This guidance should address evidence-
based strategies for helping formerly incarcerated people to 
secure housing, employment, and other Federal benefits, as well 
as re-enroll in college, access Federal and State financial 
aid, and secure campus housing and student employment. The 
Department should convey to institutions of higher education 
that they should work to ensure that every student who 
participates in the new Prison Education Program is able to 
reenter their communities successfully post-release.
    Experimental Site Initiatives.--The Committee encourages 
the Department to pilot activities to support and encourage 
accelerated, cost-effective, 3-year bachelor's degree programs, 
such as the ``College in 3'' project.

Federal Supplemental Educational Opportunity Grant Program

    The Committee recommends $900,000,000 for the Supplemental 
Educational Opportunity Grant [SEOG] program. The SEOG program 
provides funds to institutions of higher education for need-
based grants to students. Institutions must contribute at least 
25 percent toward SEOG awards.

Federal Work-Study Program

    The Committee bill provides $1,220,000,000 for the Federal 
Work-Study [FWS] program. This program provides grants to 
institutions of higher education to help undergraduate, 
graduate, and professional students meet the costs of 
postsecondary education through part-time employment. 
Institutions must provide at least 25 percent of student 
earnings.
    Within the total for FWS, the Committee recommendation 
includes $11,053,000, for the Work Colleges program authorized 
under section 448 of the Higher Education Act (Public Law 89-
329), as amended.

                       Student Aid Administration

Appropriations, 2023....................................  $2,033,943,000
Budget estimate, 2024...................................   2,654,034,000
Committee recommendation................................   2,183,943,000

    The Committee recommends $2,183,943,000 for the Student Aid 
Administration account. These funds are available until 
September 30, 2025, and support the Department's student aid 
management expenses.
    The Committee recommendation includes an increase in 
funding to support increased costs associated with servicing 
Federal student loans, largely related to the resumption of 
Federal student loan payments starting in September 2023 and 
helping borrowers to reenter repayment. The Committee 
recommendation also includes an increase because it reflects 
the annualized costs of administering Federal student aid 
programs in fiscal year 2024. In fiscal year 2023 the 
Department shortened the length of contracts to limit the 
effect of level funding on students and borrowers. This created 
one-time savings in fiscal year 2023 but only by shifting costs 
to and significantly increasing funding needs in fiscal year 
2024.
    The Committee directs the Department to provide a detailed 
spend plan of the planned uses of funds in this account within 
45 days of enactment, and to provide quarterly briefings on its 
implementation not later than 10 days prior to the start of the 
quarter. This should continue to include, but not be limited 
to, detailed breakouts by baseline operations and development 
efforts; and servicing, student aid core systems, IT 
activities, and other Federal Student Aid activities. These 
spend plans should also include details on major activities, 
including implementation of the Unified Servicing and Data 
Solution [USDS], FUTURE Act, and FAFSA Simplification Act, and 
other activities as appropriate. Further, the spend plan should 
include a crosswalk to activities funded under administrative 
costs and servicing activities, and any reallocation of funds 
between those two activities should be treated as a 
reprogramming of funds, and the Committees should be notified 
in advance of any such changes.
    The Committee recommendation also continues the requirement 
for the Department to provide quarterly briefings on Federal 
student loan servicing contracts, including the transition to 
USDS. Additionally, the Department is directed to provide 
notification to the Committees not later than 7 days after 
issuing a student loan servicing contract Change Request [CR], 
including a summary of any new requirements, adjustments to 
existing requirements, or removal of requirements in the CR.
    FAFSA Family Farm Impact Study.--The new Student Aid Index 
formula included in the FAFSA Simplification Act (Title VII, 
Division FF of Public Law 116-260) requires students applying 
for Federal student aid to report the net worth of the farms on 
which their family resides, which could impact the eligibility 
of students to qualify for Federal student aid. The Committee 
urges the Department to conduct a study to thoroughly 
understand the impact of the new requirement for students to 
report the farms their families live on as assets for purposes 
of applying for Federal student aid.
    Return of Title IV Funds.--The Committee continues to 
encourage the Department to pursue efforts to simplify and 
streamline the Return of Title IV Funds process for 
institutions of higher education and students.
    Return to Repayment.--The Committee directs the Secretary 
to provide monthly briefings to the Committees on 
Appropriations and to the Committees on Education and the 
Workforce of the House of Representatives and on Health, 
Education, Labor, and Pensions of the Senate on progress 
related to implementation of title IV of division B of the 
Fiscal Responsibility Act of 2023 (Public Law 118-5) for 
Federal student loans during fiscal year 2024. The briefings 
should include information on borrower status, including the 
percentage of borrowers in repayment by repayment plan and the 
percentage of borrowers who are delinquent or not making 
payments, metrics on communications with borrowers, such as 
open rates for emails, and any changes to communications with 
borrowers based on data or behavioral economics assumptions.
    State-Based and Non-Profit Servicing Organizations.--The 
Committee continues to note that many State-based and non-
profit servicing organizations have demonstrated and 
specialized experience in helping struggling borrowers, and 
continues to encourage the Department to ensure such 
organizations have a role in any new Federal student loan 
servicing environment. With the resumption of student loan 
payments, it is more important than ever that student borrowers 
are supported by mission-based organizations, like these State-
based and non-profit organizations, that have longstanding 
experience in providing proactive borrower advocacy services. 
The Committee strongly encourages the Department to explore 
incentives for Federal student loan servicers to subcontract 
with such organizations.

                            Higher Education

Appropriations, 2023....................................  $3,526,037,000
Budget estimate, 2024...................................   3,986,621,000
Committee recommendation................................   3,260,429,000

    The Committee recommends an appropriation of $3,260,429,000 
for higher education programs.

Aid for Institutional Development

    The Committee recommends $1,027,116,000 for Aid for 
Institutional Development. These totals do not include 
separately authorized and appropriated mandatory funding.
    Strengthening Institutions.--The Committee recommends 
$112,070,000 to provide competitive, 1-year planning and 5-year 
development grants for institutions with a significant 
percentage of students with financial need and with low 
educational and general expenditures per student in comparison 
with similar institutions. Applicants may use these funds to 
develop faculty, strengthen academic programs, improve 
institutional management, and expand student services.
    Hispanic-Serving Institutions [HSIs].--The Committee 
recommends $231,547,000 for competitive grants to institutions 
at which Hispanic students make up at least 25 percent of 
enrollment. 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.
    The Committee supports funding for programs that promote 
and support collaboration between Hispanic-serving institutions 
and local educational agencies that serve a significant number 
or percentage of Hispanic or Latino students for the purpose of 
improving educational attainment, including increasing high 
school graduation rates and postsecondary enrollment, transfer, 
and completion rates among Hispanic or Latino students, such as 
by strengthening pathways to postsecondary and workforce 
development programs.
    Promoting Postbaccalaureate Opportunities for Hispanic 
Americans.--The Committee recommends $27,769,000 for 
competitive, 5-year grants to HSIs to help Hispanic Americans 
gain entry into and succeed in graduate study. Institutions may 
use funding to support low-income students through outreach 
programs; academic support services; mentoring and financial 
assistance; acquisition, rental, or lease of scientific or 
laboratory equipment; construction and other facilities 
improvements; and purchase of educational materials.
    The Committee encourages the Department to prioritize 
awards for projects that support consortiums of Hispanic-
Serving Institutions that award PhDs to develop and test new 
models of cross-institutional partnerships that facilitate 
mutually reinforcing activities, such as resource-sharing 
learning communities, mentorship programs for PhD students, 
graduate research experiences, faculty mentor capacity-
building, and other uses associated with the pursuit and 
completion of PhDs by Hispanic students.
    Strengthening Historically Black Colleges and Universities 
[HBCUs].--The Committee recommends $402,585,000 for the 
Strengthening HBCUs program. The 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.
    Strengthening Historically Black Graduate Institutions 
[HBGIs].--The Committee recommends $102,462,000 for the 
Strengthening HBGIs program. This program provides 5-year 
grants to provide scholarships for low-income students and 
academic and counseling services to improve student success. 
Funds may also be used for construction, maintenance, and 
renovation activities; the purchase or lease of scientific and 
laboratory equipment; and the establishment of an endowment.
    Strengthening Predominantly Black Institutions [PBIs].--The 
Committee recommends $22,672,000 for the Strengthening PBIs 
program. This program provides 5-year grants to PBIs to plan 
and implement programs to enhance their capacity to serve more 
low- and middle-income students.
    Strengthening Asian American and Native American Pacific 
Islander-Serving Institutions [AANAPISIs].--The Committee 
recommends $18,899,000 for competitive grants to AANAPISIs that 
have an enrollment of undergraduate students that is at least 
10 percent Asian American or Native American Pacific Islander 
students. Grants may be used to improve their capacity to serve 
Asian American and Native American Pacific Islander students 
and low-income individuals.
    Strengthening Alaska Native and Native Hawaiian-Serving 
Institutions [ANNHs].--The Committee recommends $24,840,000 for 
the Strengthening ANNHs program. The purpose of this program is 
to improve and expand the capacity of institutions serving 
Alaska Native and Native Hawaiian students and low-income 
individuals. Funds may be used to plan, develop, and implement 
activities that encourage faculty and curriculum development; 
improve administrative management; renovate educational 
facilities; enhance student services; purchase library and 
other educational materials; and provide education or 
counseling services designed to improve the financial and 
economic literacy of students or their families.
    Strengthening Native American-Serving Non-Tribal 
Institutions.--The Committee recommends $11,595,000 for this 
program, which serves institutions that enroll at least 10 
percent Native American students and at least 50 percent low-
income students. This program helps institutions plan, develop, 
and implement activities that encourage faculty and curriculum 
development; improve administrative management; renovate 
educational facilities; enhance student services; and purchase 
library and other educational materials.
    Strengthening Tribally Controlled Colleges and 
Universities.--The Committee recommends $52,408,000 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.
    Strengthening Master's Degree Programs at Historically 
Black Colleges and Universities.--The Committee recommends 
$20,269,000 for this program, authorized by section 723 of the 
HEA. This program provides grants to specified colleges and 
universities making a substantial contribution to graduate 
education opportunities at the master's level in mathematics, 
engineering, the physical or natural sciences, computer 
science, information technology, nursing, allied health, or 
other scientific disciplines.

International Education and Foreign Language Studies

    The bill includes a total of $85,664,000 for International 
Education and Foreign Language Studies programs. Funds are used 
to increase the number of experts in foreign languages and area 
or international studies to meet national security needs 
through visits and study in foreign countries.
    Domestic Programs.--The Committee recommends $73,353,000 
for domestic program activities related to international 
education and foreign language studies under title VI of the 
HEA. Funds are used to support centers, programs, and 
fellowships. The Committee urges the Secretary to preserve the 
program's longstanding focus on activities and institutions 
that address the Nation's need for a strong training and 
research capacity in foreign languages and international 
studies, including increasing the pool of international experts 
in areas that are essential to national security and economic 
competitiveness.
    Overseas Programs.--The Committee recommends $10,311,000 
for overseas programs authorized under the Mutual Educational 
and Cultural Exchange Act of 1961 (Public Law 87-256), 
popularly known as the Fulbright-Hays Act. Funding is provided 
for group, faculty, or doctoral dissertation research abroad, 
as well as special bilateral projects. Grants focus on training 
American instructors and students to improve foreign language 
and area studies education in the United States.

Model Transition Programs for Students With Intellectual Disabilities 
        into Higher Education

    The Committee recommendation includes $13,800,000 for the 
Model Transition Programs for Students with Intellectual 
Disabilities into Higher Education [TPSID] program. The TPSID 
program provides competitive grants to institutions of higher 
education or consortia of institutions of higher education to 
enable them to create or expand high quality, inclusive model 
comprehensive transition and postsecondary programs for 
students with intellectual disabilities. The TPSID program also 
supports a national Coordinating Center and a technical 
assistance center to translate and disseminate research and 
best practices to IHEs more broadly.

Minority Science and Engineering Improvement

    The Committee recommends $16,370,000 for the Minority 
Science and Engineering Improvement 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.

Tribally Controlled Postsecondary Career and Technical Institutions

    The Committee recommends $11,953,000 for tribally 
controlled postsecondary vocational institutions. This program 
provides grants for the operation and improvement of tribally 
controlled postsecondary vocational institutions to ensure 
continued and expanding opportunities for Indian students.

Federal TRIO Programs

    The Committee recommends $1,191,000,000 for Federal TRIO 
programs, which provide a variety of services to improve 
postsecondary education opportunities for low-income 
individuals and first-generation college students. This 
includes: Upward Bound which offers disadvantaged high school 
students academic services to develop the skills and motivation 
needed to pursue and complete a postsecondary education; 
Student Support Services which provides developmental 
instruction, counseling, summer programs, and grant aid to 
disadvantaged college students to help them complete their 
postsecondary education; Talent Search which identifies and 
counsels individuals between ages 11 and 27 regarding 
opportunities for completing high school and enrolling in 
postsecondary education; Educational Opportunity Centers which 
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 which supports research 
internships, seminars, tutoring, and other activities to 
encourage disadvantaged college students to enroll in doctoral 
programs.
    The Committee continues to direct the Department to include 
estimated funding for each TRIO program in the operating plan 
required under section 516 of this act.
    TRIO and Justice-Impacted Students.--The Committee 
recognizes that Educational Opportunity Centers [EOC] have a 
long history of helping justice-impacted adults to enroll in 
college. The upcoming restoration of Pell Grants for people in 
prison presents an opportunity for EOCs to reach more students. 
The Committee encourages the Department to provide technical 
assistance and guidance to EOCs on best practices for 
supporting justice-impacted students, including examples of 
programs that can serve as models to others. In addition, the 
Committee encourages the Department to consider how other TRIO 
programs can support justice-impacted students and provide 
guidance to institutions of higher education.

Gaining Early Awareness and Readiness for Undergraduate Programs [GEAR 
        UP]

    The Committee recommends $388,000,000 for GEAR UP, which 
provides grants to States and partnerships of colleges, middle 
and high schools, and community organizations to assist cohorts 
or students in middle and high schools serving a high 
percentage of low-income students. Services provided help 
students prepare for and pursue a postsecondary education.
    The Committee directs the Department to announce Notices 
Inviting Applications for New Awards for State Grants and 
Partnership Grants in the Federal Register. In such notice for 
State Grants, the Committee directs the Department to uphold 
the longstanding guidance that States may only administer one 
active State GEAR UP grant at a time. The Secretary is directed 
to provide written guidance in the Federal Register notifying 
applicants that only States without an active State GEAR UP 
grant, or States that have an active State GEAR UP grant that 
is scheduled to end prior to October 1, 2024, will be eligible 
to receive a new State GEAR UP award funded in whole or in part 
by this appropriation. In making new awards, the Department 
shall ensure that not less than 33 percent of the new award 
funds are allocated to State awards, and that not less than 33 
percent of the new award funds are allocated to Partnerships 
awards, as described in section 404(b) of the HEA. The 
Secretary is further directed to ensure that no request from a 
State Grant applicant to receive an exception to the GEAR UP 
scholarship described in section 404E(b)(2) of the HEA shall be 
denied on the basis of 34 CFR 694.14(c)(3).

Graduate Assistance in Areas of National Need

    The Committee recommends $23,547,000 to support the 
Graduate Assistance in Areas of National Need [GAANN] program. 
GAANN supports fellowships through 3-year competitive grants to 
graduate academic departments and programs in scientific and 
technical fields and other areas of national need as determined 
by the Secretary. Fellowship recipients must have excellent 
academic records and high financial need and must be pursuing 
doctoral degrees or the highest graduate degrees in their 
academic field. Each fellowship consists of a student stipend 
to cover living costs and an institutional payment to cover 
each fellow's tuition and other expenses. Institutions of 
higher education must match 25 percent of the grant amount.

Teacher Quality Partnership Program

    The Committee recommends $83,000,000 for the Teacher 
Quality Partnership [TQP] program. The TQP program helps 
improve the quality of teachers working in high-need schools 
and early childhood education programs by creating model 
teacher preparation and residency programs.

Child Care Access Means Parents in Schools

    The Committee recommendation includes $80,000,000 for the 
Child Care Access Means Parents in Schools [CCAMPIS] program. 
This program provides competitive grants to institutions of 
higher education to establish or support campus-based child 
care programs, to help support needs and participation of low-
income parents in post-secondary education.
    The Committee encourages the Department to work with 
CCAMPIS grantees to conduct direct outreach to student parents 
regarding State and Federal public benefits, the Child Tax 
Credit, and education tax benefits for which the student parent 
may be eligible.

Fund for the Improvement of Post-Secondary Education

    The Committee recommendation includes $324,979,000 for the 
Fund for the Improvement of Post-Secondary Education.
    Basic Needs Systems Grants.--The Committee includes 
$10,000,000 for competitive grants to IHEs, consortia of IHEs, 
or a system of higher education, that enroll a significant 
population of low-income students to advance systemic solutions 
to student basic needs security. These grants shall prioritize 
strengthening strategic integrations of student supports which 
could include improving data infrastructure to facilitate data 
matching and streamlining student eligibility determinations, 
and other innovative solutions to better connect students to 
supports. The Committee strongly encourages the Department to 
include connecting students to mental health resources as a key 
element of addressing student's basic needs. The Committee also 
strongly encourages the Department to prioritize IHEs with a 
significant percentage of Pell-eligible students, including 
community colleges, HBCUs, and other MSIs.
    Open Textbook Pilot.--The Committee recommendation includes 
$7,000,000 for the Open Textbook Pilot program. The Committee 
directs the Department to issue a notice inviting applications, 
allow for a 60-day application period and make a significant 
number of grant awards under the same terms and conditions as 
in prior years.
    Postsecondary Student Success Grants.--The Committee 
recommendation includes $45,000,000 for Postsecondary Student 
Success Grants, to scale evidence-based practices and reforms 
to improve postsecondary retention and completion rates among 
underserved students. These funds support grants to States, 
TCCUs, and systems of institutions of higher education to 
implement or expand evidence-based, statewide, and 
institutional level practices and reforms that improve student 
outcomes, including enrollment, retention, transfer, and 
completion among underserved students including students of 
color, low-income students, students with disabilities, 
students in need of remediation, first generation college 
students, homeless youth, foster youth, and student parents. 
The Committee directs the Department continue to carry out this 
program as a tiered-evidence competition, and require rigorous 
independent evaluations of grantee projects.
    Research and Development Infrastructure Investments at 
HBCUs, TCCUs, and MSIs.--The Committee recommendation includes 
$25,000,000 to increase the capacity of HBCUs, TCCUs, and MSIs 
to conduct innovative research in emerging technology and 
industries. These funds support planning and implementation 
grants designed to promote transformational investments in 
research infrastructure, such as physical infrastructure, 
capital improvement, research-related equipment, and hiring and 
retaining of faculty and research-related staff.
    Rural Postsecondary and Economic Development Grant 
Program.--The Committee recommendation includes $35,000,000 for 
the Rural Postsecondary and Economic Development [RPED] Grant 
Program. The Committee recognizes that rural-serving 
institutions and communities face unique challenges and 
barriers. In particular, smaller, rural-serving colleges, 
universities and non-profit organizations may have 
significantly fewer staff, and less experience, in preparing to 
respond to Federal grant opportunities. The Committee 
encourages the Department to consider ways to better support 
rural applicants by recognizing the unique challenges facing 
rural communities, including but not limited to providing 
greater flexibility, longer application timelines, and targeted 
technical assistance for RPED grants.
    Congressionally Directed Spending.--The Committee 
recommendation includes $202,979,000 for the projects, and in 
the amounts, specified in the table at the end of this 
Committee Report.

Hawkins Centers of Excellence

    The Committee recommendation includes $15,000,000 for 
Hawkins Centers of Excellence. This program supports the 
expansion and improvement of teacher education programs at 
HBCUs and other MSIs in order to support diverse, well-
prepared, and effective educators.

                           Howard University

Appropriations, 2023....................................    $354,018,000
Budget estimate, 2024...................................     347,018,000
Committee recommendation................................     304,018,000

    The Committee recommends an appropriation of $304,018,000 
for Howard University. Located in the District of Columbia, 
Howard offers undergraduate, graduate, and professional degrees 
through 12 schools and colleges. The university also 
administers the Howard University Hospital. The Committee 
recommends, within the funds provided, not less than $3,405,000 
for the endowment program.
    Howard University Hospital.--Within the funds provided, the 
Committee recommendation includes $77,325,000 for Howard 
University Hospital. The hospital provides inpatient and 
outpatient care, as well as training in the health professions. 
It also 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.
    In addition to ongoing support for operations of Howard 
University Hospital, the Committee recommendation includes 
$50,000,000 to support construction of a new Howard University 
Hospital. The new hospital will provide inpatient and 
outpatient care, as well as health professional training and 
other necessary services and will continue to serve as a major 
acute and ambulatory care center for the District of Columbia. 
As a condition of receiving these funds, the Hospital must 
continue to be maintained as the teaching hospital for Howard 
University and continue succession agreements with its union. 
The Committee recommended funding level assumes the remaining 
planned Federal contribution would be provided in fiscal year 
2025.

         College Housing and Academic Facilities Loans Program

Appropriations, 2023....................................        $298,000
Budget estimate, 2024...................................         321,000
Committee recommendation................................         298,000

    Federal Administration.--The Committee bill includes 
$298,000 for Federal administration of the CHAFL, College 
Housing Loans, and Higher Education Facilities Loans programs. 
Prior to fiscal year 1994, these programs provided financing 
for the construction, reconstruction, and renovation of 
housing, academic, and other educational facilities. While no 
new loans have been awarded since fiscal year 1993, costs for 
administering the outstanding loans will continue through 2030. 
These funds will be used to reimburse the Department for 
administrative expenses incurred in managing the existing loan 
portfolio.

  Historically Black College And University Capital Financing Program 
                                Account

Appropriations, 2023....................................     $20,678,000
Budget estimate, 2024...................................      20,750,000
Committee recommendation................................      20,678,000

    The Committee recommends $20,678,000 for the HBCU Capital 
Financing Program. 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.
    The Committee recommendation includes $20,150,000 for loan 
subsidy costs in guaranteed loan authority under this program. 
This will support an estimated $377,340,824 in new loan volume 
in fiscal year 2024. In addition, the Committee recommendations 
includes $528,000 for administrative expenses.

                    Institute of Education Sciences

Appropriations, 2023....................................    $807,605,000
Budget estimate, 2024...................................     870,868,000
Committee recommendation................................     793,106,000

    The Committee recommends $793,106,000 for the IES. This 
amount includes $73,500,000 for administrative expenses and 
centralized support costs for the Institute of Education 
Sciences.
    This account supports education research, development, 
dissemination, utilization and evaluation; data collection and 
analysis activities; the assessment of student progress; and 
administrative expenses related to such activities. Funds 
provided to IES are available for obligation for 2 fiscal 
years.
    Under the Education Sciences Reform Act of 2002 [ESRA], 
Congress established IES to provide objective and valid 
research-driven knowledge that was free of political influence 
or bias so as to better inform effective education practices at 
the State and local levels. ESRA required IES, in carrying out 
its mission, ``to compile statistics, develop products, and 
conduct research, evaluations, and wide dissemination 
activities in areas of demonstrated national need and ensure 
that such activities conform to high standards of quality, 
integrity, and accuracy and are objective, secular, neutral, 
and nonideological and are free of partisan political 
influence.''
    Program Administration.--The Committee recommendation 
includes $73,500,000 for administrative expenses and 
centralized support costs. Section 312 of this act ensures 
sufficient funding for centralized support costs is available 
and properly charged to this appropriation. The Committee 
directs the Department, IES and NCES to work together to 
provide in the fiscal year 2025 and future CJs, as well as the 
fiscal year 2024 operating plan the amount for NCES 
administrative expenses supported by this program 
administration appropriation.
    Not later than 30 days after enactment of this act and each 
quarter thereafter, the Committee directs the IES Director and 
NCES Commissioner to submit administrative and staffing plans 
for their respective centers outlining staffing ceilings by 
national center, the factors considered in allocating staffing 
ceilings by national center, actual full-time equivalent 
employment [FTE] by national center, and an explanation by 
national center for FTE changes from the preceding quarter. 
Reports providing sufficient information on each of these 
required elements will satisfy the Committee's staffing report 
directive under the Program Administration account.
    Collaborative Education Research.--The Committee recognizes 
the ongoing collaborative efforts between IES and the National 
Science Foundation, including through the resources provided to 
the IES via the American Rescue Plan that support two NSF 
National Artificial Intelligence [AI] Research Institutes 
focused on education. The Committee encourages IES to pursue 
additional collaborative efforts, which may include support for 
Centers for Transformative Education Research and Translation.
    The Future of Education Research at IES.--The Committee is 
aware IES sought expert assistance in requesting the National 
Academies of Sciences, Engineering and Medicine [NASEM] provide 
guidance on the future of education research, which resulted in 
last year's publication of the ``The Future of Education 
Research at IES''. This report provides recommendations to 
build on the research supported by IES over the past 20 years. 
The Committee encourages IES to continue implementation of 
recommendations made in the report and requests the fiscal year 
2024 operating plan include a discussion of actions taken and 
planned.
    Methods Training in Data Science for Education 
Researchers.--The Committee is aware IES invited applications 
for proposals that would support training in applying data 
science methods within education research and expects to 
announce awards later this year. The Committee looks forward to 
receiving more information about these awards and requests IES 
describe additional data science-related actions in its fiscal 
year 2024 operating plan.

                RESEARCH, DEVELOPMENT, AND DISSEMINATION

    The Committee recommends $245,000,000 for education 
research, development, evaluation, and national dissemination 
activities. These funds support 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 outcomes for students.

                               STATISTICS

    The Committee recommends $121,500,000 for data gathering 
and statistical analysis activities at the National Center for 
Education Statistics [NCES].
    NCES is headed by a Commissioner appointed by the President 
and has statutory authority without supervision or approval of 
the Director for carrying out the work of NCES. The 
Commissioner also serves as the Department's Chief Statistical 
Officer under the Foundations for Evidence-Based Policymaking 
Act of 2018. NCES collects data on educational institutions at 
all levels, longitudinal data on student progress, and data 
relevant to public policy. NCES also provides technical 
assistance to SEAs, LEAs, and postsecondary institutions. 
Activities are carried out directly and through grants and 
contracts.
    A Vision and Roadmap for Education Statistics.--The 
Committee is aware IES sought expert assistance in requesting 
NASEM to ``recommend a portfolio of activities and products for 
NCES, review developments in the acquisition and use of data, 
consider current and future priorities, and suggest desirable 
changes'', which resulted in the publication of the ``A Vision 
and Roadmap for Education Statistics''. The Committee believes 
the Secretary, Commissioner and Director of IES should continue 
to support NCES in independently developing, producing, and 
disseminating statistics pursuant to recommendations of the 
NASEM report. The Commissioner, and, as applicable, Secretary 
and Director are directed to include in the required operating 
plan actions taken since the report's release and future 
actions and associated timeline to fully implement related 
recommendations. The Committee also encourages NCES to continue 
implementation of other recommendations made in the report and 
requests the fiscal year 2024 operating plan include a 
discussion of actions taken and planned.

                   REGIONAL EDUCATIONAL LABORATORIES

    The Committee recommends $53,733,000 to continue support 
for the Regional Educational Laboratories [REL] program. Given 
the 2-year availability of funding, REL annual contract costs 
of the 10 laboratories of approximately $55,000,000 are paid 
for out of the fiscal year 2023 appropriation and resources 
provided by this act. The Committee intends to sustain the 
programs of research the laboratories have developed for the 
current 2022-2027 contract cycle.
    The laboratories are responsible for promoting the 
effective use and development of knowledge and evidence in 
broad-based systemic strategies to increase student learning 
and well-being and further school improvement efforts. The 
Committee urges IES to continue its efforts to strengthen the 
connections between practitioners and the research community, 
so that federally supported research is timely, relevant, and 
responsive to the needs of the field, helps build capacity of 
LEAs and SEAs to effectively integrate evidence use in 
decision-making and is effectively utilized in education policy 
and practice

              RESEARCH AND INNOVATION IN SPECIAL EDUCATION

    The Committee recommends $64,255,000 for research and 
innovation in special education conducted by the National 
Center for Special Education Research.
    The Center addresses gaps in scientific knowledge to 
improve policies and practices in special education and early 
intervention services and outcomes for infants, toddlers, and 
children with disabilities.

               SPECIAL EDUCATION STUDIES AND EVALUATIONS

    The Committee recommends $13,318,000 for special education 
studies and evaluations.
    This program supports competitive grants, contracts, and 
cooperative agreements to assess the implementation of IDEA. 
Funds are also used to evaluate the effectiveness of State and 
local efforts to deliver special education services and early 
intervention programs.

                         STATEWIDE DATA SYSTEMS

    The Committee recommendation includes $28,500,000 for the 
Statewide Data Systems program.
    This program supports competitive grants to SEAs to support 
the development, maintenance, and expansion of State 
longitudinal data systems. Support for these systems will 
further strengthen State data infrastructure and linkages; 
improve data access and use for research and evidence-based 
policy- and decision-making; and build capacity in States to 
secure and protect data. Early childhood, postsecondary, and 
workforce information systems may be linked to such systems or 
developed with program funds. The bill also continues to allow 
up to $6,000,000 to be used for awards to improve data 
coordination, quality, and use, including support for the 
Privacy Technical Assistance Center that serves as a resource 
on privacy issues for SEAs and LEAs, the postsecondary 
education community, and others engaged in building and using 
education data systems.

                               ASSESSMENT

    The Committee recommends $193,300,000 to provide support 
for the National Assessment of Educational Progress [NAEP], a 
congressionally mandated assessment created to measure and 
report the educational achievement of American students in a 
range of subjects and analyze trends over time.
    Within the funds appropriated, the Committee recommends 
$8,300,000 for the National Assessment Governing Board [NAGB], 
which is responsible for formulating policy for NAEP. 
Additional funds are provided to help carry out an assessment 
framework update and increased communications efforts ahead of 
the 2024 Nation's Report Card.
    The Committee recommendation continues support of 
$10,000,000 for research and development investments activities 
to modernize and innovate assessments while reducing future 
program costs. NAGB and NCES should continue to consult with 
the authorizing and appropriations committees of Congress as it 
considers strategies, including those identified by NASEM, in 
achieving cost efficiencies in and upgrades of its assessment 
program. Further, the Committee requests that the fiscal year 
2025 CJ and fiscal year 2024 operating plan describe 
implemented and planned strategies for cost efficiencies and 
necessary research and development projects.

                        Departmental Management


                         PROGRAM ADMINISTRATION

Appropriations, 2023....................................    $426,907,000
Budget estimate, 2024...................................     527,609,000
Committee recommendation................................     419,907,000

    The Committee recommends $419,907,000 for program 
administration.
    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 Federal education 
programs. Support for program evaluation and studies and 
advisory councils is also provided under this account.
    The budget requests $19,250,000, to remain available until 
expended, to relocate staff and renovate and repair Department-
occupied buildings. The act does not include funding 
specifically for building modernization, but notes that the 
Department may use the Nonrecurring Expenses Fund for this 
purpose, as it has this year.
    Competitive Grant Priorities for Rural Areas.--The 
Committee continues to encourage the Department to continue 
efforts to ensure competitive grants are reaching rural areas 
so that support and solutions developed with Federal funding 
are relevant to and available in such areas.
    Cybersecurity.--The Committee is aware that elementary and 
secondary schools have faced significant impacts resulting from 
cybersecurity incidents. Last year, GAO made three 
recommendations for the Department intended to better 
coordinate cybersecurity efforts between government agencies 
and the elementary and secondary school community, measure the 
effectiveness of cybersecurity-related products and services 
available and, in coordination with Federal and non-Federal 
stakeholders, determine how to best help LEAs overcome 
challenges for addressing cyber threats. The Committee requests 
an update in the fiscal year 2025 CJ on the Departments actions 
and plans (and associated timeline) for implementing these 
recommendations.
    Education Department General Administrative Regulations.--
The Committee notes with approval that the Department plans to 
revise and update the Education Department General 
Administrative Regulations [EDGAR] including amending areas 
that are outdated. The Committee is concerned that these plans 
were announced in the Regulatory Agenda for Fall 2021 but the 
Department has not yet issued a notice of proposed rulemaking. 
The Committee urges the Department to modernize and updateo the 
construction provisions starting at 34 CFR 76.600. Given this 
delay, the Committee expects the Department has used this time 
to conduct stakeholder engagement and public input processes to 
inform the development of proposed revisions.
    Educator Equity Reporting.--The Committee commends the 
Department's work to support implementation of and enforce the 
educator equity requirements in section 1111(g)(1)(B) of the 
ESEA. The Committee directs the Department to work with each 
State to publicly report in an accessible manner not less than 
every 2 years progress made to ensure low-income and minority 
children enrolled in public schools are not served at 
disproportionate rates by ineffective, out-of-field, or 
inexperienced teachers. The Committee requests a briefing not 
later than 60 days after enactment of this act on its planned 
actions and associated timeline for implementing this 
directive.
    Evidence-Based Grant Making.--The Committee directs the 
Department to use demonstrated evidence of effectiveness as 
part of the selection criteria through its Education Department 
General Administrative Regulations, consistent with 
authorizations, for all competitive grant programs. Further, 
non-competitive formula grant funds have a range of evidence 
requirements and preferences and the Committee directs the 
Department to support entities receiving funding through those 
programs through enhancements to its technical assistance and 
support activities.
    Foreign Influence.--Under section 117 of the HEA, 
institutions of higher education receiving Federal financial 
assistance are required to disclose gifts from, or contracts 
with, foreign sources if the value is $250,000 or more. They 
must also disclose ownership or control by a foreign source. 
Such disclosures increase transparency and are in support of 
national security and academic integrity. The Department makes 
such information publicly available on its website. The 
Committee notes the Department provides on its website a 
repository of guidance and other resources related to section 
117 reporting. The Committee strongly urges the Department to 
work with IHEs to ensure they are fully complying with this 
statutory requirement and requests an update in the fiscal year 
2025 congressional justification on these efforts. 
Additionally, the Department shall report to the Committee on 
the presence and influence of Confucius Institutes and any 
steps it has taken to address undue influence within 
institutions of higher education.
    Foundation for Evidence-Based Policymaking Act.--The 
Committee continues to believe that the execution of the 
Foundations for Evidence-Based Policymaking Act will enhance 
the evidence-building capacity of Federal agencies, strengthen 
privacy protections, improve secure access to data, and provide 
more and higher quality evidence to policymakers. Therefore, 
the Committee directs the Department to continue to include in 
the fiscal year 2025 and future CJs updates on the 
implementation and planned implementation of such act for the 
current and future budget years.
    GAO Study Holocaust Education.--The Committee directs the 
GAO to conduct a study on the use of K-12 educational resources 
devoted to Holocaust education. The review should describe 
State mandates about the Holocaust, and other relevant 
information, such as associated funding levels, standards, and 
methods for ensuring school compliance with State requirements 
and standards; as well as Federal resources available to 
support Holocaust education.
    ``Grow Your Own'' Teacher Development.--The Committee 
recognizes the potential efficacy and increasing presence of 
``Grow Your Own'' teacher development programs, including 
through the use of funds under the Teacher Quality Partnerships 
and other Federal education funding streams. The Committee 
looks forward to receiving the report requested last year on 
best practices for ``Grow Your Own'' programs in increasing 
teacher diversity, recruitment efforts within local 
communities, access to high-quality pathways into the 
profession, and teacher retention, and reducing teacher 
shortages. The report should identify current opportunities to 
use funds available from the Department to support ``Grow Your 
Own'' programs and additional Federal opportunities for 
consideration.
    High-Quality Tutoring/Title I Evidence-Based 
Interventions.--The Committee notes that to remediate 
significant learning disparities particularly among underserved 
students, many LEAs have dedicated title I and other Federal 
resources to support academic tutoring. Research shows that 
using high-quality, evidence-based tutoring programs with 
evidence of effectiveness as defined in the ESEA can 
significantly improve achievement levels in reading and math. 
These proven systems include three to five sessions a week, 
integrated as part of the school day, delivered by a human 
tutor in person or virtually to a group of 1 to not more than 4 
students at a time, and use a well-structured process, high-
quality materials designed for tutoring during the school day, 
ongoing professional development and coaching for tutors, and 
assessment tools to benchmark student achievement. Proven 
tutoring models can bring struggling students up to the 
achievement level of their peers. The Committee encourages the 
Department to promote and provide technical assistance to LEAs 
and support partnerships between LEAs and education-related 
community-based organizations to implement evidence-based 
tutoring models.
    Integrating Data and Strengthening Data Privacy.--The 
Committee urges the Secretary in conjunction with the Secretary 
of Labor to provide guidance and technical assistance on 
integrated data systems, including on how to protect student 
and worker privacy. This guidance should build on and expand 
the guidance issued by the Privacy Technical Assistance Center 
in January 2017 [PTAC-IB-4).
    Late Liquidation.--The Committee emphasizes that Office of 
Management and Budget regulation 2 CFR 200.344(b) gives the 
Department broad flexibility to extend the period for 
liquidating financial obligations incurred under grants awarded 
by the Department. The Department should announce its policy 
and process as soon and transparently as possible to grant 
ESSER liquidation extensions for ARP. The Department's revised 
policy should be released as soon as possible but no later than 
September 30, 2023. The Department shall ensure that its 
process for ARP ESSER late liquidation requests minimizes the 
administrative burden on SEAs and LEAs to the extent 
practicable, including by not requiring excessive 
documentation. The Committee appreciates the Department's 
frequently asked questions, June 26, 2023 clarification, and 
availability to speak with State or other auditors about the 
late liquidation process. The Department must also provide 
explicit clarity outlining how its guidance can be implemented 
consistent with 2 CFR 200.403(h). The Department shall provide 
sufficient clarity in its guidance, and predictability in its 
process, in order to ensure that LEAs are able to enter into 
contracts for allowable costs as reasonable and necessary 
during the obligation period regardless of the contract's 
liquidation end date, as long as it is within the authorized 
late liquidation period and the LEA intends to submit an 
appropriate late liquidation request to the SEA.
    Micro-Credentialing.--The Committee recognizes the unique 
educational and workforce challenges in rural and underserved 
areas and encourages the Department to support colleges and 
universities serving rural and underserved communities 
implementing micro-credentials.
    National Advisory Council on Indian Education [NACIE].--The 
Committee is aware of the GAO recommendation to the Department 
to develop a formal process for incorporating the input of its 
Tribal advisory council, NACIE, into its annual budget request. 
The Committee directs the Department to implement this 
recommendation as soon as possible and ensure Tribal officials 
are able to provide meaningful and timely input on annual 
budget requests for programs serving tribes and their members.
    Nonrecurring Expenses Fund.--As part of the annual CJ, the 
Department is directed to include the anticipated balances 
available for transfer into and uses of the Nonrecurring 
Expenses Fund for the current and budget fiscal years. 
Additionally, the Department is directed to provide the 
Committees quarterly reports for all ongoing projects. The 
report shall include the following for each project: a 
description and timeline for each project; the date the project 
was notified to the Committees; total obligations to date; 
obligations for the prior fiscal year; anticipated obligations 
for current fiscal year; any expected future obligations; and 
the total unobligated balance in the Fund.
    Pooled Evaluation Authority.--The Committee requests that 
the Department provide a report to the Committee on the planned 
use of pooled evaluation funds under section 8601 of the ESEA, 
consistent with the required plan under such section, not later 
than 15 days prior to any transfer of funds.
    Post-Secondary Transfer Articulation Agreements.--Transfer 
articulation agreements between community colleges and 4-year 
colleges and universities can play an important role in 
promoting access, affordability, and completion in higher 
education. The Committee encourages the Department to gather 
input from States that have implemented comprehensive statewide 
programs to determine best practices for implementation, 
enhancement, or scaling-up of agreements. The Department should 
also seek input from States that do not have comprehensive 
statewide programs to identify barriers to scaling-up 
agreements. This information should be disseminated to States 
by the Department with the goal of further enhancing or 
implementing statewide transfer articulation agreements.
    Program Administration.--The fiscal year 2023 explanatory 
statement raised concerns with the Department's prioritization 
of staff resources and directed the Department to begin 
rebalancing the agency's ratio of career staff to non-career 
staff, out of concern with the agency's prioritization of staff 
resources and to ensure adequate career staff for executing 
core programs, such as in grants offices and the Budget 
Service. To ensure this rebalancing occurred, the fiscal year 
2023 explanatory statement also directed the Department not to 
expand its non-career staff on-board above December 2022 
levels. While the Committee is pleased to see that the 
Department has begun to fill key career staff positions and 
understands some non-career hires may have already been 
advanced in the hiring process, the Committee is extremely 
concerned that the number of non-career staff has gone up 
contrary to the directive in the fiscal year 2023 explanatory 
statement. This is even more important with nondefense 
discretionary spending limits recently established under the 
Fiscal Responsibility Act of 2023. The Committee directs the 
Department to reduce non-career FTE on-board to December 2022 
levels or below, and it reiterates the fiscal year 2023 
directive to continue rebalancing career and non-career staff. 
Not later than 30 days after enactment, the Department is 
directed to provide the Committee with a briefing and a written 
plan on how the Department will comply with these directives.
    Protecting Personally-Identifiable Information.--The 
Committee continues to direct the Department to ensure that its 
employees, contractors, and grantees, including States that 
receive funds from Statewide Longitudinal Data System grants, 
adhere to the strictest and highest standards for protecting 
personally identifiable information.
    Reorganization Plans.--The Committee recommendation 
continues all directives included in the Consolidated 
Appropriations Act, 2021 (Public Law 116-94) and the 
accompanying explanatory statement.
    Reports to Congress.--The Department is directed to provide 
5 business days' notice to the Committee before release of any 
congressionally directed report.
    Staffing Report.--Consistent with the fiscal year 2023 
explanatory statement, not later than 30 days after enactment, 
the Department is directed to provide the Committee an 
operating plan identifying the total FTE and non-personnel 
allocations supported by the program administration 
appropriation in total for the Department, and FTE and non-
personnel allocations for each program office supported by the 
program administration appropriation provided in this act. In 
addition, the Department shall provide on a monthly basis the 
number of on-board staff, attrition, approved hires not yet on-
boarded and projected full-year FTE usage, including approved 
hires, and actual non-personnel expenses, for each program 
office supported by, and in total for, the program 
administration appropriation provided in this act. The monthly 
reports should be detailed by career and non-career staff. In 
addition, the Department shall separately identify in such 
plans and reports total FTE allocations supported by other 
funding sources. The Department shall also provide the 
Committee on a biannual basis an excel file which includes the 
names, titles, grades, program office, and date of hire of all 
of the political appointees that were employed by the 
Department during the previous 180 days.
    State and Local Report Cards.--The Committee appreciates 
the Department's planned targeted monitoring effort this year 
on a sample of SEAs and LEAs with respect to applicable report 
card requirements of ESEA. The Committee requests an update in 
the fiscal year 2025 CJ on the findings from this targeted 
monitoring effort and the Department's planned actions to 
support SEAs and LEAs in achieving compliance with these 
requirements and improving the quality, accessibility 
(including language and data visualization) and utility of 
report card information available to parents, educators, and 
policymakers. This update should also provide steps the 
Department will take to support the inclusion of available 
information on postsecondary enrollment under section 
1111(h)(1)(C)(xiii), which could include enrollment information 
with and without remediation at the discretion of a State.
    Strengthening Data Capacity and Infrastructure.--The 
Committee urges the Secretary to clarify for grantees when 
improving data capacity, including integrated data 
infrastructure, analysis activities, and human capacity, is a 
permissible use of grant funds. Further, for grantees of 
programs where this is an eligible use of funds, the Secretary 
should provide technical assistance, highlight best practices, 
and take other steps to encourage State and local grantees to 
build this capacity, which is essential to understanding 
student needs, improving coordination across programs, 
measuring results, and evaluating which strategies and 
interventions are most effective while maintaining the privacy 
of individuals' data.
    Suicide Prevention Resources.--The Committee encourages the 
Department to pursue policies that will increase student 
awareness of mental health resources, such as urging 
institutions of higher education to prominently include phone 
numbers for the National Suicide Prevention Lifeline and campus 
resources in materials and documents routinely provided to 
students.
    Teacher and School Leader Diversity Guidance.--The 
Committee recognizes that increasing educator diversity can 
help build a strong educator workforce that supports students 
and educators from all backgrounds and is aligned with the 
Department's commitment to equitable impact of Federal 
education funding. The Committee looks forward to the 
Department's planned release of guidance on how formula funds 
across various programs, including Title I-A, Title II-A, Title 
III, Title V-B, and Title VI of the ESEA, Title III of the HEA, 
and Part B of the IDEA may be used by SEAs, LEAs and IHEs to 
increase teacher and school leader diversity, including through 
pre-service support, enhancing preparation, providing on-the-
job support, and strengthening retention and promotion 
policies.
    Team-Based Models of Instruction.--The Committee encourages 
the Department to support the expansion of team teaching and 
projects that would promote educator specialization and 
differentiated educator roles in the classroom. This would 
support innovative work taking place nationwide to design new 
systems of workforce development for teachers that include 
supports, clear pathways to advancement, and promote teacher 
retention.
    Voting-Related Activities.--The Committee directs the 
Secretary to brief the House and Senate Committees on 
Appropriations no later than 90 days after enactment of this 
act regarding any strategic plans developed by the Department 
over the three prior fiscal years outlining the ways that the 
Department has promoted voter registration, and voter 
participation.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2023....................................    $140,000,000
Budget estimate, 2024...................................     177,600,000
Committee recommendation................................     140,000,000

    The Committee recommends $140,000,000 for the Office of 
Civil Rights [OCR].
    OCR 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 that receive financial assistance from the 
Department. 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 these civil rights requirements.
    Combatting Antisemitism.--The Committee is concerned by 
reports of increased discrimination, including antisemitic 
harassment, in our Nation's education system. The Committee 
appreciates the administration's development of the first-ever 
U.S. National Strategy to Counter Antisemitism and OCR's 
release of a Dear Colleague letter reminding schools of their 
legal obligations under title VI to provide all students, 
including Jewish students, an environment free from 
discrimination. The Committee urges continued efforts, 
including timely processing of all complaints, including those 
relating to antisemitism. Within available resources, OCR 
should also consider appropriate funding for the work of the 
Outreach, Prevention, Education & Nondiscrimination Center.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2023....................................     $67,500,000
Budget estimate, 2024...................................      87,497,000
Committee recommendation................................      67,500,000

    The Committee recommends $67,500,000 for OIG. Of this 
amount, $3,000,000 is available until expended to provide 
flexibility for hiring delays and the year-end return of funds 
for common support provided by the Department that may turn out 
costing less than anticipated.
    OIG 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

    Section 301. The bill continues a provision prohibiting the 
use of funds to prevent the implementation of programs of 
voluntary prayer and meditation in public schools.
    Section 302. The bill continues a provision giving the 
Secretary authority to transfer up to 1 percent of any 
discretionary funds between appropriations.
    Section 303. The bill continues a provision making 
evaluation funds pooled under section 8601 of the ESEA 
available for obligation on a forward-funded basis.
    Section 304. The bill continues a general provision 
allowing certain institutions to continue to use endowment 
income for student scholarships.
    Section 305. The bill continues a provision extending 
authorization of the National Advisory Committee on 
Institutional Quality and Integrity.
    Section 306. The bill continues a provision extending 
authority to provide account maintenance fees to guarantee 
agencies.
    Section 307. The bill continues a provision regarding 
servicing of Federal Perkins Loans.
    Section 308. The bill modifies a provision rescinding 
fiscal year 2024 mandatory funding to pay for mandatory costs 
of increasing the maximum discretionary Pell award.
    Section. 309. The bill continues a provision regarding 
administrative costs for Public Service Loan Forgiveness.
    Section. 310. The bill continues a provision allowing up to 
0.5 percent of funds appropriated in this act for programs 
authorized under the HEA, except for the Pell Grant program, to 
be used for evaluation of any HEA program.
    Section 311. The bill modifies a provision regarding 
Congressionally Directed Spending within the Innovation and 
Improvement account.
    Section 312. The bill continues a provision regarding 
centralized support services for IES.
    Section 313. The bill modifies a provision rescinding 
unobligated balances available for the Pell Grant program.

                                TITLE IV

                            RELATED AGENCIES

 Committee for Purchase From People Who Are Blind or Severely Disabled

                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $13,124,000
Budget estimate, 2024...................................      15,400,000
Committee recommendation................................      13,124,000

    The Committee recommends $13,124,000 for the Committee for 
Purchase from People Who Are Blind or Severely Disabled 
[Commission], of which no less than $3,150,000 shall be made 
available for the Office of Inspector General.
    The Commission provides employment opportunities to 
approximately 40,000 Americans who are blind or severely 
disabled each year. The primary purpose of this program 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. Encompassing 
nearly $4,000,000,000 in products and services procured, it is 
the Federal Government's largest employment program for the 
severely disabled.
    Reports.--The Committee continues to request the reports 
listed under this heading in the explanatory statement 
accompanying Public Law 117-328.

             Corporation for National and Community Service

    The Corporation for National and Community Service [CNCS] 
was established to enhance opportunities for national and 
community service. CNCS administers programs authorized under 
the Domestic Volunteer Service Act (Public Law 93-113), the 
National and Community Service Trust Act (Public Law 103-82), 
and the SERVE America Act (Public Law 111-13). Grants are 
awarded to States, public and private nonprofit organizations, 
and other entities to create service opportunities for 
students, out-of-school youth, adults, and seniors.
    The Committee recommendation for CNCS provides a total 
program level of $1,262,806,000.
    Grantee Match Requirements.--The Committee notes that CNCS 
opened a request for comment on grantee match requirements on 
May 5, 2023. The Committee recognizes the value of the unique 
Federal-State and public-private partnership model embodied in 
CNCS programs and is aware of concerns about the impact of 
existing matching requirements. The Committee encourages CNCS 
to thoroughly review stakeholder comments and asks that it 
submit to the Committees on Appropriations a report outlining 
action CNCS may undertake using its existing authorities and 
resources as a result of that review and recommendations for 
any appropriate changes to those requirements that may fall 
outside the scope of CNCS' current authorities.

                           OPERATING EXPENSES

Appropriations, 2023....................................    $975,525,000
Budget estimate, 2024...................................   1,138,618,000
Committee recommendation................................     975,525,000

    The Committee recommends $975,525,000 for the operating 
expenses of CNCS.

Volunteers in Service to America [VISTA]

    The Committee recommends $103,285,000 for VISTA. This 
program provides capacity building for small, community-based 
organizations with a mission of combating poverty. VISTA 
members raise resources, recruit and organize volunteers, and 
establish and expand programs in housing, employment, health, 
and economic development activities.

National Senior Volunteer Corps

    The Committee recommends $236,917,000 for the National 
Senior Volunteer Corps programs, a collection of programs that 
connect Americans older than the age of 55 with opportunities 
to contribute their job skills and expertise to community 
projects and organizations. These programs include the Retired 
Senior Volunteer Program, the Foster Grandparent Program, and 
the Senior Companion Program.

AmeriCorps State and National Grants

    The Committee recommends $557,094,000 for AmeriCorps State 
and National Grants, which provide funds to local and national 
organizations and agencies to address community needs in 
education, public safety, health, and the environment. Each of 
these organizations and agencies, in turn, uses its AmeriCorps 
funding to recruit, place, and supervise AmeriCorps members. 
AmeriCorps members receive a modest living allowance and other 
benefits proportional to their level of time commitment.
    Alumni Engagement Activities.--The Committee commends CNCS 
for its current comprehensive planning process on service 
alumni engagement and its prioritization of the post-service 
member and volunteer experience in its 2022-2026 annual plan, 
including objectives 2.3 and 3.4. The Committee notes 
significant Congressional and stakeholder interest in those 
activities, including strengthening identification with the 
AmeriCorps brand; expanding education and workforce pipelines; 
soliciting feedback from alumni on member experience; directory 
data sharing; and interagency collaboration on national, 
public, and military service. The Committee encourages CNCS to 
support these and other alumni engagement activities.
    Civic Bridge Building.--The Committee supports CNCS' goal 
of uniting Americans through national service and recognizes 
that service is a proven model of civic bridge building. To 
advance these shared goals, the Committee encourages CNCS to 
consider awarding grants, within existing competitions, to: (1) 
support civic bridge building programs and projects to reduce 
polarization and community divisions; and (2) provide training 
in civic bridge building skills and techniques to CNCS members 
and host sites and provide resources that can be publicly 
disseminated to support local civic bridge building efforts, 
among other activities.
    Collaboration on Outreach and Recruitment.--The Committee 
commends recent collaboration among the Department of Defense, 
CNCS, the Selective Service System, Peace Corps, and the Office 
of Personnel Management on raising public awareness about 
military and national service opportunities. The Committee 
directs these agencies to continue exploring mutually 
beneficial ways to promote each agency's service opportunities, 
including sharing market research, providing ineligible or non-
selected applicants with information about other forms of 
service, piloting joint recruitment efforts, and providing 
information to individuals transitioning out of military and 
national service about other opportunities to serve.
    Commission Investment Fund [CIF].--The Committee 
recommendation includes no less than the fiscal year 2023 level 
for the CIF, which provides funds to State commissions for 
training and technical assistance activities to expand the 
capacity of current and potential AmeriCorps programs, 
particularly in underserved areas.
    Fixed Price Grant Program.--The Committee believes the 
fixed amount AmeriCorps State and National grant is a flexible, 
useful grant vehicle that helps minimize risk and lowers 
administrative burden on grantees. Section 129(l) of the 
National and Community Service Act of 1990, as amended by 
Public Law 111-13, provides the agency with the authority to 
adopt other terms and conditions based on the risks associated 
with the Fixed Price grant program. The Committee encourages 
CNCS to review the risks associated with the current drawdown 
formula that only allows recipients to incrementally receive 
awarded grant funds as service hours are recorded by enrolled 
members. The Committee notes that this formula may not always 
account for the many start-of-service program costs and the 
expenses grantees incur, regardless of whether a member serves 
a full term. The Committee urges CNCS to review, and if 
appropriate, modify the drawdown formula to cover allowable 
grant expenses that occur at the start of year and to minimize 
the impact that under-enrollment, attrition, and service hour 
disruptions can have on grantee operations. CNCS should report 
to the Committees, in the fiscal year 2025 Congressional 
Justification, on the modifications CNCS may make and if any 
congressional action is required to authorize or help implement 
the changes.

National Civilian Community Corps [NCCC]

    The Committee recommendation includes $37,735,000 for NCCC, 
a full-time, team-based residential program for men and women 
ages 18 to 24. Members are assigned to one of five campuses for 
a 10-month service commitment.

Innovation, Demonstration, and Assistance Activities

    The Committee recommendation includes $14,706,000 for 
innovation, demonstration, and assistance activities.
    Volunteer Generation Fund.--Within the total, the Committee 
recommendation includes $8,558,000 for the Volunteer Generation 
Fund authorized under section 198P of the SERVE America Act 
(Public Law 111-13).
    National Days of Service.--The Committee recommendation 
includes $6,148,000 for National Days of Service including the 
September 11th National Day of Service and Remembrance and the 
Martin Luther King, Jr. National Day of Service. CNCS may give 
priority to making grants, entering into Cooperative 
Agreements, or providing other forms of support to eligible 
organizations with expertise in: representing families of 
victims of the September 11, 2001 terrorist attacks and other 
impacted constituencies; promoting the establishment of 
September 11 as an annually recognized National Day of Service 
and Remembrance; and organizing volunteers to engage in service 
to meet community needs and advance the life and teachings of 
Dr. Martin Luther King, Jr.
    Service Learning.--The Committee encourages CNCS to 
continue to be a convener of the important work surrounding 
service learning, including programs in public schools and 
institutions of higher education.

Evaluation

    The Committee recommendation includes $6,250,000 for CNCS 
evaluation activities.
    Effective Interventions.--The Committee is aware of CNCS 
initiatives to help service providers apply scientific 
evaluation methods to better understand interventions and 
encourages CNCS to continue its use of randomized control 
trials to build causal evidence for effective interventions.

State Commission Grants

    The Committee recommendation includes $19,538,000 for State 
Commission Grants.

                       THE NATIONAL SERVICE TRUST

Appropriations, 2023....................................    $230,000,000
Budget estimate, 2024...................................     213,000,000
Committee recommendation................................     180,000,000

    The Committee recommends an appropriation of $180,000,000 
for the National Service Trust.
    The National Service Trust makes payments of Segal 
education awards, pays interest that accrues on qualified 
student loans for AmeriCorps participants during terms of 
service in approved national service positions, and makes other 
payments entitled to members who serve in the programs of CNCS. 
The Committee also recommends a rescission of $243,000,000 from 
the surplus unobligated balances in the Trust, which is 
$33,000,000 above the budget request level.

                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $99,686,000
Budget estimate, 2024...................................     118,434,000
Committee recommendation................................      99,686,000

    The Committee recommends an appropriation of $99,686,000 
for CNCS salaries and expenses. The salaries and expenses 
appropriation provides funds for staff salaries, benefits, 
travel, training, rent, equipment, and other operating expenses 
necessary for management of CNCS programs and activities.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2023....................................      $7,595,000
Budget estimate, 2024...................................       8,572,000
Committee recommendation................................       7,595,000

    The Committee recommends an appropriation of $7,595,000 for 
the CNCS OIG. The OIG's goals are to increase organizational 
efficiency and effectiveness within the Corporation and to 
prevent fraud, waste, and abuse.

                       ADMINISTRATIVE PROVISIONS

    The Committee recommendation includes the following general 
provisions for CNCS: requiring CNCS to make any significant 
changes to program requirements or policy through rule making 
(section 401); stipulating minimum share requirements (section 
402); requiring that donations supplement and not supplant 
operations (section 403); aligning requirements regarding the 
use of Education Awards at GI bill-eligible institutions 
(section 404); allowing the required background check of 
certain applicants to be processed by States under terms of the 
National Child Protection Act (Public Law103-209) (section 
405); allowing CNCS to fund certain member service positions 
under 1,700 hours (section 406); and modifying VISTA members' 
education awards (section 407).

                  Corporation for Public Broadcasting

Appropriations, Prior act...............................    $595,000,000
Budget estimate, This act...............................     635,000,000
Committee recommendation................................     595,000,000

    The Committee recommends $595,000,000 for the Corporation 
for Public Broadcasting [CPB]. This includes $535,000,000 as a 
2-year advance appropriation for fiscal year 2026 for CPB to 
carry out its statutory mission of sustaining the public-
private partnership underpinning public media and $60,000,000 
for fiscal year 2024 for continued support of CPB in replacing, 
upgrading, and maintaining the public broadcasting 
interconnection system and further investing in system-wide 
infrastructure and services.
    The majority of the advance appropriation goes directly to 
local public television and radio stations to support their 
programming. CPB funds also support the creation of content for 
radio, television, and other platforms; system support 
activities that benefit the entire public broadcasting 
community; and CPB's administrative costs. This funding 
supports America's local public television and radio stations 
and their mission of developing and ensuring universal access 
to noncommercial, high-quality programming and 
telecommunications services for the American public.
    Recognizing technology's power to create further cost 
efficiencies across the public media system, the Committee 
recommendation maintains an investment of $60,000,000 in 
current year funds for continued support of CPB's efforts to 
replace and upgrade the public broadcasting interconnection 
system and invest in system-wide infrastructure and services 
that benefit the American people.

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $53,705,000
Budget estimate, 2024...................................      55,815,000
Committee recommendation................................      53,705,000

    The Committee recommends $53,705,000 for the Federal 
Mediation and Conciliation Service [FMCS]. FMCS provides 
mediation, conciliation, and arbitration services to labor and 
management organizations to prevent and minimize work stoppages 
and promote stable labor-management relationships. FMCS is also 
authorized to provide dispute resolution consultation and 
training to all Federal agencies.

            Federal Mine Safety and Health Review Commission


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $18,012,000
Budget estimate, 2024...................................      18,657,000
Committee recommendation................................      18,012,000

    The Committee recommends $18,012,000 for the Federal Mine 
Safety and Health Review Commission [FMSHRC], which provides 
administrative trial and appellate review of legal disputes 
under the Federal Mine Safety and Health Act of 1977 (Public 
Law 91-173). Most cases involve civil penalties proposed by 
MSHA. FMSHRC's administrative law judges [ALJs] decide cases at 
the trial level and the five-member Commission provides review 
of the ALJ's decisions.

                Institute of Museum and Library Services


       OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2023....................................    $294,800,000
Budget estimate, 2024...................................     294,800,000
Committee recommendation................................     289,800,000

    The Committee recommends $289,800,000 for the Institute of 
Museum and Library Services [IMLS]. This agency supports 
programs for museums and libraries that encourage innovation, 
provide lifelong learning opportunities, promote cultural and 
civic engagement, and improve access to a variety of services 
and information.
    Information Literacy Task Force.--The Committee 
recommendation includes no less than $3,000,000 to continue 
work on information literacy, including the continuation and 
expansion of the Information Literacy Taskforce in accordance 
with the priorities and guidelines described in the explanatory 
statement accompanying Public Law 117-103 and Public Law 117-
328. The Committee directs IMLS to submit a report to the 
Committees on information literacy activities implemented, 
including website development and support for locally-driven, 
pilot projects established, and future plans, within 1 year of 
the date of enactment of this act.
    America250.--The Committee recognizes IMLS's commitment to 
the 250th Anniversary of the founding of the United States in 
coordination with the Semiquincentennial Commission Act of 
2016. The Committee recognizes the important role of IMLS in 
supporting existing activities and pilot projects that will 
enhance civic engagement, innovation, and community 
collaboration by convening museum and library professionals, 
facilitating community-driven discussions, and supporting 
partnership grants to museums and libraries in preparation for 
the 250th Anniversary.
    Matching Funds Requirements.--The Committee is aware of the 
challenge faced by museums during the COVID-19 pandemic. The 
Committee requests IMLS provide in its fiscal year 2025 CJ 
information on statutory and administrative barriers to IMLS 
grant support of eligible museum's programs and activities and 
unmatched museum grant funding opportunities; and steps IMLS 
has taken to assist the museum community with understanding 
cost-share requirements and accessing Federal support needed to 
operate effective museum programs.
    Tribal Consortia Eligibility.--The Committee instructs the 
IMLS to issue guidance on how consortia of Indian tribes or 
Tribal organizations could be eligible to apply for Tribal 
library and related grants.
    Museum and Library Facilities.--The Committee directs the 
GAO to conduct a study on the physical condition of library and 
museum facilities in the United States and report preliminary 
findings to the Committee within 18 months of the date of 
enactment. The GAO's study shall examine the availability and 
condition of library and museum facilities, separated by 
geographic region including non-contiguous States, urban, 
rural, and frontier areas, and economically disadvantaged and 
underserved communities; the physical accessibility of such 
facilities for individuals with disabilities; the condition of 
such facilities affected by natural disasters and extreme 
weather; the condition of such facilities affecting employee 
and patron health and safety; and what is known about the cost 
to bring such facilities to a State of good repair.
    Within the total for IMLS, the Committee recommendation 
includes the amounts below:

----------------------------------------------------------------------------------------------------------------
                                                                    Fiscal year
                         Budget activity                               2023         Fiscal year      Committee
                                                                   appropriation   2024 request   recommendation
----------------------------------------------------------------------------------------------------------------
Library Services Technology Act [LSTA]:
    Grants to States............................................     180,000,000     180,000,000     183,250,000
    Native American Library Services............................       5,763,000       5,763,000       5,763,000
    National Leadership: Libraries..............................      15,287,000      15,287,000      13,787,000
    Laura Bush 21st Century Librarian...........................      10,000,000      10,000,000       8,000,000
                                                                 -----------------------------------------------
      Subtotal, LSTA............................................     211,050,000     211,050,000     210,800,000
                                                                 ===============================================
Museum Services Act:
    Museums for America.........................................      30,330,000      27,330,000      30,330,000
    21st Century Museum Professional............................  ..............       2,000,000  ..............
    Native American/Hawaiian Museum Services....................       3,772,000       3,772,000       3,772,000
    National Leadership: Museums................................       9,348,000      10,348,000       8,848,000
                                                                 -----------------------------------------------
      Subtotal, MSA.............................................      43,450,000      43,450,000      42,950,000
                                                                 ===============================================
    African American History and Culture Act....................       6,000,000       6,000,000       5,250,000
    National Museum of the American Latino Act..................       6,000,000       6,000,000       4,000,000
    Research, Analysis and Data Collection......................       5,650,000       5,650,000       5,150,000
    Administration..............................................      22,650,000      22,650,000      21,650,000
                                                                 -----------------------------------------------
        IMLS, Total.............................................     294,800,000     294,800,000     289,800,000
----------------------------------------------------------------------------------------------------------------

            Medicaid and CHIP Payment and Access Commission


                         SALARIES AND EXPENSES

Appropriations, 2023....................................      $9,405,000
Budget estimate, 2024...................................      10,053,000
Committee recommendation................................       9,405,000

    The Committee recommends $9,405,000 for the Medicaid and 
CHIP Payment and Access Commission [MACPAC]. This commission 
was established in the Children's Health Insurance Program 
Reauthorization Act of 2009 (Public Law 111-3) and is tasked 
with reviewing State and Federal Medicaid and Children's Health 
Insurance Program access and payment policies and making 
recommendations to Congress, the Secretary of HHS, and the 
States on a wide range of issues affecting those programs. The 
Committee recommendation will allow MACPAC to continue to carry 
out these activities.

                  Medicare Payment Advisory Commission


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $13,824,000
Budget estimate, 2024...................................      13,824,000
Committee recommendation................................      13,824,000

    The Committee recommends $13,824,000 for the Medicare 
Payment Advisory Commission, which provides independent policy 
and technical advice on issues affecting the Medicare program.

                     National Council on Disability


                         SALARIES AND EXPENSES

Appropriations, 2023....................................      $3,850,000
Budget estimate, 2024...................................       4,000,000
Committee recommendation................................       3,850,000

    The Committee recommends $3,850,000 for the National 
Council on Disability [NCD]. NCD is mandated to make 
recommendations to the President, Congress, the Rehabilitation 
Services Administration, and the National Institute on 
Disability and Rehabilitation Research on issues of concern to 
individuals with disabilities. The Council gathers information 
on the implementation, effectiveness, and impact of the 
Americans with Disabilities Act (Public Law 101-336) and 
examines emerging policy issues as they affect persons with 
disabilities and their ability to enter or re-enter the 
Nation's workforce and to live independently.

                     National Labor Relations Board


                         SALARIES AND EXPENSES

Appropriations, 2023....................................    $299,224,000
Budget estimate, 2024...................................     376,163,000
Committee recommendation................................     299,224,000

    The Committee recommends $299,224,000 for the National 
Labor Relations Board [NLRB], which administers and enforces 
the National Labor Relations Act of 1935 (Public Law 74-198) 
and protects employee and employer rights provided under that 
act. The Committee maintains language restricting the use of 
electronic voting.

                        National Mediation Board


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $15,113,000
Budget estimate, 2024...................................      15,601,000
Committee recommendation................................      15,113,000

    The Committee recommends $15,113,000 for the National 
Mediation Board [NMB], which mediates labor-management 
relations in the railroad and airline industries under the 
Railway Labor Act (Public Law 88-542). The NMB mediates 
collective bargaining disputes, conducts elections to determine 
the choice of employee bargaining representatives, and 
administers arbitration of employee grievances.

            Occupational Safety and Health Review Commission


                         SALARIES AND EXPENSES

Appropriations, 2023....................................     $15,449,000
Budget estimate, 2024...................................      16,179,000
Committee recommendation................................      15,449,000

    The Committee recommends $15,449,000 for the Occupational 
Safety and Health Review Commission [OSHRC]. OSHRC serves as a 
court to resolve disputes between OSHA and employers charged 
with violations of health and safety standards enforced by 
OSHA.

                       Railroad Retirement Board

    The Railroad Retirement Board [RRB] administers the 
retirement/survivor and unemployment/sickness insurance benefit 
programs for railroad workers and their families under the 
Railroad Retirement Act (Public Law 93-445) and Railroad 
Unemployment Insurance Act (Public Law 100-647).

                     DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2023....................................      $9,000,000
Budget estimate, 2024...................................       8,000,000
Committee recommendation................................       8,000,000

    The Committee recommends $8,000,000 for the Dual Benefits 
Payments Account together with any estimated income derived 
from income taxes on vested dual benefits. This appropriation 
provides for vested dual benefit payments to beneficiaries 
covered under both the railroad retirement and Social Security 
systems.

          FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriations, 2023....................................        $150,000
Budget estimate, 2024...................................         150,000
Committee recommendation................................         150,000

    The Committee recommends $150,000 for Federal Payments to 
the Railroad Retirement Account. These funds reimburse the 
railroad retirement trust funds for interest earned on non-
negotiated checks.

                      LIMITATION ON ADMINISTRATION

Appropriations, 2023....................................    $128,000,000
Budget estimate, 2024...................................     138,575,000
Committee recommendation................................     128,000,000

    The Committee recommends $128,000,000 for RRB's costs 
associated with the administration of railroad retirement/
survivor and unemployment/sickness benefit programs. This 
account limits the amount of funds in the railroad retirement 
and railroad unemployment insurance trust funds that may be 
used by the Board for administrative expenses.
    The Committee continues to request annual updates on the 
project status, including timelines to completion, total 
anticipated cost of development, funding obligations, and 
contracts for RRB's fully funded information technology 
modernization system.
    The Committee maintains bill language giving RRB the 
authority to hire new attorneys in the excepted service.

           LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2023....................................     $14,000,000
Budget estimate, 2024...................................      14,600,000
Committee recommendation................................      14,000,000

    The Committee recommends $14,000,000 for RRB Office of the 
Inspector General. This Office conducts audits and 
investigations to protect the integrity of the RRB trust funds 
and provides comprehensive oversight of all RRB operations and 
programs.

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2023....................................     $11,000,000
Budget estimate, 2024...................................      10,000,000
Committee recommendation................................      10,000,000

    The Committee recommends $10,000,000 in mandatory funds for 
payments to Social Security trust funds. This account 
reimburses the Old Age and Survivors Insurance [OASI] and 
Disability Insurance [DI] 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 and they were properly 
charged to general revenues.

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriations, 2023.................................... $48,609,338,000
Budget estimate, 2024...................................  45,717,853,000
Committee recommendation................................  45,561,145,000

    The Committee recommends $45,561,145,000 in fiscal year 
2024 mandatory funds for the SSI program. This is in addition 
to the $15,800,000,000 provided in the fiscal year 2023 
appropriations act for the first quarter of fiscal year 2024. 
In addition, the Committee recommends $21,700,000,000 in 
advance funding for the first quarter of fiscal year 2025. The 
SSI program guarantees a minimum level of income to individuals 
who are disabled, blind, or older than age 65, and meet certain 
income and resource limitations.

Federal Benefit Payments

    The Committee recommendation includes a fiscal year 2024 
program level of $56,328,000,000 for Federal benefit payments.

Beneficiary Services

    The Committee recommendation includes $137,000,000 in new 
mandatory budget authority for beneficiary services.
    These funds reimburse vocational rehabilitation [VR] 
agencies for successfully rehabilitating disabled SSI 
recipients by helping them achieve and sustain productive, 
self-supporting work activity. Funds also support the Ticket to 
Work program that provides SSI recipients with a ticket to 
offer employment networks [ENs], including VR agencies, in 
exchange for employment and support services. Instead of 
reimbursing ENs for specific services, the Ticket to Work 
program pays ENs based on recipients achieving certain 
milestones and outcomes.

Research and Demonstration

    The Committee recommendation includes $91,000,000 in 
mandatory funds for research and demonstration projects 
conducted under sections 1110, 1115, and 1144 of the Social 
Security Act (Public Law 74-271), as amended. These funds 
support a variety of research and demonstration projects 
designed to improve the disability process, promote self-
sufficiency and assist individuals in returning to work, 
encourage savings and retirement planning through financial 
literacy, and generally provide analytical and data resources 
for use in preparing and reviewing policy proposals.

Administrative Expenses

    The Committee recommendation includes $4,805,145,000 for 
SSI program administrative expenses. This appropriation funds 
the SSI program's share of administrative expenses incurred 
through the Limitation on Administrative Expenses [LAE] 
account.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2023.................................... $14,125,978,000
Budget estimate, 2024...................................  15,488,200,000
Committee recommendation................................  14,417,978,000

    This account provides resources for SSA to administer the 
OASI, DI, and SSI programs, and to support CMS in administering 
the Medicare program. The LAE account is funded by the Social 
Security and Medicare trust funds for their share of 
administrative expenses, the general fund for the SSI program's 
share of administrative expenses, and applicable user fees. 
These funds support core administrative activities including 
processing retirement and disability claims, conducting 
hearings to review disability determination appeals, issuing 
Social Security numbers and cards, processing individuals' 
annual earnings information, and ensuring the integrity of 
Social Security programs through continuing disability reviews 
[CDR] and SSI redeterminations of non-medical eligibility.
    The Committee recommendation includes $1,851,000,000 for 
program integrity activities, including CDRs, SSI 
redeterminations of non-medical eligibility, and Cooperative 
Disability Investigations units. This includes $273,000,000 in 
base funding and $1,578,000,000 in cap adjustment funding, as 
authorized and specified in the Fiscal Responsibility Act of 
2023.
    The Committee recommendation also includes up to 
$151,000,000 for administrative activities funded from user 
fees. This includes up to $150,000,000 in fees collected from 
States that request SSA to administer State SSI supplementary 
payments and up to $1,000,000 from fees collected from non-
attorney claimant representatives.
    The Committee recommendation also includes not less than 
$2,700,000 for the Social Security Advisory Board. This board 
advises the Commissioner of Social Security and makes 
recommendations to Congress and the President on policies 
relating to the OASI, DI, and SSI programs.
    Cooperative Disability Investigations [CDI].--The Committee 
directs SSA to provide an update in its fiscal year 2025 CJ on 
CDI units, including updates on the program's projected savings 
to SSA's disability programs, total recovery amounts, and 
projected savings to other Federal and State programs. Such 
updates shall also include suggestions regarding other ways 
Federal and State agencies may partner on anti-fraud 
initiatives with respect to Social Security programs.
    Disability Backlogs.--The Committee recognizes the pandemic 
created significant challenges for SSA, which has contributed 
to a significant increase in processing times for initial 
disability claims. The Committee is deeply concerned that 
staffing challenges will make it difficult for SSA to address 
growing backlogs but expects SSA will, to the greatest extent 
possible, prioritize funding to reduce the initial disability 
claims backlog. The Committee directs SSA to continue to 
provide monthly reports to the Committee on key agency 
performance metrics and to provide quarterly briefings to the 
Committees on its progress towards reducing the initial 
disability claims and hearings backlogs, as well as addressing 
other service delivery challenges.
    Express Appointments.--The Committee commends SSA for the 
creation of innovative service delivery improvements 
implemented during the pandemic. Given SSA's stated plans to 
expand the number of visitors that are served at field offices 
since the pandemic, the Committee directs SSA to provide an 
update in the 2025 CJ detailing the agency's plans for 
expansion of Express Services, including the expected timeline 
of such expansion, mechanisms for providing such services, and 
planned national availability and capacity. Such update shall 
also include any substantial progress made or plans to 
implement other significant service delivery changes in field 
offices.
    IT Modernization Procurement Policies.--According to the 
SSA's OIG report titled Agile Software Development at the 
Social Security Administration, SSA implemented some 
appropriate control and practices to manage its Agile software 
development projects, but is not using Agile consistently 
across all of its software development projects. The OIG's 
analysis identified instances in which SSA did not follow key 
Agile development best practices related to delivery of planned 
work; appropriate development of system requirements, 
capabilities and features; size and composition of Agile 
development teams; definition of team policies and other basic 
practices; lessons learned; human-centered design practices; 
testing; and peer reviews. The Committee encourages SSA to 
implement OIG's recommendations and requests a briefing within 
90 days of enactment on its progress in doing so.
    Outreach to People with Disabilities and Experiencing 
Homelessness.--The Committee strongly encourages SSA to expand 
outreach to potential beneficiaries, prioritizing underserved 
communities and individuals most likely to need support, 
including those experiencing homelessness. The Committee 
encourages SSA to leverage its existing Federal and State 
relationships to identify individuals who may be eligible for 
the SSI and SSDI programs. The Committee directs SSA to include 
information in its fiscal year 2025 CJ on such efforts.
    Reducing Submission of Physical Documentation.--Pursuant to 
Executive Order 14058, Transforming Federal Customer Experience 
and Service Delivery to Rebuild Trust in Government, SSA is 
directed to identify ``potential opportunities for policy 
reforms that can support modernized customer experiences while 
ensuring original or physical documentation requirements remain 
where there is a statutory or strong policy rationale.'' SSA 
was also directed to ``develop a mobile mobile-accessible, 
online process so that any individual applying for or receiving 
services from the Social Security Administration can upload 
forms, documentation, evidence, or correspondence associated 
with their transaction without the need for service-specific 
tools or traveling to a field office.'' The Committee directs 
SSA to submit a report to the House and Senate Committee on 
Appropriations, the House Committee on Ways and Means, and the 
Senate Committee on Finance within 180 days of enactment on the 
list of proposed policy reforms to improve customer experience, 
as well as a project timeline on implementing the online portal 
allowing individuals submitting documents electronically.
    Staffing Plan.--The Committee notes the importance of 
ensuring SSA has the necessary workforce to operate efficiently 
and provide high-quality service to program beneficiaries. The 
Committee requests SSA, within 90 days of enactment of this act 
and quarterly thereafter, provide a staffing report detailing 
FTEs and new hires by component. These reports shall include 
the total number of new hires, departed employees, net change 
in FTEs, and funds obligated and expended on new hires, broken 
down by programmatic area. These reports should also include a 
written hiring plan detailing SSA's strategy to enhance its 
recruitment and retention, its implementation of the strategy, 
and recommended administrative and legislative actions to 
enhance the agency's recruitment and retention.
    Supplemental Security Income Application Simplification.--
The complexity of the SSI program and application process can 
make it difficult for individuals to apply for benefits. This 
is an even bigger challenge given the individuals relying on 
SSI, including those experiencing homelessness, diagnosed with 
a terminal illness, and disabled veterans. It is also one of 
SSA's most resource intensive and time-consuming workloads that 
contributes to SSA's overall service delivery challenges and 
funding needs. The Committee strongly encourages SSA to 
prioritize simplifying the SSI application and making it 
available online. As many components of the SSI application are 
required by statute, simplification may require legislative 
changes. Therefore, within 120 days of enactment, SSA shall 
submit a report to the Committees on Appropriations and Ways 
and Means of the House of Representatives and the Committees on 
Appropriations and Finance of the Senate regarding the agency's 
efforts to simplify the SSI application and program, including 
a list of proposed legislative changes aimed at simplifying the 
SSI application for claimants.
    Work Incentives Planning and Assistance [WIPA] and 
Protection and Advocacy for Beneficiaries of Social Security 
[PABSS].--The Committee recommendation includes $23,000,000 for 
WIPA and $10,000,000 for PABSS, the same as the comparable 
fiscal year 2023 levels, respectively. These programs provide 
valuable services to help Social Security disability 
beneficiaries return to work. The Committee notes that delayed 
suitability determinations have in some cases significantly 
affected the ability of PABSS grantees to carry out their 
mission to protect the rights and best interests of individuals 
with disabilities.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2023....................................    $114,665,000
Budget estimate, 2024...................................     120,400,000
Committee recommendation................................     114,665,000

    The Committee recommends $114,665,000 for SSA's OIG. This 
includes $82,665,000 funded from the OASI and DI trust funds 
for those programs' share of OIG's expenses and $32,000,000 
funded from general revenues for the SSI program's share of 
expenses.
    Combating Social Security Impersonation Scams.--According 
to the SSA OIG, reports of the Social Security Impersonation 
Scam increased rapidly from 2018 to 2020. Since this time, 
reports of this scam have declined but still number in the tens 
of thousands each year. The Committee commends the work that 
SSA OIG has done thus far to combat these scams, encourages SSA 
OIG to continue to prioritize working with the SSA to increase 
awareness of this scam, and urges SSA OIG to pursue the 
criminals perpetrating this fraud.

                                TITLE V

                           GENERAL PROVISIONS

    Section 501. The bill continues a provision authorizing 
transfers of unexpended balances.
    Section 502. The bill continues a provision limiting 
funding to 1-year availability unless otherwise specified.
    Section 503. The bill continues a provision limiting 
lobbying and related activities.
    Section 504. The bill modifies a provision limiting 
official representation expenses.
    Section 505. The bill continues a provision clarifying the 
requirement to identify Federal funding made available in this 
act as a component of State and local grant funds in all public 
materials related to such funds.
    Sections 506 and 507. The bill continues provisions 
limiting the use of funds for abortions.
    Section. 508. The bill continues a provision restricting 
human embryo research.
    Section 509. The bill continues a provision limiting the 
use of funds for promotion of legalization of controlled 
substances.
    Section 510. The bill continues a provision prohibiting the 
use of funds to promulgate regulations regarding the individual 
health identifier.
    Section 511. The bill continues a provision limiting the 
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.
    Section 512. The bill continues a provision prohibiting the 
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.
    Section 513. The bill continues a provision prohibiting 
Federal funding in this act for libraries unless they are in 
compliance with the Children's Internet Protection Act (Public 
Law 106-554).
    Section 514. The bill continues a provision maintaining a 
procedure for reprogramming of funds.
    Section 515. The bill continues a provision prohibiting 
candidates for scientific advisory committees from having to 
disclose their political activities.
    Section 516. The bill continues a provision requiring each 
department and related agency to submit an operating plan.
    Section 517. The bill continues a provision requiring the 
Secretaries of Labor, Health and Human Services, and Education 
to submit a report on the number and amounts of contracts, 
grants, and cooperative agreements awarded by the Departments 
on a noncompetitive basis.
    Section 518. The bill continues a provision prohibiting SSA 
from processing earnings for work performed under a fraudulent 
social security number if based on a conviction for a violation 
under section 208(a)(6) or (7) of the Social Security Act 
(Public Law 74-271).
    Section 519. The bill continues a provision prohibiting SSA 
from establishing a totalization agreement with Mexico.
    Section 520. The bill continues a provision requiring 
computer networks to block pornography.
    Section 521. The bill continues a provision related to 
reporting requirements for conference spending.
    Section 522. The bill continues a provision related to 
advertisement costs.
    Section 523. The bill modifies a provision on Performance 
Partnerships.
    Section 524. The bill continues a provision regarding 
reporting status of balances of appropriations.
    Section 525. The bill continues a provision on grant 
notifications.
    Section 526. The bill continues a provision regarding 
funding for programs that carry out distribution of sterile 
needles or syringes.
    Section 527. The bill includes a new provision providing an 
additional $10,000,000 available for obligation through 
September 30, 2028 solely for costs necessary to achieve rent 
reductions through the expiration and replacement of leases for 
NLRB's headquarters and several regional offices. The Committee 
directs NLRB to submit an operating plan for this capital 
investment not later than 30 days after enactment of this act 
and quarterly updates on its execution. Further, the Committee 
expects future CJs to describe prior year rent costs, current 
year rent costs and projected rent costs for the next 5 years.
    Section 528. The bill continues a provision requiring 
questions for the record be submitted within 45 days of 
receipt.
    Section 529. The bill modifies a provision rescinding funds 
from the Children's Health Insurance Program child enrollment 
contingency fund.
    Sections 530. The bill includes a provision rescinding 
funds from the Children's Insurance Program Performance Bonus 
Fund.
    Section 531. The bill includes a provision rescinding funds 
from Section 2401 of the American Rescue Plan Act of 2021 
(Public Law 117-2).
    Section 532. The bill continues a provision related to 
research and evaluation funding flexibility.
    Section 533. The bill includes a new provision (regarding 
funds available in this act designated as an emergency).

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

    Paragraph 7 of rule XVI requires that Committee reports 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 Committee is filing an original bill, which is not 
covered under this rule, but reports this information in the 
spirit of full disclosure.
    The Committee recommends funding for the following programs 
and activities which currently lack authorization: Workforce 
Innovation and Opportunity Act programs; Trade Adjustment 
Assistance; School-Based Health Centers; Nurse Education Loan 
Repayment; Education and Training Related to Geriatrics; Mental 
and Behavioral Health Training; Children's Hospital Graduate 
Medical Education; Title XVII of the PHS Act; Ryan White CARE 
Act; Ending the HIV Epidemic; Universal Newborn Hearing 
Screening; Organ Transplantation; Family Planning; Rural Health 
programs; Traumatic Brain Injury programs; Autism 
Collaboration, Accountability, Research, Education, and Support 
Act; Public Health Improvement Act; Firefighter Cancer Registry 
Act of 2018; Cybersecurity and National Security programs; 
Healthy Start; Telehealth; Health Professions Education 
Partnership Act; Children's Health Act; Women's Health Research 
and Prevention Amendments of 1998; Birth Defects Prevention, 
Preventive Health Amendments of 1993; Research on Health Costs, 
Quality, and Outcomes; Substance Use and Mental Health Services 
programs; Protection and Advocacy for Individuals with Mental 
Illness; State Opioid Response Grants; Low Income Home Energy 
Assistance Program; Refugee and Entrant Assistance programs; 
Child Care and Development Block Grant; Children and Families 
Services Programs; Head Start; Preschool Development Grants; 
Runaway and Homeless Youth programs; Adoption and Legal 
Guardianship Incentive Payments; CAPTA programs; Family 
Violence programs; National Domestic Violence Hotline; Child 
Welfare Services; Developmental Disabilities programs; Voting 
Access for Individuals with Disabilities; Native American 
Programs; Community Services Block Grant Act programs; National 
Institutes of Health; Assets for Independence; Alzheimer's 
Disease Demonstration Grants; Office of Disease Prevention and 
Health Promotion; Assistive Technology Act; Elementary and 
Secondary Education Act of 1965; Rehabilitation Act of 1973 
programs; Helen Keller National Center Act; Education of the 
Deaf Act; Adult Education and Family Literacy Act programs; 
Education Sciences Reform Act; Parts C and D of the Individuals 
with Disabilities Education Act; Special Olympics Sport and 
Empowerment Act of 2004; Corporation for Public Broadcasting; 
Corporation for National and Community Service; National 
Council on Disability; Older Americans Act; Second Chance Act; 
Work Incentive Planning and Assistance; and Protection and 
Advocacy for Beneficiaries of Social Security.

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

    Pursuant to paragraph 7(c) of rule XXVI, on July 27, 2023, 
the Committee ordered favorably reported an original bill (S. 
2624) making appropriations for the Departments of Labor, 
Health and Human Services, and Education, and related agencies 
for the fiscal year ending September 30, 2024, and for other 
purposes, provided, that the bill be subject to amendment and 
that the bill be consistent with its budget allocation, and 
provided that the Chairman of the Committee or his designee be 
authorized to offer the substance of the original bill as a 
Committee amendment in the nature of a substitute to the House 
companion measure, by a recorded vote of 26-2, a quorum being 
present. The vote was as follows:
        Yeas                          Nays
Chair Murray                        Mr. Hagerty
Mrs. Feinstein                      Mrs. Fischer
Mr. Reed
Mr. Tester
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy
Mr. Manchin
Mr. Van Hollen
Mr. Heinrich
Mr. Peters
Ms. Collins
Mr. McConnell
Ms. Murkowski
Mr. Graham
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Kennedy
Mrs. Hyde-Smith
Mrs. Britt
Mr. Rubio

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

    Paragraph 12 of rule XXVI requires that the Committee 
report on a bill or joint resolution repealing or amending any 
statute or part of 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.''
    In compliance with this rule, changes in existing law 
proposed to be made by the bill are shown as follows: existing 
law to be omitted is enclosed in black brackets; new matter is 
printed in italic; and existing law in which no change is 
proposed is shown in roman.

                          TITLE 20--EDUCATION


     Chapter 28--Higher Education Resources and Student Assistance


                    Subchapter I--General Provisions


                 PART B--ADDITIONAL GENERAL PROVISIONS

Sec. 1011c. National Advisory Committee on Institutional Quality and 
                    Integrity

(a) Establishment

           *       *       *       *       *       *       *


(f) Termination

    The Committee shall terminate on September 30, [2021] 2024.

           *       *       *       *       *       *       *


                   Subchapter IV--Student Assistance


          PART D--WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM

Sec. 1087h. Funds for administrative expenses

(a) Administrative expenses

  (1) Mandatory funds for fiscal year 2006

           *       *       *       *       *       *       *


  (4) Continuing mandatory funds for account maintenance fees

    For each of the fiscal years 2007 through [2021] 2024, 
there shall be available to the Secretary, from funds not 
otherwise appropriated, funds to be obligated for account 
maintenance fees payable to guaranty agencies under part B and 
calculated in accordance with subsection (b).
                                ------                                


     NATIONAL AND COMMUNITY SERVICE ACT OF 1990, PUBLIC LAW 101-610


SEC. 148. DISBURSEMENT OF EDUCATIONAL AWARDS.

    (a) In General.--

           *       *       *       *       *       *       *

    (f) Transfer of Educational Awards.--

            (1) In general.-- * * *

            (2) Conditions for transfer.--An educational award 
        may be transferred under this subsection if--

                    (A)(i) the award is a national service 
                educational award for service in [a national 
                service program that receives a grant under 
                subtitle C] an approved national service 
                position; and
                                ------                                


                CONSOLIDATED APPROPRIATIONS ACT, 2014, 
                           PUBLIC LAW 113-76


   DIVISION H--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND 
        EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2014


                                TITLE V


                           GENERAL PROVISIONS

    Sec. 526. (a) Definitions.-- * * *

           *       *       *       *       *       *       *

    (b) Use of Discretionary Funds in [Fiscal Year 2014] Fiscal 
Year 2024.-- * * *

           *       *       *       *       *       *       *

    (c) Performance Partnership Agreements.--Federal agencies 
may use Federal discretionary funds, as authorized in 
subsection (b), to participate in a Performance Partnership 
Pilot only in accordance with the terms of a Performance 
Partnership Agreement that--

            (1) is entered into between--

           *       *       *       *       *       *       *

            (2) specifies, at a minimum, the following 
        information: (A) the length of the Agreement (which 
        shall not extend beyond [September 30, 2018] September 
        30, 2028);

           *       *       *       *       *       *       *

    (e) Transfer Authority.--For the purpose of carrying out 
the Pilot in accordance with the Performance Partnership 
Agreement, and subject to the written approval of the Director 
of the Office of Management and Budget, the head of each 
participating Federal agency may transfer Federal discretionary 
funds that are being used in the Pilot to an account of the 
lead Federal administering agency that includes Federal 
discretionary funds that are being used in the Pilot. Subject 
to the waiver authority under subsection (f), such transferred 
funds shall remain available for the same purposes for which 
such funds were originally appropriated: Provided, That such 
transferred funds shall remain available for obligation by the 
Federal Government until the expiration of the period of 
availability for those Federal discretionary funds (which are 
being used in the Pilot) that have the longest period of 
availability, except that any such transferred funds shall not 
remain available beyond [September 30, 2018] September 30, 
2028.
                                ------                                


                        BUDGETARY IMPACT OF BILL


  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO PSEC. 308(A), PUBLIC LAW 93-344, AS
                                                     AMENDED
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                  Budget authority               Outlays
                                                             ---------------------------------------------------
                                                               Committee    Amount  in   Committee    Amount  in
                                                               allocation      bill      allocation      bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the subcommittee
 allocation for 2024: Subcommittee on Labor, HHS, Education,
 and Related Agencies:
    Mandatory...............................................    1,064,077    1,064,077    1,062,276  \1\1,062,27
                                                                                                               6
    Discretionary...........................................      195,231      202,178      263,863   \1\256,369
        Defense.............................................  ...........  ...........           NA           NA
        Non-defense.........................................      195,231      202,178           NA           NA
Projections of outlays associated with the recommendation:
    2024....................................................  ...........  ...........  ...........  \2\1,132,40
                                                                                                               6
    2025....................................................  ...........  ...........  ...........      113,468
    2026....................................................  ...........  ...........  ...........       32,122
    2027....................................................  ...........  ...........  ...........        6,594
    2028 and future years...................................  ...........  ...........  ...........        1,653
Financial assistance to State and local governments for                NA      492,271           NA   \2\578,195
 P2024......................................................
 
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
\2\Excludes outlays from prior-year budget authority.
 
NA: Not applicable.
 
NOTE.--Consistent with the funding recommended in the bill for continuing disability reviews and
  redeterminations, for health care fraud and abuse control, for reemployment services and eligibility
  assessments, and for emergency requirements in accordance with subparagraphs (B), (C), (E), and (A)(i) of the
  Balanced Budget and Emergency Deficit Control Act of 1985, the Committee anticipates that the Budget Committee
  will provide, at the appropriate time, a 302(a) allocation for the Committee on Appropriations reflecting a
  net upward adjustment of $6,947,000,000 in budget authority plus the associated outlays. Pursuant to section
  1001(b)(3)(B) of the 21st Century Cures Act (Public Law 114-255), $407,000,000 in budget authority and the
  resulting outlays do not count for the purposes of estimates under the Congressional Budget and Impoundment
  Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985.

         DISCLOSURE OF CONGRESSIONALLY DIRECTED SPENDING ITEMS

    The Constitution vests in the Congress the power of the 
purse. The Committee believes strongly that Congress should 
make the decisions on how to allocate the people's money. As 
defined in Rule XLIV of the Standing Rules of the Senate, the 
term ``congressionally directed spending item'' means a 
provision or report language included primarily at the request 
of a Senator, providing, authorizing, or recommending a 
specific amount of discretionary budget authority, credit 
authority, or other spending authority for a contract, loan, 
loan guarantee, grant, loan authority, or other expenditure 
with or to an entity, or targeted to a specific State, locality 
or congressional district, other than through a statutory or 
administrative, formula-driven, or competitive award process.
    For each item, a Member is required to provide a 
certification that neither the Member nor the Member's 
immediate family has a pecuniary interest in such 
congressionally directed spending item. Such certifications are 
available to the public on the website of the Senate Committee 
on Appropriations (https://www.appropriations.senate.gov/
congressionally-directed-spending-requests). Following is a 
list of congressionally directed spending items included in the 
Senate recommendation discussed in this explanatory statement, 
along with the name of each Senator who submitted a request to 
the Committee of jurisdiction for each item so identified. 
Neither the Committee recommendation nor this report contains 
any limited tax benefits or limited tariff benefits as defined 
in rule XLIV.

                                                         CONGRESSIONALLY DIRECTED SPENDING ITEMS
--------------------------------------------------------------------------------------------------------------------------------------------------------
           Department                        Account                                   Project                          Amount          Requestor(s)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          A Precious Child, Inc., CO, for workforce               400,000  Hickenlooper
                                  Administration.                  development programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Advocate Christ Medical Center, IL, for a career        500,000  Durbin
                                  Administration.                  pipeline program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          African Alliance of Rhode Island, RI, for               200,000  Reed, Whitehouse
                                  Administration.                  workforce training and apprenticeship programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Alaska Joint Electrical Apprenticeship and            1,600,000  Murkowski
                                  Administration.                  Training Trust, AK, for an apprenticeship
                                                                   program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Alaska Joint Electrical Apprenticeship and              350,000  Murkowski
                                  Administration.                  Training Trust, AK, for an apprenticeship
                                                                   program, including the purchase of equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Alaska Legal Services Corporation, AK, for a            500,000  Murkowski
                                  Administration.                  workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Alaska Operating Engineers Employers Training         1,999,000  Murkowski
                                  Administration.                  Trust Fund, AK, for the purchase of equipment
                                                                   for an apprenticeship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Alaska Works Partnership, Inc., AK, for a             1,000,000  Murkowski
                                  Administration.                  workforce training program, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          arc Thrift Stores, CO, for workforce development         51,000  Bennet, Hickenlooper
                                  Administration.                  activities, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Arizona Commerce Authority, AZ, for the               2,000,000  Kelly, Sinema
                                  Administration.                  semiconductor workforce accelerator project,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          AS220, RI, for a workforce training program......       870,000  Reed, Whitehouse
                                  Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Automotive Training Center, Inc., GA, for               250,000  Ossoff, Warnock
                                  Administration.                  equipment for a workforce development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Best Buddies International, Inc., WA, for               250,000  Murray
                                  Administration.                  workforce development activities for individuals
                                                                   with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Beyond Literacy, PA, for an education and               395,000  Casey
                                  Administration.                  training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Big Brothers Big Sisters of Flint and Genesee            75,000  Stabenow
                                  Administration.                  County, MI, for a youth workforce opportunity
                                                                   initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Blue Ridge Community & Technical College                492,000  Capito
                                  Administration.                  Foundation Inc., WV, for advanced manufacturing
                                                                   training programs, including the purchase of
                                                                   equipment, technology, and curriculum design.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Boys & Girls Clubs of the Chattahoochee Valley,         500,000  Warnock
                                  Administration.                  Inc., GA, for college preparation, career
                                                                   training, and workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Capital Workforce Partners, Inc. (CWP), CT, for         876,000  Blumenthal, Murphy
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Center for Community Health Alignment, University       112,000  Graham
                                  Administration.                  of South Carolina Arnold School of Public
                                                                   Health, SC, for a workforce development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Children's Health Care, MN, for workforce               875,000  Klobuchar, Smith
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          City of Elkins, WV, for an apprenticeship program        60,000  Capito, Manchin
                                  Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          CitySeed, Inc., CT, for a culinary training             150,000  Blumenthal, Murphy
                                  Administration.                  program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Civic Works, Inc., MD, for workforce development        788,000  Cardin, Van Hollen
                                  Administration.                  services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Clark College, WA, for the purchase and               1,000,000  Cantwell, Murray
                                  Administration.                  installation of equipment and development of
                                                                   curriculum for a clean energy technical
                                                                   education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Coalfield Development, WV, for workforce              1,200,000  Manchin
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          College of Staten Island of the City University       1,720,000  Gillibrand, Schumer
                                  Administration.                  of New York, NY, for a wind energy workforce
                                                                   education and training initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Colorado State University--Pueblo, CO, for a            949,000  Bennet, Hickenlooper
                                  Administration.                  transportation technology workforce development
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Connecticut NAACP, CT, for workforce development        350,000  Blumenthal, Murphy
                                  Administration.                  activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Cook Inlet Tribal Council Inc., AK, for a             1,000,000  Murkowski
                                  Administration.                  workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          County of Middlesex, NJ, for a healthcare             1,400,000  Booker, Menendez
                                  Administration.                  workforce training project, including curriculum
                                                                   development and the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Cowley Community College, KS, for welding               264,000  Moran
                                  Administration.                  education, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Dartmouth Hitchcock Nashua, NH, for a behavioral      1,292,000  Shaheen
                                  Administration.                  workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Delaware Bioscience Association, DE, for              2,168,000  Carper, Coons
                                  Administration.                  workforce development activities, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Delaware Department of Safety and Homeland            1,800,000  Coons
                                  Administration.                  Security--State Fire School, DE, for the
                                                                   purchase of workforce training equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Detroit Health Department, MI, for training and         900,000  Peters, Stabenow
                                  Administration.                  certification programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Doddridge County Day Report Center, WV, for the          10,000  Manchin
                                  Administration.                  purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          East River Development Alliance Inc, NY, for            912,000  Schumer
                                  Administration.                  youth development and training services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Eastern Shore Foundation Inc, VA, for a                 197,000  Kaine, Warner
                                  Administration.                  prototyping and training center for advanced
                                                                   manufacturing, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Foundation Health LLC, AK, for a workforce            1,000,000  Murkowski
                                  Administration.                  training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Fox Valley Workforce Development Board, WI, for       4,675,000  Baldwin
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Fremont Multidistrict Initiative, CO, for               450,000  Bennet, Hickenlooper
                                  Administration.                  workforce development programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Game On Upstate, NY, for workforce development        1,500,000  Schumer
                                  Administration.                  programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          George Mason University, VA, for health workforce       921,000  Kaine, Warner
                                  Administration.                  programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Hartford Promise, CT, for a student internship          116,000  Blumenthal, Murphy
                                  Administration.                  support program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Hawaii Pacific University, HI, for a physician        1,843,000  Hirono, Schatz
                                  Administration.                  assistant program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Henry Ford College, MI, for workforce development     3,000,000  Peters
                                  Administration.                  activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Hinds Community College, MS, for a STEM program,      2,847,000  Hyde-Smith
                                  Administration.                  including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Hinds Community College, MS, for a workforce          1,200,000  Wicker
                                  Administration.                  training program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Hispanic Center Lehigh Valley, PA, for workforce        350,000  Casey
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Homeboy Industries, CA, for workforce development     2,000,000  Padilla
                                  Administration.                  activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Housing Authority of the City of Providence,            150,000  Reed, Whitehouse
                                  Administration.                  Rhode Island (dba Providence Housing Authority),
                                                                   RI, for workforce development services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Ibero-American Action League Inc., NY, for a            800,000  Schumer
                                  Administration.                  community health workers apprenticeship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Illinois Central College, IL, for the purchase of       547,000  Duckworth
                                  Administration.                  workforce training equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Itasca Economic Development Corporation, MN, for        339,000  Klobuchar, Smith
                                  Administration.                  workforce training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          IYRS School of Technology and Trades, RI, for           550,000  Whitehouse
                                  Administration.                  robotics enabled workforce development programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Kawerak, Inc., AK, for a workforce training             568,000  Murkowski
                                  Administration.                  program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          La Colaborativa, MA, for a workforce development        630,000  Markey, Warren
                                  Administration.                  program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Leeward Community College, HI, for special              175,000  Schatz
                                  Administration.                  education educator apprenticeship programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Living Classrooms Foundation, MD, for a maritime        883,000  Cardin, Van Hollen
                                  Administration.                  skills workforce development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Machinists Institute, WA, for the purchase of         4,500,000  Murray
                                  Administration.                  equipment and program development for a
                                                                   manufacturing workforce development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Maine Development Foundation, ME, for a workforce       535,000  Collins, King
                                  Administration.                  development program, including the purchase of
                                                                   equipment and curriculum development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Manchester School District, NH, for an education        105,000  Shaheen
                                  Administration.                  leadership training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Mary Hitchcock Memorial Hospital, NH, for an            400,000  Shaheen
                                  Administration.                  early childhood workforce program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Maryland Reentry Resource Center Inc., MD, for          200,000  Cardin, Van Hollen
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Michigan Health & Hospital Association Keystone         756,000  Stabenow
                                  Administration.                  Center, MI, for workforce training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Midlands Technical College, SC, for a workforce       6,000,000  Graham
                                  Administration.                  development program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Minnesota Assistance Council for Veterans, MN,          420,000  Klobuchar, Smith
                                  Administration.                  for an employment services program for veterans.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Moraine Park Tech College, WI, for the purchase         150,000  Baldwin
                                  Administration.                  of equipment for a fire training center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Multi-Service Center, WA, for workforce training.       772,000  Murray
                                  Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Neighborhood, VA, for the career and community          275,000  Kaine, Warner
                                  Administration.                  development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          New Castle County Vocational Technical School         1,702,000  Carper, Coons
                                  Administration.                  District, DE, for nursing, commercial driving,
                                                                   and biopharmaceutical manufacturing programs,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          New Immigrant Community Empowerment, NY, for a          500,000  Gillibrand, Schumer
                                  Administration.                  workforce development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Newport County Community Mental Health Center,          200,000  Reed, Whitehouse
                                  Administration.                  Inc. d/b/a Newport Mental Health, RI, for
                                                                   behavioral healthcare workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Oregon Native American Chamber, OR, for a               426,000  Merkley, Wyden
                                  Administration.                  semiconductor industry workforce development
                                                                   program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Outreach Services, PA, for workforce development        250,000  Casey
                                  Administration.                  services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Pacific Mountain Workforce Development Council,       1,500,000  Murray
                                  Administration.                  WA, for workforce development services for
                                                                   veterans.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Pacific Northwest Ironworkers Training Program        1,000,000  Murkowski
                                  Administration.                  d.b.a. Alaska Ironworkers Training Program, AK,
                                                                   for a workforce training program, including the
                                                                   purchase of equipment..
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Philadelphia Area Project on Occupational Safety        100,000  Casey
                                  Administration.                  & Health, PA, for workforce development
                                                                   activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Pittsburgh Film Office, PA, for workforce               765,000  Fetterman
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Polaris MEP, RI, for a workforce training               271,000  Reed, Whitehouse
                                  Administration.                  program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Prince George's Community College, MD, for the          874,000  Cardin, Van Hollen
                                  Administration.                  commercial drivers licensure program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Prince George's County, MD, for a summer youth        1,500,000  Cardin, Van Hollen
                                  Administration.                  employment program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Prince of Wales Vocational and Technical                500,000  Murkowski
                                  Administration.                  Education Center, AK, for a workforce
                                                                   development program, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Providence Public Library (PPL), RI, for                200,000  Reed
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Quincy Asian Resources, Inc., MA, for a workforce       627,000  Markey, Warren
                                  Administration.                  initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Re-use Hawaii, HI, for workforce development            500,000  Schatz
                                  Administration.                  training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Rhode Island Manufacturers Association, RI, for a       250,000  Whitehouse
                                  Administration.                  workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Rhode Island Office of the Postsecondary                900,000  Reed, Whitehouse
                                  Administration.                  Commissioner, RI, for healthcare workforce
                                                                   development programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          SC Emergency Medical Services Association, SC,        1,650,000  Graham
                                  Administration.                  for a workforce development program, including
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Seward County Community College, KS, for the          1,200,000  Moran
                                  Administration.                  purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          SMART 33 Wheeling District JATC, WV, for                400,000  Capito, Manchin
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          So All May Eat, Inc., CO, for a culinary                157,000  Hickenlooper
                                  Administration.                  workforce training program, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Southwest Piping Institute, NM, for workforce         1,350,000  Heinrich
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          SpringForward, MD, for workforce development            307,000  Cardin, Van Hollen
                                  Administration.                  services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Starr Commonwealth, MI, for a youth career              500,000  Stabenow
                                  Administration.                  development project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          State of New Mexico Office of Broadband Access        1,993,000  Heinrich, Lujan
                                  Administration.                  and Expansion, NM, for workforce development
                                                                   including purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Steamfitters Workforce Training Program, PA, for        322,000  Casey
                                  Administration.                  workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Sunflower Bakery, MD, for workforce development          75,000  Van Hollen
                                  Administration.                  services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Arc of Hilo, HI, for a school-to-work               297,000  Schatz
                                  Administration.                  transition program for individuals with
                                                                   disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Avery Center, CO, for workforce development         109,000  Bennet, Hickenlooper
                                  Administration.                  programs for survivors of sex exploitation and
                                                                   sex trafficking.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Black Fire Brigade Org, IL, for an EMT and          500,000  Duckworth
                                  Administration.                  paramedic training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Challenge Program, DE, for workforce                465,000  Carper, Coons
                                  Administration.                  development activities, including the purchase
                                                                   of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Klamath Tribes, OR, for a workforce training      1,000,000  Merkley, Wyden
                                  Administration.                  program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Mental Health Center of Greater Manchester,         408,000  Shaheen
                                  Administration.                  NH, for mental health workforce training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Peale Center for Baltimore History and              420,000  Cardin, Van Hollen
                                  Administration.                  Architecture, Inc., MD, for historic
                                                                   preservation workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The Skills Foundation of Mississippi, MS, for a         450,000  Hyde-Smith, Wicker
                                  Administration.                  workforce training program, including curriculum
                                                                   development and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          The West Virginia Chamber Foundation Corporation,       300,000  Capito, Manchin
                                  Administration.                  WV, for workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Toledo Area Sheet Metal JATC, OH, for the               715,000  Brown
                                  Administration.                  purchase of equipment for a sheet metal
                                                                   apprenticeship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Trade Institute of Pittsburgh, PA, for workforce        450,000  Casey
                                  Administration.                  development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Turing School of Software & Design, CO, for a           575,000  Bennet, Hickenlooper
                                  Administration.                  software development training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          United Community Ministries, VA, for a workforce        326,000  Kaine, Warner
                                  Administration.                  development program and English conversation
                                                                   classes.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          United Mine Workers of America Career Centers,        1,500,000  Casey, Fetterman
                                  Administration.                  Inc. (UMWA Career Centers, Inc. UMWACC), PA, for
                                                                   workforce development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          University of Alaska Anchorage, AK, for an            1,000,000  Murkowski
                                  Administration.                  apprenticeship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          University of Rhode Island, RI, for biomedical        1,200,000  Reed
                                  Administration.                  workforce development training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Urban Affairs Coalition, PA, for a summer youth         500,000  Casey
                                  Administration.                  employment program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Urban League of Greater Southwestern Ohio, OH,          670,000  Brown
                                  Administration.                  for the Building Futures pre-apprenticeship
                                                                   Program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Vermont Healthcare Information Technology               996,000  Welch
                                  Administration.                  Education Center, Inc., VT, for apprenticeship
                                                                   programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Veterans Life Center, NC, for a workforce               750,000  Tillis
                                  Administration.                  training program for veterans.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Virginia Wesleyan University, VA, for career            625,000  Kaine, Warner
                                  Administration.                  development services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          WaterFire Providence, RI, for workforce                 250,000  Reed
                                  Administration.                  development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Wesley Dayton, OH, for a workforce development          250,000  Brown
                                  Administration.                  program for unemployed and underemployed
                                                                   Montgomery County residents.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          West Virginia Higher Education Policy Commission,     1,800,000  Capito, Manchin
                                  Administration.                  WV, for a paramedic training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          West Virginia Office of Miners' Health, Safety          300,000  Capito, Manchin
                                  Administration.                  and Training, WV, for workforce development
                                                                   activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          West Virginia Sheet Metal Workers Joint                 751,000  Brown
                                  Administration.                  Apprenticeship Training Fund, WV, for sheet
                                                                   metal workers apprenticeship training, including
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Western Slope Schools Career Collaborative, CO,         600,000  Bennet, Hickenlooper
                                  Administration.                  for the implementation of new industry
                                                                   development pathways.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Western States College of Construction, CO, for       1,018,000  Bennet, Hickenlooper
                                  Administration.                  apprenticeship programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Women's Resource Center, MI, for workforce               95,000  Stabenow
                                  Administration.                  development services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Woonasquatucket Valley Community Build Inc. dba         300,000  Reed
                                  Administration.                  The Steel Yard, RI, for workforce training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Labor              Employment and Training          Workforce Alliance, CT, for a health workforce        1,188,000  Blumenthal, Murphy
                                  Administration.                  training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Adventist Health Castle, HI, for equipment.......       700,000  Hirono, Schatz
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Agnes Scott College, GA, for facilities and           1,001,000  Ossoff, Warnock
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Aiken Technical College, SC, for facilities and       1,000,000  Graham
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Alaska Addiction Rehabilitation Services, AK, for     3,000,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Alaska Native Tribal Health Consortium, AK, for       2,000,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Albany Med Health System, NY, for equipment......       500,000  Gillibrand, Schumer
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Alcona Citizens for Health, Inc., MI, for               305,000  Stabenow
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Alivio Medical Center, IL, for facilities and           498,000  Durbin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    ALS Association, AK, for equipment...............       413,000  Murkowski
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Amador Health Center, NM, for facilities and            780,000  Heinrich
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    American Red Cross of Hawaii, HI, for a rural            50,000  Schatz
 Services                         Administration.                  training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Anchorage Community Mental Health Services Inc.       1,987,000  Murkowski
 Services                         Administration.                  d.b.a. Alaska Behavioral Health, AK, for
                                                                   facilities and equipment, including information
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Anderson Regional Medical Center, MS, for             4,300,000  Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    AnMed Health, SC, for facilities and equipment...    11,176,000  Graham
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Apicha Community Health Center, NY, for                 146,000  Gillibrand
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Apple Tree Dental, MN, for facilities and             3,690,000  Klobuchar, Smith
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Applied Research Foundation of WV, WV, for            7,415,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Arab Community Center for Economic and Social         4,000,000  Stabenow
 Services                         Administration.                  Services, MI, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Arcadia University, PA, for facilities and              342,000  Casey
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Arctic Slope Native Association Ltd., AK, for         1,500,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Arkansas State University--Mountain Home, AR, for     6,000,000  Boozman
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Aroostook Mental Health Services, Inc., ME, for       4,300,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Ashland Ambulance Service, ME, for equipment.....       431,000  Collins
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Asian Health Services, CA, for facilities and         1,000,000  Feinstein, Padilla
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Aunt Martha's Health and Wellness, IL, for              450,000  Duckworth, Durbin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Avera McKennan, SD, for facilities and equipment,       997,000  Rounds
 Services                         Administration.                  including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Axis Health System, CO, for facilities and            1,107,000  Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Baltimore County Government, MD, for facilities         500,000  Cardin, Van Hollen
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Bangor Nursing and Rehabilitation Center, ME, for       366,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Bangor Young Men's Christian Association, ME, for     5,000,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Barnes-Kasson County Hospital, PA, for equipment.       600,000  Casey
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Barrow Neurological Foundation, AZ, for equipment     1,053,000  Sinema
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Bartlett Regional Hospital, AK, for facilities        4,000,000  Murkowski
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Beebe Medical Center, Inc. d/b/a Beebe                1,500,000  Carper
 Services                         Administration.                  Healthcare, DE, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Berks Community Health Center, PA, for facilities     1,001,000  Casey, Fetterman
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Bethel Family Clinic, AK, for facilities and          2,000,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Blue Ridge Hospice, VA, to expand access to high-       561,000  Kaine, Warner
 Services                         Administration.                  quality preventive, primary, acute and long term
                                                                   care under its Program of All-Inclusive Care for
                                                                   the Elderly.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Blue Sky Bridge, CO, for facilities and equipment       807,000  Bennet, Hickenlooper
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Boone Memorial Hospital Inc., WV, for facilities      2,202,000  Capito, Manchin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Borough of Waynesboro, PA, for facilities and         1,114,000  Casey
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Braxton County, WV, for equipment................       400,000  Capito, Manchin
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Broaddus Hospital Association Incorporation, WV,        529,000  Capito, Manchin
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Brooks Ambulance, Inc., ME, for facilities and        1,650,000  Collins
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Bryant University, RI, for facilities and             1,500,000  Reed
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Calais Community Hospital, ME, for facilities and     1,354,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Camden-on-Gauley Medical Center, Inc., WV, for        5,000,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Camp Kita Inc., ME, for facilities and equipment.     3,330,000  Collins, King
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Cancer Can't, WA, for facilities and equipment...     1,500,000  Cantwell
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Canyonlands Community Health Care, AZ, for            2,500,000  Kelly, Sinema
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Cape Fear Valley Health, NC, for facilities and         903,000  Tillis
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Capital Health System, Inc., NJ, for facilities       1,500,000  Booker, Menendez
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Caring Hands Healthcare Centers Inc., OK, for         3,000,000  Mullin
 Services                         Administration.                  facilities and equipment, including information
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Catholic Medical Center, NH, for facilities and         407,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    CCI Health Services, MD, for facilities and             940,000  Cardin, Van Hollen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Centra Health, VA, for facilities and equipment..       190,000  Kaine, Warner
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Central Maine Community College, ME, for              3,325,000  Collins
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Central Maine Medical Center, ME, for facilities      2,100,000  Collins
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Central Virginia Health Services, Inc., VA, for         355,000  Kaine, Warner
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Centreville Clinics, Inc., PA, for facilities and       500,000  Casey
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Charleston Area Medical Center Inc., WV, for          7,516,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment for a multispecialty
                                                                   facility.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Charleston Area Medical Center Inc., WV, for         15,000,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment to improve neurological
                                                                   care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    CHI Memorial Hospital-Georgia, Inc. d/b/a CHI         1,500,000  Ossoff, Warnock
 Services                         Administration.                  Memorial Hospital Georgia, GA, for facilities
                                                                   and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Chicago Family Health Center, Inc. (CFHC), IL,          122,000  Duckworth
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Children's Hospital of Colorado, CO, to support a       421,000  Bennet, Hickenlooper
 Services                         Administration.                  rural nurse training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Chiricahua Community Health Centers, Inc., AZ,          789,000  Kelly, Sinema
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Choptank Community Health Systems, MD, for              892,000  Cardin, Van Hollen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    CIL Community Resources Inc, CT, for facilities       1,403,000  Blumenthal, Murphy
 Services                         Administration.                  and construction.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Circle the City, AZ, for facilities and equipment       500,000  Sinema
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Citizens Foundation, KS, for facilities and           3,000,000  Moran
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    City and County of San Francisco, CA, for             1,000,000  Feinstein, Padilla
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    City of Caribou Cary Medical Center, ME, for          9,800,000  Collins
 Services                         Administration.                  facilities and equipment, including information
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    City of Hobbs Fire Department, NM, for equipment.       400,000  Lujan
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    City of Talladega, AL, for rural emergency            3,980,000  Britt
 Services                         Administration.                  medical services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    City of Waterbury, CT, for facilities and             5,000,000  Blumenthal, Murphy
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Claflin University, SC, for facilities and            3,563,000  Graham
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Clearfield Educational Foundation--Future, PA,          900,000  Fetterman
 Services                         Administration.                  for equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Clemson University, SC, for facilities and            6,000,000  Graham
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Cleveland Clinic Akron General, OH, for                 856,000  Brown
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    CODAC Behavioral Health, RI, for facilities and       1,200,000  Reed, Whitehouse
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Codman Square Health Center, MA, for facilities         179,000  Markey, Warren
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Colorado Mountain College, CO, for facilities and     3,000,000  Bennet, Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Columbia County Health & Human Services, WI, for      1,000,000  Baldwin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Columbus Consolidated Government, GA, for               139,000  Ossoff
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Columbus Neighborhood Health Center, Inc., dba/       1,200,000  Brown
 Services                         Administration.                  PrimaryOne Health, OH, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Community College of Allegheny County, PA, for          500,000  Casey
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Community Health and Wellness Center of Greater         232,000  Blumenthal, Murphy
 Services                         Administration.                  Torrington, Inc., CT, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Community Health Care Systems, Inc., GA, for            132,000  Ossoff
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Community Health Centers of Burlington, Inc, VT,      3,000,000  Sanders
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Community Housing of Maine, Inc., ME, for            15,000,000  Collins
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    CommunityHealth, IL, for facilities and equipment       516,000  Duckworth
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    COMPASS Family and Community Services, OH, for          750,000  Brown
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Comprehensive Community Action Inc. (CCAP), RI,       1,000,000  Reed, Whitehouse
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Comprehensive Life Resources, WA, for facilities      1,500,000  Cantwell
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Connections for Abused Women and their Children,        500,000  Durbin
 Services                         Administration.                  IL, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Copper River Native Association, AK, for                300,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    County of Los Angeles, CA, for facilities and         1,500,000  Feinstein, Padilla
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    County of San Diego, CA, for equipment...........     2,500,000  Feinstein, Padilla
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Crisp Regional Hospital, Inc., GA, for facilities       580,000  Ossoff, Warnock
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Critical Care Services, Inc. (D.B.A. Life Link        1,500,000  Klobuchar, Smith
 Services                         Administration.                  III), MN, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Cuba Independent Schools, NM, for facilities and        680,000  Lujan
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Curry Health Network, OR, for facilities and          2,000,000  Merkley, Wyden
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Dakota Child and Family Clinic, MN, for                 350,000  Klobuchar, Smith
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Dartmouth Health, NH, for facilities and                650,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Day One, RI, for facilities and equipment........       273,000  Whitehouse
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Deborah Heart and Lung Center, NJ, for equipment.     1,500,000  Booker, Menendez
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Delaware Health Information Network, DE, for          1,430,000  Carper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Delta Health, CO, for facilities and equipment...       158,000  Hickenlooper
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    DuPagePads, IL, for facilities and equipment.....       280,000  Duckworth
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    East Bay Community Action Program, RI, for            1,500,000  Whitehouse
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Eastern Maine Healthcare Systems, Acadia Hospital     1,330,000  Collins
 Services                         Administration.                  Corporation d.b.a. Northern Light Acadia
                                                                   Hospital, ME, for a rural health training
                                                                   program to improve dementia care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Eastern Maine Healthcare Systems, Eastern Maine       1,097,000  Collins, King
 Services                         Administration.                  Medical Center, ME, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Eastern Maine Healthcare Systems, The Aroostook       3,016,000  Collins, King
 Services                         Administration.                  Medical Center d.b.a. Northern Light A.R. Gould
                                                                   Hospital, ME, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Eastern Shore Rural Health System, Inc., VA, to         159,000  Kaine, Warner
 Services                         Administration.                  support rural pediatric health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Eastport Health Care, Inc., ME, for facilities        5,061,000  Collins
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Education Health and Research International, DE,      1,501,000  Carper
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Elliot Health System, NH, for facilities and            577,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Ellis Hospital, NY, for facilities and equipment.       500,000  Gillibrand, Schumer
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Emory University, GA, for facilities and                536,000  Ossoff
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Entre Hermanos, WA, for facilities and equipment.       706,000  Murray
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Erie Family Health Center, Inc., IL, for              3,000,000  Durbin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Escambia County Alabama Community Hospitals, Inc.     2,000,000  Britt
 Services                         Administration.                  dba Atmore Community Hospital, AL, for
                                                                   facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Esperanza Health Center, PA, for facilities and         464,000  Casey
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Fairbanks Native Association, AK, for facilities      5,000,000  Murkowski
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Fairmont State University, WV, for facilities and     3,059,000  Capito, Manchin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    FaithHealth Appalachia Inc., WV, for facilities         470,000  Capito, Manchin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Fallon Paiute-Shoshone Tribe, NV, for equipment..       210,000  Cortez Masto, Rosen
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Family Health Centers, WA, for facilities and         1,633,000  Cantwell
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Family Service of Rhode Island, RI, for               1,000,000  Reed, Whitehouse
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Florence Crittenton Programs Inc., WV, for            3,042,000  Capito
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Forsyth Community Clinic, GA, for equipment......        11,000  Warnock
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Frankford Community Development Corporation, PA,      1,000,000  Casey
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Free Clinic of the New River Valley DBA Community     1,250,000  Kaine, Warner
 Services                         Administration.                  Health Center of the New River Valley, VA, for
                                                                   facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Fresno County, CA, for facilities and equipment..     1,000,000  Feinstein
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Gallup Community Health, NM, for rural healthcare       750,000  Lujan
 Services                         Administration.                  services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Gila Regional Medical Center, NM, for equipment..     1,000,000  Heinrich, Lujan
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Gilmer County Ambulance Authority, WV, for              157,000  Capito
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Grafton County Nursing Home, NH, for facilities         750,000  Shaheen
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Grant County Commission, WV, for facilities and         700,000  Capito, Manchin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Grays Harbor County Public Hospital District No.      2,500,000  Cantwell
 Services                         Administration.                  1 dba. Summit Pacific Medical Center, WA, for
                                                                   facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Great Bay Services, NH, for facilities and              272,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Greater Health Now Accountable Community of             563,000  Murray
 Services                         Administration.                  Health, WA, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Greater Seacoast Community Health, NH, for              750,000  Shaheen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Guadalupe County Hospital, NM, for equipment.....       650,000  Lujan
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hampton University School of Nursing, VA, for         1,000,000  Kaine, Warner
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hana Health, HI, for facilities and equipment....     1,440,000  Hirono, Schatz
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Harbor Hall Foundation, MI, for facilities and        1,000,000  Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Harrington Memorial Hospital, Inc., MA, for             498,000  Markey, Warren
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hartford Gay & Lesbian Health Collective, CT, for       156,000  Blumenthal, Murphy
 Services                         Administration.                  facilities and construction.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hayward Memorial Hospital, WI, for facilities and     2,000,000  Baldwin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    HealthFirst Family Care Center, NH, for                 250,000  Shaheen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    HealthPoint, WA, for facilities and equipment....     4,000,000  Murray
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hennepin County, MN, for facilities and equipment     2,700,000  Klobuchar, Smith
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    HH Health System--Shoals LLC dba Helen Keller         2,600,000  Britt
 Services                         Administration.                  Hospital, AL, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hodgeman County Health Center, KS, for facilities     4,000,000  Moran
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Holyoke Health Center, Inc., MA, for facilities       1,000,000  Markey, Warren
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    HopeHealth Hospice & Palliative Care, RI, for            41,000  Reed, Whitehouse
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    HopeSparks, WA, for facilities and equipment.....     2,000,000  Murray
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Horizon Health Services, Inc., VA, to upgrade its     2,000,000  Kaine, Warner
 Services                         Administration.                  Waverly Medical Center location to enhance and
                                                                   expand services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hospice of Hilo dba Hawaii Care Choices, HI, for      1,217,000  Schatz
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hospice of Michigan, MI, for facilities and           1,000,000  Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hospital Authority of Randolph County, GA, for        5,500,000  Ossoff, Warnock
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hospital Authority of Valdosta & Lowndes, Ga. dba     1,871,000  Ossoff, Warnock
 Services                         Administration.                  SGMC Berrien Campus, GA, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hospital Development Co., WV, for facilities and        500,000  Capito, Manchin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Hyndman Area Health Center, PA, for facilities          885,000  Fetterman
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Illinois College, IL, for facilities and                911,000  Durbin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Illinois Medical District (IMD) Guest House             168,000  Duckworth
 Services                         Administration.                  Foundation, IL, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Increase Access to Care Initiative, PA, for             875,000  Casey, Fetterman
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Inner-City Muslim Action Network, IL, for             1,000,000  Durbin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Island Hospital, WA, for facilities and equipment     2,500,000  Murray
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    J Sargeant Reynolds Community College, VA, to           924,000  Kaine, Warner
 Services                         Administration.                  renovate laboratories and purchase equipment to
                                                                   increase enrollment in programs with high-demand
                                                                   health care occupations.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Jackson Laboratory, ME, for facilities and            8,000,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Jacksonville State University Foundation, AL, for     1,760,000  Britt
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Jefferson County Community Ministries, WV, for          300,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Jefferson County Public Hospital District 2,          2,000,000  Cantwell, Murray
 Services                         Administration.                  Jefferson Healthcare, WA, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    John A Logan College, IL, for facilities and          1,235,000  Duckworth
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Johns Hopkins Community Physicians, MD, for             750,000  Cardin, Van Hollen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Johnston Memorial Hospital (Ballad Health), VA,         613,000  Kaine, Warner
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Journey Forward, MA, for facilities and equipment       500,000  Markey, Warren
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kahuku Medical Center, HI, for facilities and           812,000  Schatz
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kanawha Hospice Care Inc., WV, for facilities and       426,000  Capito
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kansas State University, KS, for facilities and       3,000,000  Moran
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kansas State University, KS, for facilities and       4,000,000  Moran
 Services                         Administration.                  equipment to support biomanufacturing training
                                                                   and education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kenai Peninsula Borough, AK, for facilities and       5,000,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kennebec Valley Community College, ME, for              513,000  Collins
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Ketchikan Indian Community, AK, for facilities        2,000,000  Murkowski
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    KidsTLC, Inc., KS, for facilities and equipment..     3,000,000  Moran
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Kodiak Area Native Association, AK, for               5,000,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    KVC Health Systems Inc., KS, for facilities and       2,000,000  Moran
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    La Clinica De Los Campesinos, dba Family Health       2,000,000  Baldwin
 Services                         Administration.                  La Clinica, WI, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    La Clinica del Valle Family Health Care Center,       2,000,000  Merkley, Wyden
 Services                         Administration.                  Inc. (dba La Clinica), OR, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    LaGrange College, GA, for facilities and                214,000  Ossoff, Warnock
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lakes Region Mental Health Center, NH, for an           630,000  Shaheen
 Services                         Administration.                  electronic health records system.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lamoille Health Partners, Inc., VT, for               1,500,000  Sanders
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lanai Kinaole Inc, HI, for facilities and             1,150,000  Schatz
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lander University, SC, for facilities and             2,400,000  Graham
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lane County, OR, for facilities and equipment....     1,500,000  Merkley, Wyden
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Larry Labonte Recovery Center, ME, for facilities       178,000  Collins, King
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lawrence County Hospital, MS, for facilities and      8,600,000  Hyde-Smith
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lawrence General Hospital, MA, for facilities and     2,975,000  Markey, Warren
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Leg Up Farm, Inc., PA, for facilities and               500,000  Casey, Fetterman
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    LifeFlight of Maine, LLC, ME, for equipment......     1,920,000  Collins, King
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lifeways, Inc., OR, for facilities and equipment.       978,000  Merkley, Wyden
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lily's Place, WV, for facilities and equipment...     1,085,000  Capito
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lorain County Health and Dentistry, OH, for           2,000,000  Brown
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Loudoun County Community Health Center dba              359,000  Kaine, Warner
 Services                         Administration.                  HealthWorks, VA, to purchase radiology equipment
                                                                   and to renovate imaging room.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Louisiana State University and A&M College, LA,       3,000,000  Cassidy
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Loyola University of Chicago, IL, for facilities      1,000,000  Durbin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    LSU Health Sciences Center, LA, for facilities        1,735,000  Cassidy
 Services                         Administration.                  and equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Lyon College, AR, for facilities and equipment...    15,000,000  Boozman
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Madera County, CA, for equipment.................       940,000  Feinstein, Padilla
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Magnolia Regional Health Center, MS, for                500,000  Hyde-Smith, Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Maine Veterans' Homes, ME, for facilities and         3,680,000  Collins, King
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    MaineGeneral Medical Center, ME, for facilities       2,000,000  Collins, King
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    MaineHealth, ME, for LincolnHealth facilities and     4,500,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    MaineHealth, ME, for Maine Behavioral Healthcare      1,350,000  Collins, King
 Services                         Administration.                  Knox County facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    MaineHealth, ME, for Maine Behavioral Healthcare      2,825,000  Collins, King
 Services                         Administration.                  York County facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Maniilaq Association, AK, for facilities and            750,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Marathon County Government, WI, for facilities        2,000,000  Baldwin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Marion Township Volunteer Fire Company, PA, for          13,000  Fetterman
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Marshall University Research Corporation, WV, for    15,000,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Martha's Vineyard Hospital, MA, for equipment....     1,070,000  Markey, Warren
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mary's Center for Maternal & Child Care, Inc.,        5,000,000  Cardin, Van Hollen
 Services                         Administration.                  MD, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mascoma Community Healthcare, Inc., NH, for a           189,000  Shaheen
 Services                         Administration.                  rural public health initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mazzoni Center, PA, for facilities and equipment.       400,000  Casey
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    McLaren Oakland Hospital, MI, for facilities and        500,000  Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Memorial Medical Center, WI, for facilities and       2,000,000  Baldwin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Memorial Sloan Kettering Cancer Center, NY, for       1,200,000  Gillibrand, Schumer
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mercy Health Foundation Ada, OK, for facilities      10,000,000  Mullin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Meta House, WI, for facilities and equipment.....     3,000,000  Baldwin
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Michigan State University, MI, for facilities and       572,000  Peters, Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mid-Maine Homeless Shelter Inc., ME, for                 75,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mid-Michigan Recovery Services, MI, for                 500,000  Stabenow
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mid-State Health Center, NH, for facilities and       2,200,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Millinocket Regional Hospital, ME, for facilities     9,893,000  Collins, King
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mineral County Health Department, WV, for             1,260,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Minneola District Hospital NBR2, KS, for              1,000,000  Moran
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Minnie Hamilton Health Care Center, WV, for           5,000,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mississippi Children's Home Society d.b.a. Canopy     5,000,000  Hyde-Smith, Wicker
 Services                         Administration.                  Children's Solutions, MS, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mississippi State University, MS, for facilities        600,000  Hyde-Smith
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Monroe County Health Center, WV, for facilities          98,000  Capito
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mora County Ambulance Services, NM, for equipment       900,000  Heinrich
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Morgantown Community Resources Inc., WV, for            500,000  Capito, Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Morton County Health System, KS, for facilities         470,000  Moran
 Services                         Administration.                  and equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mother Nation, WA, for facilities and equipment..     1,148,000  Murray
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mothers' Milk Bank of the Western Great Lakes,          850,000  Duckworth
 Services                         Administration.                  IL, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mount Desert Island Biological Laboratory, ME,        1,607,000  Collins, King
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mount Desert Island Hospital, ME, for facilities      5,000,000  Collins, King
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mount Graham Regional Medical Center, AZ, for           500,000  Kelly, Sinema
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Mount Washington Valley Adult Day Center, NH, for        71,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Multnomah County, OR, for facilities and              1,970,000  Merkley, Wyden
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    MUSC Health Orangeburg, SC, for facilities and        4,300,000  Graham
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Native Village of Eyak, AK, for facilities and        5,000,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Nemaha Valley Community Hospital, KS, for               415,000  Moran
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Niagara University, NY, for facilities and            1,000,000  Gillibrand, Schumer
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Nisqually Indian Tribe, WA, for facilities and        5,000,000  Murray
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    North Country HealthCare, Inc., AZ, for               1,733,000  Kelly, Sinema
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    North Country Home Health & Hospice Agency, NH,         155,000  Shaheen
 Services                         Administration.                  to support a rural health initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    North Sunflower Medical Center, MS, for               1,034,000  Hyde-Smith
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Northwest Technical Institute Education              10,000,000  Boozman
 Services                         Administration.                  Foundation, AR, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Nottawaseppi Huron Band of the Potawatomi, MI,        1,500,000  Peters
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Noxubee General Critical Access Hospital, MS, for     5,000,000  Hyde-Smith, Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    NYC Health + Hospitals/Elmhurst, NY, for              2,000,000  Gillibrand, Schumer
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    NYU Langone Hospitals, NY, for facilities and         1,500,000  Gillibrand, Schumer
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Oakland University, MI, for facilities and              350,000  Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Ohio University, OH, for facilities and equipment     2,352,000  Brown
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Oktibbeha County Hospital (OCH) Regional Medical      9,500,000  Wicker
 Services                         Administration.                  Center, MS, for facilities and equipment,
                                                                   including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    OU Medicine, Inc. d.b.a. OU Health, OK, for           1,300,000  Mullin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Paden City Development Authority, WV, for               200,000  Manchin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pali Momi Foundation, HI, for equipment..........       500,000  Schatz
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Park West Health System, MD, for facilities and       1,500,000  Cardin, Van Hollen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Parrott Creek Child & Family Services, OR, for        2,000,000  Merkley, Wyden
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    PeaceHealth Southwest Medical Center, WA, for         1,000,000  Murray
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Peninsula Community Health Services of Alaska,          500,000  Murkowski
 Services                         Administration.                  Inc., AK, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Penobscot Community Health Center, ME, for            1,322,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Philadelphia Midwife Collective (PMC), PA, for          550,000  Casey
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pikes Peak State College, CO, for facilities and      1,000,000  Bennet, Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pinckneyville Community Hospital, IL, for               192,000  Duckworth
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pioneers Medical Center, CO, for facilities and         371,000  Bennet, Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pocahontas Memorial Hospital, WV, for facilities      6,000,000  Capito, Manchin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Portland Community Health Center dba Greater            775,000  King
 Services                         Administration.                  Portland Health, ME, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Potomac Valley Hospital Inc., WV, for facilities      1,000,000  Capito, Manchin
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Presbyterian Healthcare Service's Espanola            1,800,000  Heinrich
 Services                         Administration.                  Hospital, NM, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Prestera Center for Mental Health Services, WV,         350,000  Capito, Manchin
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Prisma Health--Upstate, SC, for facilities and       10,700,000  Graham
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Providence Community Health Centers, Inc., RI,          500,000  Reed
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Pushing Boundaries, WA, for facilities and            1,367,000  Murray
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Recovery Point of Huntington d.b.a. Recovery            600,000  Capito, Manchin
 Services                         Administration.                  Point West Virginia, WV, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Rector and Visitors of the University of                367,000  Kaine, Warner
 Services                         Administration.                  Virginia, VA, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Regional Hospice and Home Care of Western             2,000,000  Blumenthal, Murphy
 Services                         Administration.                  Connecticut, Inc., CT, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Regional Medical Center at Lubec, ME, for             5,000,000  Collins
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Richford Health Center, Inc. d/b/a Northern Tier      2,500,000  Sanders
 Services                         Administration.                  Center for Health (Notch), VT, for facilities
                                                                   and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Richland Hospital, WI, for facilities and             4,640,000  Baldwin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Rivier University, NH, for facilities and             2,000,000  Shaheen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Rochester General Hospital, NY, for facilities        1,000,000  Gillibrand, Schumer
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Roper St. Francis Hospital, SC, for facilities        8,000,000  Graham
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Rutgers University-New Brunswick, NJ, for             2,000,000  Booker, Menendez
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    RWJ Barnabas Health, NJ, for facilities and             981,000  Menendez
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Saint Antoine Residence, RI, for facilities and         250,000  Reed
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Saint Joseph's Mercy Care Services, Inc., GA, for       540,000  Warnock
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Santa Clara Pueblo, NM, for facilities and              350,000  Heinrich, Lujan
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Save a Life, Inc., ME, for facilities and               167,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Scenic Bluffs Community Health Center, WI, for        1,600,000  Baldwin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Scranton Primary Health Care Center, Inc., PA,          441,000  Casey
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Self Help Movement, Inc., PA, for facilities and      1,500,000  Fetterman
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Sinai Hospital of Baltimore, MD, for facilities       1,500,000  Cardin, Van Hollen
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Sokaogon Chippewa Health Clinic, WI, for              3,000,000  Baldwin
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    South Central Regional Medical Center, MS, for        7,500,000  Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    South Routt Medical Center, CO, for facilities        2,300,000  Bennet, Hickenlooper
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Southcentral Foundation, AK, for facilities and       1,000,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Southeast Colorado Hospital District, CO, for           205,000  Bennet, Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Southern Maine Community College, ME, for             4,100,000  Collins
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Southern New Hampshire Health, NH, for facilities       453,000  Shaheen
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Southwestern Vermont Medical Center, VT, for          2,000,000  Sanders, Welch
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Spanish Peaks Regional Health Center, CO, for         1,100,000  Bennet, Hickenlooper
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Sparrow Carson Hospital, MI, for facilities and         559,000  Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Spoon River College, IL, for facilities and           1,000,000  Durbin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    St. Andre Health Care Facility, ME, for               1,328,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    St. Dominic--Jackson Memorial Hospital, MS, for         500,000  Hyde-Smith, Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    St. Francis Medical Center--Allina Health, MN,        1,000,000  Klobuchar, Smith
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    St. Joseph Hospital, ME, for facilities and           1,550,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    St. Mary's Regional Medical Center, ME, for           3,989,000  Collins, King
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Stamford Health, CT, for facilities and equipment       750,000  Blumenthal, Murphy
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Stanton County Hospital, KS, for facilities and       1,500,000  Moran
 Services                         Administration.                  equipment, including information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Star Community Health, Inc., PA, for equipment...       500,000  Fetterman
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    STAT (Southern Tier Alternative Therapies, Inc.)        250,000  Casey
 Services                         Administration.                  Ligonier Therapeutic Center, PA, for facilities
                                                                   and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    State of Alaska Department of Health, AK, for         1,200,000  Murkowski
 Services                         Administration.                  equipment, including information technology for
                                                                   information management.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    State of Alaska Department of Health, AK, for           500,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    State of Alaska Department of Health, AK, for         1,000,000  Murkowski
 Services                         Administration.                  facilities and equipment, including information
                                                                   technology for health records.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Stephens County Hospital, GA, for facilities and      1,270,000  Warnock
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Sturdy Memorial Hospital, MA, for facilities and      2,835,000  Markey, Warren
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Summers County Commission, WV, for facilities and     3,000,000  Capito, Manchin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    SUNY Downstate Health Sciences University, NY,        2,758,000  Gillibrand, Schumer
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Susanville Indian Rancheria, CA, for facilities       2,500,000  Feinstein
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Tapestry 360 Health, IL, for facilities and             415,000  Durbin
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Tate County Hospital, MS, for facilities and          8,500,000  Hyde-Smith, Wicker
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Aliveness Project, MN, for facilities and         1,000,000  Klobuchar, Smith
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Board of Trustees of The University of              550,000  Britt
 Services                         Administration.                  Alabama, for and on behalf of The University of
                                                                   Alabama in Huntsville, AL, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Cheshire Medical Center, NH, for facilities         750,000  Shaheen
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Children's Place, AK, for facilities and          2,000,000  Murkowski
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Health Care Authority of the City of              2,500,000  Britt
 Services                         Administration.                  Huntsville DBA Huntsville Hospital Health
                                                                   System, AL, for equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Jackson Laboratory, CT, for facilities and          449,000  Blumenthal, Murphy
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Medical Center of Baldwin County, Inc., GA,         558,000  Ossoff, Warnock
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Providence Center, RI, for facilities and         1,320,000  Reed, Whitehouse
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The University of Cincinnati Medical Center           3,000,000  Brown
 Services                         Administration.                  (UCMC), OH, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    The Valley Hospital, NJ, for facilities and           3,100,000  Booker, Menendez
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    ThedaCare Regional Medical Center--Neenah, Inc,       1,500,000  Baldwin
 Services                         Administration.                  WI, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Tift Regional Health System, Inc., GA, for              600,000  Ossoff
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Town of Islesboro, ME, for facilities and               845,000  Collins, King
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Town of Milbridge, ME, for facilities and               370,000  Collins
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Trillium Health, Inc., NY, for facilities and         1,673,000  Gillibrand, Schumer
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Troy University, AL, for facilities and equipment     2,200,000  Britt
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Turner House Clinic, Inc. DBA Vibrant Health, KS,     4,000,000  Moran
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Tuscarawas County General Health Department dba         750,000  Brown
 Services                         Administration.                  Tuscarawas County Health Department (TCHD), OH,
                                                                   for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Tyler Holmes Memorial Hospital, MS, for               4,300,000  Wicker
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    UC Davis Health, CA, for facilities and equipment     1,800,000  Feinstein
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Umpqua Community College, OR, for facilities and      2,034,000  Merkley, Wyden
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University Hospital, NJ, for emergency response       4,000,000  Booker, Menendez
 Services                         Administration.                  vehicles and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Alaska Anchorage, AK, for                 500,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Alaska Anchorage, AK, for               2,000,000  Murkowski
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas--Rich Mountain, AR, for       12,000,000  Boozman
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas at Pine Bluff, AR, for        15,000,000  Boozman
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas for Medical Sciences, AR,      5,000,000  Boozman
 Services                         Administration.                  for a rural maternal and child health program,
                                                                   including equipment and information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas for Medical Sciences, AR,      3,000,000  Boozman
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas for Medical Sciences, AR,      4,000,000  Boozman
 Services                         Administration.                  for facilities and equipment to improve cancer
                                                                   care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Arkansas for Medical Sciences, AR,      8,000,000  Boozman
 Services                         Administration.                  for facilities and equipment to improve
                                                                   digestive disease care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Colorado Colorado Springs, CO, for        374,000  Bennet, Hickenlooper
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Delaware, DE, for facilities and        5,000,000  Coons
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Kansas Cancer Center, KS, for          10,000,000  Moran
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Kansas Hospital, KS, for facilities    10,000,000  Moran
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Maine System, ME, for facilities        4,500,000  Collins, King
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Michigan, MI, for facilities and        2,263,000  Peters, Stabenow
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Mississippi Medical Center, MS, for     3,200,000  Hyde-Smith
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Mississippi Medical Center, MS, for     4,300,000  Wicker
 Services                         Administration.                  facilities and equipment for the Mississippi
                                                                   Burn Center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Mississippi Medical Center, MS, for     1,090,000  Wicker
 Services                         Administration.                  rural telehealth and other services to address
                                                                   congenital syphilis.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Mississippi, MS, for equipment.....     4,500,000  Hyde-Smith
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Mississippi, MS, for facilities and     1,350,000  Hyde-Smith, Wicker
 Services                         Administration.                  equipment for medical device innovation.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Nevada Las Vegas, NV, for                 400,000  Cortez Masto, Rosen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Oklahoma Health Sciences Center,        1,200,000  Mullin
 Services                         Administration.                  OK, for facilities and equipment, including
                                                                   information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of South Carolina, SC, for facilities      3,010,000  Graham
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of South Carolina Lancaster, SC, for       2,800,000  Graham
 Services                         Administration.                  facilities and equipment, including information
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of South Carolina Upstate, SC, for         1,331,000  Graham
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of South Dakota, SD, for facilities        1,100,000  Rounds
 Services                         Administration.                  and equipment, including telehealth and
                                                                   information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    University of Washington, WA, for facilities and      3,500,000  Cantwell
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Uwchlan Ambulance Corps, PA, for equipment.......       121,000  Fetterman
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Valley Health Systems, Inc., WV, for a rural          1,000,000  Manchin
 Services                         Administration.                  healthcare outreach initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Vermont State Colleges System, VT, for facilities     5,982,000  Welch
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    VNA Home & Hospice d.b.a. Northern Light Home         1,000,000  Collins, King
 Services                         Administration.                  Care & Hospice, ME, for rural telehealth and
                                                                   information technology, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Volunteers in Medicine Berkshires, Inc., MA, for        441,000  Markey, Warren
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Volunteers of America Southeast Louisiana Inc.        4,500,000  Cassidy
 Services                         Administration.                  and Subsidiaries, LA, for facilities and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Wahiawa Center for Community Health, HI, for          1,500,000  Schatz
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Washington County, OR, for facilities and             2,500,000  Merkley, Wyden
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Washington State University, WA, for facilities       1,470,000  Murray
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Wayne Memorial Hospital, PA, for equipment.......     1,000,000  Casey
 Services                         Administration.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    West Hawaii Region of the Hawaii Health Systems       2,500,000  Hirono, Schatz
 Services                         Administration.                  Corporation, HI, for electronic medical records
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    West Side Community Health Services (dba              3,700,000  Klobuchar, Smith
 Services                         Administration.                  Minnesota Community Care), MN, for facilities
                                                                   and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    West Virginia School of Osteopathic Medicine          6,000,000  Capito
 Services                         Administration.                  Clinic Inc., WV, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    West Virginia University Hospitals, Inc., WV, for     6,428,000  Capito, Manchin
 Services                         Administration.                  WVU Medicine Children's Hospital for facilities
                                                                   and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    West Virginia University Research Corporation,       12,600,000  Capito, Manchin
 Services                         Administration.                  WV, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    WestCare Arizona, Inc., AZ, for facilities and          303,000  Sinema
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Western Nevada College, NV, for facilities and        4,392,000  Cortez Masto, Rosen
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Westside Family Healthcare, DE, for facilities        5,000,000  Carper, Coons
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    WhidbeyHealth Medical Center, WA, for facilities      2,500,000  Murray
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    White Mountain Regional Medical Center, f.k.a.        3,000,000  Kelly, Sinema
 Services                         Administration.                  White Mountain Communities Hospital, Inc., AZ,
                                                                   for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    William S. Baer School Partnership Board, MD, for       300,000  Cardin, Van Hollen
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Williams County Health Department, OH, for            1,000,000  Brown
 Services                         Administration.                  facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Women and Infants Hospital, RI, for facilities        1,808,000  Reed, Whitehouse
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Wood County Parks and Recreation Commission/            300,000  Capito, Manchin
 Services                         Administration.                  Mountwood Park, WV, for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Wood River Health, RI, for facilities and               100,000  Reed
 Services                         Administration.                  equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Yalobusha General Hospital and Nursing Home, MS,        591,000  Wicker
 Services                         Administration.                  for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Health Resources and Services    Yuma Regional Medical Center, AZ, for facilities      1,500,000  Kelly, Sinema
 Services                         Administration.                  and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       A Place to Belong, MN, for services for adults           75,000  Klobuchar, Smith
 Services                         Health Services Administration.  diagnosed with a serious mental illness.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Addiction Recovery Coalition of New Hampshire,          308,000  Shaheen
 Services                         Health Services Administration.  NH, for substance use disorder treatment and
                                                                   recovery services, including peer support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       AIDS Service Center of Lower Manhattan, Inc. dba        500,000  Gillibrand, Schumer
 Services                         Health Services Administration.  Alliance for Positive Change, NY, for substance
                                                                   use and mental health treatment services,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Allegheny-Singer Research Institute D/B/A AHN           900,000  Casey
 Services                         Health Services Administration.  Research Institute, PA, for mental health
                                                                   programming, including through the creation of a
                                                                   digital application.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Appalachian Children Coalition, OH, for substance     1,220,000  Brown
 Services                         Health Services Administration.  use prevention, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Axiom Community of Recovery, AZ, for recovery           638,000  Sinema
 Services                         Health Services Administration.  services, including peer-based support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Board of Trustees of the University of Illinois,      1,500,000  Durbin
 Services                         Health Services Administration.  IL, for school-based mental health services,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Boys & Girls Clubs of Southern Maine, ME, for           508,000  Collins
 Services                         Health Services Administration.  youth mental and behavioral health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Briarpatch Youth Services, WI, for counseling           400,000  Baldwin
 Services                         Health Services Administration.  services for at-risk youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Cambria County Drug Coalition, PA, for a mobile         115,000  Casey, Fetterman
 Services                         Health Services Administration.  crisis response unit, including supplies.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Carlsbad LifeHouse, NM, for mental and behavioral     1,000,000  Heinrich
 Services                         Health Services Administration.  health care services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Cathedral Square Corporation, VT, for mental          1,776,000  Welch
 Services                         Health Services Administration.  health services, including technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Catholic Charities, Inc.-Archdiocese of Hartford,       616,000  Blumenthal, Murphy
 Services                         Health Services Administration.  CT, for a substance use disorder treatment
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Children's Hospital and Health Systems Inc., WI,      1,000,000  Baldwin
 Services                         Health Services Administration.  to help children and families access mental
                                                                   health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Chinese-American Planning Council, Inc., NY, for        500,000  Gillibrand, Schumer
 Services                         Health Services Administration.  mental health support services, including
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       City of Everett, WA, for an alternative response      4,500,000  Murray
 Services                         Health Services Administration.  team for individuals experiencing behavioral and
                                                                   mental health crises.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Clark County, NV, for behavioral health training        934,000  Cortez Masto, Rosen
 Services                         Health Services Administration.  and peer support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Clark County, NV, for crisis response services,         535,000  Cortez Masto, Rosen
 Services                         Health Services Administration.  including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Clark County, NV, for substance use treatment           942,000  Cortez Masto, Rosen
 Services                         Health Services Administration.  services in detention facilities including
                                                                   medication assisted treatment, counseling, and
                                                                   referral services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Cohen Veterans Network Inc., AK, for mental and       1,315,000  Murkowski
 Services                         Health Services Administration.  behavioral health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Colorado Meth Project Inc./DBA Rise Above               500,000  Bennet, Hickenlooper
 Services                         Health Services Administration.  Colorado, CO, for a substance use and overdose
                                                                   prevention program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Communities United, IL, for mental health and           450,000  Durbin
 Services                         Health Services Administration.  wellness services for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Community Mental Health Authority of Clinton,         1,972,000  Peters
 Services                         Health Services Administration.  Eaton, and Ingham Counties, MI, for a mental
                                                                   health crisis stabilization center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       County of Orange, CA, to increase opioid                872,000  Feinstein, Padilla
 Services                         Health Services Administration.  prevention, education, and intervention
                                                                   services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Cowlitz Indian Tribe, WA, for a mobile health           700,000  Cantwell, Murray
 Services                         Health Services Administration.  unit for substance use disorder treatment,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Division of Indian Work, MN, for services to            200,000  Klobuchar, Smith
 Services                         Health Services Administration.  mothers and infants to improve outcomes for
                                                                   infants with prenatal exposure to drugs or
                                                                   alcohol.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Envision:You, CO, to expand access to mental            845,000  Bennet
 Services                         Health Services Administration.  health services for at-risk communities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Families Reaching Into Each New Day (FRIENDS             50,000  Reed
 Services                         Health Services Administration.  WAY), RI, for mental health services for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Gallup Community Health, NM, for mental health          516,000  Heinrich
 Services                         Health Services Administration.  and substance use treatment services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Garrett County Lighthouse, Inc., MD, for mental          85,000  Cardin, Van Hollen
 Services                         Health Services Administration.  health crisis services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Gateways Hospital and Mental Health Center, CA,         500,000  Padilla
 Services                         Health Services Administration.  for mental health services for youth, including
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Hawaii Health & Harm Reduction Center, HI, for          550,000  Schatz
 Services                         Health Services Administration.  behavioral health services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       HopeHealth Hospice & Palliative Care, RI, for            80,000  Reed
 Services                         Health Services Administration.  mental health services for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Jacob's Ladder Assistance Fund Inc., WV, for            127,000  Capito
 Services                         Health Services Administration.  behavioral health and support services to
                                                                   address adverse childhood experiences, including
                                                                   training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Kauai Planning and Action Alliance, HI, for youth       200,000  Hirono, Schatz
 Services                         Health Services Administration.  mental health and suicide prevention services,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Kennebec Behavioral Health (KBH), ME, for mental        750,000  King
 Services                         Health Services Administration.  and behavioral services, including crisis
                                                                   support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Kent County, MI, for a behavioral health crisis         750,000  Peters, Stabenow
 Services                         Health Services Administration.  stabilization unit.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Kettle Moraine YMCA, WI, for youth mental health        150,000  Baldwin
 Services                         Health Services Administration.  programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Lauren's Wish Addiction Triage Center Inc., WV,         838,000  Capito, Manchin
 Services                         Health Services Administration.  for substance use disorder treatment and support
                                                                   services, including supplies and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Libera, Inc, WV, for a mental health program,           200,000  Capito, Manchin
 Services                         Health Services Administration.  including the purchase of vehicles.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Lily's Place, WV, for substance use disorder            395,000  Capito
 Services                         Health Services Administration.  treatment and other support services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Lines for Life, OR, for suicide prevention            1,163,000  Merkley, Wyden
 Services                         Health Services Administration.  services, including expansion of a peer-to-peer
                                                                   program for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Lyon County Department of Human Services, NV, for       673,000  Cortez Masto, Rosen
 Services                         Health Services Administration.  a youth mobile crisis team, including a vehicle.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Marshall University Research Corporation, WV, for     1,000,000  Capito, Manchin
 Services                         Health Services Administration.  services for youth affected by parental
                                                                   substance use.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Marshall University Research Corporation, WV, to        500,000  Manchin
 Services                         Health Services Administration.  support psychology graduate students to increase
                                                                   access to mental health services in schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Mercy Family Center, LA, for mental health and        1,000,000  Cassidy
 Services                         Health Services Administration.  support services, including case management and
                                                                   information technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Mid Fairfield Child Guidance Center, Inc., CT,        1,398,000  Blumenthal, Murphy
 Services                         Health Services Administration.  for school-based mental health services and care
                                                                   coordinators.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Minnesota State University, Mankato, MN, for a        1,000,000  Klobuchar, Smith
 Services                         Health Services Administration.  mental health training clinic, including
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Mississippi State University, MS, for mental and      2,557,000  Hyde-Smith
 Services                         Health Services Administration.  behavioral health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Morgan County Partnership, Inc., WV, for                500,000  Capito, Manchin
 Services                         Health Services Administration.  behavioral health and support services to
                                                                   address adverse childhood experiences, including
                                                                   training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Mothers United Against Violence Inc., CT, for           500,000  Blumenthal, Murphy
 Services                         Health Services Administration.  trauma support and mental health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       NAMI New Hampshire (National Alliance on Mental         128,000  Shaheen
 Services                         Health Services Administration.  Illness), NH, for mental health and substance
                                                                   use disorder services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       National Alliance on Mental Illness of New York         750,000  Schumer
 Services                         Health Services Administration.  City, Inc. (NAMI-NYC), NY, for mental health
                                                                   services including peer-based support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Native American LifeLines, Inc, MA, for a               600,000  Markey, Warren
 Services                         Health Services Administration.  substance use and behavioral health education
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Nazareth College of Rochester, NY, for mental           250,000  Gillibrand, Schumer
 Services                         Health Services Administration.  health care including therapy and wellness
                                                                   services for underserved children and adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       New Mexico Department of Health, NM, to improve         700,000  Heinrich, Lujan
 Services                         Health Services Administration.  care coordination through a community hub,
                                                                   including through integrating mental and
                                                                   behavioral healthcare with primary care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Oregon Health Authority, OR, for a public             3,000,000  Merkley, Wyden
 Services                         Health Services Administration.  awareness campaign to prevent suicide.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Out Boulder County, CO, for mental health               223,000  Hickenlooper
 Services                         Health Services Administration.  services for youth, including buses.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Pediatric Resource Center of Alaska, AK, for             74,000  Murkowski
 Services                         Health Services Administration.  behavioral health services training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Portage Recovery Center, WI, for recovery               100,000  Baldwin
 Services                         Health Services Administration.  services including peer support.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Preventing Tobacco Addiction Foundation, OH, for        961,000  Brown
 Services                         Health Services Administration.  a tobacco education program, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Pueblo of Laguna, NM, for an overdose prevention         35,000  Heinrich
 Services                         Health Services Administration.  program, including supplies and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Red Oak Behavioral Health, OH, for school-based         750,000  Brown
 Services                         Health Services Administration.  mental health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Rise Above, WA, for a youth mental health and           755,000  Murray
 Services                         Health Services Administration.  wellness program for indigenous adolescents.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Sinai Health System, IL, for mental health            1,250,000  Durbin
 Services                         Health Services Administration.  services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Socorro County Options Prevention and Education          81,000  Lujan
 Services                         Health Services Administration.  (SCOPE), NM, for mental health and suicide
                                                                   prevention.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       St. Charles Health System, Inc., OR, to improve       1,142,000  Merkley, Wyden
 Services                         Health Services Administration.  access to mental and behavioral health services,
                                                                   including equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       StayWell Health Care, Inc., CT, for a mental            330,000  Blumenthal, Murphy
 Services                         Health Services Administration.  health program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Stratis Health, MN, for a substance use treatment       550,000  Klobuchar, Smith
 Services                         Health Services Administration.  and overdose prevention program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Taos Whole Community Health, NM, for a substance        700,000  Heinrich
 Services                         Health Services Administration.  use disorder treatment program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       The Alliance for Community Wellness, CA, for a          357,000  Padilla
 Services                         Health Services Administration.  mobile mental health clinic, including a vehicle.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       The Martinsburg Initiative, Inc., WV, for               500,000  Capito
 Services                         Health Services Administration.  behavioral health and support services to
                                                                   address adverse childhood experiences, including
                                                                   training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       The Martinsburg Initiative, Inc., WV, for               201,000  Capito
 Services                         Health Services Administration.  substance use prevention and treatment services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       The University of New Hampshire (UNH), NH, for a        112,000  Shaheen
 Services                         Health Services Administration.  youth mental health first aid program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Tides Family Services, RI, for mental and               150,000  Whitehouse
 Services                         Health Services Administration.  behavioral health care and supportive services,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       United Community and Family Servicers, Inc., CT,        335,000  Blumenthal, Murphy
 Services                         Health Services Administration.  for a medication assisted treatment program,
                                                                   including equipment and the purchase of a van.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       United Way of Matanuska-Susitna Borough, AK, for         38,000  Murkowski
 Services                         Health Services Administration.  youth substance use prevention services,
                                                                   including training and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       University of Chicago Medical Center, IL, for         1,100,000  Durbin
 Services                         Health Services Administration.  mental health and trauma recovery services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       University of Mississippi, MS, for substance use      3,230,000  Hyde-Smith, Wicker
 Services                         Health Services Administration.  prevention and treatment services, including
                                                                   training and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       University of New Mexico, NM, for training and          600,000  Lujan
 Services                         Health Services Administration.  technical assistance for school-based health
                                                                   centers to prevent and treat adolescent
                                                                   substance use.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       University of New Mexico, NM, to expand a             3,905,000  Heinrich
 Services                         Health Services Administration.  training program for providers to better treat
                                                                   babies exposed to opioids.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       University of Oregon Ballmer Institute for            1,304,000  Merkley, Wyden
 Services                         Health Services Administration.  Children's Behavioral Health, OR, for mental and
                                                                   behavioral health care for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       UW Madison, WI, to establish a regional center to     2,000,000  Baldwin
 Services                         Health Services Administration.  combat the opioid and fentanyl crisis and
                                                                   increase access to treatment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Virginia Hospital & Healthcare Association              969,000  Kaine, Warner
 Services                         Health Services Administration.  Foundation, VA, to improve access to treatment
                                                                   for individuals with substance use disorder.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       W.A.R.M. Inc., NY, for mental health and trauma-        588,000  Gillibrand, Schumer
 Services                         Health Services Administration.  related therapy.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Walker, Inc. (dba Walker Therapeutic and                400,000  Markey, Warren
 Services                         Health Services Administration.  Educational Programs), MA, for mental health and
                                                                   therapeutic programming for children, including
                                                                   training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Wellspring Inc., ME, for substance use disorder         467,000  King
 Services                         Health Services Administration.  treatment services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       West Liberty University, WV, for a therapy and           80,000  Manchin
 Services                         Health Services Administration.  counseling program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       Women In Leadership, NM, for a substance use and        530,000  Heinrich
 Services                         Health Services Administration.  overdose prevention program, including supplies.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       WV Game Changers Inc., WV, for youth substance           50,000  Capito, Manchin
 Services                         Health Services Administration.  use prevention education, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       YMCA of Honolulu, HI, for programming to support        864,000  Hirono, Schatz
 Services                         Health Services Administration.  youth mental health.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Substance Abuse and Mental       YWCA Alaska, AK, for youth mental and behavioral        500,000  Murkowski
 Services                         Health Services Administration.  health services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  4MYCITY INC, MD, for a program to improve food        1,000,000  Van Hollen
 Services                         Families.                        security among low income individuals.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  A Wider Circle, MD, for a donation program for          500,000  Cardin, Van Hollen
 Services                         Families.                        low income individuals.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Adoptive and Foster Families of Maine, Inc., ME,        100,000  Collins
 Services                         Families.                        for a kinship caregiver program, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Alaska Children's Trust, AK, for child abuse            250,000  Murkowski
 Services                         Families.                        prevention.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Annie C. Courtney Foundation, Inc., CT, for job         150,000  Blumenthal, Murphy
 Services                         Families.                        training and employment opportunities for foster
                                                                   youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Bean's Cafe Inc., AK, for dependency prevention       1,000,000  Murkowski
 Services                         Families.                        programming, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Bethel Winter Shelter Lions Club, AK, for case          300,000  Murkowski
 Services                         Families.                        management services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Big Brothers Big Sisters of New Hampshire, NH,          260,000  Shaheen
 Services                         Families.                        for a mentoring program for at-risk youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Brigid's Path, OH, for services to support Title        500,000  Brown
 Services                         Families.                        IV-E prevention services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Brown County United Way, WI, to expand access to        450,000  Baldwin
 Services                         Families.                        childcare services for immigrant and refugee
                                                                   families.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  CASA Youth Advocates Inc., PA, to connect               161,000  Fetterman
 Services                         Families.                        vulnerable children and families to community
                                                                   services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  CASA, MD, to increase access to services for          1,000,000  Cardin, Van Hollen
 Services                         Families.                        vulnerable communities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Centro Hispano Daniel Torres Inc., PA, for a            235,000  Casey
 Services                         Families.                        family support and skill-building program for
                                                                   parents.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Centro Romero, IL, for programming and support          150,000  Duckworth
 Services                         Families.                        for vulnerable communities and to support
                                                                   financial self-sufficiency.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Child and Family Charities, MI, for supportive        1,500,000  Stabenow
 Services                         Families.                        services for low income families.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Children Unlimited, Inc., NH, for quality               115,000  Shaheen
 Services                         Families.                        improvement for early learning programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  City of Dearborn, MI, for supportive services to      1,000,000  Peters
 Services                         Families.                        families to reduce poverty.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Clark County, NV, to support foster youth through       949,000  Cortez Masto, Rosen
 Services                         Families.                        outreach and recruitment of quality caregivers.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Colorado Food Cluster Inc., CO, to reduce food          903,000  Hickenlooper
 Services                         Families.                        insecurity, including food, supplies, and
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Community Action Organization of Western New            310,000  Gillibrand, Schumer
 Services                         Families.                        York, NY, for a support program for at-risk
                                                                   youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Consejo Counseling and Referral Service, WA, for        750,000  Murray
 Services                         Families.                        a trauma-informed domestic violence therapy and
                                                                   recovery services program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  County of Union, New Jersey, NJ, to improve           1,880,000  Booker, Menendez
 Services                         Families.                        access to human services, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Court Appointed Special Advocates of New                175,000  Shaheen
 Services                         Families.                        Hampshire, NH, for child abuse prevention.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Covenant House Alaska, AK, for youth homelessness     2,000,000  Murkowski
 Services                         Families.                        prevention and response.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Cradles to Crayons, Inc., MA, to support a              270,000  Markey, Warren
 Services                         Families.                        donation program for low income children,
                                                                   including equipment and the purchase of a truck.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Cradles to Crayons, Inc., PA, to expand a diaper        363,000  Casey
 Services                         Families.                        distribution program and to study its impact,
                                                                   including the purchase of diapers and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Digital NEST, CA, for supportive services for           840,000  Feinstein, Padilla
 Services                         Families.                        families to improve career opportunities and
                                                                   economic mobility.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  F.A.I.T.H., Inc., GA, for supportive services to        400,000  Warnock
 Services                         Families.                        survivors of child abuse and their non-offending
                                                                   caregiver(s).
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Feeding America Eastern Wisconsin, WI, to reduce        500,000  Baldwin
 Services                         Families.                        food insecurity including through the purchase
                                                                   of food.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Food Link, Inc., MA, to support low income              100,000  Markey, Warren
 Services                         Families.                        families through a food distribution program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Franklin County and North Quabbin Children's            194,000  Markey, Warren
 Services                         Families.                        Advocacy Center, Inc., MA, MA, to provide
                                                                   services to children and families affected by
                                                                   child sexual abuse.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Hale Kipa, HI, to improve economic mobility for         521,000  Schatz
 Services                         Families.                        at-risk youth, including supplies.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Hampton Roads Community Action Program, Inc., VA,       498,000  Kaine, Warner
 Services                         Families.                        for supportive services for families, including
                                                                   equipment and transportation.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Hawaii Children's Action Network, HI, for               150,000  Schatz
 Services                         Families.                        programming to support low income populations.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Hazleton Integration Project, PA, for a pilot to        419,000  Casey
 Services                         Families.                        increase access to healthy food for low income
                                                                   individuals, including equipment and a van.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Heart of Maine United Way, ME, for an early             370,000  Collins, King
 Services                         Families.                        childhood program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Hispanic Federation, NY, to provide assistance to     1,000,000  Gillibrand, Schumer
 Services                         Families.                        low income individuals, including food and
                                                                   hygiene products.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Illuminate Colorado, CO, for services including         670,000  Bennet, Hickenlooper
 Services                         Families.                        home visitation to reduce child maltreatment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  International Rescue Committee in Denver, CO, for        93,000  Bennet, Hickenlooper
 Services                         Families.                        services and a community navigation program for
                                                                   immigrants and refugees.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  L.E.A.D., Inc., GA, for programming for middle          400,000  Ossoff
 Services                         Families.                        and high school aged girls, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Latin American Association, GA, for supportive          200,000  Ossoff
 Services                         Families.                        programming for students and their families to
                                                                   enhance college and career opportunities,
                                                                   including technology and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Marshfield Area United Way, WI, to reduce                10,000  Baldwin
 Services                         Families.                        childhood hunger, including through the purchase
                                                                   of food.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  McAuley Ministries, RI, for programs and services       110,000  Reed
 Services                         Families.                        for the unhoused, including equipment and food.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Mitzvah Circle Foundation, PA, to support low           500,000  Casey
 Services                         Families.                        income families, including through the purchase
                                                                   of basic essential items including hygiene
                                                                   products.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Nine Star Enterprises Inc., AK, for dependency        1,650,000  Murkowski
 Services                         Families.                        prevention programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Pacific Resources for Education and Learning             84,000  Hirono
 Services                         Families.                        (PREL), HI, to examine the root causes of
                                                                   absenteeism to improve financial outcomes and
                                                                   reduce poverty.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Pacific Survivor Center, HI, for resiliency              75,000  Schatz
 Services                         Families.                        trainings to prevent adverse childhood
                                                                   experiences.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Pennsylvania CASA Association, PA, for a training       456,000  Casey
 Services                         Families.                        program to support vulnerable children.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  R Kids, Inc., CT, to improve outcomes for               355,000  Blumenthal, Murphy
 Services                         Families.                        children exposed to trauma.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Refugee Women's Alliance, WA, to provide child        2,000,000  Murray
 Services                         Families.                        care and early childhood education to under-
                                                                   resourced populations.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Residential Youth Services and Empowerment              850,000  Hirono
 Services                         Families.                        (RYSE), HI, for education, outreach, programming
                                                                   and services to support at-risk individuals.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Rhode Island Coalition to End Homelessness, RI,         750,000  Reed
 Services                         Families.                        for supportive services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Rural Alaska Community Action Program, Inc., AK,         99,000  Murkowski
 Services                         Families.                        for child care services, including scholarships.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Saint Francis Hospital and Medical Center, CT,        1,274,000  Blumenthal, Murphy
 Services                         Families.                        for a community health worker program and to
                                                                   provide wrap-around services to low income
                                                                   patients.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Ser Familia, GA, for a culturally proficient            500,000  Ossoff, Warnock
 Services                         Families.                        family resource center for Latino families.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  TEAM for West Virginia Children, Inc., WV, for          100,000  Capito, Manchin
 Services                         Families.                        child abuse prevention.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  TEAM, Inc., CT, for a healthy food access program       230,000  Blumenthal, Murphy
 Services                         Families.                        for low income individuals, including food.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Giving Kitchen Initiative, GA, to improve           250,000  Ossoff
 Services                         Families.                        economic outcomes and financial stability for
                                                                   low income workers.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The National Runaway Safeline, IL, to support           425,000  Duckworth
 Services                         Families.                        youth experiencing homelessness through an
                                                                   evaluation of crisis intervention and prevention
                                                                   programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Northern Lighthouse, Inc., ME, for services         510,000  King
 Services                         Families.                        and education for homeless youth, including the
                                                                   purchase of a van.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Open Door Network, CA, for services and           1,500,000  Padilla
 Services                         Families.                        support to individuals at risk of experiencing
                                                                   homelessness.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Peche Hen DBA Over the Moon, GA, for a diaper       381,000  Ossoff, Warnock
 Services                         Families.                        distribution program, including diapers and
                                                                   vehicles.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Spirit Horse Ranch, HI, for youth trauma            541,000  Schatz
 Services                         Families.                        support services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  The Zero Abuse Project, MN, for a child abuse         1,200,000  Klobuchar, Smith
 Services                         Families.                        prevention program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  United Jewish Organizations of Williamsburg Inc,        750,000  Schumer
 Services                         Families.                        NY, to provide assistance to low income
                                                                   individuals and families.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  University of New Mexico, NM, to measure the            500,000  Heinrich, Lujan
 Services                         Families.                        prevalence of child abuse and neglect.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Vicksburg Family Development Service, MS, for           247,000  Hyde-Smith
 Services                         Families.                        child abuse prevention, including the purchase
                                                                   of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Warroad Community Childcare Center, MN, for child       322,000  Klobuchar, Smith
 Services                         Families.                        care services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  West Virginia Food and Farm Coalition, Inc., WV,        200,000  Manchin
 Services                         Families.                        for a food assistance program for low income
                                                                   individuals.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  Young Fathers dba; Fathers New Mexico, NM, for          213,000  Heinrich
 Services                         Families.                        family support services for young fathers to
                                                                   improve outcomes for children.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  YWCA Clark County, WA, for a therapeutic                475,000  Cantwell, Murray
 Services                         Families.                        preschool program that increases resiliency
                                                                   among children and families, including
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Children and  YWCA Tri-County Area, PA, to provide services to        828,000  Fetterman
 Services                         Families.                        reduce poverty.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  African American Museum of Bucks County, PA, for        260,000  Casey
                                                                   support of educational programs of the African
                                                                   American Education Center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Alaska Humanities Forum, AK, for an Alaska              150,000  Murkowski
                                                                   studies program, including curriculum
                                                                   development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Alaska Library Network, AK, for a reading               250,000  Murkowski
                                                                   program, including the purchase of technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Amigos del Museo del Barrio, Inc., NY, to expand        500,000  Gillibrand, Schumer
                                                                   bilingual, arts-based educational programming
                                                                   and support education initiatives.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Anchorage School District, AK, for the purchase         301,000  Murkowski
                                                                   of technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Arctic Slope Community Foundation, AK, for a          1,000,000  Murkowski
                                                                   teacher recruitment and preparation program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Art with a Heart, MD, for arts education and out        506,000  Cardin, Van Hollen
                                                                   of school time programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  ArtsQuest, PA, for youth enrichment, education        1,000,000  Casey
                                                                   and arts-based learning.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Baltimore Symphony Orchestra, MD, for music             249,000  Cardin, Van Hollen
                                                                   education, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Bernice Pauahi Bishop Museum, HI, for curriculum        500,000  Hirono, Schatz
                                                                   and website development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Best Buddies International, Inc., IL, for the           250,000  Duckworth
                                                                   Best Buddies in Illinois Inclusion Project for
                                                                   Students with Intellectual and Developmental
                                                                   Disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Best Buddies International, Inc., PA, for the           125,000  Casey
                                                                   Pennsylvania Best Buddies inclusion project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Big Brothers Big Sisters of Greater Pittsburgh,         275,000  Fetterman
                                                                   PA, for mentoring programs at Woodland Hills and
                                                                   Clairton City School Districts.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Big Brothers Big Sisters of Metro Atlanta, Inc.,        250,000  Ossoff, Warnock
                                                                   GA, for youth mentoring.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Big Brothers Big Sisters of Southwest Washington,       750,000  Murray
                                                                   WA, for a career exploration program for high
                                                                   school students.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Blueprint for Change, HI, for family resource         1,150,000  Hirono, Schatz
                                                                   centers, including the purchase of a vehicle.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Books Are Wings, RI, for an early literacy               20,000  Reed
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Boys & Girls Club of Greater Milwaukee, WI, for         930,000  Baldwin
                                                                   high school completion and transition support
                                                                   for postsecondary education and the workforce.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Boys & Girls Club of Northeast Mississippi Inc.,      1,000,000  Hyde-Smith, Wicker
                                                                   MS, for an out of school time program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Boys & Girls Club of Pawtucket, RI, to expand           642,000  Reed, Whitehouse
                                                                   access to youth programs and transition supports.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Boys & Girls Club of Rochester, MN, for out-of-         250,000  Klobuchar, Smith
                                                                   school time program expansion.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Boys & Girls Clubs of Newport County, RI, for           300,000  Reed, Whitehouse
                                                                   afterschool programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  BPE Inc., MA, for STEM career pathways...........       400,000  Markey, Warren
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Bridgeport Public Schools, CT, for social-              706,000  Blumenthal, Murphy
                                                                   emotional and mental health support for students.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Bright Lights Book Project, AK, for a reading            25,000  Murkowski
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Bristol Virginia Public Schools, VA, to acquire         567,000  Kaine, Warner
                                                                   and install an inclusive and accessible
                                                                   playground.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Building One Community, Inc., CT, for afterschool       200,000  Blumenthal, Murphy
                                                                   and summer programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  California State University East Bay, CA, for the     1,200,000  Feinstein, Padilla
                                                                   California Promise Neighborhood program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Carden Academy of Maui, HI, for STEM education,         184,000  Hirono, Schatz
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Center for the Innovative Training of Youth,          3,000,000  Cassidy
                                                                   Inc., LA, for a STEM program, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Cherokee By Choice, Inc., GA, for mobile workshop        83,000  Ossoff
                                                                   for skilled trades career, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  City of Lynn, MA, for early childhood education..     1,658,000  Markey, Warren
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  City of New Haven, CT, for a bioscience academic      1,500,000  Blumenthal, Murphy
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Clifford W. Beers Guidance Clinic, Inc., CT, to       1,162,000  Blumenthal, Murphy
                                                                   improve mental health services at Hamden Public
                                                                   Schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Colorado River BOCES, CO, for a regional career       1,021,000  Bennet
                                                                   pathway education and training initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Community Education Commission, MI, for                 800,000  Stabenow
                                                                   afterschool programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Community Libraries of Providence, RI, for              100,000  Reed
                                                                   library materials for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Creative Nomads, MD, for arts education and youth        80,000  Cardin, Van Hollen
                                                                   development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Danbury Public Schools, CT, for curriculum            1,875,000  Blumenthal, Murphy
                                                                   redesign.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  DAY ONE Early Learning Community, NY, for early       1,200,000  Gillibrand, Schumer
                                                                   childhood education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Delaware Division of Libraries, DE, to acquire        1,938,000  Carper, Coons
                                                                   school library books.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Desert Research Institute, NV, for STEM education     2,800,000  Cortez Masto, Rosen
                                                                   and career development, including scholarships
                                                                   for postsecondary education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Dual Language Education of New Mexico, NM, for          250,000  Heinrich
                                                                   culturally and linguistically responsive
                                                                   education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  East Bay Educational Collaborative, RI, for             565,000  Reed
                                                                   science education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Eastern Rhode Island Conservation District               50,000  Reed
                                                                   (ERICD), RI, for science-based learning.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Eaton Regional Education Service Agency, MI, for        340,000  Peters
                                                                   equipment for an aviation-focused career and
                                                                   technical education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Educate Maine, ME, for the Maine Center for             525,000  King
                                                                   Teaching and learning to strengthen, grow, and
                                                                   diversify Maine's educator workforce.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  EXCEL Alaska, Inc., AK, for a rural outreach            750,000  Murkowski
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Fairbanks North Star Borough School District, AK,       100,000  Murkowski
                                                                   for farming education, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Fine Arts Work Center in Provincetown, MA, for          750,000  Markey, Warren
                                                                   arts education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  FIRST Washington Robotics, WA, to expand access         511,000  Murray
                                                                   to STEM education programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Flint River Fresh, Inc., GA, to expand farm to          269,000  Ossoff
                                                                   school programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  ForKids, inc., VA, for afterschool programming...       170,000  Kaine, Warner
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Friends of the Future, HI, to expand the health         235,000  Hirono, Schatz
                                                                   and wellness program, including the purchase of
                                                                   a vehicle.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Garden State Equality Education Fund, Inc., NJ,         400,000  Booker, Menendez
                                                                   for trauma-informed strategies to support LGBTQ+
                                                                   youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Grand Rapids African American Health Institute,         800,000  Stabenow
                                                                   MI, for healthcare career education and training
                                                                   pathways.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Greater Providence YMCA, RI, for physical               600,000  Reed, Whitehouse
                                                                   education and water safety programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Greenbrier Valley Theatre, WV, for education            350,000  Capito, Manchin
                                                                   programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Harriet Tubman Museum of Cape May, NJ, for              421,000  Booker
                                                                   educational programming, curriculum development,
                                                                   and arts education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Hawaii Agriculture Foundation, HI, for                  949,000  Hirono, Schatz
                                                                   agricultural-focused education programs,
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Hawaii Literacy, HI, for literacy programs.......       252,000  Schatz
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Hawaii Teach for America, HI, for tutoring,             174,000  Hirono, Schatz
                                                                   including stipends for tutors.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Heartlinks Grief Center at Family Hospice of            120,000  Duckworth
                                                                   Belleville Area, IL, for grief support
                                                                   curriculum for elementary and secondary
                                                                   education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Honolulu First Church of the Nazarene, HI, for           40,000  Hirono
                                                                   the Waolani Judd Nazarene School Hawaiian
                                                                   cultural enrichment program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Hydaburg City School District, AK, for the              100,000  Murkowski
                                                                   purchase of technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Illinois State Alliance of YMCAs, IL, for youth         400,000  Duckworth
                                                                   development, physical education and water safety.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Imua Family Services, HI, for an outdoor                 91,000  Schatz
                                                                   inclusion preschool, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Itawamba Agricultural High School, MS, for               94,000  Hyde-Smith
                                                                   agricultural education, including the purchase
                                                                   of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  KID Museum, MD, for STEM education and youth            704,000  Cardin, Van Hollen
                                                                   development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Las Cruces Public Schools, NM, to support the           427,000  Heinrich
                                                                   career ready toolbox program including stipends,
                                                                   supplies and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Lincoln Center for the Performing Arts, Inc., NY,     1,000,000  Gillibrand, Schumer
                                                                   for arts programming for youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Make the Road States, Inc., DBA Make the Road CT,       155,000  Blumenthal, Murphy
                                                                   CT, for student success centers to improve
                                                                   college access for youth from historically
                                                                   underserved communities, including stipends for
                                                                   college ambassadors.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Maui Academy of Performing Arts, HI, for arts           375,000  Schatz
                                                                   education programming, including scholarships.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Maui Economic Opportunity (MEO), HI, for early          105,000  Hirono, Schatz
                                                                   childhood education workforce training,
                                                                   including student stipends.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  McDuffie County School System, GA, for STEM             105,000  Ossoff
                                                                   education and outdoor learning, including
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Michigan Science Center, MI, for science                987,000  Stabenow
                                                                   education programs, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Milwaukee Public Schools, WI, for the Success         1,600,000  Baldwin
                                                                   Center and support of social and emotional
                                                                   learning and mental health services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Mission Economic Development Agency, CA, for the        750,000  Feinstein, Padilla
                                                                   California Promise Neighborhood program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Mission West Virginia, WV, for a mentoring              225,000  Capito, Manchin
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Mississippi Charter School Authorizer Board, MS,        510,000  Hyde-Smith
                                                                   for immersive education technology and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Mount Vernon School District, WA, to improve            436,000  Murray
                                                                   student safety and provide outreach for drug
                                                                   impacted and gang involved youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Mystic Seaport Museum, CT, for mentoring, STEM          570,000  Blumenthal, Murphy
                                                                   education, and enrichment, including student
                                                                   stipends.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Nashua PAL, NH, for youth development programs,         108,000  Shaheen
                                                                   including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Native Village of Kotzebue, AK, for native               50,000  Murkowski
                                                                   language and culture education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Navajo Preparatory School, NM, for a student            500,000  Heinrich
                                                                   leadership development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Neighborhood Housing Services of Greater                264,000  Blumenthal, Murphy
                                                                   Waterbury, CT, for the pathways to success
                                                                   initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  New England Institute of Technology, RI, for            100,000  Reed
                                                                   career exposure for high school students.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  New Hampshire Learning Initiative, NH, to improve       424,000  Shaheen
                                                                   math teaching and learning, including through
                                                                   subgrants.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Newark Mentoring Movement, NJ, for a school-based       135,000  Booker
                                                                   mentoring initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Newport Public Schools, RI, for equipment for           500,000  Reed
                                                                   career and technical education programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  North Light Community Center, PA, for the Teen           90,000  Casey
                                                                   Services Program, including student stipends.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  North Slope Borough School District, AK, for            580,000  Murkowski
                                                                   native language and culture education, including
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  OH WOW! Center for Science & Technology, OH, for      1,450,000  Brown
                                                                   STEM education and workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Oregon Department of Education, OR, to revitalize       450,000  Merkley, Wyden
                                                                   rural public school libraries.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Our Piece of the Pie, CT, for youth development,        750,000  Blumenthal, Murphy
                                                                   postsecondary education preparation and
                                                                   workforce readiness training for youth and young
                                                                   adults in foster care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Pacific Historic Parks, HI, for an interactive          341,000  Schatz
                                                                   education project, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Phoenixville Area School District, PA, for               75,000  Casey
                                                                   education and curriculum for a greenhouse
                                                                   learning initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Pocono Mountains United Way, PA, to develop and         397,000  Casey
                                                                   expand community schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Prevention of Blindness Society of Metropolitan         200,000  Cardin, Van Hollen
                                                                   Washington, MD, for school-based vision health
                                                                   services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Project GOAL Inc., RI, for academic programming..       146,000  Reed
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Project Vision Hawaii, HI, for equipment and a          300,000  Schatz
                                                                   vehicle for hearing health care in schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Quaker Valley School District, PA, for life             100,000  Casey
                                                                   skills curriculum and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Reach Out and Read Rhode Island, RI, for a               50,000  Reed
                                                                   literacy program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Read Alliance, Inc., NY, to expand tutoring             300,000  Gillibrand, Schumer
                                                                   programs, include stipends.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Reading Is Fundamental, Inc., DC, for a literacy      1,500,000  Wicker
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Reading is Fundamental, MD, for childhood               500,000  Cardin, Van Hollen
                                                                   literacy in pre-K through middle school in
                                                                   Baltimore City Public Schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Rhode Island Black Heritage Society, RI, for            400,000  Reed, Whitehouse
                                                                   educational programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Rhode Island Center for the Book, RI, for writing        20,000  Reed
                                                                   programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Rhode Island School of Design, RI, for                   60,000  Reed
                                                                   professional development curriculum for
                                                                   elementary and secondary educators.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  RSU 13, ME, for mentoring, education and support        450,000  King
                                                                   services for at-risk and system-involved youth.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Rural Alaska Community Action Program, Inc., AK,        261,000  Murkowski
                                                                   for early childhood education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  San Diego Zoo Wildlife Alliance, CA, for the            500,000  Feinstein
                                                                   Native Biodiversity Corps program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  San Miguel Education Center, RI, for a Student           50,000  Whitehouse
                                                                   Sponsorship Program to provide year-round
                                                                   educational opportunities to middle school
                                                                   students in the Providence community.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Save the Children Federation, Inc., CA, to            1,000,000  Feinstein, Padilla
                                                                   improve food security and access to educational
                                                                   resources for underserved children and families,
                                                                   including purchase of three vehicles.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Save the Children Federation, Inc., MS, for a           997,000  Wicker
                                                                   literacy program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Save the Children Federation, Inc., WV, to              750,000  Capito, Manchin
                                                                   improve early childhood education and education
                                                                   programs including through food security and
                                                                   nutrition education programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Sealaska Heritage Institute, AK, for a literacy         250,000  Murkowski
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  SEE Science Center, NH, for STEM education,             200,000  Shaheen
                                                                   including exhibits and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Siembra Leadership High School, NM, for dual            113,000  Heinrich
                                                                   enrollment and college transition programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  South Bay Community Services, CA, for the               876,000  Feinstein, Padilla
                                                                   California Promise Neighborhood program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Southern West Virginia Community College                800,000  Capito, Manchin
                                                                   Foundation, WV, for an early college program,
                                                                   including the purchase of technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Stamford Public Education Foundation, CT, for an        200,000  Blumenthal, Murphy
                                                                   early childhood education summer program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Summer Search Philadelphia, PA, for mentoring           200,000  Casey
                                                                   programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The African Alliance of Rhode Island, RI, for           180,000  Reed, Whitehouse
                                                                   agricultural education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Agoge Project, MD, for out-of-school time            75,000  Cardin, Van Hollen
                                                                   programs, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Carnegie Hall Corporation, NY, for an             1,000,000  Gillibrand, Schumer
                                                                   orchestral education program, with a special
                                                                   emphasis on recruiting students from communities
                                                                   historically underrepresented in the field of
                                                                   classical music, and for culminating concerts
                                                                   and associated travel.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Center for Holocaust & Humanity Education,          237,000  Brown
                                                                   DBA: Nancy & David Wolf Holocaust & Humanity
                                                                   Center, OH, to address antisemitism through
                                                                   school district partnerships.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Education Alliance--Business and Community          400,000  Capito, Manchin
                                                                   for Public Schools, Inc., WV, for a work-based
                                                                   learning program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Ethan Miller Song Foundation, CT, for firearm        59,000  Blumenthal, Murphy
                                                                   safety curriculum for middle and high schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Viscardi Center, Inc., NY, for disabilities         150,000  Gillibrand, Schumer
                                                                   history education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  The Water Council, WI, for academic and career          300,000  Baldwin
                                                                   development in the water sector.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Tree of Life, Inc., PA, for elementary and            1,000,000  Casey
                                                                   secondary education curriculum and programming
                                                                   on preventing antisemitism and identity-based
                                                                   hate.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  U.S. Olympic & Paralympic Museum (USOPM), CO, for       889,000  Bennet
                                                                   social-emotional learning through Team STRONG
                                                                   program expansion in Colorado.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  United Way of Erie County, PA, for a community          350,000  Casey
                                                                   schools initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  United Way of Kenosha County, WI, for literacy          200,000  Baldwin
                                                                   programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  University of Alaska Anchorage, AK, for a STEM        1,000,000  Murkowski
                                                                   education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  University of Maine System, ME, for a teacher         3,300,000  Collins, King
                                                                   retention program, including for teacher
                                                                   stipends and the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  University of Mississippi, MS, for a family             600,000  Hyde-Smith, Wicker
                                                                   engagement program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  University of Mississippi, MS, for                      700,000  Hyde-Smith, Wicker
                                                                   interdisciplinary Autism Spectrum Disorder
                                                                   evaluation services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  University of Nebraska Board of Regents, NE, for      2,000,000  Fischer
                                                                   an early childhood education workforce network
                                                                   and training initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  USS Constitution Museum, MA, for education              125,000  Markey, Warren
                                                                   programs, including exhibits.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Vermont Agency of Education, VT, to expand the        1,895,000  Sanders
                                                                   global leadership program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Vermont Student Assistance Corporation, VT, for a       296,000  Welch
                                                                   career and education pathway initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Very Merry Theatre, VT, for arts-based summer           118,000  Sanders
                                                                   education programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Virginia Department of Education, VA, for the         1,028,000  Kaine, Warner
                                                                   Virginia STEM ecosystem.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Vision to Learn, GA, for a mobile vision clinic         400,000  Ossoff
                                                                   for student vision care, including equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Vision to Learn, MI, for a vision care program        1,100,000  Stabenow
                                                                   for students.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Washington Middle School, HI, for STEM education,       380,000  Schatz
                                                                   including student fellowships.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Washoe County School District, NV, for a school       2,000,000  Cortez Masto, Rosen
                                                                   leadership pathway project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Waterbury School District, CT, to increase               85,000  Blumenthal, Murphy
                                                                   student attendance.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Waterville School System, ME, for the purchase of       718,000  Collins
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Weitzman National Museum of American Jewish             250,000  Casey
                                                                   History, PA, for educational programming on the
                                                                   history and present-day impact of antisemitism.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  West End Neighborhood House, DE, for youth              600,000  Carper, Coons
                                                                   programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  West Virginia Coding Club, WV, for training in           30,000  Manchin
                                                                   computer coding.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  Western Museum Of Mining & Industry, CO, for a           87,000  Bennet, Hickenlooper
                                                                   mobile STEM education program, including
                                                                   purchase of a vehicle.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Innovation and Improvement.....  YMCA of Snohomish County, WA, to expand access to       943,000  Murray
                                                                   early childhood education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Alaska Pacific University, AK, for a teacher            985,000  Murkowski
                                                                   apprenticeship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Alcorn State University and Alcorn Extension          1,366,000  Hyde-Smith
                                                                   Program, MS, for agricultural education,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Allan Hancock Joint Community College District,       1,500,000  Padilla
                                                                   CA, for a nursing program, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Alma College, MI, for equipment for the Great           850,000  Stabenow
                                                                   Lakes Watershed Institute.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Averett University, VA, for a center for                670,000  Kaine, Warner
                                                                   continuing education.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Bard College, NY, for prison education and            4,500,000  Schumer
                                                                   reentry programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Bellin College, WI, for a mental health nurse           400,000  Baldwin
                                                                   practitioner program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Benedictine College, KS, for the purchase of          1,000,000  Moran
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Bethany College, WV, for online education,            1,000,000  Capito, Manchin
                                                                   including the purchase of equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Blue Mountain College, MS, for nursing education,     1,530,000  Hyde-Smith, Wicker
                                                                   including scholarships and the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Blue Ridge Community and Technical College, WV,         254,000  Capito, Manchin
                                                                   for veterinary technician training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  BridgeValley Community & Technical College            1,586,000  Capito, Manchin
                                                                   Foundation Inc., WV, for a nursing program,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  BridgeValley Community & Technical College              212,000  Capito, Manchin
                                                                   Foundation Inc., WV, for a medical laboratory
                                                                   technology program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Building Futures, RI, for educator workforce            360,000  Reed
                                                                   development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Central Arizona College, AZ, for a                    1,024,000  Kelly, Sinema
                                                                   telecommunications training initiative,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Central New Mexico Community College, NM, for a         500,000  Heinrich
                                                                   teacher training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Central New Mexico Community College, NM, for           862,000  Lujan
                                                                   quantum and STEM-related programs, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Chaminade University of Honolulu, HI, for a           1,500,000  Schatz
                                                                   prison education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Clark Atlanta University, GA, for cybersecurity         500,000  Ossoff, Warnock
                                                                   and critical infrastructure programs, including
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Coker University, SC, for a healthcare education      2,000,000  Graham
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  College of Southern Nevada, NV, for the nursing       2,300,000  Cortez Masto, Rosen
                                                                   simulation lab project, including the purchase
                                                                   of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  College Unbound, RI, for college completion and         900,000  Reed
                                                                   workforce development services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  College Visions, RI, for a college access program       300,000  Reed, Whitehouse
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Colorado Mountain College, CO, for bilingual            300,000  Bennet, Hickenlooper
                                                                   workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Columbia University in the City of New York, NY,        388,000  Gillibrand, Schumer
                                                                   for Project Start Right.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Columbus State University, GA, for the Curricula        550,000  Ossoff, Warnock
                                                                   for CHIPS Education project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Commonwealth of Virginia, VA, for a scholarship         500,000  Kaine, Warner
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Community College of Rhode Island, RI, for              814,000  Reed, Whitehouse
                                                                   education and workforce programs, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Community College System of New Hampshire, NH,          280,000  Shaheen
                                                                   for a dual and concurrent enrollment program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Complete College America (CCA), NM, for a college       900,000  Lujan
                                                                   retention and completion program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Creighton University Health Sciences-- Phoenix        1,450,000  Sinema
                                                                   Campus, Phoenix AZ, Maricopa County, AZ, for the
                                                                   purchase of equipment for a medical virtual
                                                                   reality training room.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Delaware State University, DE, for the purchase       2,346,000  Carper, Coons
                                                                   of equipment for the aviation program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Delta College, MI, for development of                   284,000  Peters, Stabenow
                                                                   semiconductor curriculum and apprenticeship
                                                                   programming.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Delta State University, MS, for the purchase of         500,000  Hyde-Smith, Wicker
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Delta State University, MS, for the purchase of       1,000,000  Hyde-Smith
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Desert Research Institute, NV, for the purchase       1,800,000  Cortez Masto, Rosen
                                                                   of equipment for the environmental studies
                                                                   project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Dominican University, IL, for a masters in            1,000,000  Durbin
                                                                   nursing program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Eastern Maine Community College, ME, for              1,648,000  Collins
                                                                   workforce training, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Eastern West Virginia Community and Technical           150,000  Capito, Manchin
                                                                   College Foundation Inc., WV, for an aviation
                                                                   program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Edison State Community College, OH, for the             900,000  Brown
                                                                   purchase of equipment for a new respiratory care
                                                                   degree program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  El Puente de Encuentros, NM, for a behavioral           247,000  Heinrich, Lujan
                                                                   health professionals programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Fort Hays State University, KS, for the purchase      3,000,000  Moran
                                                                   of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Francis Marion University, SC, for the purchase       1,200,000  Graham
                                                                   of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Glenville State College Research Corporation, WV,     2,120,000  Capito, Manchin
                                                                   for the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Goucher College, MD, for the Prison Education           355,000  Cardin, Van Hollen
                                                                   Partnership.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Grand Valley State University, MI, for the Blue       2,500,000  Peters, Stabenow
                                                                   Dot Center for Talent, Technology and
                                                                   Transformation, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Great Basin College, NV, for a health science           760,000  Cortez Masto, Rosen
                                                                   program, including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Great Basin College, NV, for workforce                1,422,000  Cortez Masto, Rosen
                                                                   preparedness training systems.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Greenville Technical College, SC, for the             2,980,000  Graham
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Greenville University, IL, for the purchase of          665,000  Durbin
                                                                   equipment for science facilities and building a
                                                                   nursing pipeline.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Higher Education Regional Alliance--Greater           1,500,000  Baldwin
                                                                   Milwaukee Committee, WI, for microcredentials
                                                                   project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Hispanic Federation, IL, for a college readiness,       700,000  Duckworth
                                                                   achievement, and retention program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Hostos Community College, City University of New      1,000,000  Gillibrand, Schumer
                                                                   York, NY, for student mentorship and research
                                                                   assistant programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Hudson County Community College (HCCC), NJ, for       1,000,000  Booker, Menendez
                                                                   the Hudson Scholars Program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Hudson Valley Community College, NY, for an             500,000  Gillibrand, Schumer
                                                                   aircraft mechanic training program, including
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Husson University, ME, for the purchase of              999,000  Collins, King
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  I Know I Can, OH, for programs to increase              994,000  Brown
                                                                   college and career enrollment and graduation.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Inver Hills Community College, MN, for the              250,000  Klobuchar, Smith
                                                                   purchase of equipment for a health sciences
                                                                   center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Jackson State University, MS, for a journalism        1,172,000  Wicker
                                                                   program, including the purchase of equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Jackson State University, MS, for cyber security      1,500,000  Wicker
                                                                   education, including for scholarships and the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  James Madison University, VA, for early               1,000,000  Kaine, Warner
                                                                   healthcare workforce development programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Journey into Education & Teaching (JET), MA, for        300,000  Markey, Warren
                                                                   educator workforce programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Juniata College, PA, for a nursing program.......       500,000  Casey
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Kansas State University--Salina Aerospace and         4,000,000  Moran
                                                                   Technology Campus, KS, for the purchase of
                                                                   aviation equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Kawerak, Inc., AK, for a teacher training program       484,000  Murkowski
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Keene State College, NH, for education and            3,000,000  Shaheen
                                                                   training programs in ultra-precision
                                                                   manufacturing, optics, and thin film coatings.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  King's College, PA, for an occupational therapy         450,000  Casey
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Laurel Ridge Community College Educational              305,000  Kaine, Warner
                                                                   Foundation on behalf of Laurel Ridge Community
                                                                   College, VA, for the purchase of a virtual
                                                                   reality training system for prospective surgical
                                                                   technologists and assistants.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Long Island University--Roc Nation School of          1,000,000  Gillibrand, Schumer
                                                                   Music, Sports & Entertainment, NY, for the early
                                                                   scholars program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Lourdes University, OH, for an educator workforce       374,000  Brown
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Maine Maritime Academy, ME, for the development       3,000,000  Collins
                                                                   of training programs, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Malcolm X College, IL, for the purchase of              355,000  Duckworth
                                                                   equipment for the child development program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Marian University, WI, for the purchase of            1,049,000  Baldwin
                                                                   equipment of health and STEM education programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Maricopa Community Colleges, AZ, for a                2,500,000  Kelly
                                                                   semiconductor workforce training program,
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Marquette University, WI, for the purchase of         1,611,000  Baldwin
                                                                   equipment for a simulation center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Marshall University Research Corporation, WV, for     1,500,000  Capito, Manchin
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Maryland Association of Community Colleges, MD,       2,000,000  Cardin, Van Hollen
                                                                   for the purchase of equipment for a
                                                                   cybersecurity workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Massachusetts Women of Color Coalition, Inc, MA,        655,000  Markey, Warren
                                                                   for a leadership academy, including a data
                                                                   collection system.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  MATC Fast Fund, WI, for supporting students'            500,000  Baldwin
                                                                   basic needs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  McHenry County College, IL, for the purchase of       1,060,000  Durbin
                                                                   equipment for Foglia Center for Advanced
                                                                   Technology and Innovation.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  McKendree University, IL, for a rural nurse             980,000  Durbin
                                                                   educator workforce program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  McPherson College, KS, for health care education,     2,100,000  Moran
                                                                   including the purchase of equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Medgar Evers College, NY, for an environmental          500,000  Schumer
                                                                   health program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Medical College of Wisconsin, WI, for workforce         500,000  Baldwin
                                                                   development in biomedical sciences, healthcare,
                                                                   and STEM fields, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Mercyhurst University, PA, for a program for            250,000  Casey
                                                                   students with autism.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Miami University, OH, to support educator               415,000  Brown
                                                                   workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Michigan State University, MI, for cybercrimes        1,000,000  Peters
                                                                   investigations and training programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Minnesota State Community and Technical College,      1,650,000  Klobuchar, Smith
                                                                   MN, for the purchase of equipment for healthcare
                                                                   simulation labs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Monroe Community College, NY, for a semiconductor       259,000  Schumer
                                                                   training initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Mount Marty College, SD, for the purchase of            370,000  Rounds
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Mountwest Foundation Inc., WV, for workforce            195,000  Capito, Manchin
                                                                   development programs, including faculty stipends.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Mt. San Antonio Community College District, CA,         534,000  Feinstein, Padilla
                                                                   for the purchase of equipment for the Wildland
                                                                   Fire Training Program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Nevada State College, NV, for a speech-language         938,000  Cortez Masto, Rosen
                                                                   pathologist educational and training project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Nevada State College, NV, for the mental health       1,650,000  Cortez Masto, Rosen
                                                                   workforce development project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  New York University, NY, for the Institute of         1,150,000  Gillibrand, Schumer
                                                                   Public Knowledge.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Newberry College, SC, for the purchase of               506,000  Graham
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Newman University Inc., KS, for agribusiness          1,200,000  Moran
                                                                   education, including the purchase of equipment
                                                                   and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northeastern Illinois University, IL, for a             145,000  Duckworth
                                                                   veterans resource center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northern Illinois University, IL, for the LEAP        1,660,000  Durbin
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northern Maine Community College Foundation, ME,        550,000  Collins, King
                                                                   for the purchase of communications equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northern Maine Community College Foundation, ME,        410,000  Collins, King
                                                                   for the purchase of equipment and technology for
                                                                   a diesel hydraulic program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northwest Indian College, WA, for the purchase of     1,200,000  Cantwell
                                                                   science education equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Northwestern Michigan College, MI, for the              550,000  Stabenow
                                                                   purchase of student aviation equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  O.S. Johnson Technical Institute, PA, for               806,000  Fetterman
                                                                   technology and equipment for a Johnson College
                                                                   satellite campus.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Oakton College, IL, for education and                   800,000  Duckworth
                                                                   experiential learning for students entering the
                                                                   medical field, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Oregon Coast Community College, OR, for a               896,000  Merkley, Wyden
                                                                   maritime construction and technician training
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Oregon Health & Science University, OR, for a         2,000,000  Merkley, Wyden
                                                                   nursing education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Ottawa University, KS, for the purchase of              900,000  Moran
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Paul D. Camp Community College, VA, to establish        293,000  Kaine, Warner
                                                                   and expand nursing and allied health programs
                                                                   and purchase equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Peninsula College, WA, for a dental school            1,936,000  Murray
                                                                   training clinic, including the purchase of
                                                                   equipment and retrofitting.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Pennsylvania College of Art & Design, PA, for a         725,000  Casey
                                                                   live-experience design and production degree
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Pierpont Foundation Inc., WV, for the purchase of     1,496,000  Capito, Manchin
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Portland Community College, OR, for a program to      1,675,000  Merkley, Wyden
                                                                   expand the healthcare workforce.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Prisma Health, SC, for a nursing program,               500,000  Graham
                                                                   including scholarships and the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Providence College, RI, for mental health nursing       600,000  Reed, Whitehouse
                                                                   education and workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Providence Promise, RI, for a postsecondary              50,000  Reed
                                                                   access program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rensselaer Polytechnic Institute, NY, for the         1,000,000  Gillibrand, Schumer
                                                                   purchase of equipment for the Center for Robotic
                                                                   Manufacturing Systems.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rhode Island College, RI, for a financial aid         1,020,000  Reed
                                                                   management system.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rhode Island College, RI, for technology for a        1,270,000  Reed
                                                                   continuing education program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rhode Island College, RI, for the purchase of           340,000  Whitehouse
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Richland Community College, IL, for an EV             1,100,000  Duckworth
                                                                   innovation hub.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rockford Public Schools, IL, for an education           300,000  Duckworth
                                                                   pathway partnership.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rowan University, NJ, for a regenerative food         1,000,000  Booker, Menendez
                                                                   systems program, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Rust College, MS, for a communications degree           695,000  Wicker
                                                                   program, including the purchase of equipment and
                                                                   technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Shawnee Community College, IL, for the welding          336,000  Duckworth
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Shepherd University Foundation Inc., WV, for the      2,235,000  Capito, Manchin
                                                                   purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Shepherd University, WV, for the Stubblefied            250,000  Manchin
                                                                   Institute's WV Emerging Project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Shorter College, AR, for a STEAM center,              2,000,000  Boozman
                                                                   including the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Siena College, NY, for the purchase of equipment      1,000,000  Gillibrand, Schumer
                                                                   for a new science complex.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Skills for Rhode Island's Future, RI, for an            730,000  Reed, Whitehouse
                                                                   experiential learning program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Southern Oregon University, OR, to support              500,000  Merkley, Wyden
                                                                   educational opportunities for college students.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Southern University and A&M College, LA, for          2,100,000  Cassidy
                                                                   legal education, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Southern University and A&M College, LA, for            365,000  Cassidy
                                                                   technology education, including the purchase of
                                                                   equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  St. Bonaventure University, NY, for the purchase        750,000  Gillibrand, Schumer
                                                                   of equipment for the School of Communications.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Sterling College, VT, for workforce readiness and       695,000  Welch
                                                                   experiential learning programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  SUNY Geneseo, NY, for the purchase of equipment..       500,000  Schumer
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Sussex County Community College, NJ, for the            546,000  Booker
                                                                   Public Safety Training Academy, including the
                                                                   purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  The City College of New York, NY, for skills-         1,500,000  Gillibrand, Schumer
                                                                   based workforce development.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  The Research Foundation for SUNY at Binghamton        1,000,000  Gillibrand, Schumer
                                                                   University, NY, for the purchase of equipment
                                                                   for a cleanroom.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  The University of Vermont and State Agricultural      1,999,000  Sanders
                                                                   College, VT, for a university assisted community
                                                                   schools collaborative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Tuskegee University, AL, for an aviation and aero     6,724,000  Britt
                                                                   technology program, including scholarships and
                                                                   the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Alaska Anchorage, AK, for                 750,000  Murkowski
                                                                   development of a graduate degree program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Alaska Anchorage, AK, for expanding       295,000  Murkowski
                                                                   social workers in schools.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of California, San Diego, CA, for the      1,656,000  Padilla
                                                                   PATHS Scholars Program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Delaware, DE, for workforce             1,000,000  Carper
                                                                   education and development in battery
                                                                   manufacturing, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Hartford, CT, for teacher                 300,000  Blumenthal, Murphy
                                                                   certification programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Hawaii System, HI, for the purchase       900,000  Hirono, Schatz
                                                                   of equipment for a medical education, residency,
                                                                   and fellowship expansion initiative.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Maine System, ME, for the               3,057,000  Collins, King
                                                                   development of a doctoral nursing program,
                                                                   including scholarships.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Maine System, ME, for the purchase        463,000  Collins, King
                                                                   of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Maryland Eastern Shore, MD, for the     1,071,000  Cardin, Van Hollen
                                                                   veterinary medicine program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Nevada Las Vegas, NV, for the           4,000,000  Cortez Masto, Rosen
                                                                   purchase of high-performance computing equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Nevada Reno, NV, for the purchase       2,406,000  Cortez Masto, Rosen
                                                                   of a Nuclear Magnetic Resonance Spectrometer.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Nevada Reno, NV, for the purchase       1,800,000  Cortez Masto, Rosen
                                                                   of research and educational platform equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of North Alabama, AL, for the purchase       500,000  Britt
                                                                   of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of North Carolina System, NC, for the      7,800,000  Tillis
                                                                   purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of South Dakota, SD, for biomedical        6,500,000  Rounds
                                                                   computation education, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Southern Mississippi, MS, for a         3,000,000  Hyde-Smith, Wicker
                                                                   teacher resident program, including scholarships
                                                                   and the purchase of equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  University of Virginia, VA, for the Youth               900,000  Kaine, Warner
                                                                   Leadership Initiative, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Virginia Foundation for Community College             1,500,000  Kaine, Warner
                                                                   Education, VA, for the purchase of equipment for
                                                                   skilled trades training programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Virginia Polytechnic Institute and State              2,000,000  Kaine, Warner
                                                                   University, VA, for the purchase of
                                                                   semiconductor automatic testing equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Viterbo University, WI, for a healthcare                150,000  Baldwin
                                                                   workforce training program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Warren Community College, NJ, for a precision           699,000  Booker, Menendez
                                                                   agriculture technology project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Washington County Community College, ME, for the      1,629,000  Collins, King
                                                                   purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Wayne State University, MI, for equipment for a       1,000,000  Stabenow
                                                                   school of public health.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  West Virginia Higher Education Policy Commission,       250,000  Capito, Manchin
                                                                   WV, for the development and implementation of
                                                                   career pathways.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  West Virginia University Research Corporation,        1,100,000  Capito, Manchin
                                                                   WV, for the purchase of equipment and training.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Westminster College, PA, an exercise science            376,000  Casey
                                                                   program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  Wichita State University Campus of Applied            1,000,000  Moran
                                                                   Sciences and Technology, KS, for aviation
                                                                   education, including the purchase of equipment
                                                                   and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  William & Mary (W&M), VA, for a national security       500,000  Kaine, Warner
                                                                   internship program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  William James College, MA, for educator workforce       496,000  Markey, Warren
                                                                   development activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  William Rainey Harper College, IL, for a                500,000  Duckworth
                                                                   semiconductor and nanotechnology technician
                                                                   project.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  William Rainey Harper College, IL, for the            1,000,000  Durbin
                                                                   purchase of equipment for the emergency services
                                                                   training center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  YMCA of Greater Providence (GPYMCA), RI, for out-       635,000  Reed, Whitehouse
                                                                   of-school time programs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Education          Higher Education...............  York County Community College, ME, for the              986,000  Collins, King
                                                                   purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Albuquerque Community Foundation, NM, to support        208,000  Lujan
 Services                         Living.                          services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Albuquerque Sign Language Academy, NM, to support       300,000  Heinrich
 Services                         Living.                          services for individuals with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Alzheimer's Family Caregiver Support Center,            994,000  Markey, Warren
 Services                         Living.                          Inc., MA, to support services for families,
                                                                   individuals, and communities living with
                                                                   Alzheimer's and other dementia-related disease.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Arc Massachusetts Inc., MA, to support services       1,635,000  Markey, Warren
 Services                         Living.                          for individuals with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Autism Society Northwestern Pennsylvania, PA, to        350,000  Casey
 Services                         Living.                          support services for individuals on the Autism
                                                                   Spectrum.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Blackstone Valley Community Action Program, Inc.         85,000  Reed
 Services                         Living.                          (BVCAP), RI, for supportive services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Cape Abilities, MA, for vehicles and equipment...     1,618,000  Markey, Warren
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Challenge Aspen, CO, for equipment...............        94,000  Bennet, Hickenlooper
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Community Health Centers of America, CA, for            125,000  Padilla
 Services                         Living.                          geriatric health and supportive services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Direction Home of Eastern Ohio, OH, to expand           239,000  Brown
 Services                         Living.                          kinship care.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Eastern Area Agency on Aging, ME, for expanding         270,000  Collins, King
 Services                         Living.                          access to services for older adults, including
                                                                   the purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Give Comfort, Inc., WV, for supportive services..        10,000  Manchin
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     JASA, NY, for supportive services for older             750,000  Schumer
 Services                         Living.                          adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Jefferson Area Board for Aging (JABA), Inc., VA,        100,000  Kaine, Warner
 Services                         Living.                          for supportive services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Jewish Community Center on the Palisades (DBA:          965,000  Menendez
 Services                         Living.                          Kaplen JCC on the Palisades), NJ, to expand
                                                                   services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Las Cumbres Community Services, NM, to expand           944,000  Heinrich
 Services                         Living.                          services for individual with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Laura Baker Services Association, MN, to support        500,000  Klobuchar, Smith
 Services                         Living.                          services for individuals with disabilities and
                                                                   their families.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Lehigh Valley Center for Independent Living             150,000  Casey
 Services                         Living.                          (LVCIL), PA, for supportive services for
                                                                   individuals with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     LGBTQ Senior Housing, Inc., MA, for services for        850,000  Markey, Warren
 Services                         Living.                          older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Liberty Resources Inc., PA, to support services       1,516,000  Fetterman
 Services                         Living.                          for individuals with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Lyon County Human Services, NV, for respite and         411,000  Cortez Masto, Rosen
 Services                         Living.                          supportive services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     McDowell County Commission on Aging, Inc., WV,          554,000  Manchin
 Services                         Living.                          for equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Mississippi State University, MS, for enhancing         882,000  Hyde-Smith, Wicker
 Services                         Living.                          college accessibility for students with
                                                                   disabilities, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Northwest Colorado Health, CO, for equipment.....       105,000  Bennet, Hickenlooper
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Partners In Care Maryland, Inc., MD, to support       1,000,000  Cardin, Van Hollen
 Services                         Living.                          services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Pathways Community HUB Institute, OH, to support        640,000  Brown
 Services                         Living.                          integrated services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Port Resources, ME, for enhancing community             100,000  Collins, King
 Services                         Living.                          access for individuals with developmental
                                                                   disabilities, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Queen's Health System, HI, for a training program       300,000  Schatz
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Rural Alaska Community Action Program, Inc., AK,        138,000  Murkowski
 Services                         Living.                          for expanding access to supports, services, and
                                                                   activities for older individuals.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     SAGE, NY, for supportive services................     1,000,000  Gillibrand, Schumer
 Services                         Living.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Sounding Joy Music Therapy, Inc., HI, for               125,000  Schatz
 Services                         Living.                          supportive services.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Southern Maine Agency on Aging, ME, for expanding       600,000  Collins
 Services                         Living.                          access to services for older adults, including
                                                                   the purchase of equipment and technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Special Education Center of Hawaii (SECOH), HI,         250,000  Hirono
 Services                         Living.                          for facilities and equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Specially Adapted Resource Clubs (SPARC), VA, to        763,000  Kaine, Warner
 Services                         Living.                          expand services for individuals with
                                                                   disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Summit County Combined General Health District,         504,000  Brown
 Services                         Living.                          OH, to support services for at risk older adults
                                                                   and family caregivers..
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Taylor County Senior Citizens, Inc., WV, to              18,000  Manchin
 Services                         Living.                          support renovations for a senior center.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Team Gleason Foundation, LA, for addressing the       6,000,000  Cassidy
 Services                         Living.                          needs of individuals with ALS, including the
                                                                   purchase of equipment and assistive technology.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     The Disability Action Center, WV, for facilities,       500,000  Capito, Manchin
 Services                         Living.                          equipment and to expand services for individuals
                                                                   with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     United Way of the Greater Lehigh Valley, PA, for        423,000  Casey
 Services                         Living.                          supportive services for older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     University of Southern Mississippi, MS, for             200,000  Hyde-Smith, Wicker
 Services                         Living.                          enhancing networks and supports for students
                                                                   with disabilities, including the purchase of
                                                                   equipment.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     Voices for Independence, PA, to support services         99,000  Fetterman
 Services                         Living.                          for individuals with disabilities.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     WV Bureau of Senior Services, WV, for facilities,     2,565,000  Manchin
 Services                         Living.                          equipment and services that support senior
                                                                   centers.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department of Health & Human     Administration for Community     YMCA of Honolulu, HI, to expand services for            388,000  Hirono, Schatz
 Services                         Living.                          older adults.
--------------------------------------------------------------------------------------------------------------------------------------------------------


  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2023 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
                                                                        YEAR 2024
                                                                [In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Senate Committee recommendation
                                                                                                                            compared with (+ or -)
                             Item                                     2023         Budget estimate      Committee    -----------------------------------
                                                                  appropriation                      recommendation         2023
                                                                                                                        appropriation    Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
 
                 TITLE I--DEPARTMENT OF LABOR
 
            EMPLOYMENT AND TRAINING ADMINISTRATION
 
               Training and Employment Services
 
Grants to States:
    Adult Training, current year appropriations...............          173,649           187,987           173,649   ................          -14,338
        Available from prior year appropriations..............          712,000           712,000           712,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, available this fiscal year..............          885,649           899,987           885,649   ................          -14,338
 
        Advance appropriation FY 2025.........................          712,000           712,000           712,000   ................  ................
        less prior year appropriations........................         -712,000          -712,000          -712,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, appropriated in this bill...............          885,649           899,987           885,649   ................          -14,338
 
    Youth Training............................................          948,130           963,837           948,130   ................          -15,707
    Dislocated Worker Assistance, current year appropriations.          235,553           295,278           235,553   ................          -59,725
        Available from prior year appropriations..............          860,000           860,000           860,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, available this fiscal year..............        1,095,553         1,155,278         1,095,553   ................          -59,725
 
        Advance appropriation FY 2025.........................          860,000           860,000           860,000   ................  ................
        less prior year appropriations........................         -860,000          -860,000          -860,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, appropriated in this bill...............        1,095,553         1,155,278         1,095,553   ................          -59,725
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Grants to States............................        2,929,332         3,019,102         2,929,332   ................          -89,770
 
            Current year appropriations.......................       (1,357,332)       (1,447,102)       (1,357,332)  ................         (-89,770)
            Advance appropriations............................       (1,572,000)       (1,572,000)       (1,572,000)  ................  ................
 
National Programs:
    Dislocated Worker Assistance National Reserve:
        Current year appropriations...........................          125,859           164,386           105,859           -20,000           -58,527
        Available from prior year appropriations..............          200,000           200,000           200,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, available this fiscal year..............          325,859           364,386           305,859           -20,000           -58,527
 
        Advance appropriations FY 2025........................          200,000           200,000           200,000   ................  ................
        less prior year appropriations........................         -200,000          -200,000          -200,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, appropriated in this bill...............          325,859           364,386           305,859           -20,000           -58,527
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Dislocated Worker Assistance................        1,421,412         1,519,664         1,401,412           -20,000          -118,252
 
    Indian and Native American programs.......................           60,000            63,800            60,000   ................           -3,800
    Migrant and Seasonal Farmworker programs..................           97,396            97,396            97,396   ................  ................
    YouthBuild activities.....................................          105,000           145,000           105,000   ................          -40,000
    Reintegration of Ex-Offenders.............................          115,000           170,000           115,000   ................          -55,000
    Workforce Data Quality Initiative.........................            6,000            11,000             6,000   ................           -5,000
    Apprenticeship programs...................................          285,000           335,000           290,000            +5,000           -45,000
    Congressionally Directed Spending/Community Project                 217,324   ................          107,939          -109,385          +107,939
     Funding..................................................
    Climate Corps.............................................  ................           15,000   ................  ................          -15,000
    SECTOR....................................................  ................          200,000   ................  ................         -200,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, National Programs...........................        1,211,579         1,401,582         1,087,194          -124,385          -314,388
 
            Current year appropriations.......................        1,011,579         1,201,582           887,194          -124,385          -314,388
            Advance appropriations............................          200,000           200,000           200,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Training and Employment Services...............        4,140,911         4,420,684         4,016,526          -124,385          -404,158
                                                               =========================================================================================
            Current year appropriations.......................       (2,368,911)       (2,648,684)       (2,244,526)        (-124,385)        (-404,158)
            Advance appropriations............................       (1,772,000)       (1,772,000)       (1,772,000)  ................  ................
 
                           Job Corps
 
Operations....................................................        1,603,325         1,603,133         1,603,325   ................             +192
Construction, Rehabilitation and Acquisition..................          123,000           183,000           123,000   ................          -60,000
Administration................................................           33,830            49,334            33,830   ................          -15,504
                                                               -----------------------------------------------------------------------------------------
    Total, Job Corps..........................................        1,760,155         1,835,467         1,760,155   ................          -75,312
                                                               =========================================================================================
Community Service Employment For Older Americans..............          405,000           405,000           405,000   ................  ................
Federal Unemployment Benefits and Allowances (indefinite).....          494,400            30,700            30,700          -463,700   ................
 
State Unemployment Insurance and Employment Service Operations
 
Unemployment Compensation (trust fund)........................  ................  ................  ................  ................  ................
    State Administration......................................        2,750,635         2,947,318         2,815,635           +65,000          -131,683
    Reemployment Services and Eligibility Assessments--UI               117,000           117,000           117,000   ................  ................
     integrity................................................
    RESEA cap adjustment......................................          258,000           433,000           265,000            +7,000          -168,000
    UI Integrity Center of Excellence.........................            9,000             9,000             9,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Unemployment Compensation...................        3,134,635         3,506,318         3,206,635           +72,000          -299,683
 
    Federal-State UI National Activities (trust fund).........           23,000           173,255            18,000            -5,000          -155,255
 
Employment Service [ES]:
    Grants to States:
        Federal Funds.........................................           21,413            21,413            21,413   ................  ................
        Trust Funds...........................................          658,639           677,449           653,639            -5,000           -23,810
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Grants to States........................          680,052           698,862           675,052            -5,000           -23,810
 
    ES National Activities (trust fund).......................           25,000            25,000            25,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Employment Service..........................          705,052           723,862           700,052            -5,000           -23,810
 
            Federal Funds.....................................          (21,413)          (21,413)          (21,413)  ................  ................
            Trust Funds.......................................         (683,639)         (702,449)         (678,639)          (-5,000)         (-23,810)
 
Foreign Labor Certifications:
    Federal Administration....................................           60,528            75,044            61,528            +1,000           -13,516
    Grants to States..........................................           23,282            28,282            23,282   ................           -5,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Foreign Labor Certification.................           83,810           103,326            84,810            +1,000           -18,516
 
One-Stop Career Centers/Labor Market Information..............           62,653            85,653            62,653   ................          -23,000
                                                               -----------------------------------------------------------------------------------------
    Total, State Unemployment Insurance and Employment Service        4,009,150         4,592,414         4,072,150           +63,000          -520,264
     Operations...............................................
                                                               =========================================================================================
        Federal Funds.........................................          (84,066)         (107,066)          (84,066)  ................         (-23,000)
        Trust Funds...........................................       (3,925,084)       (4,485,348)       (3,988,084)         (+63,000)        (-497,264)
 
                    Program Administration
 
Training and Employment.......................................           68,919            93,485            68,919   ................          -24,566
    Trust Funds...............................................            9,253            10,430             9,253   ................           -1,177
Employment Security...........................................            3,621             4,181             3,621   ................             -560
    Trust Funds...............................................           42,574            55,006            42,574   ................          -12,432
Apprenticeship Services.......................................           38,913            50,397            38,913   ................          -11,484
Executive Direction...........................................            7,447             9,281             7,447   ................           -1,834
    Trust Funds...............................................            2,188             2,686             2,188   ................             -498
                                                               -----------------------------------------------------------------------------------------
        Total, Program Administration.........................          172,915           225,466           172,915   ................          -52,551
                                                               =========================================================================================
            Federal Funds.....................................         (118,900)         (157,344)         (118,900)  ................         (-38,444)
            Trust Funds.......................................          (54,015)          (68,122)          (54,015)  ................         (-14,107)
                                                               -----------------------------------------------------------------------------------------
        Total, Employment and Training Administration.........       10,982,531        11,509,731        10,457,446          -525,085        -1,052,285
                                                               =========================================================================================
            Federal Funds.....................................        7,003,432         6,956,261         6,415,347          -588,085          -540,914
                Current year appropriations...................       (5,231,432)       (5,184,261)       (4,643,347)        (-588,085)        (-540,914)
                Advance appropriations........................       (1,772,000)       (1,772,000)       (1,772,000)  ................  ................
            Trust Funds.......................................        3,979,099         4,553,470         4,042,099           +63,000          -511,371
 
       Employee Benefits Security Administration [EBSA]
 
                     Salaries and Expenses
 
Enforcement and Participant Assistance........................  ................          202,596   ................  ................         -202,596
Policy and Compliance Assistance..............................  ................           37,045   ................  ................          -37,045
Executive Leadership, Program Oversight and Administration....  ................            9,318   ................  ................           -9,318
Employee benefits security programs...........................          191,100   ................          191,100   ................         +191,100
                                                               -----------------------------------------------------------------------------------------
    Total, Employee Benefits Security Administration..........          191,100           248,959           191,100   ................          -57,859
                                                               =========================================================================================
 
           Pension Benefit Guaranty Corporation Fund
 
Consolidated Administrative Activities........................         (493,314)         (512,900)         (512,900)         (+19,586)  ................
 
                    Wage and Hour Division
 
Salaries and Expenses.........................................          260,000           340,953           264,500            +4,500           -76,453
 
             Office of Labor-Management Standards
 
Salaries and Expenses.........................................           48,515            53,469            48,515   ................           -4,954
 
        Office of Federal Contract Compliance Programs
 
Salaries and Expenses.........................................          110,976           151,462           110,976   ................          -40,486
 
           Office of Workers' Compensation Programs
 
Salaries and Expenses.........................................          120,500           149,675           120,500   ................          -29,175
    Trust Funds...............................................            2,205             2,271             2,205   ................              -66
                                                               -----------------------------------------------------------------------------------------
        Total, Salaries and Expenses..........................          122,705           151,946           122,705   ................          -29,241
                                                               =========================================================================================
 
                       Special Benefits
 
Federal Employees' Compensation Benefits......................          248,000           698,000           698,000          +450,000   ................
Longshore and Harbor Workers' Benefits........................            2,000             2,000             2,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Special Benefits...................................          250,000           700,000           700,000          +450,000   ................
                                                               =========================================================================================
 
           Special Benefits for Disabled Coal Miners
 
Benefit Payments..............................................           42,000            28,000            28,000           -14,000   ................
Administration................................................            5,031             5,140             5,140              +109   ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, available this fiscal year......................           47,031            33,140            33,140           -13,891   ................
 
Advance appropriations, FY 2025, 1st quarter..................           10,250             7,000             7,000            -3,250   ................
Less prior year advance appropriations........................          -11,000           -10,250           -10,250              +750   ................
                                                               -----------------------------------------------------------------------------------------
    Total, appropriated in this bill..........................           46,281            29,890            29,890           -16,391   ................
                                                               =========================================================================================
 
    Energy Employees Occupational Illness Compensation Fund
 
Administrative Expenses.......................................           64,564            66,532            66,532            +1,968   ................
 
               Black Lung Disability Trust Fund
 
Benefit Payments and Interest on Advances.....................          313,586           366,906           366,906           +53,320   ................
Workers' Compensation Programs, Salaries and Expenses.........           42,194            44,059            44,059            +1,865   ................
Departmental Management, Salaries and Expenses................           38,407            41,178            41,178            +2,771   ................
Departmental Management, Inspector General....................              353               368               368               +15   ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Black Lung Disability Trust Fund................          394,540           452,511           452,511           +57,971   ................
 
Treasury Department Administrative Costs......................              356               356               356   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Black Lung Disability Trust Fund...................          394,896           452,867           452,867           +57,971   ................
                                                               =========================================================================================
    Total, Office of Workers' Compensation Programs...........          878,446         1,401,235         1,371,994          +493,548           -29,241
                                                               =========================================================================================
        Federal Funds.........................................          876,241         1,398,964         1,369,789          +493,548           -29,175
            Current year appropriations.......................         (865,991)       (1,391,964)       (1,362,789)        (+496,798)         (-29,175)
            Advance appropriations............................          (10,250)           (7,000)           (7,000)          (-3,250)  ................
        Trust Funds...........................................            2,205             2,271             2,205   ................              -66
 
     Occupational Safety and Health Administration (OSHA)
 
                     Salaries and Expenses
 
Safety and Health Standards...................................           21,000            31,214            21,000   ................          -10,214
Federal Enforcement...........................................          243,000           286,429           243,000   ................          -43,429
Whistleblower enforcement.....................................           22,500            29,158            22,500   ................           -6,658
State Programs................................................          120,000           127,115           120,000   ................           -7,115
Technical Support.............................................           26,000            30,623            26,000   ................           -4,623
 
Compliance Assistance:
    Federal Assistance........................................           78,262           101,073            77,262            -1,000           -23,811
    State Consultation Grants.................................           63,160            64,160            63,160   ................           -1,000
    Training Grants...........................................           12,787            13,787            10,000            -2,787            -3,787
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Compliance Assistance.......................          154,209           179,020           150,422            -3,787           -28,598
 
Safety and Health Statistics..................................           35,500            43,896            35,500   ................           -8,396
Executive Direction and Administration........................           10,100            11,213            10,100   ................           -1,113
                                                               -----------------------------------------------------------------------------------------
    Total, Occupational Safety and Health Administration......          632,309           738,668           628,522            -3,787          -110,146
                                                               =========================================================================================
 
             Mine Safety and Health Administration
 
                     Salaries and Expenses
 
Mine Safety and Health Enforcement............................          265,774           301,528           265,774   ................          -35,754
Standards Development.........................................            5,000             5,583             5,000   ................             -583
Assessments...................................................            7,191             9,093             7,191   ................           -1,902
Educational Policy and Development............................           39,820            43,642            39,820   ................           -3,822
Technical Support.............................................           36,041            39,755            36,041   ................           -3,714
Program Evaluation and Information Resources [PEIR]...........           17,990   ................           17,990   ................          +17,990
Program Administration........................................           16,000   ................           16,000   ................          +16,000
Program Administration, Evaluation, and Information Resources.  ................           38,493   ................  ................          -38,493
                                                               -----------------------------------------------------------------------------------------
    Total, Mine Safety and Health Administration..............          387,816           438,094           387,816   ................          -50,278
                                                               =========================================================================================
    Total, Labor Enforcement Agencies.........................        1,753,421         2,123,551         1,754,134              +713          -369,417
                                                               =========================================================================================
        Federal Funds.........................................       (1,751,216)       (2,121,280)       (1,751,929)            (+713)        (-369,351)
        Trust Funds...........................................           (2,205)           (2,271)           (2,205)  ................             (-66)
 
                  Bureau of Labor Statistics
 
                     Salaries and Expenses
 
Employment and Unemployment Statistics........................          243,952           278,649           243,952   ................          -34,697
Labor Market Information (trust fund).........................           68,000            68,000            68,000   ................  ................
Prices and Cost of Living.....................................          246,000           264,782           246,000   ................          -18,782
Compensation and Working Conditions...........................           91,000            94,929            91,000   ................           -3,929
Productivity and Technology...................................           12,000            13,184            12,000   ................           -1,184
Executive Direction and Staff Services........................           37,000            38,826            37,000   ................           -1,826
                                                               -----------------------------------------------------------------------------------------
    Total, Bureau of Labor Statistics.........................          697,952           758,370           697,952   ................          -60,418
                                                               =========================================================================================
        Federal Funds.........................................          629,952           690,370           629,952   ................          -60,418
        Trust Funds...........................................           68,000            68,000            68,000   ................  ................
 
            Office of Disability Employment Policy
 
Salaries and Expenses.........................................           43,000            60,549            37,000            -6,000           -23,549
 
                     Department Management
 
                     Salaries and Expenses
 
Executive Direction...........................................           32,658            48,778            32,658   ................          -16,120
Departmental Program Evaluation...............................            8,281            11,540             4,281            -4,000            -7,259
Legal Services................................................          130,754           190,553           135,254            +4,500           -55,299
    Trust Funds...............................................              308               308               308   ................  ................
International Labor Affairs...................................          116,125           130,525           116,125   ................          -14,400
Administration and Management.................................           30,804            63,148            30,804   ................          -32,344
Adjudication..................................................           37,000            45,885            37,000   ................           -8,885
Women's Bureau................................................           23,000            32,426            23,000   ................           -9,426
Civil Rights Activities.......................................            7,586            11,911             7,586   ................           -4,325
Chief Financial Officer.......................................            5,681             6,268             5,681   ................             -587
GSA Technology Transformation.................................  ................            4,182   ................  ................           -4,182
                                                               -----------------------------------------------------------------------------------------
    Total, Salaries and Expenses..............................          392,197           545,524           392,697              +500          -152,827
                                                               =========================================================================================
        Federal Funds.........................................         (391,889)         (545,216)         (392,389)            (+500)        (-152,827)
        Trust Funds...........................................             (308)             (308)             (308)  ................  ................
 
               Veterans' Employment and Training
 
State Administration, Grants..................................          185,000           185,000           185,000   ................  ................
Transition Assistance Program.................................           34,379            34,379            34,379   ................  ................
Federal Administration........................................           47,048            59,334            47,048   ................          -12,286
National Veterans' Employment and Training Services Institute.            3,414             3,414             3,414   ................  ................
Homeless Veterans' Programs...................................           65,500            65,500            65,500   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Veterans' Employment and Training..................          335,341           347,627           335,341   ................          -12,286
                                                               =========================================================================================
        Federal Funds.........................................           65,500            65,500            65,500   ................  ................
        Trust Funds...........................................         (269,841)         (282,127)         (269,841)  ................         (-12,286)
 
                        IT Modernization
 
Departmental support systems..................................            6,889            51,689             6,889   ................          -44,800
Infrastructure technology modernization.......................           27,380            27,504            22,380            -5,000            -5,124
                                                               -----------------------------------------------------------------------------------------
    Total, IT Modernization...................................           34,269            79,193            29,269            -5,000           -49,924
                                                               =========================================================================================
 
                  Office of Inspector General
 
Program Activities............................................           91,187           105,439            91,187   ................          -14,252
    Trust Funds...............................................            5,841             5,841             5,841   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Office of Inspector General....................           97,028           111,280            97,028   ................          -14,252
                                                               =========================================================================================
            Federal funds.....................................          (91,187)         (105,439)          (91,187)  ................         (-14,252)
            Trust funds.......................................           (5,841)           (5,841)           (5,841)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Departmental Management........................          858,835         1,083,624           854,335            -4,500          -229,289
                                                               =========================================================================================
            Federal Funds.....................................         (582,845)         (795,348)         (578,345)          (-4,500)        (-217,003)
            Trust Funds.......................................         (275,990)         (288,276)         (275,990)  ................         (-12,286)
                                                               -----------------------------------------------------------------------------------------
        Total, Workforce Innovation and Opportunity Act               5,901,066         6,256,151         5,776,681          -124,385          -479,470
         Programs.............................................
                                                               =========================================================================================
            Current year appropriations.......................       (4,129,066)       (4,484,151)       (4,004,681)        (-124,385)        (-479,470)
            Advance appropriations............................       (1,772,000)       (1,772,000)       (1,772,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Title I, Department of Labor...................       15,091,480        16,785,114        15,050,156           -41,324        -1,734,958
                                                               =========================================================================================
            Federal Funds.....................................      (10,766,186)      (11,873,097)      (10,661,862)        (-104,324)      (-1,211,235)
                Current year appropriations...................       (8,983,936)      (10,094,097)       (8,882,862)        (-101,074)      (-1,211,235)
                Advance appropriations........................       (1,782,250)       (1,779,000)       (1,779,000)          (-3,250)  ................
            Trust Funds.......................................       (4,325,294)       (4,912,017)       (4,388,294)         (+63,000)        (-523,723)
                                                               -----------------------------------------------------------------------------------------
        Total, title I discretionary appropriations...........       13,841,339        15,505,125        13,770,167           -71,172        -1,734,958
                                                               =========================================================================================
 
       TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
                     PUBLIC HEALTH SERVICE
 
      HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
 
                      Primary Health Care
 
Health Centers................................................        1,857,772         1,937,772         1,857,772   ................          -80,000
Free Clinics Medical Malpractice..............................            1,000             1,000             1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Primary Health Care................................        1,858,772         1,938,772         1,858,772   ................          -80,000
                                                               =========================================================================================
 
                       Health Workforce
 
National Health Service Corps.................................          125,600           175,600           128,600            +3,000           -47,000
 
Training for Diversity:
    Centers of Excellence.....................................           28,422            36,711            28,422   ................           -8,289
    Health Careers Opportunity Program........................           16,000            18,500            16,000   ................           -2,500
    Faculty Loan Repayment....................................            2,310             2,310             2,310   ................  ................
    Scholarships for Disadvantaged Students...................           55,014            55,014            55,014   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Training for Diversity......................          101,746           112,535           101,746   ................          -10,789
 
Primary Care Training and Enhancement.........................           49,924            53,924            49,924   ................           -4,000
Oral Health Training..........................................           42,673            42,673            42,673   ................  ................
 
Interdisciplinary Community-Based Linkages:
    Area Health Education Centers.............................           47,000            47,000            47,000   ................  ................
    Geriatric Workforce Enhancement Program...................           47,245            47,245            48,245            +1,000            +1,000
    Mental and Behavioral Health..............................           44,053            50,000            44,053   ................           -5,947
    Behavioral Health Workforce Education and Training........          153,000           337,374           172,000           +19,000          -165,374
    Substance Use Disorder Treatment and Recovery Loan          ................  ................  ................  ................  ................
     Repayment Program........................................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Interdisciplinary Community Linkages........          291,298           481,619           311,298           +20,000          -170,321
 
Workforce Information and Analysis............................            5,663             5,663             5,663   ................  ................
Public Health and Preventive Medicine programs................           18,000            18,000            18,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Title VII Health Professions Education and                509,304           714,414           529,304           +20,000          -185,110
     Training.................................................
 
Nursing Workforce Development Programs:
    Advanced Nursing Education................................           89,581           106,581            89,581   ................          -17,000
    Nurse Education, Practice, and Retention..................           59,413            91,873            60,413            +1,000           -31,460
    Nurse Practitioner Optional Fellowship Program............            6,000             6,000             6,000   ................  ................
    Nursing Workforce Diversity...............................           24,343            24,343            24,343   ................  ................
    Nurse Corps Loan Repayment and Scholarship................           92,635            92,635            92,635   ................  ................
    Nursing Faculty Loan Program..............................           28,500            28,500            29,500            +1,000            +1,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Title VIII Nursing Workforce Development              300,472           349,932           302,472            +2,000           -47,460
         Programs.............................................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Health Professions (Titles VII and VIII)....          809,776         1,064,346           831,776           +22,000          -232,570
 
Children's Hospitals Graduate Medical Education...............          385,000           385,000           385,000   ................  ................
Medical Student Education.....................................           60,000            60,000            36,000           -24,000           -24,000
Pediatric Subspecialty Loan Repayment Program.................           10,000            10,000            10,000   ................  ................
Supporting the Mental Health of the Health Professions          ................           25,000   ................  ................          -25,000
 Workforce....................................................
Health Care Workforce Innovation Program......................  ................           27,540   ................  ................          -27,540
National Practitioner Data Bank...............................           18,814            18,814            18,814   ................  ................
    User Fees.................................................          -18,814           -18,814           -18,814   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Health Workforce............................        1,390,376         1,747,486         1,391,376            +1,000          -356,110
 
                   Maternal and Child Health
 
Maternal and Child Health Block Grant:
    Maternal and Child Health Block Grant.....................          603,584           603,584           603,584   ................  ................
    Special Projects of National Significance.................          219,116           333,716           209,116           -10,000          -124,600
                                                               -----------------------------------------------------------------------------------------
        Subtotal, MCH Block Grant.............................          822,700           937,300           812,700           -10,000          -124,600
 
Sickle Cell Disease Treatment Program.........................            8,205             8,205             8,205   ................  ................
Autism and Other Developmental Disabilities...................           56,344            57,344            56,344   ................           -1,000
Heritable Disorders in Newborns and Children..................           20,883            20,883            20,883   ................  ................
Healthy Start.................................................          145,000           185,000           145,000   ................          -40,000
Early Hearing Detection and Intervention......................           18,818            18,818            18,818   ................  ................
Emergency Medical Services for Children.......................           24,334            28,134            24,334   ................           -3,800
Screening and Treatment for Maternal Depression...............           10,000            10,000            11,000            +1,000            +1,000
Pediatric Mental Health Care Access...........................           13,000            13,000            13,000   ................  ................
Innovation for Maternal Health................................           15,300            15,300            15,300   ................  ................
Maternal Mental Health Hotline................................  ................            7,000             7,000            +7,000   ................
Training for Health Care Professionals........................  ................            5,000   ................  ................           -5,000
Poison Control Centers........................................           26,846            26,846            26,846   ................  ................
Integrated Services for Pregnant and Postpartum Women.........           10,000            25,000            10,000   ................          -15,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Maternal and Child Health.......................        1,171,430         1,357,830         1,169,430            -2,000          -188,400
 
                  Ryan White HIV/AIDS Program
 
Emergency Assistance (Part A).................................          680,752           680,752           680,752   ................  ................
Comprehensive Care Programs (Part B)..........................        1,364,878         1,364,878         1,364,878   ................  ................
    AIDS Drug Assistance Program [ADAP] (NA)..................         (900,313)         (900,313)         (900,313)  ................  ................
Early Intervention Program (Part C)...........................          208,970           208,970           208,970   ................  ................
Children, Youth, Women, and Families (Part D).................           77,935            77,935            77,935   ................  ................
AIDS Dental Services (Part F).................................           13,620            13,620            13,620   ................  ................
Education and Training Centers (Part F).......................           34,886            34,886            34,886   ................  ................
Special Projects of Regional and National Significance........           25,000            25,000            25,000   ................  ................
Ending the HIV/AIDS Epidemic Initiative.......................          165,000           290,000           165,000   ................         -125,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Ryan White HIV/AIDS program.....................        2,571,041         2,696,041         2,571,041   ................         -125,000
 
                        Health Systems
 
Organ Transplantation.........................................           31,049            67,049            33,049            +2,000           -34,000
Blood Stem Cell Transplantation Program.......................  ................           52,275   ................  ................          -52,275
National Cord Blood Inventory.................................           19,266   ................           19,266   ................          +19,266
CW Bill Young Cell Transplantation............................           33,009   ................           33,009   ................          +33,009
Hansen's Disease Services.....................................           13,706            13,706            13,706   ................  ................
Hansen's Disease Program--Buildings and Facilities............              122               122               122   ................  ................
Payment to Hawaii, Treatment of Hansen's......................            1,857             1,857             1,857   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Health Systems..................................           99,009           135,009           101,009            +2,000           -34,000
 
                         Rural Health
 
Rural Outreach Grants.........................................           92,975            95,375            94,975            +2,000              -400
Rural Health Research/Policy Development......................           11,076            11,076            11,076   ................  ................
Rural Hospital Flexibility Grants.............................           64,277            64,277            64,277   ................  ................
State Offices of Rural Health.................................           12,500            12,500            12,500   ................  ................
Black Lung Clinics............................................           12,190            12,190            12,190   ................  ................
Radiation Exposure Screening and Education Program............            1,889             2,734             1,889   ................             -845
Rural Communities Opioid Response.............................          145,000           165,000           155,000           +10,000           -10,000
Rural Residency Program.......................................           12,500            12,700            12,500   ................             -200
Rural Health Clinic Behavioral Health Initiative..............  ................           10,000   ................  ................          -10,000
Financial and Community Sustainability for At-Risk Rural        ................           10,000   ................  ................          -10,000
 Hospitals....................................................
Rural Hospital Stabilization Pilot Program....................  ................           20,000   ................  ................          -20,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Rural Health....................................          352,407           415,852           364,407           +12,000           -51,445
 
Family Planning...............................................          286,479           512,000           286,479   ................         -225,521
 
           HRSA-Wide Activities and Program Support
 
Program Management............................................          163,800           168,971           165,300            +1,500            -3,671
Congressionally Directed Spending/Community Project Funding...        1,521,681   ................          891,997          -629,684          +891,997
340B Drug Pricing/Office of Pharmacy Affairs..................           12,238            17,238            12,238   ................           -5,000
Telehealth....................................................           38,050            44,500            38,050   ................           -6,450
Long COVID....................................................  ................          130,000             5,000            +5,000          -125,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, HRSA-Wide Activities and Program Support........        1,735,769           360,709         1,112,585          -623,184          +751,876
                                                               -----------------------------------------------------------------------------------------
    Total, Health Resources and Services (HRS)................        9,465,283         9,163,699         8,855,099          -610,184          -308,600
                                                               =========================================================================================
 
        Vaccine Injury Compensation Program Trust Fund
 
Post-FY 1988 Claims...........................................          256,370           261,497           261,497            +5,127   ................
HRSA Administrative expenses..................................           15,200            26,200            15,200   ................          -11,000
                                                               -----------------------------------------------------------------------------------------
    Total, Vaccine Injury Compensation Trust Fund.............          271,570           287,697           276,697            +5,127           -11,000
                                                               =========================================================================================
Countermeasures Injury Compensation Trust Fund................            7,000            15,000             7,000   ................           -8,000
                                                               -----------------------------------------------------------------------------------------
    Total, Health Resources and Services Administration.......        9,743,853         9,466,396         9,138,796          -605,057          -327,600
                                                               =========================================================================================
        Discretionary.........................................        9,487,483         9,204,899         8,877,299          -610,184          -327,600
 
          CENTERS FOR DISEASE CONTROL AND PREVENTION
 
Immunization and Respiratory Diseases.........................          499,941           750,930           217,041          -282,900          -533,889
    Prevention and Public Health Fund.........................         (419,350)         (505,000)         (702,250)        (+282,900)        (+197,250)
                                                               -----------------------------------------------------------------------------------------
        Subtotal..............................................          919,291         1,255,930           919,291   ................         -336,639
 
HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and         1,391,056         1,544,556         1,395,056            +4,000          -149,500
 Tuberculosis Prevention......................................
Emerging and Zoonotic Infectious Diseases.....................          698,772           793,772           698,772   ................          -95,000
    Prevention and Public Health Fund.........................          (52,000)          (52,000)          (52,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, EZID program level..........................          750,772           845,772           750,772   ................          -95,000
 
Chronic Disease Prevention and Health Promotion...............        1,175,464         1,551,339         1,180,464            +5,000          -370,875
    Prevention and Public Health Fund.........................         (254,950)         (262,200)         (254,950)  ................          (-7,250)
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Chronic Disease Prevention and Health               1,430,414         1,813,539         1,435,414            +5,000          -378,125
         Promotion, program level.............................
 
Birth Defects, Developmental Disabilities, Disabilities and             205,560           222,560           206,060              +500           -16,500
 Health.......................................................
Public Health Scientific Services.............................          754,497           651,222           495,167          -259,330          -156,055
    Evaluation Tap Funding....................................  ................         (170,342)         (244,330)        (+244,330)         (+73,988)
    Prevention and Public Health Fund.........................  ................         (140,000)  ................  ................        (-140,000)
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Public Health Scientific Services, program            754,497           961,564           739,497           -15,000          -222,067
         level................................................
 
Environmental Health..........................................          229,850           396,850           229,850   ................         -167,000
    Prevention and Public Health Fund.........................          (17,000)          (17,000)          (17,000)  ................  ................
    Evaluation Tap Funding....................................  ................           (7,000)  ................  ................          (-7,000)
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Environmental Health, program level.........          246,850           420,850           246,850   ................         -174,000
 
Injury Prevention and Control.................................          761,379         1,351,669           761,879              +500          -589,790
National Institute for Occupational Safety and Health.........          362,800           362,800           362,800   ................  ................
Energy Employees Occupational Illness Compensation Program....           55,358            55,358            55,358   ................  ................
Global Health.................................................          692,843           764,843           692,843   ................          -72,000
Public Health Preparedness and Response.......................          883,200           943,200           898,200           +15,000           -45,000
Buildings and Facilities......................................           40,000            55,000            40,000   ................          -15,000
CDC-Wide Activities and Program Support.......................  ................  ................  ................  ................  ................
    Prevention and Public Health Fund.........................         (160,000)         (160,000)         (160,000)  ................  ................
    Office of the Director....................................          128,570           143,570           128,570   ................          -15,000
    Infectious Diseases Rapid Response Reserve Fund...........           35,000            35,000            10,000           -25,000           -25,000
    Public Health Infrastructure and Capacity.................          350,000           600,000           350,000   ................         -250,000
        Prevention and Public Health Fund.....................  ................  ................  ................  ................  ................
    Center for Forecasting and Outbreak Analytics.............           50,000            50,000            45,000            -5,000            -5,000
        Prevention and Public Health Fund.....................  ................          (50,000)  ................  ................         (-50,000)
                                                               -----------------------------------------------------------------------------------------
            Subtotal..........................................           50,000           100,000            45,000            -5,000           -55,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, CDC-Wide Activities.........................          563,570           828,570           533,570           -30,000          -295,000
                                                               -----------------------------------------------------------------------------------------
        Total, Centers for Disease Control and Prevention.....        8,314,290        10,272,669         7,767,060          -547,230        -2,505,609
                                                               =========================================================================================
            Discretionary.....................................       (8,258,932)      (10,217,311)       (7,711,702)        (-547,230)      (-2,505,609)
            Mandatory.........................................          (55,358)          (55,358)          (55,358)  ................  ................
        (Evaluation Tap Funding)..............................  ................         (177,342)         (244,330)        (+244,330)         (+66,988)
        (Prevention and Public Health Fund)...................         (903,300)       (1,186,200)       (1,186,200)        (+282,900)  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Centers for Disease Control program level......       (9,217,590)      (11,636,211)       (9,197,590)         (-20,000)      (-2,438,621)
                                                               =========================================================================================
 
                 NATIONAL INSTITUTES OF HEALTH
 
National Cancer Institute (NCI)...............................        7,104,159         7,820,159         7,164,159           +60,000          -656,000
    NIH Innovation Account, CURES Act.........................         (216,000)  ................  ................        (-216,000)  ................
    National Cancer Institute (NCI) (emergency)...............  ................  ................          216,000          +216,000          +216,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, NCI, program level..........................        7,320,159         7,820,159         7,380,159           +60,000          -440,000
 
National Heart, Lung, and Blood Institute (NHLBI).............        3,982,345         3,985,158         3,982,345   ................           -2,813
National Institute of Dental and Craniofacial Research (NIDCR)          520,163           520,138           520,163   ................              +25
National Institute of Diabetes and Digestive and Kidney               2,300,721         2,303,098         2,310,721           +10,000            +7,623
 Diseases [NIDDK].............................................
National Institute of Neurological Disorders and Stroke               2,588,925         2,739,418         2,624,925           +36,000          -114,493
 (NINDS)......................................................
    NIH Innovation Account, CURES Act.........................         (225,000)          (86,000)          (86,000)        (-139,000)  ................
    National Institute of Neurological Disorders and Stroke     ................  ................          139,000          +139,000          +139,000
     (NINDS) (emergency)......................................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, NINDS, program level........................        2,813,925         2,825,418         2,849,925           +36,000           +24,507
 
National Institute of Allergy and Infectious Diseases (NIAID).        6,562,279         6,561,652         6,562,279   ................             +627
National Institute of General Medical Sciences (NIGMS)........        1,827,197         1,291,570         1,827,197   ................         +535,627
    Evaluation Tap Funding....................................       (1,412,482)       (1,948,109)       (1,412,482)  ................        (-535,627)
                                                               -----------------------------------------------------------------------------------------
        Subtotal, NIGMS, program level........................        3,239,679         3,239,679         3,239,679   ................  ................
 
Eunice Kennedy Shriver National Institute of Child Health and         1,749,078         1,747,784         1,759,078           +10,000           +11,294
 Human Development (NICHD)....................................
National Eye Institute (NEI)..................................          896,549           896,136           896,549   ................             +413
National Institute of Environmental Health Sciences (NIEHS)...          913,979           938,807           913,979   ................          -24,828
National Institute on Aging (NIA).............................        4,407,623         4,412,090         4,509,623          +102,000           +97,533
National Institute of Arthritis and Musculoskeletal and Skin            685,465           687,639           685,465   ................           -2,174
 Diseases (NIAMS).............................................
National Institute on Deafness and Other Communication                  534,333           534,330           534,333   ................               +3
 Disorders (NIDCD)............................................
National Institute of Nursing Research (NINR).................          197,693           197,671           197,693   ................              +22
National Institute on Alcohol Abuse and Alcoholism (NIAAA)....          595,318           596,616           595,318   ................           -1,298
National Institute on Drug Abuse (NIDA).......................        1,662,695         1,663,365         1,672,695           +10,000            +9,330
National Institute of Mental Health (NIMH)....................        2,112,843         2,455,653         2,212,843          +100,000          -242,810
    NIH Innovation Account, CURES Act.........................         (225,000)          (86,000)          (86,000)        (-139,000)  ................
    National Institute of Mental Health (NIMH) (emergency)....  ................  ................          139,000          +139,000          +139,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, NIMH, program level.........................        2,337,843         2,541,653         2,437,843          +100,000          -103,810
 
National Human Genome Research Institute (NHGRI)..............          663,200           660,510           663,200   ................           +2,690
National Institute of Biomedical Imaging and Bioengineering             440,627           440,625           440,627   ................               +2
 (NIBIB)......................................................
National Center for Complementary and Integrative Health                170,384           170,277           170,384   ................             +107
 (NCCIH)......................................................
National Institute on Minority Health and Health Disparities            524,395           525,138           524,395   ................             -743
 (NIMHD)......................................................
John E Fogarty International Center (FIC).....................           95,162            95,130            95,162   ................              +32
National Library of Medicine (NLM)............................          497,548           495,314           497,548   ................           +2,234
National Center for Advancing Translational Sciences (NCATS)..          923,323           923,323           923,323   ................  ................
Office of the Director........................................        2,642,914         2,890,779         2,637,914            -5,000          -252,865
    Common Fund...............................................         (722,401)         (722,401)         (722,401)  ................  ................
    Gabriella Miller Kids First Research Act..................           12,600            12,600            12,600   ................  ................
    Office of the Director (emergency)........................  ................  ................          184,000          +184,000          +184,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Office of the Director......................        2,655,514         2,903,379         2,650,514            -5,000          -252,865
 
NIH Innovation Account, CURES Act.............................         (419,000)         (235,000)         (235,000)        (-184,000)  ................
Buildings and Facilities......................................          350,000           350,000           292,000           -58,000           -58,000
Advanced Research Projects Agency for Health (ARPA-H).........        1,500,000         2,500,000         1,500,000   ................       -1,000,000
                                                               -----------------------------------------------------------------------------------------
    Total, National Institutes of Health (NIH) with CURES Act        47,546,518        48,821,980        47,811,518          +265,000        -1,010,462
     funding..................................................
                                                               =========================================================================================
    (Evaluation Tap Funding)..................................       (1,412,482)       (1,948,109)       (1,412,482)  ................        (-535,627)
                                                               -----------------------------------------------------------------------------------------
    Total, National Institutes of Health program level........       48,959,000        50,770,089        49,224,000          +265,000        -1,546,089
                                                               =========================================================================================
    Total, NIH program level (excluding ARPA-H)...............       47,459,000        48,270,089        47,724,000          +265,000          -546,089
                                                               =========================================================================================
 
   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
                           (SAMHSA)
 
                         Mental Health
 
Programs of Regional and National Significance................          991,453         1,787,689         1,065,453           +74,000          -722,236
    Prevention and Public Health Fund.........................          (12,000)          (12,000)          (12,000)  ................  ................
    CR Funding--Public Law 117-180 Suicide Lifeline...........           62,000   ................  ................          -62,000   ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal..............................................        1,065,453         1,799,689         1,077,453           +12,000          -722,236
 
Mental Health Block Grant (MHBG)..............................          986,532         1,631,532         1,021,532           +35,000          -610,000
    Evaluation Tap Funding....................................          (21,039)          (21,039)          (21,039)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal..............................................        1,007,571         1,652,571         1,042,571           +35,000          -610,000
 
Certified Community Behavioral Health Clinics.................          385,000           552,500           400,000           +15,000          -152,500
National Child Traumatic Stress Initiative....................           93,887           150,000            93,887   ................          -56,113
Children's Mental Health Services.............................          130,000           225,000           130,000   ................          -95,000
Projects for Assistance in Transition from Homelessness (PATH)           66,635           109,635            66,635   ................          -43,000
Protection and Advocacy for Individuals with Mental Illness              40,000            40,000            40,000   ................  ................
 (PAIMI)......................................................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Mental Health...................................        2,755,507         4,496,356         2,817,507           +62,000        -1,678,849
 
    (Evaluation Tap Funding)..................................          (21,039)          (21,039)          (21,039)  ................  ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Mental Health program level.....................        2,788,546         4,529,395         2,850,546           +62,000        -1,678,849
 
                   Substance Abuse Treatment
 
Programs of Regional and National Significance................          572,219           753,008           574,219            +2,000          -178,789
    Evaluation Tap Funding....................................           (2,000)           (2,000)           (2,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal..............................................          574,219           755,008           576,219            +2,000          -178,789
 
Substance Abuse Prevention and Treatment Block Grant..........        1,928,879         2,628,879         1,968,879           +40,000          -660,000
    Evaluation Tap Funding....................................          (79,200)          (79,200)          (79,200)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal Substance Abuse Prevention and Treatment             2,008,079         2,708,079         2,048,079           +40,000          -660,000
         Block Grant, program level...........................
 
State Opioid Response grants..................................        1,575,000         2,000,000         1,378,000          -197,000          -622,000
State Opioid Response grants (emergency)......................  ................  ................          217,000          +217,000          +217,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, State Opioid Response grants....................        1,575,000         2,000,000         1,595,000           +20,000          -405,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Substance Abuse Treatment.......................        4,076,098         5,381,887         4,138,098           +62,000        -1,243,789
 
    (Evaluation Tap Funding)..................................          (81,200)          (81,200)          (81,200)  ................  ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Substance Abuse Treatment, program level........        4,157,298         5,463,087         4,219,298           +62,000        -1,243,789
 
                  Substance Abuse Prevention
 
Programs of Regional and National Significance................          236,879           245,738           236,879   ................           -8,859
 
            Health Surveillance and Program Support
 
Health Surveillance and Program Support.......................          301,932           150,827           212,117           -89,815           +61,290
    Congressionally Directed Spending/Community Project                (160,777)  ................          (70,962)         (-89,815)         (+70,962)
     Funding (non-add)........................................
        Bipartisan Safer Communities Act (PL 117-159) (prior           (162,500)         (162,500)         (162,500)  ................  ................
         year emergency advance)..............................
        Evaluation Tap Funding................................          (31,428)          (31,428)          (31,428)  ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Health Surveillance and Program Support           495,860           344,755           406,045           -89,815           +61,290
             program level....................................
                                                               -----------------------------------------------------------------------------------------
            Total, SAMHSA.....................................        7,370,416        10,274,808         7,404,601           +34,185        -2,870,207
                                                               =========================================================================================
            (Evaluation Tap Funding)..........................         (133,667)         (133,667)         (133,667)  ................  ................
            (Prevention and Public Health Fund)...............          (12,000)          (12,000)          (12,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
            Total, SAMHSA, program level, including                   7,678,583        10,582,975         7,712,768           +34,185        -2,870,207
             emergencies......................................
                                                               =========================================================================================
 
       AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
 
                Healthcare Research and Quality
 
Research on Health Costs, Quality, and Outcomes:
    Federal Funds.............................................          228,609           251,924           225,609            -3,000           -26,315
        Evaluation Tap funding................................  ................          (45,000)  ................  ................         (-45,000)
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Research on Health Costs, Quality, and            228,609           296,924           225,609            -3,000           -71,315
             Outcomes, program level..........................
 
Medical Expenditures Panel Surveys:
    Federal Funds.............................................           71,791            71,791            71,791   ................  ................
 
Program Support:
    Appropriation.............................................           73,100            78,785            73,100   ................           -5,685
                                                               -----------------------------------------------------------------------------------------
        Total, AHRQ...........................................          373,500           402,500           370,500            -3,000           -32,000
                                                               =========================================================================================
        (Evaluation Tap Funding)..............................  ................          (45,000)  ................  ................         (-45,000)
                                                               -----------------------------------------------------------------------------------------
        Total, AHRQ, program level............................          373,500           447,500           370,500            -3,000           -77,000
                                                               =========================================================================================
        Total, Public Health Service with CURES Act funding...       73,348,577        79,238,353        72,492,475          -856,102        -6,745,878
                                                               =========================================================================================
        Total, Public Health Service, program level...........       75,810,026        82,740,671        75,481,154          -328,872        -7,259,517
                                                               =========================================================================================
 
           CENTERS FOR MEDICARE AND MEDICAID SERVICES
 
                 Grants to States for Medicaid
 
Medicaid Current Law Benefits.................................      503,821,443       574,100,474       574,100,474       +70,279,031   ................
State and Local Administration................................       23,649,059        24,622,000        24,622,000          +972,941   ................
Vaccines for Children.........................................        5,608,606         5,814,850         5,814,850          +206,244   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Medicaid program level, available this fiscal year.      533,079,108       604,537,324       604,537,324       +71,458,216   ................
                                                               =========================================================================================
        New advance, 1st quarter, FY 2025.....................      197,580,474       245,580,414       245,580,414       +47,999,940   ................
        Less appropriations provided in prior years...........     -165,722,018      -197,580,474      -197,580,474       -31,858,456   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Grants to States for Medicaid, appropriated in this      564,937,564       652,537,264       652,537,264       +87,599,700   ................
     bill.....................................................
                                                               =========================================================================================
 
              Payments to Health Care Trust Funds
 
Supplemental Medical Insurance................................      434,349,000       373,973,000       373,973,000       -60,376,000   ................
Federal Uninsured Payment.....................................           52,000            44,000            44,000            -8,000   ................
Program Management............................................        1,000,000         1,000,000         1,000,000   ................  ................
General Revenue for Part D Benefit............................      111,800,000       100,805,000       100,805,000       -10,995,000   ................
General Revenue for Part D Administration.....................          600,000           523,000           523,000           -77,000   ................
HCFAC Reimbursement...........................................          324,000           375,000           375,000           +51,000   ................
State Low-Income Determination for Part D.....................            5,000             5,000             5,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Payments to Trust Funds............................      548,130,000       476,725,000       476,725,000       -71,405,000   ................
                                                               =========================================================================================
 
                      Program Management
 
Research, Demonstration, and Evaluation.......................           20,054   ................           20,054   ................          +20,054
Program Operations............................................        2,479,823         3,130,183         2,479,823   ................         -650,360
State Survey and Certification................................          397,334           565,860           397,334   ................         -168,526
Federal Administration........................................          772,533           854,027           772,533   ................          -81,494
                                                               -----------------------------------------------------------------------------------------
    Total, Program Management.................................        3,669,744         4,550,070         3,669,744   ................         -880,326
                                                               =========================================================================================
 
          Health Care Fraud and Abuse Control Account
 
Centers for Medicare and Medicaid Services....................          665,648           667,359           682,048           +16,400           +14,689
HHS Office of Inspector General...............................          105,145           112,434           107,735            +2,590            -4,699
Senior Medicare Patrol........................................  ................           35,000   ................  ................          -35,000
Department of Justice.........................................          122,207           122,207           125,217            +3,010            +3,010
                                                               -----------------------------------------------------------------------------------------
    Total, Health Care Fraud and Abuse Control................          893,000           937,000           915,000           +22,000           -22,000
                                                               =========================================================================================
        Program integrity (cap adjustment)....................         (576,000)         (612,000)         (604,000)         (+28,000)          (-8,000)
                                                               -----------------------------------------------------------------------------------------
    Total, Centers for Medicare and Medicaid Services.........    1,117,630,308     1,134,749,334     1,133,847,008       +16,216,700          -902,326
                                                               =========================================================================================
        Federal funds.........................................   (1,113,067,564)   (1,129,262,264)   (1,129,262,264)     (+16,194,700)  ................
            Current year appropriations.......................     (915,487,090)     (883,681,850)     (883,681,850)     (-31,805,240)  ................
            Advance appropriations............................     (197,580,474)     (245,580,414)     (245,580,414)     (+47,999,940)  ................
        Trust Funds...........................................       (4,562,744)       (5,487,070)       (4,584,744)         (+22,000)        (-902,326)
 
         ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)
 
  Payments to States for Child Support Enforcement and Family
                       Support Programs
 
Payments to Territories.......................................           33,000            33,000            33,000   ................  ................
Repatriation..................................................           10,177            18,199            18,199            +8,022   ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal..................................................           43,177            51,199            51,199            +8,022   ................
 
Child Support Enforcement:
    State and Local Administration............................        3,474,868         3,840,888         3,840,888          +366,020   ................
    Federal Incentive Payments................................          654,955           706,913           706,913           +51,958   ................
    Access and Visitation.....................................           10,000            10,000            10,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Child Support Enforcement...................        4,139,823         4,557,801         4,557,801          +417,978   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Child Support Enforcement and Family Support               4,183,000         4,609,000         4,609,000          +426,000   ................
     Payments, program level available this fiscal year.......
                                                               =========================================================================================
        Less appropriations provided in prior years...........       -1,300,000        -1,300,000        -1,300,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Child Support Enforcement and Family Support               2,883,000         3,309,000         3,309,000          +426,000   ................
     Payments, available in this bill.........................
                                                               =========================================================================================
        New advance, 1st quarter, FY 2025.....................        1,300,000         1,400,000         1,400,000          +100,000   ................
 
      Low Income Home Energy Assistance Program (LIHEAP)
 
Formula Grants................................................        1,500,000         4,111,000         1,500,000   ................       -2,611,000
Formula Grants (emergency)....................................        2,500,000   ................        2,575,000           +75,000        +2,575,000
                                                               -----------------------------------------------------------------------------------------
    Total, LIHEAP.............................................        4,000,000         4,111,000         4,075,000           +75,000           -36,000
                                                               =========================================================================================
C R funding (Public Law 117-180) (Sec 146) (emergency)........        1,000,000   ................  ................       -1,000,000   ................
Appropriation from prior year advances (PL 117-58 Div                  (100,000)         (100,000)         (100,000)  ................  ................
 J)(emergency)................................................
 
                Refugee and Entrant Assistance
 
Transitional and Medical Services.............................          564,000         1,000,000           564,000   ................         -436,000
Refugee Support Services......................................          307,201           686,000           307,201   ................         -378,799
Victims of Trafficking........................................           30,755            39,497            30,755   ................           -8,742
Unaccompanied Children........................................        5,506,258         5,506,258         5,506,258   ................  ................
Survivors of Torture..........................................           19,000            27,000            19,000   ................           -8,000
                                                               -----------------------------------------------------------------------------------------
    Total, Refugee and Entrant Assistance.....................        6,427,214         7,258,755         6,427,214   ................         -831,541
                                                               =========================================================================================
C R Funding--Public Law 117-180 (emergency)...................        1,775,000   ................  ................       -1,775,000   ................
Payments to States for the Child Care and Development Block           8,021,387         9,000,000         8,721,387          +700,000          -278,613
 Grant........................................................
Social Services Block Grant (Title XX)........................        1,700,000         1,700,000         1,700,000   ................  ................
 
            Children and Families Services Programs
 
Programs for Children, Youth and Families:
    Head Start................................................       11,996,820        13,111,586        11,996,820   ................       -1,114,766
    Head Start (emergency)....................................  ................  ................          275,000          +275,000          +275,000
                                                               -----------------------------------------------------------------------------------------
        Total, Head Start.....................................       11,996,820        13,111,586        12,271,820          +275,000          -839,766
                                                               =========================================================================================
    Preschool Development Grants..............................          315,000           360,000           310,000            -5,000           -50,000
    Consolidated Runaway and Homeless Youth Program...........          125,283           136,803           125,283   ................          -11,520
    Prevention Grants to Reduce Abuse of Runaway Youth........           21,000            22,000            21,000   ................           -1,000
    Child Abuse State Grants..................................          105,091           125,000           105,091   ................          -19,909
    Child Abuse Discretionary Activities......................           38,000            42,000            36,000            -2,000            -6,000
    Community Based Child Abuse Prevention....................           70,660            90,000            70,660   ................          -19,340
    Child Welfare Services....................................          268,735           278,900           268,735   ................          -10,165
    Child Welfare Training, Research, or Demonstration                   18,984           101,000            21,984            +3,000           -79,016
     projects.................................................
    Adoption Opportunities....................................           51,000            51,000            51,000   ................  ................
    Adoption Incentive Grants.................................           75,000            75,000            70,000            -5,000            -5,000
    Social Services and Income Maintenance Research...........          142,860            37,512            70,523           -72,337           +33,011
    Congressionally Directed Spending/Community Project                (107,848)  ................          (40,011)         (-67,837)         (+40,011)
     Funding (non-add)........................................
Native American Programs......................................           60,500            87,499            60,500   ................          -26,999
 
Community Services:
    Community Services Block Grant Act programs:
        Grants to States for Community Services...............          770,000           770,000           765,000            -5,000            -5,000
        Economic Development..................................           22,383            23,615            22,383   ................           -1,232
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Community Services Block Grant Act                804,383           805,891           799,383            -5,000            -6,508
             programs.........................................
 
Domestic Violence Hotline.....................................           20,500            27,360            20,500   ................           -6,860
Family Violence Prevention and Services.......................          240,000           491,869           235,000            -5,000          -256,869
Chafee Education and Training Vouchers........................           44,257            48,257            43,257            -1,000            -5,000
Disaster Human Services Case Management.......................            1,864             8,000             1,864   ................           -6,136
Program Direction.............................................          218,500           239,988           218,500   ................          -21,488
                                                               -----------------------------------------------------------------------------------------
    Total, Children and Families Services Programs............       14,618,437        16,139,665        14,801,100          +182,663        -1,338,565
                                                               =========================================================================================
 
               Promoting Safe and Stable Families
 
Promoting Safe and Stable Families............................          345,000           345,000           345,000   ................  ................
    Discretionary Funds.......................................           86,515           106,000            72,515           -14,000           -33,485
                                                               -----------------------------------------------------------------------------------------
        Total, Promoting Safe and Stable Families.............          431,515           451,000           417,515           -14,000           -33,485
                                                               =========================================================================================
 
            Payments for Foster Care and Permanency
 
Foster Care...................................................        6,190,000         6,615,000         6,615,000          +425,000   ................
Adoption Assistance...........................................        4,128,000         4,706,000         4,706,000          +578,000   ................
Guardianship..................................................          345,000           330,000           330,000           -15,000   ................
Independent Living............................................          143,000           143,000           143,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Payments to States available this fiscal year......       10,806,000        11,794,000        11,794,000          +988,000   ................
                                                               =========================================================================================
    Advance appropriations, 1st quarter, FY 2025..............        3,200,000         3,400,000         3,400,000          +200,000   ................
    less appropriations provided in prior years...............       -3,200,000        -3,200,000        -3,200,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Payments to States available in this bill......       10,806,000        11,994,000        11,994,000        +1,188,000   ................
                                                               =========================================================================================
    Total, Administration for Children and Families...........       52,962,553        55,363,420        52,845,216          -117,337        -2,518,204
                                                               =========================================================================================
        Current year appropriations...........................      (48,462,553)      (50,563,420)      (48,045,216)        (-417,337)      (-2,518,204)
        Advance appropriations................................       (4,500,000)       (4,800,000)       (4,800,000)        (+300,000)  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Administration for Children and Families,                (35,928,553)      (36,615,420)      (34,097,216)      (-1,831,337)      (-2,518,204)
     discretionary............................................
                                                               =========================================================================================
    Total, ACF (excluding emergencies)........................       47,687,553        55,363,420        49,995,216        +2,307,663        -5,368,204
                                                               =========================================================================================
 
              ADMINISTRATION FOR COMMUNITY LIVING
 
            Aging and Disability Services Programs
 
Grants to States:
    Home and Community-based Supportive Services..............          410,000           500,000           410,000   ................          -90,000
    Preventive Health.........................................           26,339            26,399            26,339   ................              -60
    Protection of Vulnerable Older Americans-Title VII........           26,658            32,059            26,658   ................           -5,401
                                                               -----------------------------------------------------------------------------------------
        Subtotal..............................................          462,997           558,458           462,997   ................          -95,461
 
    Family Caregivers.........................................          205,000           249,936           210,000            +5,000           -39,936
    Native American Caregivers Support........................           12,000            15,806            12,000   ................           -3,806
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Caregivers..................................          217,000           265,742           222,000            +5,000           -43,742
 
    Nutrition:
        Congregate Meals......................................          540,342           762,050           565,342           +25,000          -196,708
        Home Delivered Meals..................................          366,342           410,335           381,342           +15,000           -28,993
        Nutrition Services Incentive Program..................          160,069           112,000           112,000           -48,069   ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Nutrition...............................        1,066,753         1,284,385         1,058,684            -8,069          -225,701
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Grants to States............................        1,746,750         2,108,585         1,743,681            -3,069          -364,904
 
Grants for Native Americans...................................           38,264            70,208            38,264   ................          -31,944
Aging Network Support Activities..............................           30,461            40,000            30,461   ................           -9,539
 
Alzheimer's Disease Demonstrations:
    Appropriation.............................................           16,800            16,800            16,800   ................  ................
    Prevention and Public Health Fund.........................          (14,700)          (14,700)          (14,700)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Alzheimer's Disease Demonstrations, program            31,500            31,500            31,500   ................  ................
         level................................................
Lifespan Respite Care.........................................           10,000            14,220            11,500            +1,500            -2,720
 
Chronic Disease Self-Management:
    Prevention and Public Health Fund.........................           (8,000)           (8,000)           (8,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Chronic Self-Management, program level......            8,000             8,000             8,000   ................  ................
 
Elder Falls Prevention:
    Appropriation.............................................            2,500             5,000             2,500   ................           -2,500
    Prevention and Public Health Fund.........................           (5,000)           (5,000)           (5,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Elder Falls Prevention, program level.......            7,500            10,000             7,500   ................           -2,500
 
Elder Rights Support Activities...............................           33,874            77,400            33,874   ................          -43,526
Aging and Disability Resources................................            8,619            10,000             8,619   ................           -1,381
State Health Insurance Program (SHIP).........................           55,242            55,242            55,242   ................  ................
 
Paralysis Resource Center:
    Appropriation.............................................           10,700            10,700            10,700   ................  ................
 
Limb Loss Resource Center:
    Appropriation.............................................            4,200             4,200             4,200   ................  ................
 
Traumatic Brain Injury:
    Appropriation.............................................           13,118            13,118            13,118   ................  ................
 
Developmental Disabilities Programs:
    State Councils............................................           81,000            82,000            81,000   ................           -1,000
    Protection and Advocacy...................................           45,000            59,659            45,000   ................          -14,659
    Voting Access for Individuals with Disabilities...........           10,000            10,000            10,000   ................  ................
    Developmental Disabilities Projects of National                      12,250            16,000            12,250   ................           -3,750
     Significance.............................................
    University Centers for Excellence in Developmental                   43,119            46,173            43,119   ................           -3,054
     Disabilities.............................................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Developmental Disabilities Programs.........          191,369           213,832           191,369   ................          -22,463
 
Workforce Innovation and Opportunity Act:
    Independent Living........................................          128,183           161,458           128,183   ................          -33,275
    National Institute on Disability, Independent Living, and           119,000           119,000           119,000   ................  ................
     Rehabilitation Research..................................
    Assistive Technology......................................           40,000            44,000            40,000   ................           -4,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Workforce Innovation and Opportunity Act....          287,183           324,458           287,183   ................          -37,275
 
Congressionally Directed Spending/Community Project Funding...           41,644   ................           29,268           -12,376           +29,268
Program Administration........................................           47,063            63,859            47,813              +750           -16,046
                                                               -----------------------------------------------------------------------------------------
    Total, Administration for Community Living................        2,537,787         3,027,622         2,524,592           -13,195          -503,030
                                                               =========================================================================================
        Federal funds.........................................       (2,482,545)       (2,972,380)       (2,469,350)         (-13,195)        (-503,030)
        Trust Funds...........................................          (55,242)          (55,242)          (55,242)  ................  ................
    (Prevention and Public Health Fund).......................          (27,700)          (27,700)          (27,700)  ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Administration for Community Living, program level.        2,565,487         3,055,322         2,552,292           -13,195          -503,030
                                                               =========================================================================================
 
    ADMINISTRATION FOR STRATEGIC PREPAREDNESS AND RESPONSE
 
            Research, Development, and Procurement
 
Biomedical Advanced Research and Development Authority (BARDA)          950,000         1,015,132           820,000          -130,000          -195,132
Biomedical Advanced Research and Development Authority (BARDA)  ................  ................          150,000          +150,000          +150,000
 (emergency)..................................................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, BARDA...........................................          950,000         1,015,132           970,000           +20,000           -45,132
 
Project BioShield.............................................          820,000           830,000           670,000          -150,000          -160,000
Project BioShield (emergency).................................  ................  ................          150,000          +150,000          +150,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Project BioShield...............................          820,000           830,000           820,000   ................          -10,000
 
Strategic National Stockpile..................................          965,000           995,000           965,000   ................          -30,000
 
Pandemic Influenza Preparedness:
    Pandemic Influenza Preparedness...........................          327,991           374,991           301,991           -26,000           -73,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal Research, Development, and Procurement.......        3,062,991         3,215,123         3,056,991            -6,000          -158,132
 
       Operations, Preparedness, and Emergency Response
 
Operations....................................................           34,376            69,867            34,376   ................          -35,491
H-Core........................................................           75,000            82,801            50,000           -25,000           -32,801
Preparedness and Emergency Operations.........................           31,154            31,300            31,154   ................             -146
National Disaster Medical System..............................           96,904           130,030            96,904   ................          -33,126
 
Hospital Preparedness Program:
    Formula Grants............................................          305,055           312,055           305,055   ................           -7,000
Policy and Planning...........................................           14,877            21,417            14,877   ................           -6,540
Medical Reserve Corps.........................................            6,240             6,240             6,240   ................  ................
Preparedness and Response Innovation..........................            3,080             3,080             3,080   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Operations and Emergency Response...............          566,686           656,790           541,686           -25,000          -115,104
 
                 Manufacturing and Production
 
Pandemic Preparedness and Biodefense..........................  ................          400,000   ................  ................         -400,000
Pandemic Preparedness and Biodefense (emergency)..............  ................  ................           75,000           +75,000           +75,000
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Manufacturing and Production....................  ................          400,000            75,000           +75,000          -325,000
                                                               -----------------------------------------------------------------------------------------
    Total, Administration for Strategic Preparedness and              3,629,677         4,271,913         3,673,677           +44,000          -598,236
     Response.................................................
                                                               =========================================================================================
 
                    OFFICE OF THE SECRETARY
 
                General Departmental Management
 
General Departmental Management, Federal Funds................          221,169           287,345           221,169   ................          -66,176
Teen Pregnancy Prevention Community Grants....................          101,000           111,000           101,000   ................          -10,000
    Evaluation Tap Funding....................................           (6,800)           (7,892)           (6,800)  ................          (-1,092)
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Teen Pregnancy Prevention Community Grants,           107,800           118,892           107,800   ................          -11,092
         program level........................................
 
Sexual Risk Avoidance.........................................           35,000   ................           35,000   ................          +35,000
Office of Minority Health.....................................           74,835            85,835            74,835   ................          -11,000
Office on Women's Health......................................           44,140            44,140            44,140   ................  ................
Minority HIV/AIDS Fund........................................           60,000            60,000            60,000   ................  ................
Embryo Adoption Awareness Campaign............................            1,000             1,000             1,000   ................  ................
Electric Vehicle Program......................................  ................           22,000   ................  ................          -22,000
Planning and Evaluation, Evaluation Tap Funding...............          (58,028)          (85,354)          (58,028)  ................         (-27,326)
                                                               -----------------------------------------------------------------------------------------
    Total, General Departmental Management....................          537,144           611,320           537,144   ................          -74,176
                                                               =========================================================================================
    (Evaluation Tap Funding)..................................          (64,828)          (93,246)          (64,828)  ................         (-28,418)
                                                               -----------------------------------------------------------------------------------------
    Total, General Departmental Management fiscal year program          601,972           704,566           601,972   ................         -102,594
     level....................................................
                                                               =========================================================================================
Medicare Hearings and Appeals.................................          196,000           199,000           196,000   ................           -3,000
Office of the National Coordinator for Health Information       ................  ................  ................  ................  ................
 Technology...................................................
    Evaluation Tap Funding....................................          (66,238)         (103,614)          (71,238)          (+5,000)         (-32,376)
                                                               -----------------------------------------------------------------------------------------
        Total, Program Level..................................           66,238           103,614            71,238            +5,000           -32,376
                                                               =========================================================================================
 
                  Office of Inspector General
 
Inspector General Federal Funds...............................           87,000           116,801            87,000   ................          -29,801
 
                    Office for Civil Rights
 
Federal Funds.................................................           39,798            78,000            39,798   ................          -38,202
Customer Experience...........................................  ................           20,000   ................  ................          -20,000
 
 Retirement Pay and Medical Benefits for Commissioned Officers
 
Retirement Payments...........................................          573,441           657,647           657,647           +84,206   ................
Survivors Benefits............................................           35,964            37,681            37,681            +1,717   ................
Dependents' Medical Care......................................          100,922            97,363            97,363            -3,559   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Medical benefits for commissioned officers.........          710,327           792,691           792,691           +82,364   ................
                                                               =========================================================================================
 
   Public Health and Social Services Emergency Fund (PHSSEF)
 
Assistant Secretary for Administration:
    Cybersecurity.............................................          100,000           188,326           100,000   ................          -88,326
    Other PHSSEF--Cybersecurity...............................           21,900   ................  ................          -21,900   ................
    Office of National Security...............................            8,983            11,983             8,983   ................           -3,000
Office of the Assistant Secretary of Health...................  ................           20,000   ................  ................          -20,000
Public Health Emergency Fund..................................  ................           50,000   ................  ................          -50,000
Office of Global Affairs Pandemic Preparedness................            7,009             8,009             7,009   ................           -1,000
                                                               -----------------------------------------------------------------------------------------
    Total, PHSSEF.............................................          137,892           278,318           115,992           -21,900          -162,326
                                                               =========================================================================================
    Total, Office of the Secretary............................        1,708,161         2,096,130         1,768,625           +60,464          -327,505
                                                               =========================================================================================
        Federal Funds.........................................       (1,512,161)       (1,897,130)       (1,572,625)         (+60,464)        (-324,505)
        Trust Funds...........................................         (196,000)         (199,000)         (196,000)  ................          (-3,000)
    (Evaluation Tap Funding)..................................         (131,066)         (196,860)         (136,066)          (+5,000)         (-60,794)
                                                               -----------------------------------------------------------------------------------------
    Total, Office of the Secretary Program Level..............        1,839,227         2,292,990         1,904,691           +65,464          -388,299
                                                               =========================================================================================
    Total, Title II, Department of Health and Human Services..    1,250,732,063     1,278,339,772     1,266,744,593       +16,012,530       -11,595,179
                                                               =========================================================================================
        Federal Funds.........................................    1,245,902,877     1,272,572,260     1,261,893,407       +15,990,530       -10,678,853
            Appropriations....................................   (1,038,547,403)   (1,022,191,846)   (1,007,392,993)     (-31,154,410)     (-14,798,853)
            Emergency appropriations..........................       (5,275,000)  ................       (4,120,000)      (-1,155,000)      (+4,120,000)
            Advance appropriations, FY 2025...................     (202,080,474)     (250,380,414)     (250,380,414)     (+48,299,940)  ................
        Trust Funds...........................................       (4,829,186)       (5,767,512)       (4,851,186)         (+22,000)        (-916,326)
    CURES Act.................................................       (1,085,000)         (407,000)         (407,000)        (-678,000)  ................
    Prevention and Public Health Fund.........................         (943,000)       (1,225,900)       (1,225,900)        (+282,900)  ................
 
              TITLE III--DEPARTMENT OF EDUCATION
 
                EDUCATION FOR THE DISADVANTAGED
 
Grants to Local Educational Agencies (LEAs)...................  ................  ................  ................  ................  ................
 
    Basic Grants:
        Appropriations from prior year advances...............          763,776           763,776           763,776   ................  ................
        Forward funded........................................        5,690,625         5,690,625         5,690,625   ................  ................
        Current appropriation.................................            5,000             5,000             5,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Basic Grants available this fiscal year.        5,695,625         5,695,625         5,695,625   ................  ................
 
    Advance appropriations, FY 2025...........................          763,776           763,776           763,776   ................  ................
    less appropriations available from prior year advances....         -763,776          -763,776          -763,776   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Basic Grants, appropriated in this bill.        6,459,401         6,459,401         6,459,401   ................  ................
 
    Concentration Grants:
        Appropriations from prior year advances...............        1,362,301         1,362,301         1,362,301   ................  ................
        Advance appropriations FY 2025........................        1,362,301         1,362,301         1,362,301   ................  ................
        less appropriations provided from prior year advances.       -1,362,301        -1,362,301        -1,362,301   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Concentration Grants, appropriated in           1,362,301         1,362,301         1,362,301   ................  ................
             this bill........................................
 
    Targeted Grants:
        Appropriations from prior year advances...............        4,357,550         4,357,550         4,357,550   ................  ................
        Forward funded........................................          925,000         2,000,000         1,012,500           +87,500          -987,500
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Targeted Grants available this fiscal           5,282,550         6,357,550         5,370,050           +87,500          -987,500
             year.............................................
 
        Advance appropriations FY 2025........................        4,357,550         4,357,550         4,357,550   ................  ................
        less appropriations provided from prior year advances.       -4,357,550        -4,357,550        -4,357,550   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Targeted Grants, appropriated in this           5,282,550         6,357,550         5,370,050           +87,500          -987,500
             bill.............................................
 
    Education Finance Incentive Grants:
        Appropriations from prior year advances...............        4,357,550         4,357,550         4,357,550   ................  ................
        Forward Funded........................................          925,000         2,000,000         1,012,500           +87,500          -987,500
        Advance appropriations, FY 2025.......................        4,357,550         4,357,550         4,357,550   ................  ................
        less appropriations provided from prior year advances.       -4,357,550        -4,357,550        -4,357,550   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Education Finance Incentive Grants,             5,282,550         6,357,550         5,370,050           +87,500          -987,500
             appropriated in this bill........................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Grants to LEAs, fiscal year program            18,386,802        20,536,802        18,561,802          +175,000        -1,975,000
             level............................................
 
Innovative Approaches to Literacy.............................           30,000            30,000            30,000   ................  ................
Comprehensive literacy development grants.....................          194,000           194,000           194,000   ................  ................
 
State Agency Programs:
    Migrant...................................................          375,626           375,626           375,626   ................  ................
    Neglected and Delinquent/High Risk Youth..................           49,239            52,000            49,239   ................           -2,761
                                                               -----------------------------------------------------------------------------------------
        Subtotal, State Agency programs.......................          424,865           427,626           424,865   ................           -2,761
 
Special Programs for Migrant Students.........................           52,123            66,123            52,123   ................          -14,000
                                                               -----------------------------------------------------------------------------------------
    Total, Education for the disadvantaged....................       19,087,790        21,254,551        19,262,790          +175,000        -1,991,761
                                                               =========================================================================================
        Current year appropriations...........................       (8,246,613)      (10,413,374)       (8,421,613)        (+175,000)      (-1,991,761)
            (Forward Funded)..................................       (8,159,490)      (10,312,251)       (8,334,490)        (+175,000)      (-1,977,761)
        Advance appropriations................................      (10,841,177)      (10,841,177)      (10,841,177)  ................  ................
 
                          IMPACT AID
 
Basic Support Payments........................................        1,468,242         1,468,242         1,477,000            +8,758            +8,758
Payments for Children with Disabilities.......................           48,316            48,316            48,316   ................  ................
Facilities Maintenance (Sec 8008).............................            4,835             4,835             4,835   ................  ................
Construction (Sec 8007).......................................           18,406            18,406            19,000              +594              +594
Payments for Federal Property (Sec 8002)......................           78,313            78,313            79,000              +687              +687
                                                               -----------------------------------------------------------------------------------------
    Total, Impact aid.........................................        1,618,112         1,618,112         1,628,151           +10,039           +10,039
                                                               =========================================================================================
 
                  SCHOOL IMPROVEMENT PROGRAMS
 
Supporting Effective Instruction State Grants.................          508,639           508,639           508,639   ................  ................
    Appropriations from prior year advances...................        1,681,441         1,681,441         1,681,441   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Supporting Effective Instruction State              2,190,080         2,190,080         2,190,080   ................  ................
         Grants available this fiscal year....................
 
    Advance appropriations, FY 2025...........................        1,681,441         1,681,441         1,681,441   ................  ................
    less appropriations provided from prior year advances.....       -1,681,441        -1,681,441        -1,681,441   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Supporting Effective Instruction State              2,190,080         2,190,080         2,190,080   ................  ................
         Grants appropriated in this bill.....................
 
Supplemental Education Grants.................................           24,464   ................           24,464   ................          +24,464
Nita M Lowey 21st Century Community Learning Centers..........        1,329,673         1,329,673         1,329,673   ................  ................
State Assessments.............................................          390,000           469,100           380,000           -10,000           -89,100
Education for Homeless Children and Youth.....................          129,000           129,000           129,000   ................  ................
Training and Advisory Services (Civil Rights).................            6,575             6,575             6,575   ................  ................
Education for Native Hawaiians................................           45,897            45,897            45,897   ................  ................
Alaska Native Education Equity................................           44,953            44,953            44,953   ................  ................
Rural Education...............................................          215,000           215,000           220,000            +5,000            +5,000
Comprehensive Centers.........................................           55,000            55,000            50,000            -5,000            -5,000
Student Support and Academic Enrichment grants................        1,380,000         1,405,000         1,400,000           +20,000            -5,000
                                                               -----------------------------------------------------------------------------------------
    Total, School Improvement Programs........................        5,810,642         5,890,278         5,820,642           +10,000           -69,636
                                                               =========================================================================================
        Current year appropriations...........................       (4,129,201)       (4,208,837)       (4,139,201)         (+10,000)         (-69,636)
            (Forward Funded)..................................       (3,952,312)       (4,056,412)       (3,967,312)         (+15,000)         (-89,100)
        Advance appropriations................................       (1,681,441)       (1,681,441)       (1,681,441)  ................  ................
 
                       SCHOOL READINESS
 
Preschool Incentive Demonstration Program (legislative          ................          500,000   ................  ................         -500,000
 proposal)....................................................
 
                       INDIAN EDUCATION
 
Grants to Local Educational Agencies..........................          110,381           117,381           110,381   ................           -7,000
 
Federal Programs:
    Special Programs for Indian Children......................           72,000            72,000            72,000   ................  ................
    National Activities.......................................           12,365            12,365            12,365   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Federal Programs............................           84,365            84,365            84,365   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Indian Education...................................          194,746           201,746           194,746   ................           -7,000
                                                               =========================================================================================
 
                  INNOVATION AND IMPROVEMENT
 
Education Innovation and Research.............................          284,000           405,000           240,000           -44,000          -165,000
American History and Civics Academies.........................            3,000   ................            3,000   ................           +3,000
American History and Civics National Activities...............           20,000            73,000            20,000   ................          -53,000
School Leader Recruitment and Support.........................  ................           40,000   ................  ................          -40,000
Charter Schools Grants........................................          440,000           440,000           440,000   ................  ................
Magnet Schools Assistance.....................................          139,000           149,000           139,000   ................          -10,000
Congressionally Directed Spending/Community Project Funding...          200,443   ................           87,344          -113,099           +87,344
Teacher and School Leader Incentive Grants....................          173,000           200,000           120,000           -53,000           -80,000
Ready-to-Learn Television.....................................           31,000            31,000            31,000   ................  ................
Supporting Effective Educator Development (SEED)..............           90,000            93,000            90,000   ................           -3,000
Arts in Education.............................................           36,500            36,500            30,000            -6,500            -6,500
Javits Gifted and Talented Students...........................           16,500            16,500            16,500   ................  ................
Statewide Family Engagement Centers...........................           20,000            20,000            20,000   ................  ................
Fostering Diverse Schools (legislative proposal)..............  ................          100,000   ................  ................         -100,000
                                                               -----------------------------------------------------------------------------------------
    Total, Innovation and Improvement.........................        1,453,443         1,604,000         1,236,844          -216,599          -367,156
                                                               =========================================================================================
 
            SAFE SCHOOLS AND CITIZENSHIP EDUCATION
 
Promise Neighborhoods.........................................           91,000           106,000            91,000   ................          -15,000
School Safety National Activities.............................          216,000           601,000           196,000           -20,000          -405,000
    Bipartisan Safer Communities Act (PL 117-159) (prior year          (200,000)         (200,000)         (200,000)  ................  ................
     emergency advance).......................................
Full-Service Community Schools................................          150,000           368,000           150,000   ................         -218,000
                                                               -----------------------------------------------------------------------------------------
    Total, Safe Schools and Citizenship Education.............          457,000         1,075,000           437,000           -20,000          -638,000
                                                               =========================================================================================
    Total, Safe Schools and Citizenship Education, program              657,000         1,275,000           637,000           -20,000          -638,000
     level (with emergencies).................................
                                                               =========================================================================================
 
                 ENGLISH LANGUAGE ACQUISITION
 
Current year appropriations...................................           57,850            95,600            58,305              +455           -37,295
Forward funded................................................          832,150         1,099,400           838,695            +6,545          -260,705
                                                               -----------------------------------------------------------------------------------------
    Total, English Language Acquisition.......................          890,000         1,195,000           897,000            +7,000          -298,000
                                                               =========================================================================================
 
                       SPECIAL EDUCATION
 
State Grants:
    Grants to States Part B current year......................        4,910,321         6,975,810         5,085,321          +175,000        -1,890,489
        Part B advance from prior year........................       (9,283,383)       (9,283,383)       (9,283,383)  ................  ................
    Grants to States Part B (FY 2024).........................        9,283,383         9,283,383         9,283,383   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, program level...............................       14,193,704        16,259,193        14,368,704          +175,000        -1,890,489
 
    Preschool Grants..........................................          420,000           502,620           420,000   ................          -82,620
    Grants for Infants and Families...........................          540,000           932,000           560,000           +20,000          -372,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, program level...............................       15,153,704        17,693,813        15,348,704          +195,000        -2,345,109
 
IDEA National Activities (current funded):
    State Personnel Development...............................           38,630            53,630            38,630   ................          -15,000
    Technical Assistance and Dissemination....................           45,345            55,345            39,345            -6,000           -16,000
    Personnel Preparation.....................................          115,000           250,000           134,500           +19,500          -115,500
    Parent Information Centers................................           33,152            49,152            33,152   ................          -16,000
    Educational Technology, Media, and Materials..............           31,433            41,433            31,433   ................          -10,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, IDEA National Activities....................          263,560           449,560           277,060           +13,500          -172,500
 
Special Olympics Education Programs...........................           36,000            36,000            36,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Special education..................................       15,453,264        18,179,373        15,661,764          +208,500        -2,517,609
                                                               =========================================================================================
        Current Year appropriations...........................       (6,169,881)       (8,895,990)       (6,378,381)        (+208,500)      (-2,517,609)
            (Forward Funded)..................................       (5,870,321)       (8,410,430)       (6,065,321)        (+195,000)      (-2,345,109)
        Advance appropriations................................       (9,283,383)       (9,283,383)       (9,283,383)  ................  ................
 
                    REHABILITATION SERVICES
 
Vocational Rehabilitation State Grants........................        3,949,707         4,253,834         4,253,834          +304,127   ................
Client Assistance State grants................................           13,000            15,000            13,000   ................           -2,000
Training......................................................           29,388            29,388            29,388   ................  ................
Demonstration and Training programs...........................            5,796             7,296             5,796   ................           -1,500
Protection and Advocacy of Individual Rights [PAIR]...........           20,150            20,150            20,150   ................  ................
Supported Employment State grants.............................           22,548            22,548            22,548   ................  ................
Services for Older Blind Individuals..........................           33,317            38,317            33,317   ................           -5,000
Helen Keller National Center for Deaf/Blind Youth and.........  ................  ................  ................  ................  ................
    Adults....................................................           19,000            19,000            19,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Rehabilitation Services........................        4,092,906         4,405,533         4,397,033          +304,127            -8,500
                                                               =========================================================================================
            (Discretionary)...................................         (143,199)         (151,699)         (143,199)  ................          (-8,500)
            (Mandatory).......................................       (3,949,707)       (4,253,834)       (4,253,834)        (+304,127)  ................
 
      SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
 
American Printing House for the Blind.........................           43,431            43,431            43,431   ................  ................
 
National Technical Institute for the Deaf [NTID]:
    Operations................................................           92,500            92,500            92,500   ................  ................
 
Gallaudet University:
    Operations................................................          165,361           165,361           165,361   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Special Institutions for Persons with                    301,292           301,292           301,292   ................  ................
         Disabilities.........................................
                                                               =========================================================================================
 
            CAREER, TECHNICAL, AND ADULT EDUCATION
 
Career Education:
    Basic State Grants:
        State Grants..........................................          638,848           682,312           678,848           +40,000            -3,464
        Appropriations available from prior year advances.....          791,000           791,000           791,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Total, Basic State Grants, fiscal year program            1,429,848         1,473,312         1,469,848           +40,000            -3,464
             level............................................
                                                               =========================================================================================
        Advance appropriations, FY 2025.......................          791,000           791,000           791,000   ................  ................
        less appropriations provided in prior years...........         -791,000          -791,000          -791,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Basic State Grants appropriated in this         1,429,848         1,473,312         1,469,848           +40,000            -3,464
             bill.............................................
 
    National Programs.........................................           32,421           215,421            12,421           -20,000          -203,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Career Education............................        1,462,269         1,688,733         1,482,269           +20,000          -206,464
 
Adult Education:
    State Grants/Adult Basic and Literacy Education:
        State Grants, forward funded..........................          715,455           715,455           715,455   ................  ................
    National Leadership Activities............................           13,712            43,712            13,712   ................          -30,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Adult education.............................          729,167           759,167           729,167   ................          -30,000
                                                               -----------------------------------------------------------------------------------------
        Total, Career, Technical, and Adult Education.........        2,191,436         2,447,900         2,211,436           +20,000          -236,464
                                                               =========================================================================================
            Current Year appropriations.......................       (1,400,436)       (1,656,900)       (1,420,436)         (+20,000)        (-236,464)
                (Forward Funded)..............................       (1,400,436)       (1,656,900)       (1,420,436)         (+20,000)        (-236,464)
            Advance appropriations............................         (791,000)         (791,000)         (791,000)  ................  ................
 
                 STUDENT FINANCIAL ASSISTANCE
 
Pell Grants--maximum grant (NA)...............................           (6,335)           (6,835)           (6,585)            (+250)            (-250)
Pell Grants...................................................       22,475,352        24,275,352        22,475,352   ................       -1,800,000
Federal Supplemental Educational Opportunity Grants...........          910,000           910,000           900,000           -10,000           -10,000
Federal Work Study............................................        1,230,000         1,230,000         1,220,000           -10,000           -10,000
                                                               -----------------------------------------------------------------------------------------
    Total, Student Financial Assistance.......................       24,615,352        26,415,352        24,595,352           -20,000        -1,820,000
                                                               =========================================================================================
 
                  STUDENT AID ADMINISTRATION
 
Salaries and Expenses.........................................        1,058,943         1,205,412           996,667           -62,276          -208,745
Servicing Activities..........................................          975,000         1,448,622         1,187,276          +212,276          -261,346
                                                               -----------------------------------------------------------------------------------------
    Total, Student Aid Administration.........................        2,033,943         2,654,034         2,183,943          +150,000          -470,091
                                                               =========================================================================================
 
         FREE COMMUNITY COLLEGE AND TUITION SUBSIDIES
 
Accelerated Success: Free Community College...................  ................          500,000   ................  ................         -500,000
 
                       HIGHER EDUCATION
 
Aid for Institutional Development:
    Strengthening Institutions................................          122,070           209,007           112,070           -10,000           -96,937
    Hispanic-Serving Institutions.............................          227,751           236,732           231,547            +3,796            -5,185
    Promoting Postbaccalaureate Opportunities for Hispanic               27,314            28,845            27,769              +455            -1,076
     Americans................................................
    Strengthening Historically Black Colleges (HBCUs).........          395,986           402,619           402,585            +6,599               -34
    Strengthening Historically Black Graduate Institutions....          100,782           102,313           102,462            +1,680              +149
    Strengthening Predominantly Black Institutions............           22,300            23,218            22,672              +372              -546
    Strengthening Asian American and Native American Pacific             18,589            20,120            18,899              +310            -1,221
     Islander-Serving Institutions............................
    Strengthing Alaska Native and Native Hawaiian-Serving                24,433            25,044            24,840              +407              -204
     Institutions.............................................
    Strengthening Native American-Serving Nontribal                      11,405            12,120            11,595              +190              -525
     Institutions.............................................
    Strengthening Tribal Colleges.............................           51,549            53,080            52,408              +859              -672
    Strengthening HBCU Masters programs.......................           19,937            20,956            20,269              +332              -687
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Aid for Institutional Development...........        1,022,116         1,134,054         1,027,116            +5,000          -106,938
 
International Education and Foreign Language:
    Domestic Programs.........................................           75,353            75,353            75,353   ................  ................
    Overseas Programs.........................................           10,311            10,311            10,311   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, International Education and Foreign Language           85,664            85,664            85,664   ................  ................
 
Transition and Postsecondary Programs for Students with                  13,800            15,180            13,800   ................           -1,380
 Intellectual Disabilities....................................
Minority Science and Engineering Improvement..................           16,370            18,370            16,370   ................           -2,000
Tribally Controlled Postsec Voc/Tech Institutions.............           11,953            11,953            11,953   ................  ................
Federal TRIO Programs.........................................        1,191,000         1,297,761         1,191,000   ................         -106,761
GEAR UP.......................................................          388,000           408,000           388,000   ................          -20,000
Graduate Assistance in Areas of National Need.................           23,547            23,547            23,547   ................  ................
Teacher Quality Partnerships..................................           70,000           132,092            83,000           +13,000           -49,092
Child Care Access Means Parents in School.....................           75,000            95,000            80,000            +5,000           -15,000
Fund for the Improvement of Postsecondary Ed (FIPSE)..........          613,587           725,000           324,979          -288,608          -400,021
Congressionally Directed Spending/Community Project Funding            (429,587)  ................         (202,979)        (-226,608)        (+202,979)
 (non-add)....................................................
Hawkins Centers of Excellence.................................           15,000            30,000            15,000   ................          -15,000
Graduate Fellowships to Prepare Faculty.......................  ................           10,000   ................  ................          -10,000
                                                               -----------------------------------------------------------------------------------------
    Total, Higher Education...................................        3,526,037         3,986,621         3,260,429          -265,608          -726,192
                                                               =========================================================================================
 
                       HOWARD UNIVERSITY
 
Academic Program..............................................          223,288           223,288           223,288   ................  ................
Endowment Program.............................................            3,405             3,405             3,405   ................  ................
Howard University Hospital....................................          127,325           120,325            77,325           -50,000           -43,000
                                                               -----------------------------------------------------------------------------------------
    Total, Howard University..................................          354,018           347,018           304,018           -50,000           -43,000
                                                               =========================================================================================
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM.........              298               321               298   ................              -23
 
        HISTORICALLY BLACK COLLEGE AND UNIVERSITY [HBCU]
 
               CAPITAL FINANCING PROGRAM ACCOUNT
 
HBCU Federal Administration...................................              528               600               528   ................              -72
HBCU Loan Subsidies...........................................           20,150            20,150            20,150   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, HBCU Capital Financing Program.....................           20,678            20,750            20,678   ................              -72
                                                               =========================================================================================
 
             INSTITUTE OF EDUCATION SCIENCES (IES)
 
Research, Development and Dissemination.......................          245,000           291,877           245,000   ................          -46,877
Statistics....................................................          121,500           127,000           121,500   ................           -5,500
Regional Educational Laboratories.............................           58,733            60,733            53,733            -5,000            -7,000
Research in Special Education.................................           64,255            64,255            64,255   ................  ................
Special Education Studies and Evaluations.....................           13,318            13,318            13,318   ................  ................
Statewide Data Systems........................................           38,500            38,500            28,500           -10,000           -10,000
 
Assessment:
    National Assessment.......................................          185,000           189,000           185,000   ................           -4,000
    National Assessment Governing Board.......................            7,799             9,300             8,300              +501            -1,000
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Assessment..................................          192,799           198,300           193,300              +501            -5,000
 
Program Administration........................................           73,500            76,885            73,500   ................           -3,385
                                                               -----------------------------------------------------------------------------------------
    Total, Institute of Education Sciences....................          807,605           870,868           793,106           -14,499           -77,762
                                                               =========================================================================================
 
                    DEPARTMENTAL MANAGEMENT
 
Program Administration:
    Salaries and Expenses.....................................          419,907           508,359           419,907   ................          -88,452
    Building Modernization....................................            7,000            19,250   ................           -7,000           -19,250
                                                               -----------------------------------------------------------------------------------------
        Total, Program administration.........................          426,907           527,609           419,907            -7,000          -107,702
                                                               =========================================================================================
Office for Civil Rights.......................................          140,000           177,600           140,000   ................          -37,600
Office of Inspector General...................................           67,500            87,497            67,500   ................          -19,997
                                                               -----------------------------------------------------------------------------------------
    Total, Departmental management............................          634,407           792,706           627,407            -7,000          -165,299
                                                               =========================================================================================
    Total, Title III, Department of Education.................       83,542,969        94,260,455        83,833,929          +290,960       -10,426,526
                                                               =========================================================================================
        Current Year appropriations...........................      (60,945,968)      (71,663,454)      (61,236,928)        (+290,960)     (-10,426,526)
        Advance appropriations................................      (22,597,001)      (22,597,001)      (22,597,001)  ................  ................
 
                  TITLE IV--RELATED AGENCIES
 
COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY             13,124            15,400            13,124   ................           -2,276
 DISABLED.....................................................
    Office of Inspector General...............................           (3,150)           (3,600)           (3,150)  ................            (-450)
 
        CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
 
                      Operating Expenses
 
Domestic Volunteer Service Programs:
    Volunteers in Service to America [VISTA]..................          103,285           141,626           103,285   ................          -38,341
 
    National Senior Volunteer Corps:
        Foster Grandparents Program...........................          125,363           143,450           125,363   ................          -18,087
        Senior Companion Program..............................           56,449            63,809            56,449   ................           -7,360
        Retired Senior Volunteer Program......................           55,105            55,105            55,105   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Senior Volunteer Corps..................          236,917           262,364           236,917   ................          -25,447
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Domestic Volunteer Service..................          340,202           403,990           340,202   ................          -63,788
 
National and Community Service Programs:
    AmeriCorps State and National Grants......................          557,094           650,834           557,094   ................          -93,740
    Innovation, Assistance, and Other Activities..............           14,706            14,706            14,706   ................  ................
    Evaluation................................................            6,250             6,250             6,250   ................  ................
    National Civilian Community Corps (subtitle E)............           37,735            43,300            37,735   ................           -5,565
    State Commission Support Grants...........................           19,538            19,538            19,538   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, National and Community Service..............          635,323           734,628           635,323   ................          -99,305
                                                               -----------------------------------------------------------------------------------------
    Total, Operating expenses.................................          975,525         1,138,618           975,525   ................         -163,093
                                                               =========================================================================================
National Service Trust........................................          230,000           213,000           180,000           -50,000           -33,000
Salaries and Expenses.........................................           99,686           118,434            99,686   ................          -18,748
Office of Inspector General...................................            7,595             8,572             7,595   ................             -977
                                                               -----------------------------------------------------------------------------------------
    Total, Corporation for National and Community Service.....        1,312,806         1,478,624         1,262,806           -50,000          -215,818
                                                               =========================================================================================
 
CORPORATION FOR PUBLIC BROADCASTING:
Appropriation available from FY 2022 advance..................          475,000           525,000           525,000           +50,000   ................
                                                               -----------------------------------------------------------------------------------------
    Total, available this fiscal year.........................          475,000           525,000           525,000           +50,000   ................
                                                               =========================================================================================
    Advance appropriation, FY 2026............................          535,000           575,000           535,000   ................          -40,000
    less appropriations provided from prior year advances (FY          -475,000          -525,000          -525,000           -50,000   ................
     2022)....................................................
    Public television interconnection system..................           60,000            60,000            60,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total CPB, appropriated in this bill......................          595,000           635,000           595,000   ................          -40,000
                                                               =========================================================================================
Federal Mediation and Conciliation Service....................           53,705            55,815            53,705   ................           -2,110
Federal Mine Safety and Health Review Commission..............           18,012            18,657            18,012   ................             -645
Institute of Museum and Library Services......................          294,800           294,800           289,800            -5,000            -5,000
Medicaid and CHIP Payment and Access Commission...............            9,405            10,053             9,405   ................             -648
Medicare Payment Advisory Commission..........................           13,824            13,824            13,824   ................  ................
National Council on Disability................................            3,850             3,850             3,850   ................  ................
National Labor Relations Board................................          299,224           376,163           299,224   ................          -76,939
National Mediation Board......................................           15,113            15,601            15,113   ................             -488
Occupational Safety and Health Review Commission..............           15,449            16,179            15,449   ................             -730
 
                   RAILROAD RETIREMENT BOARD
 
Dual Benefits Payments Account................................            9,000             8,000             8,000            -1,000   ................
    Less Income Tax Receipts on Dual Benefits.................           -1,000            -1,000            -1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Dual Benefits...............................            8,000             7,000             7,000            -1,000   ................
 
Federal Payments to the Railroad Retirement Accounts..........              150               150               150   ................  ................
Limitation on administrative expenses.........................          128,000           138,575           128,000   ................          -10,575
Limitation on the Office of Inspector General.................           14,000            14,600            14,000   ................             -600
                                                               -----------------------------------------------------------------------------------------
    Total, Railroad Retirement Board..........................          150,150           160,325           149,150            -1,000           -11,175
                                                               =========================================================================================
 
                SOCIAL SECURITY ADMINISTRATION
 
Payments to Social Security Trust Funds.......................           11,000            10,000            10,000            -1,000   ................
 
             Supplemental Security Income Program
 
Federal Benefit Payments......................................       59,225,000        56,328,000        56,328,000        -2,897,000   ................
Beneficiary Services..........................................          124,000           137,000           137,000           +13,000   ................
Research and Demonstration....................................           86,000            91,000            91,000            +5,000   ................
Administration................................................        4,774,338         4,961,853         4,805,145           +30,807          -156,708
                                                               -----------------------------------------------------------------------------------------
    Subtotal, available this fiscal year......................       64,209,338        61,517,853        61,361,145        -2,848,193          -156,708
 
Less appropriations provided from prior year advances.........      -15,600,000       -15,800,000       -15,800,000          -200,000   ................
                                                               -----------------------------------------------------------------------------------------
    Subtotal, current year appropriation......................       48,609,338        45,717,853        45,561,145        -3,048,193          -156,708
                                                               -----------------------------------------------------------------------------------------
    Subtotal, Mandatory.......................................       43,835,000        40,756,000        40,756,000        -3,079,000   ................
 
Advance appropriations, 1st quarter, FY 2025..................       15,800,000        21,700,000        21,700,000        +5,900,000   ................
                                                               -----------------------------------------------------------------------------------------
    Total, SSI program appropriated in this bill..............       64,409,338        67,417,853        67,261,145        +2,851,807          -156,708
                                                               =========================================================================================
 
             Limitation on Administrative Expenses
 
OASI/DI Trust Funds...........................................        5,840,734         6,567,231         5,938,485           +97,751          -628,746
HI/SMI Trust Funds............................................        3,075,880         3,430,858         3,132,598           +56,718          -298,260
Social Security Advisory Board................................            2,700             3,020             2,700   ................             -320
SSI...........................................................        3,282,664         3,467,091         3,343,195           +60,531          -123,896
                                                               -----------------------------------------------------------------------------------------
    Subtotal..................................................       12,201,978        13,468,200        12,416,978          +215,000        -1,051,222
 
User Fees:
    SSI User Fee activities...................................          140,000           150,000           150,000           +10,000   ................
    SSPA User Fee Activities..................................            1,000             1,000             1,000   ................  ................
        CBO adjustment........................................           -1,000            -1,000            -1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
            Subtotal, User fees...............................          140,000           150,000           150,000           +10,000   ................
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Limitation on administrative expenses.......       12,341,978        13,618,200        12,566,978          +225,000        -1,051,222
 
Program Integrity:
    OASDI Trust Funds.........................................          292,326           375,238           389,050           +96,724           +13,812
    SSI.......................................................        1,491,674         1,494,762         1,461,950           -29,724           -32,812
                                                               -----------------------------------------------------------------------------------------
        Subtotal, Program integrity funding...................        1,784,000         1,870,000         1,851,000           +67,000           -19,000
 
            Base Program Integrity............................         (273,000)         (287,000)         (273,000)  ................         (-14,000)
            Program Integrity (cap adjustment)................       (1,511,000)       (1,583,000)       (1,578,000)         (+67,000)          (-5,000)
                                                               -----------------------------------------------------------------------------------------
        Total, Limitation on Administrative Expenses..........       14,125,978        15,488,200        14,417,978          +292,000        -1,070,222
                                                               =========================================================================================
        Total, Limitation on Administrative Expenses (less           13,985,978        15,338,200        14,267,978          +282,000        -1,070,222
         user fees)...........................................
                                                               =========================================================================================
 
                  Office of Inspector General
 
Federal Funds.................................................           32,000            34,000            32,000   ................           -2,000
Trust Funds...................................................           82,665            86,400            82,665   ................           -3,735
                                                               -----------------------------------------------------------------------------------------
    Total, Office of Inspector General........................          114,665           120,400           114,665   ................           -5,735
                                                               =========================================================================================
Adjustment: Trust fund transfers from general revenues........       -4,774,338        -4,961,853        -4,805,145           -30,807          +156,708
                                                               -----------------------------------------------------------------------------------------
    Total, Social Security Administration.....................       73,886,643        78,074,600        76,998,643        +3,112,000        -1,075,957
                                                               =========================================================================================
        Federal funds.........................................      (64,592,338)      (67,611,853)      (67,453,145)      (+2,860,807)        (-158,708)
            Current year......................................      (48,792,338)      (45,911,853)      (45,753,145)      (-3,039,193)        (-158,708)
            New advances, 1st quarter, FY 2024................      (15,800,000)      (21,700,000)      (21,700,000)      (+5,900,000)  ................
        Trust funds...........................................       (9,294,305)      (10,462,747)       (9,545,498)        (+251,193)        (-917,249)
                                                               -----------------------------------------------------------------------------------------
    Total, Title IV, Related Agencies.........................       76,681,105        81,168,891        79,737,105        +3,056,000        -1,431,786
                                                               =========================================================================================
        Federal Funds.........................................      (67,230,976)      (70,539,145)      (70,035,783)      (+2,804,807)        (-503,362)
            Current Year......................................      (50,895,976)      (48,264,145)      (47,800,783)      (-3,095,193)        (-463,362)
            FY 2025 Advance...................................      (15,800,000)      (21,700,000)      (21,700,000)      (+5,900,000)  ................
            FY 2026 Advance...................................         (535,000)         (575,000)         (535,000)  ................         (-40,000)
        Trust Funds...........................................       (9,450,129)      (10,629,746)       (9,701,322)        (+251,193)        (-928,424)
 
                   DISCRETIONARY ADJUSTMENTS
 
Traditional Medicare Program..................................          455,000   ................          455,000   ................         +455,000
National Labor Relations Board Moving Expenses................  ................  ................           10,000           +10,000           +10,000
    Less advances for subsequent years........................      -24,904,001       -24,944,001       -24,904,001   ................          +40,000
    Less advance emergency appropriations.....................  ................  ................  ................  ................  ................
    Plus advances provided in prior years.....................       24,844,001        24,894,001        24,894,001           +50,000   ................
    Plus emergency advances provided in prior years...........          494,500           494,500           494,500   ................  ................
    Average Weekly Insured Unemployment (AWIU) Contingent.....           40,000           100,000            20,000           -20,000           -80,000
    Medicare Eligible Accruals (permanent,indefinite).........           37,000            42,000            42,000            +5,000   ................
    SSI User Fee Collection...................................         -140,000          -150,000          -150,000           -10,000   ................
        CBO adjustment........................................           -5,000             6,000             6,000           +11,000   ................
    Surplus property (Department of Labor)....................            2,000             2,000             2,000   ................  ................
    H-1B (rescission) (DOL)...................................         -142,000   ................         -206,000           -64,000          -206,000
Dislocated Worker National Reserve............................  ................  ................         -100,000          -100,000          -100,000
    Nonrecurring expenses fund (rescission)...................         -650,000          -350,000        -1,000,000          -350,000          -650,000
American Rescue Plan COVID Balances (rescission)..............  ................  ................         -850,000          -850,000          -850,000
Child Enrollment Contingency Fund.............................      -14,628,000       -19,193,000       -19,193,000        -4,565,000   ................
    Pell unobligated balances (rescission)....................         -360,000   ................         -200,000          +160,000          -200,000
    Pell: Increase maximum award..............................           75,000            85,000            50,000           -25,000           -35,000
    Pell max award (rescission)...............................          -75,000           -62,000           -50,000           +25,000           +12,000
    CNCS National Service Trust (rescission)..................  ................         -210,000          -243,000          -243,000           -33,000
    Performance Bonus Payments................................  ................      -10,732,000        -5,031,000        -5,031,000        +5,701,000
    CBO adjustment: Extension of Parolee Eligibility Public               1,000   ................  ................           -1,000   ................
     Law 117-180 (Sec 149)(emergency).........................
    Refugee and Entrant Assistance Contingency Fund...........          360,000   ................  ................         -360,000   ................
    Refugee and Entrant Assistance Contingency Fund             ................        4,650,000           380,000          +380,000        -4,270,000
     (emergency)..............................................
Proceeds from Job Corps facilities (Sec 114)..................  ................            1,000   ................  ................           -1,000
                                                               -----------------------------------------------------------------------------------------
    Total, Discretionary adjustments..........................      -15,050,500       -25,366,500       -26,038,500       -10,988,000          -672,000
                                                               =========================================================================================
 
                     OTHER APPROPRIATIONS
 
       THE INFRASTRUCTURE INVESTMENT AND JOBS ACT, 2022
 
                      (Public Law 117-58)
 
                  DIVISION J--APPROPRIATIONS
 
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
           Administration for Children and Families
 
Low Income Home Energy Assistance:
    Appropriations available from prior year (emergency)......          100,000           100,000           100,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
        Total, Low Income Home Energy Assistance..............          100,000           100,000           100,000   ................  ................
                                                               =========================================================================================
    Total, Infrastructure Investment and Jobs Act.............          100,000           100,000           100,000   ................  ................
                                                               =========================================================================================
 
 BIPARTISAN SAFER COMMUNITIES SUPPLEMENTAL APPROPRIATIONS ACT,
                             2022
 
                     (Public Law 117-159)
 
                  DIVISION B--APPROPRIATIONS
 
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
Health Workforce (by transfer) (emergency)....................          (12,000)          (12,000)          (12,000)  ................  ................
Maternal and Child Health (by transfer) (emergency)...........          (20,000)          (20,000)          (20,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Health Resources and Services Administration.......           32,000            32,000            32,000   ................  ................
                                                               =========================================================================================
 
   Substance Abuse and Mental Health Services Administration
 
Health Surveillance and Program Support:
    Appropriations available from prior year advances                   162,500           162,500           162,500   ................  ................
     (emergency)..............................................
                                                               -----------------------------------------------------------------------------------------
        Total, Health Surveillance and Program Support........          162,500           162,500           162,500   ................  ................
                                                               =========================================================================================
 
                    Office of the Secretary
 
Public Health and Social Services Emergency Fund:
    (transfer out) (emergency)................................         (-32,000)         (-32,000)         (-32,000)  ................  ................
    Appropriations available from prior year advances                    32,000            32,000            32,000   ................  ................
     (emergency)..............................................
                                                               -----------------------------------------------------------------------------------------
        Total, Public Health and Social Services Emergency               32,000            32,000            32,000   ................  ................
         Fund.................................................
                                                               =========================================================================================
    Total Department of Health and Human Services.............          194,500           194,500           194,500   ................  ................
                                                               =========================================================================================
 
                    DEPARTMENT OF EDUCATION
 
Safe Schools and Citizenship Education:
    Appropriations available from prior year advances                   200,000           200,000           200,000   ................  ................
     (emergency)..............................................
                                                               -----------------------------------------------------------------------------------------
        Total, Safe Schools and Citizenship Education.........          200,000           200,000           200,000   ................  ................
                                                               =========================================================================================
        Total, Bipartisan Safer Communities Supplemetal                 394,500           394,500           394,500   ................  ................
         Appriations Act, 2022................................
                                                               =========================================================================================
 
   ADDITIONAL UKRAINE SUPPLEMENTAL APPROPRIATIONS ACT, 2023
 
                (Public Law 117-328 DIVISION M)
 
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
           Administration for Children and Families
 
Refugee and Entrant Assistance (emergency)....................        2,400,000   ................  ................       -2,400,000   ................
 
                General Provisions--This Title
 
Afghan resettlement (Sec 1501) (emergency)....................            9,000   ................  ................           -9,000   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Additional Ukraine Supplemental Appropriations Act,        2,409,000   ................  ................       -2,409,000   ................
     2023.....................................................
                                                               =========================================================================================
 
     DISASTER RELIEF SUPPLEMENTAL APPROPRIATIONS ACT, 2023
 
                (Public Law 117-328 DIVISION N)
 
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
          Centers for Disease Control and Prevention
 
CDC-Wide Activities and Program Support (emergency)...........           86,000   ................  ................          -86,000   ................
 
                 National Institutes of Health
 
National Institute of Environmental Health Sciences                       2,500   ................  ................           -2,500   ................
 (emergency)..................................................
Office of the Director (emergency)............................           25,000   ................  ................          -25,000   ................
                                                               -----------------------------------------------------------------------------------------
    Total, National Institutes of Health......................           27,500   ................  ................          -27,500   ................
                                                               =========================================================================================
 
           Administration for Children and Families
 
Low Income Energy Assistance (emergency)......................        1,000,000   ................  ................       -1,000,000   ................
Payments to States for the Child Care and Development Block             100,000   ................  ................         -100,000   ................
 Grant (emergency)............................................
Children and Families Services Programs (emergency)...........          408,000   ................  ................         -408,000   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Administration for Children and Families...........        1,508,000   ................  ................       -1,508,000   ................
                                                               =========================================================================================
 
                    Office of the Secretary
 
Public Health and Social Services Emergency Fund (emergency)..          128,792   ................  ................         -128,792   ................
                                                               -----------------------------------------------------------------------------------------
    Total, Disaster Relief Supplemental Appropriations Act,           1,750,292   ................  ................       -1,750,292   ................
     2023.....................................................
                                                               =========================================================================================
Less prior year appropriations (emergency)....................         -494,500          -494,500          -494,500   ................  ................
                                                               -----------------------------------------------------------------------------------------
    Total, Other Appropriations...............................        4,159,292   ................  ................       -4,159,292   ................
                                                               =========================================================================================
Less prior year appropriations (emergency)....................  ................  ................  ................  ................  ................
                                                               -----------------------------------------------------------------------------------------
Grand Total...................................................    1,430,661,909     1,470,554,232     1,445,830,783       +15,168,874       -24,723,449
                                                               =========================================================================================
    Appropriations............................................   (1,185,495,784)   (1,177,588,043)   (1,151,017,067)     (-34,478,717)     (-26,570,976)
    Emergency appropriations..................................       (9,435,292)       (4,650,000)       (4,500,000)      (-4,935,292)        (-150,000)
    Trust funds...............................................      (18,644,609)      (21,409,275)      (18,960,802)        (+316,193)      (-2,448,473)
    Advance Appropriations, FY 25.............................     (242,259,725)     (296,456,415)     (296,456,415)     (+54,196,690)  ................
    Advance appropriations, FY 26.............................         (535,000)         (575,000)         (535,000)  ................         (-40,000)
21st Century CURES Act funding................................       (1,085,000)         (407,000)         (407,000)        (-678,000)  ................
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