Centers for Disease Control and Prevention: Changes in		 
Obligations and Activities before and after Fiscal Year 2005	 
Budget Reorganization (25-FEB-08, GAO-08-328R). 		 
                                                                 
Congress asked us to examine issues regarding changes in	 
obligations for administrative activities--generally conducted in
CDC's leadership and management levels--and public health	 
programs--generally conducted in CDC's division level--before and
after the organizational restructuring and budget reorganization.
GAO examined the following questions: 1. How were obligations	 
distributed between CDC's division level and CDC's leadership and
management levels from fiscal years 2003 through 2006? 2. How	 
have obligations and activities at CDC's leadership and 	 
management levels--including shared business services in the CDC 
Office of the Director--changed from fiscal year 2003 through	 
fiscal year 2006? 3. How have obligations and activities at CDC's
division level changed from fiscal years 2003 through 2006?The	 
Centers for Disease Control and Prevention's (CDC) mission is to 
promote health and quality of life by preventing and controlling 
disease, injury, and disability. In fiscal year 2005, CDC, an	 
agency within the Department of Health and Human Services (HHS), 
completed its first major organizational restructuring in more	 
than 25 years, known as the Futures Initiative, as part of its	 
efforts to prioritize its strategies, programs, resources, and	 
needs. In accordance with the conference report accompanying its 
2005 appropriation, CDC also implemented a new internal budget	 
reporting structure that specifically identifies funding	 
obligated for leadership and management activities. However,	 
questions have been raised concerning whether changing the budget
reporting structure has made it difficult to compare obligations 
over time for leadership and management activities and for public
health program activities. Prior to the fiscal year 2005	 
organizational restructuring, CDC consisted of an Office of the  
Director and national centers that housed CDC's public health	 
programs, including programs to reduce or prevent infectious	 
diseases, cancer, birth defects, injuries, and other health	 
problems. CDC had two organizational levels that were primarily  
responsible for leadership and management: the CDC Office of the 
Director and the national center directors' offices. In fiscal	 
year 2005, CDC added two national centers. CDC also added a new  
leadership and management organizational level, which consists of
six coordinating centers designed to better integrate the work of
the national centers. Four of the six coordinating centers each  
manage the work of two or more specific national centers, while  
the other two coordinating centers each manage agencywide issues 
related to global health and terrorism preparedness and emergency
response. Adding coordinating centers to CDC's structure was	 
consistent with our 2004 recommendation that CDC oversee the	 
national centers' programmatic work at a level below that of the 
CDC Director. In addition to its leadership and management	 
levels, CDC has one organizational level--consisting of the	 
national center divisions, branches, and other units--that is	 
primarily responsible for operating public health programs. In	 
this report, we refer to this level as CDC's division level. You 
asked us to examine issues regarding changes in obligations for  
administrative activities--generally conducted in CDC's 	 
leadership and management levels--and public health		 
programs--generally conducted in CDC's division level--before and
after the organizational restructuring and budget reorganization.
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-328R					        
    ACCNO:   A80993						        
  TITLE:     Centers for Disease Control and Prevention: Changes in   
Obligations and Activities before and after Fiscal Year 2005	 
Budget Reorganization						 
     DATE:   02/25/2008 
  SUBJECT:   Acquired immunodeficiency syndrome 		 
	     Budget obligations 				 
	     Disease control					 
	     Disease detection or diagnosis			 
	     Diseases						 
	     Information technology				 
	     Organizational change				 
	     Public health					 
	     Strategic planning 				 
	     Futures Initiative 				 

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GAO-08-328R

   

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February 25, 2008: 

The Honorable Henry A. Waxman: 
Chairman: 
Committee on Oversight and Government Reform: 
House of Representatives: 

Subject: Centers for Disease Control and Prevention: Changes in 
Obligations and Activities before and after Fiscal Year 2005 Budget 
Reorganization: 

Dear Mr. Chairman: 

The Centers for Disease Control and Prevention's (CDC) mission is to 
promote health and quality of life by preventing and controlling 
disease, injury, and disability. In fiscal year 2005, CDC, an agency 
within the Department of Health and Human Services (HHS), completed its 
first major organizational restructuring in more than 25 years, known 
as the Futures Initiative, as part of its efforts to prioritize its 
strategies, programs, resources, and needs.[Footnote 1] In accordance 
with the conference report accompanying its 2005 appropriation, CDC 
also implemented a new internal budget reporting structure that 
specifically identifies funding obligated for leadership and management 
activities. However, questions have been raised concerning whether 
changing the budget reporting structure has made it difficult to 
compare obligations over time for leadership and management activities 
and for public health program activities.[Footnote 2] 

Prior to the fiscal year 2005 organizational restructuring, CDC 
consisted of an Office of the Director and national centers that housed 
CDC's public health programs, including programs to reduce or prevent 
infectious diseases, cancer, birth defects, injuries, and other health 
problems.[Footnote 3] CDC had two organizational levels that were 
primarily responsible for leadership and management:[Footnote 4] the 
CDC Office of the Director and the national center directors' offices. 
In fiscal year 2005, CDC added two national centers. CDC also added a 
new leadership and management organizational level, which consists of 
six coordinating centers designed to better integrate the work of the 
national centers.[Footnote 5] Four of the six coordinating centers each 
manage the work of two or more specific national centers, while the 
other two coordinating centers each manage agencywide issues related to 
global health and terrorism preparedness and emergency response. Adding 
coordinating centers to CDC's structure was consistent with our 2004 
recommendation that CDC oversee the national centers' programmatic work 
at a level below that of the CDC Director.[Footnote 6] In addition to 
its leadership and management levels, CDC has one organizational level-
-consisting of the national center divisions, branches, and other 
units--that is primarily responsible for operating public health 
programs. In this report, we refer to this level as CDC's division 
level. (See table 1.) 

Table 1: CDC's Organizational Levels: 

Prior to fiscal year 2005: Leadership and management levels: CDC Office 
of the Director: * Immediate Office of the Director[A]; 
* CDC-wide shared business services[B]; 
National center directors' offices. 

Beginning in fiscal year 2005: Leadership and management levels: CDC 
Office of the Director:  * Immediate Office of the Director[A]; 
* CDC-wide shared business services[B]; 
Coordinating centers; 
National center directors' offices[C]. 

Prior to fiscal year 2005: Division level: National center divisions, 
branches, and other units. 

Beginning in fiscal year 2005: Division level: National center 
divisions, branches, and other units[C]. 

Source: GAO analysis of information from CDC. 

[A] The immediate Office of the Director consists of the offices that 
report to the CDC director. 

[B] Shared business services are agencywide administrative services, 
such as rent, utilities, security, maintenance, contract and grants 
administration, financial management, information technology, human 
resources, telecommunications, and postage. 

[C] In fiscal year 2005, CDC established two additional national 
centers. 

[End of table] 

Under CDC's new budget reporting structure, the agency began allocating 
funding for staff and activities at its leadership and management 
levels under two new elements within CDC's Disease Control, Research, 
and Training account, titled "Public Health Improvement and Leadership" 
and "Business Services Support." Each of these elements is a Program, 
Project, or Activity (PPA).[Footnote 7] Under the previous structure in 
effect through fiscal year 2004, funds for CDC's leadership and 
management levels, including shared business services[Footnote 8] in 
the CDC Office of the Director, were derived from a combination of 
CDC's "Office of the Director" 

PPA and indirect cost allocations[Footnote 9] against other CDC units, 
primarily from the division level. The "Office of the Director" PPA and 
the indirect cost allocations were eliminated as part of the budget 
reorganization. 

You asked us to examine issues regarding changes in obligations for 
administrative activities--generally conducted in CDC's leadership and 
management levels--and public health programs--generally conducted in 
CDC's division level--before and after the organizational restructuring 
and budget reorganization. In response to your request, we examined the 
following questions: 

1. How were obligations distributed between CDC's division level and 
CDC's leadership and management levels from fiscal years 2003 through 
2006? 

2. How have obligations and activities at CDC's leadership and 
management levels--including shared business services in the CDC Office 
of the Director--changed from fiscal year 2003 through fiscal year 
2006? 

3. How have obligations and activities at CDC's division level changed 
from fiscal years 2003 through 2006? 

To address these questions about CDC's implementation of its budget 
reorganization in fiscal year 2005, we obtained and analyzed 
obligations data at CDC's leadership and management levels and at CDC's 
division level from fiscal year 2003 through fiscal year 2006.[Footnote 
10] Our work was limited to CDC's discretionary budget, which 
constituted about 77 percent of CDC's total budget in fiscal year 
2006.[Footnote 11] We reviewed documents, including those related to 
relevant legislation and CDC's budget and obligations, and interviewed 
officials from CDC's Financial Management Office and from CDC's 
leadership and management levels to understand changes in obligations. 
Although administrative activities are generally conducted at 
leadership and management levels and public health programs are 
generally conducted at the division level, some administrative and 
public health activities are conducted at each CDC level. Therefore, we 
also examined the types of activities conducted at each level. In 
addition, to examine obligations at CDC's national centers in greater 
detail, we selected five national centers and their related funding 
sources, based on changes in obligations from fiscal year: 

2003 through fiscal year 2006.[Footnote 12] Specifically, we selected 
the two national centers' PPAs or their subcategories with the largest 
increases in obligations, the two with the largest decreases, and one 
with a small overall change. To better understand changes in 
obligations over time, we also adjusted CDC obligations data from 
fiscal year 2003 through fiscal year 2006 for inflation using the Gross 
Domestic Product (GDP) price index. We compared the adjusted 
obligations data to the unadjusted obligations data, particularly for 
the division level, because the effect of inflation was greater there 
than at the leadership and management levels. Throughout this report, 
we present unadjusted obligations data, unless otherwise noted. To 
assess the reliability of the obligations data provided by CDC, we (1) 
performed electronic testing for obvious errors in accuracy and 
completeness, (2) reviewed related documentation, including contractor 
reports concerning the data, and (3) worked closely with agency 
officials to reconcile questions about the data before conducting our 
analyses. We did not find any errors, and therefore we determined that 
the data were sufficiently reliable for the purposes of our report. Our 
review focused on how obligations and activities shifted among CDC's 
organizational levels over time and not whether these changes resulted 
in improved efficiency or effectiveness. We conducted our work from May 
2007 to January 2008 in accordance with generally accepted government 
auditing standards. For more information on our scope and methodology, 
see enclosure III. 

Results in Brief: 

The distribution of obligations between CDC's division level, which is 
primarily responsible for carrying out public health programs, and its 
leadership and management levels remained relatively stable from fiscal 
year 2003 through fiscal year 2006. Obligations at CDC's division level 
accounted for between 87 and 89 percent of CDC's obligations in each 
year, while obligations at CDC's leadership and management levels 
accounted for between 8 and 9 percent of CDC obligations. Obligations 
for buildings and facilities, which are not considered part of CDC's 
division level or CDC's leadership and management levels because they 
generally consist of onetime capital expenses, accounted for the 
remaining portion of CDC obligations. Overall, CDC's obligations 
increased from $6.05 billion in fiscal year 2003 to $6.14 billion in 
fiscal year 2006. Obligations at leadership and management levels 
fluctuated from about $483 million in fiscal year 2003 to a high of 
about $592 million in fiscal year 2004, before ending at $516 million 
in fiscal year 2006, as obligations and activities such as shared 
business services were consolidated in the CDC Office of the Director. 
Obligations at CDC's division level remained between about $5.4 billion 
and about $5.6 billion, despite the movement of some activities to the 
division level from leadership and management levels and the movement 
of some administrative activities from the division level to the 
leadership and management levels. However, after adjusting for 
inflation, from fiscal year 2003 to fiscal year 2006, obligations 
declined at the division level to a greater extent than at the 
leadership and management levels. 

We received written comments on a draft of this report from HHS. In its 
comments, HHS interpreted our findings to suggest that its 2005 
organizational restructuring has had limited or no impact on funding 
available for public health program activities. However, because it is 
difficult to separate the effects of the organizational restructuring, 
inflation, or other factors on obligations for public health program 
activities, we did not draw this conclusion. We did note that, after 
adjusting for inflation, obligations at CDC's division level declined 
more than obligations at CDC's leadership and management levels from 
fiscal year 2003 to fiscal year 2006. HHS's written comments are 
reprinted in enclosure IV. HHS also provided technical comments, which 
we incorporated as appropriate. 

Background: 

Under CDC's new structure, the agency's organization consists of the 
CDC Office of the Director, coordinating centers, and national centers. 
The coordinating centers include the Coordinating Office for Global 
Health, the Coordinating Office for Terrorism Preparedness and 
Emergency Response, the Coordinating Center for Environmental Health 
and Injury Prevention, the Coordinating Center for Health Information 
and Service, the Coordinating Center for Health Promotion, and the 
Coordinating Center for Infectious Diseases. Coordinating centers are 
intended to allow CDC's scientists to collaborate and innovate across 
organizational boundaries, improve efficiency, and improve the internal 
services that support and develop CDC staff. Four of these coordinating 
centers oversee the activities at multiple national centers. In 
addition to establishing coordinating centers, CDC added two new 
national centers, the National Center for Public Health Informatics and 
the National Center for Health Marketing. (Encl. I contains CDC's 
organizational chart.) 

For fiscal year 2005, CDC restructured the 13 PPAs in its Disease 
Control, Research, and Training budget account into 10 PPAs to 
correspond with its new organizational structure and, in accordance 
with language in the Senate and conference reports accompanying its 
2005 appropriation, to separate actual program costs from management 
and administrative costs.[Footnote 13] The new Public Health 
Improvement and Leadership PPA includes obligations for staff and 
activities at each of CDC's three leadership and management 
organizational levels.[Footnote 14] The new Business Services Support 
PPA includes obligations in the CDC Office of the Director on shared 
business services that benefit the entire agency. In addition, CDC 
consolidated the PPAs that it uses to track funding for its public 
health programs, creating new PPAs and subcategories to correspond with 
the newly created coordinating centers. (See encl. II for a list of 
PPAs and their subcategories before and after CDC's budget 
reorganization.) 

The Distribution of Obligations between CDC's Division Level and Its 
Leadership and Management Levels Remained Relatively Stable: 

The distribution of obligations between CDC's division level, primarily 
responsible for operating CDC's public health programs, and its 
leadership and management levels remained relatively stable from fiscal 
year 2003 through fiscal year 2006. CDC's total obligations were about 
$6.05 billion in fiscal year 2003, $6.24 billion in fiscal year 2004, 
$6.28 billion in fiscal year 2005, and $6.14 billion in fiscal year 
2006. Obligations at CDC's division level accounted for between 87 and 
89 percent of CDC's total obligations in each year. Obligations at 
CDC's leadership and management levels accounted for between 8 and 9 
percent of its total obligations in each year. The remaining 2 to 3 
percent of CDC's obligations were for the purchase and construction of 
buildings and facilities, which are not considered part of CDC's 
division level or CDC's leadership and management levels because they 
generally consist of onetime capital expenses. Figure 1 indicates CDC's 
total obligations from fiscal year 2003 through fiscal year 2006, 
broken out according to obligations at the division level, obligations 
at leadership and management levels, and obligations for buildings and 
facilities. 

Figure 1: CDC's Obligations by Level, Fiscal Year 2003 through Fiscal 
Year 2006: 

This figure is a combination bar graph showing CDC's obligations by 
level, fiscal year 2003 through fiscal year 2006. The X axis represents 
the fiscal year, and the Y axis represents dollars (in millions). The 
bars represent total buildings and facilities obligations, total-
leadership-and management-level obligations, and total division-level 
obligations. 

[See PDF for image] 

Source: GAO analysis of CDC data. 

Note: CDC's division level consists of the national center divisions, 
branches, and other units. In fiscal year 2003 and fiscal year 2004, 
CDC's leadership and management levels consisted of the CDC Office of 
the Director and the national center directors' offices. As of fiscal 
year 2005, CDC's leadership and management levels also include the 
coordinating centers. 

[End of figure] 

Obligations within CDC's Leadership and Management Levels Have 
Increased, and Obligations and Activities Have Been Consolidated in the 
CDC Office of the Director: 

Total obligations at CDC's leadership and management levels, which 
include the CDC Office of the Director, coordinating centers, and 
national center directors' offices, have fluctuated and increased 
overall, from $483 million in fiscal year 2003 to $516 million in 
fiscal year 2006. During this time, obligations and activities within 
the leadership and management levels were consolidated in the CDC 
Office of the Director. Obligations and activities at national center 
directors' offices have decreased, while obligations and activities at 
the CDC Office of the Director have increased as a result of the 
consolidation. Several activities previously performed in national 
center directors' offices were consolidated in the CDC Office of the 
Director, moved to the division level, or discontinued, thereby 
affecting obligations at these levels. Obligations for some public 
health program activities were part of the CDC Office of the Director 
from fiscal year 2003 through fiscal year 2006. In addition, 
obligations for shared business services within the CDC Office of the 
Director, which include the majority of obligations at CDC's leadership 
and management levels, have fluctuated and increased overall as new 
services, including information technology services, have been 
consolidated from other components throughout CDC. 

Overall Obligations within CDC's Leadership and Management Levels Have 
Increased, and Obligations Have Been Consolidated in the CDC Office of 
the Director: 

Obligations at leadership and management levels from fiscal year 2003 
through fiscal year 2006 have fluctuated but increased overall by about 
6.9 percent. This increase is greater than the increase in CDC's total 
obligations, which rose by about 1.5 percent over the same period. It 
is also greater than the increase in obligations at CDC's division 
level, which rose by about 1.9 percent over the same period. 
Specifically, obligations at leadership and management levels increased 
from about $483 million in fiscal year 2003 to about $592 million in 
fiscal year 2004, but then decreased to about $530 million in fiscal 
year 2005 and about $516 million in fiscal year 2006. Figure 2 shows 
the obligations at CDC's three leadership and management levels from 
fiscal year 2003 through fiscal year 2006. 

Figure 2: CDC Obligations at Leadership and Management Levels, Fiscal 
Years 2003 through 2006: 

This figure is a combination bar graph showing CDC obligations at 
leadership and management levels, fiscal year 2003 through 2006. The X 
axis represents the fiscal year, and the Y axis represents dollars (in 
millions). 

CDC Office of the Director: Fiscal year 2003: 328; 
CDC Office of the Director: Fiscal year 2004: 402; 
CDC Office of the Director: Fiscal year 2005: 389; 
CDC Office of the Director: Fiscal year 2006: 408. 

Coordinating centers: Fiscal year 2003: [Empty]; 
Coordinating centers: Fiscal year 2004: [Empty]; 
Coordinating centers: Fiscal year 2005: 19; 
Coordinating centers: Fiscal year 2006: 28. 

National center directors' offices: Fiscal year 2003: 155; 
National center directors' offices: Fiscal year 2004: 190; 
National center directors' offices: Fiscal year 2005: 122; 
National center directors' offices: Fiscal year 2006: 80. 

[See PDF for image] 

Note: CDC's coordinating centers were established in fiscal year 2005. 

[End of figure] 

As shown in figure 2, obligations within CDC's leadership and 
management levels increased at the CDC Office of the Director and at 
coordinating centers but decreased at national center directors' 
offices. The portion of CDC's total leadership-and management-level 
obligations in the CDC Office of the Director increased from 68 percent 
in fiscal year 2003 to 79 percent in fiscal year 2006. This percentage 
increase corresponded to an increase in CDC Office of the Director 
obligations from $328 million in fiscal year 2003 to $408 million in 
fiscal year 2006. The portion of CDC's total leadership-and management- 
level obligations that was part of CDC national center directors' 
offices decreased from 32 percent in fiscal year 2003 to 15 percent in 
fiscal year 2006. This decrease corresponded with a decline in 
obligations at national center directors' offices from $155 million in 
fiscal year 2003 to $80 million in fiscal year 2006. The portion of 
leadership and management level obligations in coordinating centers, 
which were established in fiscal year 2005, was 4 percent or $19 
million in fiscal year 2005 and 5 percent or $28 million in fiscal year 
2006. 

Obligations at national center directors' offices decreased for four of 
the five PPAs that we examined in detail. (See fig. 3.) The decreases 
in these four PPAs ranged from about 42 percent or $4 million for Birth 
Defects, Developmental Disabilities, Disability and Health to about 68 
percent or $24 million for Chronic Disease Prevention and Health 
Promotion from fiscal year 2003 through fiscal year 2006. 

Figure 3: Leadership-and Management-Level Obligations at National 
Center Directors' Offices for Selected PPAs, Fiscal Years 2003 through 
2006: 

This figure is a combination of five bar graphs. The X axis represents 
the fiscal year, and the Y axis represents dollars in millions. 

HIV/AIDS, STD, and TB Prevention(Funding for the National Center for 
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally reported 
under this PPA.) 

Fiscal year 2003: $21.7; 
Fiscal year 2004: $17.8; 
Fiscal year 2005: $9.1; 
Fiscal year 2006: $6.9. 

Infectious Disease Control(Funding for the National Center for 
Preparedness, Detection, and Control of Infectious Diseases is 
generally reported under this PPA.)

Fiscal year 2003: $28.3; 
Fiscal year 2004: $25.1; 
Fiscal year 2005: $23.8; 
Fiscal year 2006: $11.3. 

Chronic Disease Prevention and Health Promotion (Funding for the 
National Center for Chronic Disease Prevention and Health Promotion is 
generally reported under this PPA.) 

Fiscal year 2003: $35.6; 
Fiscal year 2004: $44.2; 
Fiscal year 2005: $33.5; 
Fiscal year 2006: $11.5. 

Birth Defects, Develop-mental Disabilities, Disability and 
Health(Funding for the National Center on Birth Defects and 
Developmental Disabilities is generally reported under this PPA.) 

Fiscal year 2003: $9.6; 
Fiscal year 2004: $11.8; 
Fiscal year 2005: $9.1; 
Fiscal year 2006: $5.6. 

Occupational Safety and Health(Funding for the National Center for 
Occupational Safety and Health is generally reported under this PPA.) 

Fiscal year 2003: $5.3; 
Fiscal year 2004: $5.6; 
Fiscal year 2005: $9.8; 
Fiscal year 2006: $7.1. 

[See PDF for image] 

Source: GAO analysis of CDC data. 

Note: With the exception of Occupational Safety and Health, these PPAs 
became subcategories of newly established broader PPAs in fiscal year 
2005 due to the reorganization of CDC's budget. See enclosure II for 
the full list of changes to CDC's PPAs. 

[End of figure] 

Several Activities Previously Performed in National Center Directors' 
Offices Have Moved or Been Discontinued: 

Some administrative activities and public health program functions 
previously performed in national center directors' offices have been 
consolidated in the CDC Office of the Director, moved to the division 
level, or discontinued. CDC officials told us that it was common for 
public health program functions to be placed in national center 
directors' offices in fiscal year 2003 and fiscal year 2004 because 
these offices had funding available to them that could be utilized for 
program functions. It has become less common for program functions to 
be placed in national center directors' offices as funding levels for 
national center directors' offices have declined, leading to program 
functions being moved or discontinued. CDC officials provided the 
following examples of these changes in activities. 

Consolidated in the CDC Office of the Director--CDC officials indicated 
that some administrative activities that were previously performed in 
national center directors' offices were consolidated into the CDC 
Office of the Director. For example, budget analysts had been 
distributed throughout CDC, including the national center directors' 
offices. CDC consolidated its budget analysts in the CDC Office of the 
Director as part of the Financial Management Office in fiscal year 
2005, contributing to an increase in financial management obligations 
at the CDC Office of the Director level from about $17 million in 
fiscal year 2004 to about $34 million in fiscal year 2005. 

Moved from National Center Directors' Offices--CDC officials in five 
national centers also provided examples of public health program 
functions that were moved from national center directors' offices to 
the division level in fiscal year 2005 and fiscal year 2006, including 
the following: 

* Antimicrobial Resistance Program functions, previously housed in the 
director's office of the National Center for Infectious Diseases, were 
moved to the Division of Healthcare Quality Promotion in fiscal years 
2005 and 2006. Obligations for these program functions totaled $7.7 
million in fiscal year 2004 and decreased to $3.1 million in fiscal 
year 2006. 

* Functions of the Emerging Infections Office/Program, which were 
previously located in the director's office of the National Center for 
Infectious Diseases, were moved to the Division of Emerging Infections 
and Surveillance Services in fiscal years 2005 and 2006. Obligations 
for these program functions totaled $33 million in fiscal year 2004 and 
decreased to $22 million in fiscal year 2006. 

* The National AIDS Clearing House, which was previously located in the 
director's office of the National Center for HIV, STD, and TB 
Prevention,[Footnote 15] was moved to the National Center for Health 
Marketing in fiscal year 2005. Obligations for this program function 
totaled $9.5 million in fiscal year 2004 and remained at the same level 
for fiscal year 2006. 

Discontinued Activities That Had Been in National Center Directors' 
Offices--Other activities were discontinued from national center 
directors' offices. For example, the alcohol activity grant and global 
health evaluation projects were located in the director's office of the 
National Center for Chronic Disease Prevention and Health Promotion. In 
fiscal year 2004, obligations for these programs totaled $100,000 and 
$205,000, respectively. These activities were discontinued in fiscal 
year 2006. CDC officials stated that CDC does not keep data on the 
total amount of obligations for public health programs in national 
center directors' offices. However, the amount of obligations for 
grants--one type of program obligations--in national center directors' 
offices decreased from about $28.8 million in fiscal year 2004 to $1.1 
million in fiscal year 2006. CDC officials told us that most of this 
decrease was due to programs being moved to divisions or discontinued, 
but that some program-related activities were moved to the CDC Office 
of the Director. An additional $700,000 in obligations for grants 
occurred at the coordinating centers in fiscal year 2006, and 
obligations for grants at the CDC Office of the Director increased from 
about $1.2 million in fiscal year 2004 to about $3.8 million in fiscal 
year 2006. As a result, the net decrease in obligations for grants at 
CDC's leadership and management levels was about 81 percent from fiscal 
years 2004 to 2006. 

Some Additional Obligations for Public Health Program Activities Were 
Part of the CDC Office of the Director in Fiscal Years 2005 and 2006: 

In addition to obligations for grants, some other public health program 
obligations became part of the CDC Office of the Director in fiscal 
years 2005 and 2006. About $2.2 million of the director's discretionary 
fund was used to finance public heath programs concerning influenza and 
obesity in fiscal year 2005, and about $3.3 million was used to finance 
public health programs concerning infant mortality and other issues in 
fiscal year 2006. Furthermore, $19.6 million in fiscal year 2005 and 
$18.5 million in fiscal year 2006 from the Office of Workforce and 
Career Development, part of the CDC Office of the Director, were used 
for workforce and career development activities within CDC's public 
health programs. These amounts constitute a relatively small percentage 
of overall obligations for the CDC Office of the Director, which were 
$389 million in fiscal year 2005 and $408 million in 2006. 

Obligations for Shared Business Services within the CDC Office of the 
Director Have Fluctuated and Increased Overall as New Services Have 
Been Consolidated: 

Obligations for shared business services within the CDC Office of the 
Director--which included between 58 and 62 percent of the obligations 
at CDC's leadership and management levels--have fluctuated and 
increased overall as new services, particularly information technology 
services, have been moved from other components within CDC and 
consolidated in that office. From fiscal year 2003 through fiscal year 
2006, obligations on shared business services have fluctuated from 
about $278 million, or 4.6 percent of CDC's total obligations in fiscal 
year 2003, to about $353 million, or 5.7 percent of CDC's total 
obligations in fiscal year 2004. Obligations for shared business 
services peaked in fiscal year 2004 and have since declined to about 
$318 million in fiscal year 2006. (See fig. 4.) 

Figure 4: Obligations on Shared Business Services in the CDC Office of 
the Director, Fiscal Year 2003 through Fiscal Year 2006: 

This figure is a combination bar graph showing obligations on shared 
business services in the CDC Office of the Director, fiscal year 2003 
through fiscal year 2006. The X axis represents the fiscal year, and 
the Y axis represents dollars (in millions). The bars represent 
information technology services; telecommunications; HHS assessments 
and support costs, postage; General Services Administration vehicles; 
General Services Administration rental payments, lease purchases, 
maintenance costs, utilities, and security; and all other shared 
business services. 

[See PDF for image] 

Source: GAO analysis of CDC data. 

[End of figure] 

Shared business services were centrally located as part of the CDC 
Office of the Director in each year from fiscal year 2003 through 
fiscal year 2006 even though the method for funding them changed in 
fiscal year 2005. Beginning in that year, CDC started using its newly 
created Business Services Support PPA to allocate funding for these 
services.[Footnote 16] Although shared business services have been part 
of the CDC Office of the Director in each year, the types of services 
and the amount of obligations for shared business services have changed 
over time, in part due to functions moving between the CDC Office of 
the Director and the national centers. As shown in figure 4, the 
largest fluctuations in obligations on shared business services from 
fiscal years 2003 through 2006 were for CDC's information technology 
services. However, the CDC information technology offices included 
within CDC's shared business services have changed from year to year, 
and CDC officials told us that changes in services provided by these 
offices were largely responsible for the fluctuations in obligations. 
The information technology offices that were part of shared business 
services during this period were the Information Resource Management 
Office (IRMO), the Information Technology Service Office (ITSO), the 
Office of the Chief Information Officer (OCIO), and the Management 
Information Systems Office (MISO). See table 2 for the offices that CDC 
included in its shared business services in each fiscal year and how 
the corresponding obligations have fluctuated. 

Table 2: Information Technology Offices Included in CDC's Shared 
Business Services and Corresponding Obligation Levels, Fiscal Year 2003 
through Fiscal Year 2006: 

Information technology offices included in CDC's shared business 
services; 
Fiscal year 2003: 
* Information Resource Management Office (IRMO); 
Fiscal year 2004: 
* IRMO; 
* Information Technology Service Office (ITSO); 
* Office of the Chief Information Officer (OCIO); 
Fiscal year 2005: 
* ITSO; 
* OCIO; 
* Management Information Systems Office (MISO); 
Fiscal year 2006: 
* ITSO; 
* OCIO; 
* MISO. 

CDC obligations for these offices; 
Fiscal year 2003: $34.5 million; 
Fiscal year 2004: $89.3 million; 
Fiscal year 2005: $65.1 million; 
Fiscal year 2006: $59.1 million. 

Source: GAO analysis of CDC data. 

Note: In fiscal year 2005, IRMO was eliminated. Its functions were 
moved into ITSO, OCIO, MISO, and the National Center for Public Health 
Informatics. 

[End of table] 

Information technology personnel were moved from other components 
within CDC and consolidated into the newly created ITSO in fiscal year 
2004, contributing to the increase in obligations in CDC's information 
technology offices from about $35 million in fiscal year 2003 to about 
$89 million in fiscal year 2004. Although IRMO was CDC's primary 
centralized information technology organization in fiscal year 2003, 
the majority of information technology obligations, approximately $57 
million, were outside of the CDC Office of the Director in the division 
level and directors' offices of national centers. In fiscal year 2004 
when ITSO was formed within the CDC Office of the Director, these 
decentralized information technology obligations were consolidated to 
form ITSO and several related functions within IRMO. IRMO was 
eliminated for fiscal year 2005 and its functions were moved into ITSO, 
OCIO, and MISO. About an additional $21 million was moved out of the 
CDC Office of the Director to the National Center for Public Health 
Informatics, contributing to the decrease in shared business services 
information technology obligations from about $89 million in fiscal 
year 2004 to about $65 million in fiscal year 2005. 

Obligations at CDC's Division Level Remained Generally Stable from 
Fiscal Year 2003 through Fiscal Year 2006 but Have Declined When 
Adjusted for Inflation: 

Obligations at CDC's division level, which includes most CDC public 
health programs, remained generally stable from fiscal year 2003 
through fiscal year 2006. Division level obligations increased by 1.9 
percent from fiscal year 2003 through fiscal year 2006, from about $5.4 
billion to about $5.5 billion. This increase is similar to the increase 
in CDC's total obligations, which rose 1.5 percent over the same 
period. However, after adjusting for inflation, from fiscal year 2003 
through fiscal year 2006, obligations declined. 

Without adjusting for inflation, obligations at the division level for 
the PPAs we selected have remained generally stable. Division level 
obligations declined for two of the selected PPAs and increased 
slightly for three of the selected PPAs. (See fig. 5.) 

Figure 5: CDC Division-Level Obligations for Selected PPAs, Fiscal 
Years 2003 through 2006: 

This figure is a combination of four graphs showing CDC division-level 
obligations for selected PPAs, fiscal 2003 through 2006. The X axis 
represents the fiscal year, and the Y axis represents dollars in 
millions. 

HIV/AIDS, STD, and TB Prevention(Funding for the National Center for 
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally reported 
under this PPA.) 

Fiscal year 2003: $940; 
Fiscal year 2004: $931; 
Fiscal year 2005: $960; 
Fiscal year 2006: $913. 

Infectious Disease Control(Funding for the National Center for 
Preparedness, Detection, and Control of Infectious Diseases is 
generally reported under this PPA.)

Fiscal year 2003: $250; 
Fiscal year 2004: $237; 
Fiscal year 2005: $228; 
Fiscal year 2006: $217. 

Chronic Disease Prevention and Health Promotion (Funding for the 
National Center for Chronic Disease Prevention and Health Promotion is 
generally reported under this PPA.) 

Fiscal year 2003: $761; 
Fiscal year 2004: $818; 
Fiscal year 2005: $897; 
Fiscal year 2006: $808. 

Birth Defects, Develop-mental Disabilities, Disability and 
Health(Funding for the National Center on Birth Defects and 
Developmental Disabilities is generally reported under this PPA.) 

Fiscal year 2003: $106; 
Fiscal year 2004: $115; 
Fiscal year 2005: $124; 
Fiscal year 2006: $121. 

Occupational Safety and Health(Funding for the National Center for 
Occupational Safety and Health is generally reported under this PPA.) 

Fiscal year 2003: $233; 
Fiscal year 2004: $228; 
Fiscal year 2005: $230; 
Fiscal year 2006: $242. 

[See PDF for image] 

Source: GAO analysis of CDC data. 

[See PDF for image] 

Note: With the exception of Occupational Safety and Health, these PPAs 
became subcategories of newly established broader PPAs in fiscal year 
2005 due to the reorganization of CDC's budget. See enclosure II for 
the full list of changes to CDC's PPAs. 

[End of figure] 

The shifting of obligations and activities between CDC's leadership and 
management levels and CDC's division level had varying effects at CDC's 
division level. Program functions that were moved to divisions from 
national center directors' offices, such as Antimicrobial Resistance 
Program functions in fiscal years 2005 and 2006, expanded the 
responsibilities of the division level. Officials from a CDC national 
center director's office told us that these new program functions often 
had to be absorbed by the divisions without any overall increase in 
obligations. Alternatively, divisions no longer had to fund 
administrative activities and personnel that were consolidated into 
CDC's leadership and management levels, such as budget analysts or 
information technology personnel who were moved to the CDC Office of 
the Director in fiscal year 2005. 

After adjusting for inflation, division-level obligations declined from 
fiscal year 2003 to fiscal year 2006.[Footnote 17] Obligations at CDC's 
leadership and management levels also declined during this period after 
adjusting for inflation, but the decline was smaller than at the 
division level. (See fig. 6.) To have kept pace with inflation, 
obligations at CDC's division level would have had to increase by 
almost 9 percent from fiscal year 2003 to fiscal year 2006, but they 
increased less than 2 percent. Figure 6 shows how obligations at CDC's 
division level and leadership and management levels compare with the 
respective inflation-adjusted obligation amounts.[Footnote 18] The fact 
that obligations declined after adjusting for inflation is not unique 
to CDC; obligations at many other federal agencies also did not keep 
pace with inflation during this period. 

Figure 6: Comparative Unadjusted and Adjusted Obligations at CDC 
Leadership and Management Levels and Division Level, Fiscal Year 2003 
through Fiscal Year 2006: 

This figure is a combination of two bar graphs showing comparative 
unadjusted and adjusted obligations at CDC leadership and management 
levels and division level, fiscal year 2003 through fiscal year 2006. 
The X axis represents the fiscal year, and the Y axis represents the 
dollars in millions. 

Division-level obligations: 

Fiscal year 2003: $5,384; 
Fiscal year 2004: $5,431; 
Fiscal year 2005: $5,562; 
Fiscal year 2006: $5,486. 

Leadership-and management-level obligations: 

Fiscal year 2003: $483; 
Fiscal year 2004: $592; 
Fiscal year 2005: $530; 
Fiscal year 2006: $516. 

[See PDF for image] 

Source: GAO analysis of CDC data. 

Note: CDC's division level consists of the national center divisions, 
branches, and other units. In fiscal year 2003 and fiscal year 2004, 
CDC's leadership and management levels consisted of the CDC Office of 
the Director and the national center directors' offices. As of fiscal 
year 2005, CDC's leadership and management levels also include the 
coordinating centers. 

[End of figure] 

Agency Comments and Our Evaluation: 

We received written comments on a draft of this report from HHS. In its 
comments, HHS provided information on CDC's mission, goals, and the 
rationale for its current organizational structure. In regard to this 
report, HHS interpreted our findings to suggest that its 2005 
organizational restructuring has had limited or no impact on funding 
available for public health program activities. However, because it is 
difficult to separate the effects of the organizational restructuring, 
inflation, or other factors on obligations for public health program 
activities, we did not draw this conclusion. We did note that, after 
adjusting for inflation, obligations at CDC's division level declined 
more than obligations at CDC's leadership and management levels from 
fiscal year 2003 to fiscal year 2006. HHS's written comments are 
reprinted in enclosure IV. HHS also provided technical comments, which 
we incorporated as appropriate. 

As we agreed with your office, unless you publicly announce the 
contents of this report earlier, we plan no further distribution of 
this report until 30 days after the date of this letter. At that time, 
we will send copies to the Secretary of Health and Human Services and 
other interested parties. We will also make copies available to others 
on request. In addition, the report will be available at no charge on 
GAO's Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact me at (202) 512-7114 or [email protected]. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. Key contributors to this report were 
Sheila Avruch, Assistant Director; Linda Kohn, Assistant Director; 
Timothy Cunningham; Roseanne Price; William Simerl; and Michael Zose. 

Sincerely yours, 

Signed by: 

Cynthia Bascetta: 

Director, Health Care: 

[End of section] 

Enclosures - 4: 

Figure: Centers for Disease Control and Prevention (CDC) Organizational 
Chart (effective March 22, 2007): 

This figure is a layout showing centers for disease control and 
prevention (CDC) organizational chart (effective March 22, 2007). 

[See PDF for image] 

Source: GAO analysis of CDC data. 

Note: The national centers in this chart include both their respective 
directors' office and their divisions, branches, and other units, which 
we refer to collectively as CDC's division level in this report. We use 
the term national center to refer to the 11 national centers listed 
above, the National Office of Public Health Genomics, and the National 
Institute for Occupational Safety and Health. This organizational chart 
reflects some changes that CDC made to its structure after the fiscal 
year 2005 organizational restructuring. 

[End of figure] 

Programs, Projects, or Activities for the Centers for Disease Control 
and Prevention's (CDC) Disease Control, Research, and Training Account: 

Programs, Projects, or Activities (PPA) are elements within an agency's 
budget or appropriations accounts intended to provide a meaningful 
representation of the operations financed by those accounts.[Footnote 
19] This enclosure lists the PPAs for the CDC's Disease Control, 
Research, and Training account. 

CDC restructured the PPAs within the Disease Control, Research, and 
Training account for fiscal year 2005 to correspond with its new 
organizational structure and to separate funding for programs from 
funding for management and administrative services. For fiscal year 
2004, Disease Control, Research, and Training included the following 13 
PPAs: 

* Birth Defects, Developmental Disabilities, Disability and Health: 

* Chronic Disease Prevention and Health Promotion: 

* Environmental Health: 

* Epidemic Services and Response: 

* Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency 
Syndrome (AIDS), Sexually Transmitted Diseases (STD) and Tuberculosis 
(TB) Prevention: 

* Immunization: 

* Infectious Disease Control: 

* Injury Prevention and Control: 

* Occupational Safety and Health: 

* Preventive Health and Health Service Block Grant: 

* Public Health Improvement: 

* Building and Facilities: 

* Office of the Director: 

For fiscal year 2005, Disease Control, Research, and Training included 
the following 10 PPAs: 

* Infectious Diseases: 

* Health Promotion: 

* Health Information and Service: 

* Environmental Health and Injury: 

* Occupational Safety and Health: 

* Global Health: 

* Public Health Improvement and Leadership: 

* Preventive Health and Health Service Block Grant: 

* Buildings and Facilities: 

* Business Services Support: 

Scope and Methodology: 

To examine (1) the distribution of obligations between the Centers for 
Disease Control and Prevention's (CDC) division level and CDC's 
leadership and management levels, (2) obligations and activities at 
CDC's leadership and management levels, including shared business 
services within the CDC Office of the Director, and (3) obligations and 
activities at CDC's division level, we obtained and reviewed 
obligations data at CDC's leadership and management levels and at CDC's 
division level from fiscal year 2003 through fiscal year 2006.[Footnote 
20] Although administrative activities are generally conducted at 
leadership and management levels and public health programs are 
generally conducted at the division level, some administrative and 
public health activities are conducted at each CDC level. Therefore, we 
also examined the types of activities conducted at each level. Our work 
was limited to CDC's discretionary obligations, which comprise about 77 
percent of CDC's overall obligations in fiscal year 2006. We also 
reviewed documents, including those related to relevant appropriations 
legislation and CDC's budget and obligations, and interviewed officials 
from CDC's Financial Management Office and from CDC's leadership and 
management levels. We did not review CDC's Vaccines for Children 
program, which is not a discretionary program and comprised most of the 
remaining 23 percent of CDC's overall obligations in that year. 

We compared obligations at CDC's division level and at CDC's leadership 
and management levels, which include the CDC Office of the Director, 
coordinating centers, and national centers directors' offices, from 
fiscal year 2003 through fiscal year 2006.[Footnote 21] For this 
comparison, we included the following items that constitute obligations 
at the CDC Office of the Director level: (1) obligations from CDC's 
Programs, Projects, or Activities (PPA) dedicated to the Office of the 
Director and the offices included in it; (2) obligations from indirect 
cost allocations[Footnote 22] against CDC components for shared 
business services in the CDC Office of the Director in fiscal year 2003 
and fiscal year 2004; (3) obligations dedicated to leadership and 
management that CDC attributed to the Office of the Director in fiscal 
year 2005 and fiscal year 2006; and (4) obligations from indirect cost 
allocations against the National Institute for Occupational Safety and 
Health (NIOSH) by the CDC Office of the Director in fiscal year 2005 
and fiscal year 2006. For the coordinating centers, we included 
obligations dedicated to leadership and management that CDC attributed 
to the coordinating centers in fiscal year 2005 and fiscal year 2006. 
For the national center directors' offices, we included (1) obligations 
from indirect cost allocations for the division level by national 
centers for the national center directors' offices in fiscal year 2003 
and fiscal year 2004, (2) obligations dedicated to leadership and 
management that CDC attributed to national center directors' offices in 
fiscal year 2005 and fiscal year 2006, and (3) the portion of the NIOSH 
appropriation obligated at the NIOSH director's office. For the 
division level, which is primarily responsible for operating public 
health programs, we included obligations at divisions and other units 
within national centers. CDC officials reviewed our analysis and 
confirmed that the way we had grouped the obligations was appropriate. 
We did not consider buildings and facilities obligations to be a part 
of obligations at CDC's division level or at CDC's leadership and 
management levels because in each year they generally consist of 
onetime capital expenses. Other building-related expenses, such as 
maintenance or rent, are included as part of obligations at CDC's 
leadership and management levels in the shared business services 
category. 

To specifically address changes in shared business services in the CDC 
Office of the Director--part of CDC's leadership and management levels-
-we obtained and reviewed CDC data on obligations for shared business 
services from fiscal years 2003 through 2006. We also determined the 
obligations for subcategories in shared business services, interviewed 
CDC officials, and reviewed documentation provided by them to determine 
how changes in CDC's PPAs have affected obligations levels for shared 
business services over time. 

Funding for each of CDC's national centers is generally reported under 
one of CDC's PPAs or subcategories within CDC's budget. We selected 
five of these national centers and their related PPAs or subcategories 
for additional analysis based on changes in obligations from fiscal 
year 2003 through fiscal year 2006. We selected the two national 
centers' PPAs or subcategories with the largest increases in 
obligations, the two with the largest decreases, and one with a small 
overall change. The PPAs or their subcategories with the largest 
increase in obligations are Chronic Disease Prevention and Health 
Promotion, under which funding for the National Center for Chronic 
Disease Prevention and Health Promotion is generally reported; and 
Birth Defects, Developmental Disabilities, Disability and Health, under 
which funding for the National Center on Birth Defects and 
Developmental Disabilities is generally reported. The PPAs or their 
subcategories with the largest decrease in obligations are HIV/AIDS, 
STD, and TB Prevention, under which funding for the National Center for 
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally 
reported; and Infectious Disease Control, under which funding for the 
National Center for Preparedness, Detection, and Control of Infectious 
Diseases is generally reported. The PPA with a small overall change in 
obligations is Occupational Safety and Health, under which funding for 
NIOSH is generally reported. In fiscal years 2003 and 2004, all five of 
these components of CDC's budget were PPAs. Starting in fiscal year 
2005, only Occupational Safety and Health remained a PPA, while the 
other components became subcategories of newly established PPAs. For 
each of the selected national centers, we reviewed obligations data 
from their PPAs or subcategories and interviewed the corresponding 
national center and coordinating center leadership and management 
officials. 

As part of our analysis of CDC obligations data, we adjusted CDC 
obligations data from fiscal year 2003 through fiscal year 2006 for 
inflation using the Gross Domestic Product (GDP) price index and 
compared it to the unadjusted obligations data. While CDC officials 
told us that they preferred to use the Bureau of Economic Analysis's 
Biomedical Research and Development Price Index (BRDPI) to measure 
inflation, which generally results in a larger adjustment than the GDP 
price index, we chose the more conservative GDP price index over the 
BRDPI. Both indexes show that obligations have declined after making 
the adjustment. Given that the choice of index does not affect our 
findings, we chose the more conservative index. 

We compared the adjusted obligations data to the unadjusted obligations 
data, particularly for the division level, because the effects of 
inflation were greater there than at the leadership and management 
levels. Throughout this report, we present unadjusted obligations data, 
unless otherwise noted. To assess the reliability of the obligations 
data provided by CDC, we (1) performed electronic testing for obvious 
errors in accuracy and completeness, (2) reviewed related 
documentation, including contractor reports concerning the data, and 
(3) worked closely with agency officials to reconcile questions about 
the data before conducting our analyses. We did not find any errors, 
and therefore we determined that the data were sufficiently reliable 
for our purposes, although we did not independently verify it. 

We conducted our work from May 2007 to January 2008 in accordance with 
generally accepted government auditing standards. 

[End of section] 

Comments from the Department of Health and Human Services: 

Footnotes: 

[1] See GAO, Centers for Disease Control and Prevention: Agency 
Leadership Taking Steps to Improve Management and Planning, but 
Challenges Remain, GAO-04-219 (Washington, D.C.: Jan. 30, 2004). 

[2] Obligations generally are commitments that create a legal liability 
of the government to pay for goods or services. 

[3] We use the term national centers to refer to CDC's National 
Centers, such as the National Center for Immunization and Respiratory 
Diseases, as well as the National Institute for Occupational Safety and 
Health and the National Office of Public Health Genomics. For an 
overview of CDC's current organizational structure, see encl. I. 

[4] We refer to the CDC Office of the Director, the coordinating 
centers, and the national center directors' offices collectively as 
CDC's leadership and management levels. 

[5] We use the term coordinating centers to refer to CDC's four 
coordinating centers and two coordinating offices. For an overview of 
CDC's current organizational structure, see encl. I. 

[6] GAO-04-219. 

[7] PPAs are elements within an agency's budget or appropriations 
accounts intended to provide a meaningful representation of the 
operations financed by that account. 

[8] Shared business services are agencywide administrative services, 
such as rent, utilities, security, maintenance, contract and grants 
administration, financial management, information technology, human 
resources, telecommunications, and postage. 

[9] CDC used two different types of indirect cost allocations. One type 
was for shared business services. The other type was used within CDC's 
national centers for the operation of the national center directors' 
offices. Methods for determining the amount of these allocations varied 
among national centers. 

[10] We included the Agency for Toxic Substances and Disease Registry 
(ATSDR) in our analysis because CDC's budget includes obligations for 
it. ATSDR is an agency of HHS; its administrative and management 
functions are consolidated with CDC's National Center for Environmental 
Health. In addition, the director of the CDC is also the administrator 
of ATSDR. 

[11] CDC's Vaccines for Children program, which is administered by the 
National Center for Immunization and Respiratory Diseases, is not a 
discretionary program and is not included in our analysis. It comprised 
most of the remaining 23 percent of CDC's overall obligations in fiscal 
year 2006. 

[12] Obligations for the National Center for Human Immunodeficiency 
Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS), Viral 
Hepatitis, Sexually Transmitted Diseases (STD), and Tuberculosis (TB) 
Prevention are generally reported under the HIV/AIDS, STD, and TB 
Prevention PPA. Obligations for the National Center for Preparedness, 
Detection, and Control of Infectious Diseases are generally reported 
under the Infectious Disease Control PPA. Obligations for the National 
Center for Chronic Disease Prevention and Health Promotion are 
generally reported under the Chronic Disease Prevention and Health 
Promotion PPA. Obligations for the National Center on Birth Defects and 
Developmental Disabilities are generally reported under the Birth 
Defects, Developmental Disabilities, Disability and Health PPA. 
Obligations for the National Institute for Occupational Safety and 
Health are generally reported under the Occupational Safety and Health 
PPA. In fiscal years 2003 and 2004, all five of these components of 
CDCï¿½s budget were PPAs. Starting in fiscal year 2005, only Occupational 
Safety and Health remained a PPA, while the other components became 
subcategories of newly established PPAs. (For more information, see 
encl. II.)

[13] S. Rep. No. 108-345, at 65 (2004); H. Rep. No. 108-792 at 1157 
(Conf. Rep.) 

[14] The Public Health Improvement and Leadership PPA has a subcategory 
called Leadership and Management, which includes funding for 
coordinating center and national center directors' offices. 

[15] The National Center for HIV, STD, and TB Prevention was renamed 
the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB 
Prevention in March 2007 to reflect the addition of CDC's Viral 
Hepatitis program. 

[16] A portion of obligations for shared business services in fiscal 
year 2005 was accounted for by one of CDC's national centers, the 
National Institute for Occupational Safety and Health (NIOSH). These 
obligations were not part of CDC's Business Services Support PPA. 
Beginning in fiscal year 2006, a corresponding amount of obligations 
was included in the Business Services Support PPA. In addition, in 
fiscal year 2006, NIOSH also accounted for a smaller, additional amount 
of obligations for CDC's shared business services. We included these 
additional amounts in our calculation of business services support 
obligations in fiscal years 2005 and 2006. 

[17] See encl. III for more information about our methodology, 
including our use of the Gross Domestic Product (GDP) price index to 
adjust for inflation. 

[18] See also Centers for Disease Control and Prevention Professional 
Judgment for Fiscal Year 2008, April 20, 2007, for CDC's analysis of 
the effects of inflation. In this statement, CDC noted that the loss of 
purchasing power due to inflation has led to the erosion of core 
funding for non-terrorism-related research and noninfluenza, non- 
emerging infectious disease science. 

[19] For annually appropriated accounts, the Office of Management and 
Budget (OMB) and agencies identify PPAs by reference to congressional 
committee reports and agency budget justifications. For permanent 
appropriations, OMB and agencies identify PPAs by the program and 
financing schedules that the President provides in the "Detailed Budget 
Estimates" in the budget submission for the relevant fiscal year. 
Program activity structures are intended to provide a meaningful 
representation of the operations financed by a specific budget account-
-usually by project, activity, or organization. See GAO, A Glossary of 
Terms Used in the Federal Budget Process, GAO-05-734SP (Washington, 
D.C.: September 2005), at 80. 

[20] Obligations generally are commitments that create a legal 
liability of the government to pay for goods or services. 

[21] Our review focused on how obligations and activities shifted among 
CDC's organizational levels over time and not whether these changes 
resulted in improved efficiency or effectiveness. 

[22] CDC used two different types of indirect cost allocations. One 
type was for shared business services, which are services such as rent, 
utilities, security, and administrative infrastructure that benefit all 
CDC components. The other type was used within CDC's national centers 
for the operation of the national center directors' offices. Methods 
for determining the amount of these allocations varied among national 
centers. 

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