DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

salaries and expenses

For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92-313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107-188; [$3,237,218,000, of which $5,509,000 shall be for the purposes, and in the amounts, specified in the eighth paragraph under "Food and Drug Administration, Salaries and Expenses'' in the statement of managers to accompany this Act] $3,699,611,000: Provided, That of the amount provided under this heading, [$578,162,000] $667,057,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h shall be credited to this account and remain available until expended, and shall not include any fees pursuant to 21 U.S.C. 379h(a)(2) and (a)(3) assessed for fiscal year [2011] 2012 but collected in fiscal year [2010] 2011; [$57,014,000] $61,860,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; [$17,280,000] $19,448,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; [$5,106,000] $5,397,000 shall be derived from animal generic drug user fees authorized by 21 U.S.C. 379f, and shall be credited to this account and shall remain available until expended; and [$235,000,000] $450,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s and shall be credited to this account and remain available until expended: Provided further, That in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees that exceed the fiscal year 2011 limitation are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device, animal drug, animal generic drug, and tobacco product assessments for fiscal year [2010] 2011 received during fiscal year [2010] 2011, including any such fees assessed prior to fiscal year [2010] 2011 but credited for fiscal year [2010] 2011, shall be subject to the fiscal year [2010] 2011 limitations: [Provided further, That in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees that exceed the fiscal year 2010 limitation are appropriated and shall be credited to this account and remain available until expended:Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: Provided further, That of the total amount appropriated: (1) $782,915,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs; (2) $880,104,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs, of which no less than $51,545,000 shall be available for the Office of Generic Drugs; (3) $305,249,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $155,540,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $349,262,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $58,745,000 shall be for the National Center for Toxicological Research; (7) $216,523,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $117,225,000 shall be for Rent and Related activities, of which $41,496,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) not to exceed $171,526,000 shall be for payments to the General Services Administration for rent; and (10) $200,129,000 shall be for other activities, including the Office of the Commissioner; the Office of Foods; the Office of the Chief Scientist; the Office of Policy, Planning and Budget; the Office of International Programs; the Office of Administration; and central services for these offices: Provided further, That none of the funds made available under this heading shall be used to transfer funds under section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd):] Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner[: Provided further, That funds may be transferred from one specified activity to another with the prior approval of the Committees on Appropriations of both Houses of Congress].

In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381, and priority review user fees authorized by 21 U.S.C. 360n may be credited to this account, to remain available until expended.

buildings and facilities

For plans, construction, repair, improvement, extension, alteration, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided, $12,433,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2010.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-9911-0-1-554 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year



01.99 Balance, start of year
Receipts:
02.20 Cooperative Research and Development Agreements, FDA 1 3 3



02.99 Total receipts and collections 1 3 3



04.00 Total: Balances and collections 1 3 3
Appropriations:
05.00 Salaries and Expenses -1 -3 -2



05.99 Total appropriations -1 -3 -2



07.99 Balance, end of year 1

Program and Financing (in millions of dollars)


Identification code 75-9911-0-1-554 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Foods 685 784 848
00.02 Drugs 775 807 840
00.03 Devices and radiological products 304 315 326
00.04 National Center for Toxicological Research 56 59 61
00.05 Other activities 130 144 164
00.06 Other rent and rent related activities 101 91 105
00.07 Rental payments 134 146 154
00.08 Buildings and facilities 6 16 12
00.09 CRADAs 3 3 3
00.10 Tobacco startup 5
09.01 Reimbursable program 631 944 1,233



10.00 Total new obligations 2,830 3,309 3,746

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 325 257 181
22.00 New budget authority (gross) 2,761 3,233 3,743
22.10 Resources available from recoveries of prior year obligations 1



23.90 Total budgetary resources available for obligation 3,087 3,490 3,924
23.95 Total new obligations -2,830 -3,309 -3,746



24.40 Unobligated balance carried forward, end of year 257 181 178

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 2,055 2,362 2,508
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 657 868 1,233
58.10 Change in uncollected customer payments from Federal sources (unexpired) 19
58.26 Offsetting collections (previously unavailable) 306 333 333
58.45 Portion precluded from obligation (limitation on obligations) -300 -333 -333



58.90 Spending authority from offsetting collections (total discretionary) 682 868 1,233
Mandatory:
60.20 Appropriation (special fund) 1 3 2
69.00 Offsetting collections (cash) 23



70.00 Total new budget authority (gross) 2,761 3,233 3,743

Change in obligated balances:
72.40 Obligated balance, start of year 834 1,117 1,209
73.10 Total new obligations 2,830 3,309 3,746
73.20 Total outlays (gross) -2,531 -3,217 -3,662
73.40 Adjustments in expired accounts (net) -6
73.45 Recoveries of prior year obligations -1
74.00 Change in uncollected customer payments from Federal sources (unexpired) -19
74.10 Change in uncollected customer payments from Federal sources (expired) 10



74.40 Obligated balance, end of year 1,117 1,209 1,293

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 1,821 2,475 2,938
86.93 Outlays from discretionary balances 685 739 722
86.97 Outlays from new mandatory authority 24 3 2
86.98 Outlays from mandatory balances 1



87.00 Total outlays (gross) 2,531 3,217 3,662

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -30 -66 -66
88.40 Non-Federal sources -659
88.45 Offsetting governmental collections (from non-Federal sources) -802 -1,167



88.90 Total, offsetting collections (cash) -689 -868 -1,233
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -19
88.96 Portion of offsetting collections (cash) credited to expired accounts 9

Net budget authority and outlays:
89.00 Budget authority 2,062 2,365 2,510
90.00 Outlays 1,842 2,349 2,429

Memorandum (non-add) entries:
94.01 Unavailable balance, start of year: Offsetting collections 307 301 301
94.02 Unavailable balance, end of year: Offsetting collections 301 301 301

Summary of Budget Authority and Outlays (in millions of dollars)


2009 actual 2010 est. 2011 est.

Enacted/requested:
Budget Authority 2,062 2,365 2,510
Outlays 1,842 2,349 2,429
Legislative proposal, not subject to PAYGO:
Budget Authority
Outlays
Total:
Budget Authority 2,062 2,365 2,510
Outlays 1,842 2,349 2,429

[In millions of dollars]


2009 2010 2011

Distribution of discretionary budget authority by account:
Salaries and expenses 2039 2346 2496
Buildings and facilities 16 16 12
Distribution of discretionary outlays by account:
Salaries and expenses 1834 2337 2418
Buildings and facilities 8 9 9

The Food and Drug Administration (FDA) is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our Nation's food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines more effective, safer, and more affordable; and helping to provide the public accurate, science-based information about medicines and foods to improve their health. FDA decisions affect Americans on a daily basis. The Budget includes funding for counterterrorism activities that specifically relate to the protection of products or therapies regulated by the FDA (such as drugs, vaccines, foods, and animal feed), and the availability of medical products for public health preparedness in the event of an attack. Specifically, the Budget requests funding for food protection, drug safety, medical device review and safety, advancing FDA's scientific infrastructure, and headquarters consolidation in White Oak, Maryland.

The Budget includes a number of new and current user fees. The Budget proposes a food registration and inspection user fee to support and improve inspections, surveillance, laboratory capacity and response to prevent and control foodborne illnesses. The Budget also proposes user fees to support activities related to generic human drug reviews, re-inspections of FDA-regulated facilities, and the issuance of export certificates for food and animal feeds.

Object Classification (in millions of dollars)


Identification code 75-9911-0-1-554 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 653 725 777
11.3 Other than full-time permanent 93 103 109
11.5 Other personnel compensation 49 55 58
11.7 Military personnel 50 55 56
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 846 939 1,001
12.1 Civilian personnel benefits 218 242 257
12.2 Military personnel benefits 25 29 30
21.0 Travel and transportation of persons 44 44 47
22.0 Transportation of things 5 5 6
23.1 Rental payments to GSA 134 146 154
23.2 Rental payments to others 3 53 67
23.3 Communications, utilities, and miscellaneous charges 45 45 47
24.0 Printing and reproduction 3 3 3
25.1 Advisory and assistance services 92 92 97
25.2 Other services 265 249 265
25.3 Other purchases of goods and services from Government accounts 139 139 146
25.4 Operation and maintenance of facilities 65 65 68
25.5 Research and development contracts 39 42 41
25.7 Operation and maintenance of equipment 45 45 47
26.0 Supplies and materials 39 39 41
31.0 Equipment 126 123 129
32.0 Land and structures 7 7 7
41.0 Grants, subsidies, and contributions 56 56 58
42.0 Insurance claims and indemnities 2 2 2



99.0 Direct obligations 2,198 2,365 2,513
99.0 Reimbursable obligations 632 944 1,233



99.9 Total new obligations 2,830 3,309 3,746

Employment Summary


Identification code 75-9911-0-1-554 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 8,117 8,815 9,846
1101 Military average strength employment 622 662 669
Reimbursable:
2001 Civilian full-time equivalent employment 2,432 2,603 2,206
2101 Military average strength employment 187 199 192
Allocation account:
3001 Civilian full-time equivalent employment 15 16 17
3101 Military average strength employment 2 2 2

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Contingent upon the enactment of authorizing legislation, the Secretary shall charge fees for generic drug review activities: Provided, That such fees, in an amount not to exceed $38,015,000 shall be credited to this account, to remain available until expended, for generic drug review activities.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge fees for reinspection: Provided, That such fees, in an amount not to exceed $27,296,000 shall be credited to this account, to remain available until expended, for reinspections.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge fees for export certification: Provided, That such fees, in an amount not to exceed $4,385,000 shall be credited to this account, to remain available until expended, for the issuance of export certifications.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge fees for food inspections and food facility registrations: Provided, That such fees, in an amount not to exceed $220,200,000 shall be credited to this account, and shall remain available until expended.

Program and Financing (in millions of dollars)


Identification code 75-9911-2-1-554 2009 actual 2010 est. 2011 est.

Obligations by program activity:
Reimbursable programs:
09.02 Food Registration and Inspection User Fee 220
09.03 Generic Drug User Fee 38
09.04 Export Certification User Fee 4
09.05 Reinspection User Fee 27



10.00 Total new obligations 289

Budgetary resources available for obligation:
22.00 New budget authority (gross) 289
23.95 Total new obligations -289



24.40 Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Discretionary:
58.00 Spending authority from offsetting collections: Offsetting collections (cash) 289

Change in obligated balances:
73.10 Total new obligations 289
73.20 Total outlays (gross) -289



74.40 Obligated balance, end of year

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 289

Offsets:
Against gross budget authority and outlays:
88.45 Offsetting collections (cash) from: Offsetting governmental collections (from non-Federal sources) -289

Net budget authority and outlays:
89.00 Budget authority
90.00 Outlays

Object Classification (in millions of dollars)


Identification code 75-9911-2-1-554 2009 actual 2010 est. 2011 est.

99.0 Reimbursable obligations 289



99.9 Total new obligations 289

Employment Summary


Identification code 75-9911-2-1-554 2009 actual 2010 est. 2011 est.

Reimbursable:
2001 Civilian full-time equivalent employment 707

Revolving Fund for Certification and Other Services

Program and Financing (in millions of dollars)


Identification code 75-4309-0-3-554 2009 actual 2010 est. 2011 est.

Obligations by program activity:
09.01 Reimbursable program 7 8 8



10.00 Total new obligations 7 8 8

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 2 2 2
22.00 New budget authority (gross) 7 8 8



23.90 Total budgetary resources available for obligation 9 10 10
23.95 Total new obligations -7 -8 -8



24.40 Unobligated balance carried forward, end of year 2 2 2

New budget authority (gross), detail:
Mandatory:
69.00 Offsetting collections (cash) 7 8 8

Change in obligated balances:
72.40 Obligated balance, start of year 4 3 3
73.10 Total new obligations 7 8 8
73.20 Total outlays (gross) -8 -8 -8



74.40 Obligated balance, end of year 3 3 3

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 7 8 8
86.98 Outlays from mandatory balances 1



87.00 Total outlays (gross) 8 8 8

Offsets:
Against gross budget authority and outlays:
88.40 Offsetting collections (cash) from: Non-Federal sources -7 -8 -8

Net budget authority and outlays:
89.00 Budget authority
90.00 Outlays 1

FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs, medical devices, and cosmetics (21 U.S.C. 346a, 356, 357, 376). These services are financed wholly by fees paid by the industries affected.

Object Classification (in millions of dollars)


Identification code 75-4309-0-3-554 2009 actual 2010 est. 2011 est.

Reimbursable obligations:
11.1 Personnel compensation: Full-time permanent 4 4 4
12.1 Civilian personnel benefits 1 1 1
23.1 Rental payments to GSA 1 1 1
25.2 Other services 1 1
26.0 Supplies and materials 1 1 1



99.9 Total new obligations 7 8 8

Employment Summary


Identification code 75-4309-0-3-554 2009 actual 2010 est. 2011 est.

Reimbursable:
2001 Civilian full-time equivalent employment 38 38 38

Health Resources and Services Administration

Federal Funds

health resources and services

For carrying out titles II, III, IV, VII, VIII, X, XI, XII, XIX, and XXVI of the Public Health Service Act ("PHS Act''), section 427(a) of the Federal Coal Mine Health and Safety Act, title V and sections 711, 1128E, and 1820 of the Social Security Act, the Health Care Quality Improvement Act of 1986, the Native Hawaiian Health Care Act of 1988, the Cardiac Arrest Survival Act of 2000, section 712 of the American Jobs Creation Act of 2004, and the Stem Cell Therapeutic and Research Act of 2005, [$7,473,522,000] $7,501,658,000, of which $41,200,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program under such section: [Provided, That of the funds made available under this heading, $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act: Provided further, That amounts provided for such grants shall be] Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for such grants available for the purchase and implementation of telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs through the use of the VISTA-Electronic Health Record: Provided further, That of the funds made available under this heading, [$129,000] $129,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: Provided further, That in addition to fees authorized by section 427(b) of the Health Care Quality Improvement Act of 1986, fees shall be collected for the full disclosure of information under the Act sufficient to recover the full costs of operating the National Practitioner Data Bank, and shall remain available until expended to carry out that Act: Provided further, That fees collected for the full disclosure of information under the "Health Care Fraud and Abuse Data Collection Program'', authorized by section 1128E(d)(2) of the Social Security Act, shall be sufficient to recover the full costs of operating the program, and shall remain available until expended to carry out that Act: Provided further, That no more than [$40,000] $40,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act including associated administrative expenses and relevant evaluations: Provided further, That no more than [$44,055,000] $44,055,000 shall be available until expended for carrying out the provisions of Public Law 104-73 and for expenses incurred by the Department of Health and Human Services ("HHS'') pertaining to administrative claims made under such law: Provided further, That of the funds made available under this heading, [$317,491,000] $327,356,000 shall be for the program under title X of the PHS Act to provide for voluntary family planning projects: Provided further, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office: Provided further, That of the funds available under this heading, [$1,932,865,000] $1,962,865,000 shall remain available to the Secretary of HHS through September 30, [2012] 2013, for parts A and B of title XXVI of the PHS Act: Provided further, That within the amounts provided for part A of title XXVI of the PHS Act, [$6,021,000] $6,021,000 shall be available to the Secretary through September 30, [2012] 2013, and shall be available to qualifying jurisdictions, within 30 days of enactment, for increasing supplemental grants for fiscal year [2010] 2011 to metropolitan and transitional areas that received grant funding in fiscal year [2009] 2010 under subparts I and II of part A of title XXVI of the PHS Act to ensure that an area's total funding under subparts I and II of part A for fiscal year [2009] 2010, together with the amount of this additional funding, is not less than [92.4] 92.4 percent of the amount of such area's total funding under part A for fiscal year 2006: Provided further, That notwithstanding section 2603(c)(1) of the PHS Act, the additional funding to areas under the immediately preceding proviso, which may be used for costs incurred during fiscal year [2009] 2010, shall be available to the area for obligation from the date of the award through the end of the grant year for the award: Provided further, That [$835,000,000] $855,000,000 shall be for State AIDS Drug Assistance Programs authorized by section 2616 of the PHS Act: Provided further, That in addition to amounts provided herein, [$25,000,000] $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, C, and D of title XXVI of the PHS Act to fund section 2691 Special Projects of National Significance: Provided further, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not to exceed [$92,551,000] $93,999,263 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and [$10,400,000] $11,810,915 shall be available for projects described in paragraphs (A) through (F) of section 501(a)(3) of such Act: [Provided further, That notwithstanding section 747(e)(2) of the PHS Act, not less than $29,025,000 shall be for family medicine programs, not less than $7,575,000 shall be for general dentistry programs, and not less than $7,575,000 shall be for pediatric dentistry programs including faculty loan repayments for service as a full-time faculty member in dentistry:] Provided further, That dentistry faculty loan repayments shall be made using the same terms and conditions as the Nursing Faculty Loan Repayment program authorized under section 738 of the PHS Act unless otherwise authorized: [Provided further, That of the funds provided, $10,000,000 shall be provided to the Denali Commission as a direct lump payment pursuant to Public Law 106-113: Provided further, That of the funds provided, $35,000,000 shall be provided for the Delta Health Initiative as authorized in section 219 of division G of Public Law 110-161 and associated administrative expenses:] Provided further, That funds provided under section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under these sections: [Provided further, That notwithstanding section 340A(d)(3)(B) of the PHS Act, $5,000,000 shall be available for 3 year grant periods under the Patient Navigator Act:] Provided further, That notwithstanding subsection (d)(3)(B) of section 340A the Public Health Service Act, $5,000,000 shall be available for activities under such section: [Provided further, That of the amount appropriated in this paragraph, $338,002,000 shall be used for the projects financing the construction and renovation (including equipment) of health care and other facilities and for other health-related activities, and in the amounts, specified under the heading "Health Resources and Services'' in the statement of the managers on the conference report accompanying this Act, and of which up to one percent of the amount for each project may be used for related agency administrative expenses:] Provided further, That notwithstanding section 338J(k) of the PHS Act, [$10,075,000] $10,075,000 shall be available for State Offices of Rural Health: Provided further, That of the funds provided, [$15,000,000] $15,000,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology: Provided further, That [$75,000,000] $75,000,000 shall be available for State Health Access Grants to expand access to affordable health care coverage for the uninsured populations in such States. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0350-0-1-550 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.10 Health centers 2,146 2,146 2,436
00.11 National Health Service Corps 40 41 46
00.12 National Health Service Corps recruitment 95 101 122
00.13 Hansen's Disease Center 16 16 16
00.14 Payment to Hawaii for the treatment of Hansen's disease 2 2 2
00.15 Black lung clinics 7 7 7
00.16 Nursing education loan repayment and scholarships 37 94 94
00.17 Health professions 359 407 414
00.18 Maternal and child health block grant 662 662 673
00.19 Healthy start 102 105 110
00.20 Poison control centers 28 29 29
00.21 EMS for children 20 22 22
00.22 Universal newborn hearing screening 19 19 19
00.23 HIV/AIDS 2,227 2,266 2,305
00.24 Organ transplantation 24 26 26
00.25 Bone marrow donor registry 24 24 27
00.26 Rural health policy development 10 10 10
00.27 Rural health outreach grants 54 56 57
00.28 Rural health flexibility grants 39 41 41
00.29 Denali Commission 20 10
00.30 Telehealth 7 12 12
00.31 Program management 142 147 154
00.32 Family planning 307 317 327
00.33 Loan Repayment/Faculty Fellowship 1 1 1
00.34 Public Health Improvement (Facilities & Other Projects) 309 338
00.36 Health centers tort claim fund 50 44 44
00.37 Heritable Disorders 10 10 10
00.38 Congenital Disabilities 1 1 1
00.39 Childrens' GME 310 318 318
00.40 State Health Access Grants 75 75 75
00.41 Delta Health Initiative 26 35
00.42 State offices of rural health 9 10 10
00.45 Rural and community access to emergency devices 2 3 3
00.46 Radiogenic diseases 2 2 2
00.47 Traumatic brain injury 10 10 10
00.48 Autism and Other Developmental Disorders 42 48 55
00.50 Cord blood stem cell bank 12 12 14
00.52 Free Clinics Medical Malpractice 1
00.54 Sickle cell 4 5 5
00.55 Drug Pricing Program 1 2 5
00.56 Family to family health information centers 5
00.57 ARRA 1,519 906 75



03.00 Total direct programs 8,776 8,380 7,577
09.01 Reimbursable program 71 68 68
09.02 Reimbursable program: PHS evaluation 25 25 25



10.00 Total new obligations 8,872 8,473 7,670

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 73 1,050 145
22.00 New budget authority (gross) 9,833 7,568 7,596
22.10 Resources available from recoveries of prior year obligations 21



23.90 Total budgetary resources available for obligation 9,927 8,618 7,741
23.95 Total new obligations -8,872 -8,473 -7,670
23.98 Unobligated balance expiring or withdrawn -5



24.40 Unobligated balance carried forward, end of year 1,050 145 71

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 9,734 7,474 7,502
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 63 74 74
58.10 Change in uncollected customer payments from Federal sources (unexpired) 12



58.90 Spending authority from offsetting collections (total discretionary) 75 74 74
Mandatory:
60.00 Appropriation 5
69.00 Offsetting collections (cash)(HPSL&NSL) 19 20 20



70.00 Total new budget authority (gross) 9,833 7,568 7,596

Change in obligated balances:
72.40 Obligated balance, start of year 4,926 6,419 6,428
73.10 Total new obligations 8,872 8,473 7,670
73.20 Total outlays (gross) -7,294 -8,464 -8,490
73.40 Adjustments in expired accounts (net) -94
73.45 Recoveries of prior year obligations -21
74.00 Change in uncollected customer payments from Federal sources (unexpired) -12
74.10 Change in uncollected customer payments from Federal sources (expired) 42



74.40 Obligated balance, end of year 6,419 6,428 5,608

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 3,168 2,989 3,000
86.93 Outlays from discretionary balances 4,106 5,455 5,470
86.97 Outlays from new mandatory authority 8 20 20
86.98 Outlays from mandatory balances 12



87.00 Total outlays (gross) 7,294 8,464 8,490

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -76 -49 -49
88.40 Non-Federal sources -45 -45 -45



88.90 Total, offsetting collections (cash) -121 -94 -94
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -12
88.96 Portion of offsetting collections (cash) credited to expired accounts 39

Net budget authority and outlays:
89.00 Budget authority 9,739 7,474 7,502
90.00 Outlays 7,173 8,370 8,396

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


Identification code 75-0350-0-1-550 2009 actual 2010 est. 2011 est.

Guaranteed loan levels supportable by subsidy budget authority:
215001 Health centers: Facilities renovation loan guarantee levels 10 10
215002 Health centers: Managed care network development loan guarantee 2 2
215003 Health centers: Managed care plan loan guarantee levels 5 5



215999 Total loan guarantee levels 17 17
Guaranteed loan subsidy (in percent):
232001 Health centers: Facilities renovation loan guarantee levels 0.00 2.92 2.72
232002 Health centers: Managed care network development loan guarantee 0.00 9.61 9.13
232003 Health centers: Managed care plan loan guarantee levels 0.00 5.72 5.69



232999 Weighted average subsidy rate 0.00 4.53 4.35



233999 Total subsidy budget authority 1 1
Guaranteed loan downward reestimates:
237003 Health centers: Managed care plan loan guarantee levels -2



237999 Total downward reestimate subsidy budget authority -2

Activities displayed here support categorical health resources and services grants, treatment and care for those living with HIV/AIDS, and the medical malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers.

Object Classification (in millions of dollars)


Identification code 75-0350-0-1-550 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 112 132 121
11.3 Other than full-time permanent 4 4 4
11.5 Other personnel compensation 3 3 3
11.7 Military personnel 17 18 18



11.9 Total personnel compensation 136 157 146
12.1 Civilian personnel benefits 30 34 32
12.2 Military personnel benefits 9 10 10
13.0 Benefits for former personnel 2 2 2
21.0 Travel and transportation of persons 3 3 3
23.1 Rental payments to GSA 11 12 17
23.2 Rental payments to others 2 2 2
23.3 Communications, utilities, and miscellaneous charges 2 1 1
25.1 Advisory and assistance services 39 39 42
25.2 Other services 150 157 149
25.3 Other purchases of goods and services from Government accounts 221 230 236
25.4 Operation and maintenance of facilities 1 1 1
25.6 Medical care 3 3 3
25.7 Operation and maintenance of equipment 10 8 10
26.0 Supplies and materials 2 1 1
31.0 Equipment 4 3 3
41.0 Grants, subsidies, and contributions 8,103 7,676 6,878
42.0 Insurance claims and indemnities 48 41 41



99.0 Direct obligations 8,776 8,380 7,577
99.0 Reimbursable obligations 96 93 93



99.9 Total new obligations 8,872 8,473 7,670

Employment Summary


Identification code 75-0350-0-1-550 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 1,227 1,352 1,264
1101 Military average strength employment 189 189 189
Reimbursable:
2001 Civilian full-time equivalent employment 53 56 53
2101 Military average strength employment 9 9 9

Vaccine Injury Compensation

Program and Financing (in millions of dollars)


Identification code 75-0320-0-1-551 2009 actual 2010 est. 2011 est.

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 9 11 11
22.00 New budget authority (gross) 2



23.90 Total budgetary resources available for obligation 11 11 11



24.40 Unobligated balance carried forward, end of year 11 11 11

New budget authority (gross), detail:
Mandatory:
69.00 Offsetting collections (cash) 2

Offsets:
Against gross budget authority and outlays:
88.40 Offsetting collections (cash) from: Non-Federal sources -2

Net budget authority and outlays:
89.00 Budget authority
90.00 Outlays -2

The Vaccine Injury Compensation Program was established pursuant to Public Law 99-660 and Public Law 100-203, and serves as a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine related injury or death occurring before October 1, 1988 are financed from the General Fund and are reflected in this account. Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be adjudicated, no appropriation is requested in 2010 to cover payment of pre-1988 claims. By statute, no new claims are accepted for this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988 are reflected in the Vaccine Injury Compensation Program trust fund account.

Covered Countermeasure Process Fund

Program and Financing (in millions of dollars)


Identification code 75-0343-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Expenses 1



10.00 Total new obligations (object class 25.2) 1

Budgetary resources available for obligation:
22.00 New budget authority (gross) 3
23.95 Total new obligations -1



24.40 Unobligated balance carried forward, end of year 2

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 3

Change in obligated balances:
73.10 Total new obligations 1
73.20 Total outlays (gross) -1

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 1

Net budget authority and outlays:
89.00 Budget authority 3
90.00 Outlays 1

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

Employment Summary


Identification code 75-0343-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 3

Health Center Guaranteed Loan Financing Account

Program and Financing (in millions of dollars)


Identification code 75-4442-0-3-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Default claims 1 1
08.02 Downward reestimates paid to receipt accounts 2



10.00 Total new obligations 2 1 1

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 4 2 1
23.95 Total new obligations -2 -1 -1



24.40 Unobligated balance carried forward, end of year 2 1

Change in obligated balances:
73.10 Total new obligations 2 1 1
73.20 Total financing disbursements (gross) -2 -1 -1

Outlays (gross), detail:
87.00 Total financing disbursements (gross) 2 1 1

Net financing authority and financing disbursements:
89.00 Financing authority
90.00 Financing disbursements 2 1 1

Status of Guaranteed Loans (in millions of dollars)


Identification code 75-4442-0-3-551 2009 actual 2010 est. 2011 est.

Position with respect to appropriations act limitation on commitments:
2111 Limitation on guaranteed loans made by private lenders
2121 Limitation available from carry-forward 70 70 53
2143 Uncommitted limitation carried forward -70 -53 -36



2150 Total guaranteed loan commitments 17 17
2199 Guaranteed amount of guaranteed loan commitments 14 14

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 69 65 71
2231 Disbursements of new guaranteed loans 17 17
2251 Repayments and prepayments -3 -10 -10
2263 Adjustments: Terminations for default that result in claim payments -1 -1 -1



2290 Outstanding, end of year 65 71 77

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 52 52 52

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year
2331 Disbursements for guaranteed loan claims 1 1
2351 Repayments of loans receivable -1 -1



2390 Outstanding, end of year

P.L. 104-299 and P.L. 104-208 authorize Health Resources and Services Administration (HRSA) to guarantee up to $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and for the construction, renovation and modernization of medical facilities. As required by the Federal Credit Reform Act of 1990, this financing account records all cash flows to and from the Government resulting from the Health Center Loan Guarantee program. The program account for this activity is displayed in the Health Resources and Services account (75-0350) as a line in the program and financing schedule.

Balance Sheet (in millions of dollars)


Identification code 75-4442-0-3-551 2008 actual 2009 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 4 4


1999 Total assets 4 4
LIABILITIES:
Non-Federal liabilities:
2204 Liabilities for loan guarantees 6 6
2207 Downward Reestimate -2 -2


2999 Total liabilities 4 4


4999 Total liabilities and net position 4 4

health education assistance loans program account

[Such sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the Public Health Service Act ("PHS Act''). For administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, $2,847,000.] (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0340-0-1-552 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.09 Administrative expenses 3 3



10.00 Total new obligations 3 3

Budgetary resources available for obligation:
22.00 New budget authority (gross) 3 3
23.95 Total new obligations -3 -3

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 3 3

Change in obligated balances:
72.40 Obligated balance, start of year 2 3 3
73.10 Total new obligations 3 3
73.20 Total outlays (gross) -2 -3



74.40 Obligated balance, end of year 3 3 3

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 2 3

Net budget authority and outlays:
89.00 Budget authority 3 3
90.00 Outlays 2 3

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


Identification code 75-0340-0-1-552 2009 actual 2010 est. 2011 est.

Guaranteed loan downward reestimates:
237001 HEAL Loan guarantee -28 -10



237999 Total downward reestimate subsidy budget authority -28 -10

Administrative expense data:
3510 Budget authority 3 3
3590 Outlays from new authority 2 3

In FY 2011, the Health Education Assistance Loan (HEAL) program will be transferred to the Department of Education. The Department of Education will assume responsibility for the program and the authority to administer, service, collect, and enforce the program as well as the functions, assets, and liabilities of the Secretary of Health and Human Services will be permanently transferred to the Secretary of Education.

Object Classification (in millions of dollars)


Identification code 75-0340-0-1-552 2009 actual 2010 est. 2011 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 1 1
25.3 Other purchases of goods and services from Government accounts 2 2



99.9 Total new obligations 3 3

Employment Summary


Identification code 75-0340-0-1-552 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 14 14

Health Education Assistance Loans Financing Account

Program and Financing (in millions of dollars)


Identification code 75-4304-0-3-552 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Default claims 11 12
08.02 Payment of downward reestimate to receipt account 15 5
08.04 Payment of interest on downward reestimate to receipt account 13 5



08.91 Subtotal (reestimates) 28 10



10.00 Total new obligations 39 22

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 91 61 45
22.00 New financing authority (gross) 9 6
22.21 Unobligated balance transferred to other accounts -45



23.90 Total budgetary resources available for obligation 100 67
23.95 Total new obligations -39 -22



24.40 Unobligated balance carried forward, end of year 61 45

New financing authority (gross), detail:
Mandatory:
69.00 Offsetting collections (cash) 9 6

Change in obligated balances:
73.10 Total new obligations 39 22
73.20 Total financing disbursements (gross) -39 -22

Outlays (gross), detail:
87.00 Total financing disbursements (gross) 39 22

Offsets:
Against gross financing authority and financing disbursements:
Offsetting collections (cash) from:
88.25 Interest on uninvested funds -3 -2
88.40 Recoveries of defaulted loans -6 -4



88.90 Total, offsetting collections (cash) -9 -6

Net financing authority and financing disbursements:
89.00 Financing authority
90.00 Financing disbursements 30 16

Status of Guaranteed Loans (in millions of dollars)


Identification code 75-4304-0-3-552 2009 actual 2010 est. 2011 est.

Position with respect to appropriations act limitation on commitments:
2111 Limitation on guaranteed loans made by private lenders
2143 Uncommitted limitation carried forward



2150 Total guaranteed loan commitments

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 833 729 658
2251 Repayments and prepayments -93 -59
Adjustments:
2261 Terminations for default that result in loans receivable -9 -11
2263 Terminations for default that result in claim payments -2 -1
2264 Other adjustments, net -658



2290 Outstanding, end of year 729 658

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 729 658

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 170 170 176
2331 Disbursements for guaranteed loan claims 9 11
2351 Repayments of loans receivable -6 -4
2361 Write-offs of loans receivable -4 -1
2364 Other adjustments, net 1 -176



2390 Outstanding, end of year 170 176

Balance Sheet (in millions of dollars)


Identification code 75-4304-0-3-552 2008 actual 2009 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 91 61
Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501 Defaulted guaranteed loans receivable, gross 169 170
1505 Allowance for subsidy cost (-) -113 -121


1599 Net present value of assets related to defaulted guaranteed loans 56 49


1999 Total assets 147 110
LIABILITIES:
Non-Federal liabilities:
2204 Liabilities for loan guarantees 119 100
2207 Other, downward reestimate 28 10


2999 Total liabilities 147 110


4999 Total liabilities and net position 147 110

Health Education Assistance Loans Liquidating Account

Program and Financing (in millions of dollars)


Identification code 75-4305-0-3-552 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.02 Defaulted loans 3 2



10.00 Total new obligations (object class 42.0) 3 2

Budgetary resources available for obligation:
22.00 New budget authority (gross) 3 2
23.95 Total new obligations -3 -2

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation 1 1
69.00 Offsetting collections (cash) 10 10
69.27 Capital transfer to general fund -8 -9



69.90 Spending authority from offsetting collections (total mandatory) 2 1



70.00 Total new budget authority (gross) 3 2

Change in obligated balances:
73.10 Total new obligations 3 2
73.20 Total outlays (gross) -3 -2



74.40 Obligated balance, end of year

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 3 2

Offsets:
Against gross budget authority and outlays:
88.40 Offsetting collections (cash) from: Non-Federal sources -10 -10

Net budget authority and outlays:
89.00 Budget authority -7 -8
90.00 Outlays -7 -8

Status of Guaranteed Loans (in millions of dollars)


Identification code 75-4305-0-3-552 2009 actual 2010 est. 2011 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 145 124 108
2251 Repayments and prepayments -18 -14
Adjustments:
2261 Terminations for default that result in loans receivable -2 -2
2263 Terminations for default that result in claim payments -1
2264 Other adjustments, net -108



2290 Outstanding, end of year 124 108

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 124 108

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 460 421 413
2331 Disbursements for guaranteed loan claims 2 2
2351 Repayments of loans receivable -10 -10
2361 Write-offs of loans receivable -15
2364 Other adjustments, net -16 -413



2390 Outstanding, end of year 421 413

Balance Sheet (in millions of dollars)


Identification code 75-4305-0-3-552 2008 actual 2009 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 1 1
1701 Defaulted guaranteed loans, gross 460 421
1703 Allowance for estimated uncollectible loans and interest (-) -1 -1


1704 Defaulted guaranteed loans and interest receivable, net 459 420


1799 Value of assets related to loan guarantees 459 420


1999 Total assets 460 421
LIABILITIES:
2104 Federal liabilities: Resources payable to Treasury 460 421


2999 Total liabilities 460 421


4999 Total liabilities and net position 460 421

Medical Facilities Guarantee and Loan Fund

Program and Financing (in millions of dollars)


Identification code 75-9931-0-3-551 2009 actual 2010 est. 2011 est.

Change in obligated balances:
72.40 Obligated balance, start of year 1 1 1



74.40 Obligated balance, end of year 1 1 1

Net budget authority and outlays:
89.00 Budget authority
90.00 Outlays

Status of Direct Loans (in millions of dollars)


Identification code 75-9931-0-3-551 2009 actual 2010 est. 2011 est.

Cumulative balance of direct loans outstanding:
1210 Outstanding, start of year 9 9 9



1290 Outstanding, end of year 9 9 9

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

Balance Sheet (in millions of dollars)


Identification code 75-9931-0-3-551 2008 actual 2009 actual

ASSETS:
1601 Direct loans, gross 10 9


1999 Total assets 10 9
LIABILITIES:
2201 Non-Federal liabilities: Accounts payable 10 9


2999 Total liabilities 10 9


4999 Total liabilities and net position 10 9

Trust Funds

vaccine injury compensation program trust fund

For payments from the Vaccine Injury Compensation Program Trust Fund ("Trust Fund''), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the Public Health Service Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed [$6,502,000] $6,502,000 shall be available from the Trust Fund to the Secretary of Health and Human Services. (Department of Health and Human Services Appropriations Act, 2010.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-8175-0-7-551 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year 2,674 2,893 3,150



01.99 Balance, start of year 2,674 2,893 3,150
Receipts:
02.00 Deposits, Vaccine Injury Compensation Trust Fund 235 295 241
02.40 Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund 89 93 97



02.99 Total receipts and collections 324 388 338



04.00 Total: Balances and collections 2,998 3,281 3,488
Appropriations:
05.00 Vaccine Injury Compensation Program Trust Fund -17 -20 -20
05.01 Vaccine Injury Compensation Program Trust Fund -88 -111 -123



05.99 Total appropriations -105 -131 -143



07.99 Balance, end of year 2,893 3,150 3,345

Program and Financing (in millions of dollars)


Identification code 75-8175-0-7-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Compensation: Claims for post - FY 1989 injuries 90 111 123
01.03 Claims processing (Claims Court) 4 5 5
01.04 Claims processing (HRSA) 5 7 7
01.05 Claims processing (Dept. of Justice) 8 8 8



01.91 Total, administrative expenses 17 20 20



10.00 Total new obligations 107 131 143

Budgetary resources available for obligation:
22.00 New budget authority (gross) 105 131 143
22.10 Resources available from recoveries of prior year obligations 2



23.90 Total budgetary resources available for obligation 107 131 143
23.95 Total new obligations -107 -131 -143

New budget authority (gross), detail:
Discretionary:
40.26 Appropriation (trust fund) 17 20 20
Mandatory:
60.26 Appropriation (Vaccine Injury Trust fund) 88 111 123



70.00 Total new budget authority (gross) 105 131 143

Change in obligated balances:
72.40 Obligated balance, start of year 9 12 12
72.45 Adjustment to obligated balance, start of year 7
73.10 Total new obligations 107 131 143
73.20 Total outlays (gross) -109 -131 -143
73.45 Recoveries of prior year obligations -2



74.40 Obligated balance, end of year 12 12 12

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 11 20 20
86.93 Outlays from discretionary balances 6
86.97 Outlays from new mandatory authority 88 111 123
86.98 Outlays from mandatory balances 4



87.00 Total outlays (gross) 109 131 143

Net budget authority and outlays:
89.00 Budget authority 105 131 143
90.00 Outlays 109 131 143

Memorandum (non-add) entries:
92.01 Total investments, start of year: Federal securities: Par value 2,668 2,884 2,932
92.02 Total investments, end of year: Federal securities: Par value 2,884 2,932 2,990

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

Object Classification (in millions of dollars)


Identification code 75-8175-0-7-551 2009 actual 2010 est. 2011 est.

Direct obligations:
25.2 Other services 5 8 8
25.3 Other purchases of goods and services from Government accounts 12 12 12
42.0 Insurance claims and indemnities 90 111 123



99.9 Total new obligations 107 131 143

Indian Health Services

Federal Funds

indian health services

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, [$3,657,618,000] $3,961,187,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b for services furnished by the Indian Health Service: Provided, That funds made available to tribes and tribal organizations through contracts, grant agreements, or any other agreements or compacts authorized by the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be obligated at the time of the grant or contract award and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That [$779,347,000] $862,765,000 for contract medical care, including [$48,000,000] $53,000,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: Provided further, That [$18,251,000 is] of the funding provided for [Headquarters operations and] information technology activities and, notwithstanding any other provision of law, [the amount available under this proviso] $4,000,000 shall be allocated at the discretion of the Director of the Indian Health Service: Provided further, That of the funds provided, up to [$32,000,000] $36,000,000 shall remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health Care Improvement Act: Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That [$16,391,000] $16,391,000 is provided for the methamphetamine and suicide prevention and treatment initiative and [$10,000,000] $10,000,000 is provided for the domestic violence prevention initiative and, notwithstanding any other provision of law, the amounts available under this proviso shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That $4,000,000 is provided for a substance abuse treatment grant program and, notwithstanding any other provision of law, the amounts available under this proviso shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until September 30, 2012: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within two fiscal years, provided the total obligation is recorded in the year the funds are appropriated: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act shall remain available until expended for the purpose of achieving compliance with the applicable conditions and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That, notwithstanding any other provision of law, of the amounts provided herein, not to exceed [$398,490,000] $444,332,000 shall be for payments to tribes and tribal organizations for contract or grant support costs associated with contracts, grants, self-governance compacts, or annual funding agreements between the Indian Health Service and a tribe or tribal organization pursuant to the Indian Self-Determination Act of 1975, as amended, prior to or during fiscal year [2010] 2011, of which not to exceed [$5,000,000] $10,000,000 may be used for contract support costs associated with new or expanded self-determination contracts, grants, self-governance compacts, or annual funding agreements: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93-638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0390-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Clinical services 2,631 2,954 3,200
00.02 Preventive health 135 144 151
00.03 Urban health 36 43 46
00.04 Indian health professions 50 41 41
00.05 Tribal management 3 3 3
00.06 Direct operations 65 69 70
00.07 Self-governance 6 6 6
00.08 Contract support costs 282 398 444
00.09 Diabetes funds 180 150 150
09.01 Reimbursable program 1,116 900 1,000



10.00 Total new obligations 4,504 4,708 5,111

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 351 393 243
22.00 New budget authority (gross) 4,110 4,558 5,011
22.10 Resources available from recoveries of prior year obligations 439



23.90 Total budgetary resources available for obligation 4,900 4,951 5,254
23.95 Total new obligations -4,504 -4,708 -5,111
23.98 Unobligated balance expiring or withdrawn -3



24.40 Unobligated balance carried forward, end of year 393 243 143

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 3,276 3,658 3,961
41.00 Transferred to other accounts -40
42.00 Transferred from other accounts 40



43.00 Appropriation (total discretionary) 3,276 3,658 3,961
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 583 750 900
58.10 Change in uncollected customer payments from Federal sources (unexpired) 101



58.90 Spending authority from offsetting collections (total discretionary) 684 750 900
Mandatory:
60.00 Appropriation 150 150 150



70.00 Total new budget authority (gross) 4,110 4,558 5,011

Change in obligated balances:
72.40 Obligated balance, start of year 577 740 763
73.10 Total new obligations 4,504 4,708 5,111
73.20 Total outlays (gross) -3,902 -4,685 -4,990
73.40 Adjustments in expired accounts (net) 86
73.45 Recoveries of prior year obligations -439
74.00 Change in uncollected customer payments from Federal sources (unexpired) -101
74.10 Change in uncollected customer payments from Federal sources (expired) 15



74.40 Obligated balance, end of year 740 763 884

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 3,078 3,600 3,968
86.93 Outlays from discretionary balances 824 938 872
86.97 Outlays from new mandatory authority 120 120
86.98 Outlays from mandatory balances 27 30



87.00 Total outlays (gross) 3,902 4,685 4,990

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -428 -450 -500
88.40 Non-Federal sources -189 -300 -400



88.90 Total, offsetting collections (cash) -617 -750 -900
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -101
88.96 Portion of offsetting collections (cash) credited to expired accounts 34

Net budget authority and outlays:
89.00 Budget authority 3,426 3,808 4,111
90.00 Outlays 3,285 3,935 4,090

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2,545 million, primarily through self determination contracts and compacts, will be administered by tribal governments in 2011.

Object Classification (in millions of dollars)


Identification code 75-0390-0-1-551 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 354 378 385
11.3 Other than full-time permanent 24 24 26
11.5 Other personnel compensation 50 52 52
11.7 Military personnel 78 78 79



11.9 Total personnel compensation 506 532 542
12.1 Civilian personnel benefits 118 122 125
12.2 Military personnel benefits 35 35 36
13.0 Benefits for former personnel 6 5 6
21.0 Travel and transportation of persons 14 15 16
21.0 Patient travel 24 26 27
22.0 Transportation of things 9 10 10
23.1 Rental payments to GSA 11 12 13
23.2 Rental payments to others 2 2 2
23.3 Communications, utilities, and miscellaneous charges 14 15 17
24.0 Printing and reproduction 1 1 1
25.1 Advisory and assistance services 20 12 13
25.2 Other services 144 150 161
25.3 Other purchases of goods and services from Government accounts 60 66 73
25.4 Operation and maintenance of facilities 4 5 5
25.6 Medical care 261 408 508
25.7 Operation and maintenance of equipment 8 6 7
25.8 Subsistence and support of persons 2 3 2
26.0 Supplies and materials 124 134 147
31.0 Equipment 15 13 14
41.0 Grants, subsidies, and contributions 2,008 2,235 2,385
42.0 Insurance claims and indemnities 2 1 1



99.0 Direct obligations 3,388 3,808 4,111
99.0 Reimbursable obligations 1,116 900 1,000



99.9 Total new obligations 4,504 4,708 5,111

Employment Summary


Identification code 75-0390-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 7,043 7,188 7,199
1101 Military average strength employment 1,085 1,115 1,117
Reimbursable:
2001 Civilian full-time equivalent employment 5,262 5,258 5,258
2101 Military average strength employment 811 815 815

indian health facilities

For construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health and facilities support activities of the Indian Health Service, [$394,757,000] $445,242,000, to remain available until expended: Provided, That notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation or expansion of health facilities for the benefit of [an] a federally-recognized Indian tribe or tribes may be used to purchase land on which such facilities will be located: Provided further, That not to exceed [$500,000] $500,000 shall be used by the Indian Health Service to purchase TRANSAM equipment from the Department of Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development: Provided further, That not to exceed [$2,700,000] $2,700,000 from this account and the "Indian Health Services'' account shall be used by the Indian Health Service to obtain ambulances for the Indian Health Service and tribal facilities in conjunction with an existing interagency agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed [$500,000] $500,000 shall be placed in a Demolition Fund, to remain available until expended, and be used by the Indian Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-0391-0-1-551 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year



01.99 Balance, start of year
Receipts:
02.20 Rent and Charges for Quarters, Indian Health Service 1 6 6



02.99 Total receipts and collections 1 6 6



04.00 Total: Balances and collections 1 6 6
Appropriations:
05.00 Indian Health Facilities -1 -6 -6



05.99 Total appropriations -1 -6 -6



07.99 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75-0391-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Sanitation and health facilities 518 125 164
00.02 Maintenance 91 54 56
00.03 Facilities and environmental health 179 193 202
00.04 Equipment 31 23 24



01.00 Total direct program 819 395 446
09.01 Reimbursable program 93 6 6



10.00 Total new obligations 912 401 452

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 307 347 353
21.45 Adjustments to unobligated balance carried forward, start of year -24
22.00 New budget authority (gross) 901 407 457
22.10 Resources available from recoveries of prior year obligations 75



23.90 Total budgetary resources available for obligation 1,259 754 810
23.95 Total new obligations -912 -401 -452



24.40 Unobligated balance carried forward, end of year 347 353 358

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 805 395 445
58.00 Spending authority from offsetting collections: Offsetting collections (cash) 95 6 6
Mandatory:
60.20 Appropriation (special fund) 1 6 6



70.00 Total new budget authority (gross) 901 407 457

Change in obligated balances:
72.40 Obligated balance, start of year 231 638 463
72.45 Adjustment to obligated balance, start of year 24
73.10 Total new obligations 912 401 452
73.20 Total outlays (gross) -454 -576 -528
73.45 Recoveries of prior year obligations -75



74.40 Obligated balance, end of year 638 463 387

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 270 125 140
86.93 Outlays from discretionary balances 183 445 382
86.97 Outlays from new mandatory authority 1 6 6



87.00 Total outlays (gross) 454 576 528

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources -95 -6 -6

Net budget authority and outlays:
89.00 Budget authority 806 401 451
90.00 Outlays 359 570 522

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service.

Object Classification (in millions of dollars)


Identification code 75-0391-0-1-551 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 39 45 45
11.3 Other than full-time permanent 5 3 4
11.5 Other personnel compensation 2 2 2
11.7 Military personnel 22 20 21



11.9 Total personnel compensation 68 70 72
12.1 Civilian personnel benefits 14 13 13
12.2 Military personnel benefits 8 8 8
21.0 Travel and transportation of persons 3 4 5
22.0 Transportation of things 4 2 2
23.1 Rental payments to GSA 2 2
23.3 Communications, utilities, and miscellaneous charges 16 19 23
25.1 Advisory and assistance services 1 1 1
25.2 Other services 111 59 53
25.3 Other purchases of goods and services from Government accounts 1 2 1
25.4 Operation and maintenance of facilities 4 4 4
25.7 Operation and maintenance of equipment 1 1
25.8 Subsistence and support of persons 221 67 64
26.0 Supplies and materials 9 3 5
31.0 Equipment 11 7 8
32.0 Land and structures 223 32 36
41.0 Grants, subsidies, and contributions 122 102 150



99.0 Direct obligations 819 395 446
99.0 Reimbursable obligations 93 6 6



99.9 Total new obligations 912 401 452

Employment Summary


Identification code 75-0391-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 960 968 970
1101 Military average strength employment 249 239 239
Reimbursable:
2001 Civilian full-time equivalent employment 28 28 28

ADMINISTRATIVE PROVISIONS

administrative provisions, indian health service

Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C. 5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by 5 U.S.C. 5901-5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service.

In accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation. Notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development to the Indian Health Service shall be administered under Public Law 86-121, the Indian Sanitation Facilities Act and Public Law 93-638, as amended.

Funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation.

[None of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process.]

Notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation.

None of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and enacted into law.

With respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance with subsequent adjustment. The reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds were originally derived, with such amounts to remain available until expended.

Reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance.

The appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010.)

Centers for Disease Control and Prevention

Federal Funds

disease control, research, and training

To carry out titles II, III, VII, XI, XV, XVII, XIX, XXI, and XXVI of the Public Health Service Act ("PHS Act''), sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act of 1977, section 13 of the Mine Improvement and New Emergency Response Act of 2006, sections 20, 21, and 22 of the Occupational Safety and Health Act of 1970, titles II and IV of the Immigration and Nationality Act, section 501 of the Refugee Education Assistance Act of 1980, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations; including purchase and insurance of official motor vehicles in foreign countries; and purchase, hire, maintenance, and operation of aircraft, [$6,390,387,000] $6,265,806,000, of which [$69,150,000] $0 shall remain available until expended for acquisition of real property, equipment, construction and renovation of facilities; of which [$595,749,000] $523,533,000 shall remain available until expended for the Strategic National Stockpile under section 319F-2 of the PHS Act; [of which $20,620,000 shall be used for the projects, and in the amounts, specified under the heading "Disease Control, Research, and Training'' in the statement of the managers on the conference report accompanying this Act]; of which [$118,979,000] $118,092,000 for international HIV/AIDS shall remain available through September 30, [2011] 2012; and of which [$70,723,000] $150,137,000 shall be available until expended to provide screening and treatment for first response emergency services personnel, residents, students, and others related to the September 11, 2001 terrorist attacks on the World Trade Center: Provided, That in addition, such sums as may be derived from authorized user fees, which shall be credited to this account: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through September 30, 2011: Provided further, That in addition to amounts provided herein, the following amounts shall be available from amounts available under section 241 of the PHS Act: (1) [$12,864,000] $12,864,000 to carry out the National Immunization Surveys; (2) [$138,683,000] $161,883,000 to carry out the National Center for Health Statistics surveys; (3) [$30,880,000] $30,880,000 for Public Health Informatics; (4) [$47,036,000] $17,151,000 for Health Marketing; (5) [$31,170,000] $31,170,000 to carry out Public Health Research; and (6) [$91,724,000] $91,724,000 to carry out research activities within the National Occupational Research Agenda: Provided further, That none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used, in whole or in part, to advocate or promote gun control: Provided further, That of the funds made available under this heading, up to $1,000 per eligible employee of the Centers for Disease Control and Prevention shall be made available until expended for Individual Learning Accounts: Provided further, That the Director may redirect the total amount made available under authority of Public Law 101-502, section 3, dated November 3, 1990, to activities the Director may so designate: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are to be notified promptly of any such redirection: Provided further, That not to exceed $20,787,000 may be available for making grants under section 1509 of the PHS Act to not less than 21 States, tribes, or tribal organizations: [Provided further, That notwithstanding any other provision of law, the Centers for Disease Control and Prevention shall award a single contract or related contracts for development and construction of the next building or facility designated in the Buildings and Facilities Master Plan that collectively include the full scope of the project:] Provided further, That the solicitation and contract shall contain the clause "availability of funds'' found at 48 CFR 52.232-18: Provided further, That of this amount, $5,789,000 shall be to assist Afghanistan in the development of maternal and child health clinics, consistent with section 103(a)(4)(H) of the Afghanistan Freedom Support Act of 2002: Provided further, That of the funds appropriated, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the Centers for Disease Control and Prevention: Provided further, That employees of the Centers for Disease Control and Prevention or the Public Health Service, both civilian and Commissioned Officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service, or the Department of Health and Human Services during the period of detail or assignment.

In addition, for necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, [$55,358,000] $55,358,000, to remain available until expended:[, of which $4,500,000 shall be for use by or in support of the Advisory Board on Radiation and Worker Health ("the Board'') to carry out its statutory responsibilities, including obtaining audits, technical assistance, and other support from the Board's audit contractor with regard to radiation dose estimation and reconstruction efforts, site profiles, procedures, and review of Special Exposure Cohort petitions and evaluation reports:] Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106-554: Provided further, That with respect to grants to States authorized under Sections 301, 307, 310, 311, 304, and 317 of the PHS Act, any State may redirect up to 10 percent of any fiscal year 2011 grant program allocation to supplement other grants the State receives from funds provided under this heading to address one or more of the top five leading causes of death within such State: Provided further, That each State choosing to redirect funds under the preceding proviso shall submit a detailed plan to the Secretary not less than 30 days prior to such redirection, and, not later than 30 days after the close of the fiscal year, provide a final report in the format specified by the Secretary on the amounts so redirected and how such amounts were used to improve the performance of State public health programs: Provided further, That such redirections may not be used to supplant State funds for such activities. (Department of Health and Human Services Appropriations Act, 2010.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-0943-0-1-999 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year



01.99 Balance, start of year
Receipts:
02.20 Cooperative Research and Development Agreements, Centers for Disease Control 2 2 2



02.99 Total receipts and collections 2 2 2



04.00 Total: Balances and collections 2 2 2
Appropriations:
05.00 Disease Control, Research, and Training -2 -2 -2



05.99 Total appropriations -2 -2 -2



07.99 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75-0943-0-1-999 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Infectious diseases 1,964 1,996 1,900
00.02 Health promotion 1,023 1,075 1,081
00.03 Health information and service 97 72 97
00.04 Environmental health and injury 329 336 330
00.05 Occupational safety and health 253 267 269
00.06 Global health 362 328 352
00.08 Public health improvement and leadership 217 211 193
00.09 Prev. health and health services block grant 102 102 102
00.10 Buildings and facilities 142 69
00.11 Business services support 359 370 382
00.12 Terrorism 1,510 1,549 1,465
00.14 World Trade Center 118 70 150
00.15 Recovery Act - Section 317 155
09.01 Health statistics 33 38 38
09.02 Other reimbursable program 496 483 483
09.03 Public health research 31 31 31



09.09 Subtotal, reimbursable programs 560 552 552



10.00 Total new obligations 7,191 6,997 6,873

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 348 559 490
22.00 New budget authority (gross) 7,397 6,928 6,805
22.10 Resources available from recoveries of prior year obligations 9



23.90 Total budgetary resources available for obligation 7,754 7,487 7,295
23.95 Total new obligations -7,191 -6,997 -6,873
23.98 Unobligated balance expiring or withdrawn -4



24.40 Unobligated balance carried forward, end of year 559 490 422

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 6,283 6,390 6,266
42.00 Transferred from other accounts 500



43.00 Appropriation (total discretionary) 6,783 6,390 6,266
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 275 481 482
58.10 Change in uncollected customer payments from Federal sources (unexpired) 282



58.90 Spending authority from offsetting collections (total discretionary) 557 481 482
Mandatory:
60.00 Appropriation 55 55 55
60.20 Appropriation (special fund) 2 2 2



62.50 Appropriation (total mandatory) 57 57 57



70.00 Total new budget authority (gross) 7,397 6,928 6,805

Change in obligated balances:
72.40 Obligated balance, start of year 5,384 5,730 5,743
73.10 Total new obligations 7,191 6,997 6,873
73.20 Total outlays (gross) -6,706 -6,984 -6,897
73.40 Adjustments in expired accounts (net) -136
73.45 Recoveries of prior year obligations -9
74.00 Change in uncollected customer payments from Federal sources (unexpired) -282
74.10 Change in uncollected customer payments from Federal sources (expired) 288



74.40 Obligated balance, end of year 5,730 5,743 5,719

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 2,592 2,494 2,452
86.93 Outlays from discretionary balances 4,074 4,441 4,396
86.97 Outlays from new mandatory authority 38 21 21
86.98 Outlays from mandatory balances 2 28 28



87.00 Total outlays (gross) 6,706 6,984 6,897

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -533 -472 -473
88.40 Non-Federal sources -5 -9 -9



88.90 Total, offsetting collections (cash) -538 -481 -482
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -282
88.96 Portion of offsetting collections (cash) credited to expired accounts 263

Net budget authority and outlays:
89.00 Budget authority 6,840 6,447 6,323
90.00 Outlays 6,168 6,503 6,415

The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health, safety, and protection of all Americans. These activities include immunization, HIV prevention, chronic disease prevention and health promotion, infectious disease control, occupational safety and health, injury prevention and control, environmental health, and programs that reduce the occurrence of birth defects and developmental disabilities. CDC also supports bioterrorism, emergency response, and pandemic influenza preparedness activities. The CDC infectious diseases activities include resources directed at enhancing preparedness for influenza pandemics. In recent years, CDC supported response activities, domestic and international surveillance, communications, community mitigation, and laboratory support for virus detection with annual budget authority. The Budget will finance these ongoing activities through unobligated balances available from P.L. 111-32, the Supplemental Appropriations Act of 2009. P.L. 111-32 appropriated $7.65 billion to the Public Health and Social Services Emergency Fund for pandemic influenza preparedness and response activities to respond to the novel H1N1 influenza pandemic and to prepare for potential future pandemic influenza outbreaks. Within this total, CDC received a direct appropriation of $200 million and over $2 billion in transfers to support the vaccination campaign, grants to States and for virus detection and disease surveillance. The pandemic preparedness activities funded through resources provided in P.L. 111-32 are shown in the total CDC obligations level for FY 2011.

Object Classification (in millions of dollars)


Identification code 75-0943-0-1-999 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 580 616 624
11.3 Other than full-time permanent 74 71 72
11.5 Other personnel compensation 31 33 34
11.7 Military personnel 63 66 67
11.8 Special personal services payments 2 1 1



11.9 Total personnel compensation 750 787 798
12.1 Civilian personnel benefits 192 192 194
12.2 Military personnel benefits 45 44 45
21.0 Travel and transportation of persons 48 55 54
22.0 Transportation of things 14 14 14
23.1 Rental payments to GSA 22 19 47
23.2 Rental payments to others 3 3 9
23.3 Communications, utilities, and miscellaneous charges 27 47 46
24.0 Printing and reproduction 7 9 9
25.1 Advisory and assistance services 452 420 355
25.2 Other services 255 214 180
25.3 Other purchases of goods and services from Government accounts 382 382 376
25.4 Operation and maintenance of facilities 72 75 75
25.5 Research and development contracts 64 70 69
25.6 Medical care 20 8 8
25.7 Operation and maintenance of equipment 31 24 24
25.8 Subsistence and support of persons 50
26.0 Supplies and materials 688 771 542
31.0 Equipment 79 57 57
32.0 Land and structures 109 9 8
41.0 Grants, subsidies, and contributions 3,321 3,245 3,411



99.0 Direct obligations 6,631 6,445 6,321
99.0 Reimbursable obligations 560 552 552



99.9 Total new obligations 7,191 6,997 6,873

Employment Summary


Identification code 75-0943-0-1-999 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 7,721 7,809 7,909
1101 Military average strength employment 762 764 764
Reimbursable:
2001 Civilian full-time equivalent employment 792 792 792
2101 Military average strength employment 63 63 63

Agency for Toxic Substances and Disease Registry

toxic substances and environmental public health

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended; section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA), as amended; and section 3019 of the Solid Waste Disposal Act, as amended, [$76,792,000] $76,337,000, of which up to $1,000 per eligible employee of the Agency for Toxic Substance and Disease Registry shall remain available until expended for Individual Learning Accounts: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA, the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation, biomedical testing, clinical evaluations, medical monitoring, and referral to accredited health care providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological profiles pursuant to section 104(i) of CERCLA during fiscal year [2010] 2011, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0944-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Direct program 74 77 76
09.01 Reimbursable program 4 6 6



10.00 Total new obligations 78 83 82

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 1 1
22.00 New budget authority (gross) 79 83 82



23.90 Total budgetary resources available for obligation 79 84 83
23.95 Total new obligations -78 -83 -82



24.40 Unobligated balance carried forward, end of year 1 1 1

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 74 77 76
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 3 6 6
58.10 Change in uncollected customer payments from Federal sources (unexpired) 2



58.90 Spending authority from offsetting collections (total discretionary) 5 6 6



70.00 Total new budget authority (gross) 79 83 82

Change in obligated balances:
72.40 Obligated balance, start of year 37 30 29
73.10 Total new obligations 78 83 82
73.20 Total outlays (gross) -83 -84 -82
73.40 Adjustments in expired accounts (net) -2
74.00 Change in uncollected customer payments from Federal sources (unexpired) -2
74.10 Change in uncollected customer payments from Federal sources (expired) 2



74.40 Obligated balance, end of year 30 29 29

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 53 58 57
86.93 Outlays from discretionary balances 30 26 25



87.00 Total outlays (gross) 83 84 82

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources -4 -6 -6
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -2
88.96 Portion of offsetting collections (cash) credited to expired accounts 1

Net budget authority and outlays:
89.00 Budget authority 74 77 76
90.00 Outlays 79 78 76

The Agency for Toxic Substances and Disease Registry (ATSDR) is authorized under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). ATSDR assesses health hazards at specific hazardous waste sites helping to prevent or reduce exposure and illnesses that result, and increasing knowledge and understanding of the health effects that may result from exposure to hazardous substances.

Object Classification (in millions of dollars)


Identification code 75-0944-0-1-551 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 22 21 21
11.3 Other than full-time permanent 1 1 1
11.5 Other personnel compensation 1 1 1
11.7 Military personnel 3 4 4



11.9 Total personnel compensation 27 27 27
12.1 Civilian personnel benefits 6 6 6
12.2 Military personnel benefits 2 1 1
21.0 Travel and transportation of persons 1 1 1
23.3 Communications, utilities, and miscellaneous charges 9 12 11
25.1 Advisory and assistance services 1 2 2
25.2 Other services 8 10 10
25.3 Other purchases of goods and services from Government accounts 2 1 1
25.5 Research and development contracts 1 2 2
31.0 Equipment 4 1 1
41.0 Grants, subsidies, and contributions 13 14 14



99.0 Direct obligations 74 77 76
99.0 Reimbursable obligations 4 6 6



99.9 Total new obligations 78 83 82

Employment Summary


Identification code 75-0944-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 239 252 252
1101 Military average strength employment 42 39 39
Reimbursable:
2001 Civilian full-time equivalent employment 15 14 14
2101 Military average strength employment 1 1

National Institutes of Health

Federal Funds

National Institutes of Health

national cancer institute

For carrying out section 301 and title IV of the Public Health Service Act with respect to cancer, [$5,103,388,000] $5,264,643,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute-Frederick Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2010.)

national heart, lung, and blood institute

For carrying out section 301 and title IV of the Public Health Service Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, [$3,096,916,000] $3,187,516,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of dental and craniofacial research

For carrying out section 301 and title IV of the Public Health Service Act with respect to dental disease, [$413,236,000] $423,511,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of diabetes and digestive and kidney diseases

For carrying out section 301 and title IV of the Public Health Service Act with respect to diabetes and digestive and kidney disease, [$1,808,100,000] $1,857,589,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of neurological disorders and stroke

For carrying out section 301 and title IV of the Public Health Service Act with respect to neurological disorders and stroke, [$1,636,371,000] $1,681,333,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of allergy and infectious diseases

(including transfer of funds)

For carrying out section 301 and title IV of the Public Health Service Act with respect to allergy and infectious diseases, [$4,818,275,000, of which $304,000,000 shall be derived by transfer from funds appropriated under the heading "Biodefense Countermeasures'' in the Department of Homeland Security Appropriations Act, 2004] $4,977,070,000: Provided, That $300,000,000 may be made available to International Assistance Programs "Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis'', to remain available until expended. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of general medical sciences

For carrying out section 301 and title IV of the Public Health Service Act with respect to general medical sciences, [$2,051,798,000] $2,125,090,000. (Department of Health and Human Services Appropriations Act, 2010.)

eunice kennedy shriver national institute of child health and human development

For carrying out section 301 and title IV of the Public Health Service Act with respect to child health and human development, [$1,329,528,000] $1,368,894,000. (Department of Health and Human Services Appropriations Act, 2010.)

national eye institute

For carrying out section 301 and title IV of the Public Health Service Act with respect to eye diseases and visual disorders, [$707,036,000] $724,360,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of environmental health sciences

For carrying out section 301 and title IV of the Public Health Service Act with respect to environmental health sciences, [$689,781,000] $707,339,000. (Department of Health and Human Services Appropriations Act, 2010.)

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, [$79,212,000] $81,763,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010.)

national institute on aging

For carrying out section 301 and title IV of the Public Health Service Act with respect to aging, [$1,110,229,000] $1,142,337,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of arthritis and musculoskeletal and skin diseases

For carrying out section 301 and title IV of the Public Health Service Act with respect to arthritis and musculoskeletal and skin diseases, [$539,082,000] $555,715,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute on deafness and other communication disorders

For carrying out section 301 and title IV of the Public Health Service Act with respect to deafness and other communication disorders, [$418,833,000] $429,007,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of nursing research

For carrying out section 301 and title IV of the Public Health Service Act with respect to nursing research, [$145,660,000] $150,198,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute on alcohol abuse and alcoholism

For carrying out section 301 and title IV of the Public Health Service Act with respect to alcohol abuse and alcoholism, [$462,346,000] $474,649,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute on drug abuse

For carrying out section 301 and title IV of the Public Health Service Act with respect to drug abuse, [$1,059,848,000] $1,094,078,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of mental health

For carrying out section 301 and title IV of the Public Health Service Act with respect to mental health, [$1,489,372,000] $1,540,345,000. (Department of Health and Human Services Appropriations Act, 2010.)

national human genome research institute

For carrying out section 301 and title IV of the Public Health Service Act with respect to human genome research, [$516,028,000] $533,959,000. (Department of Health and Human Services Appropriations Act, 2010.)

national institute of biomedical imaging and bioengineering

For carrying out section 301 and title IV of the Public Health Service Act with respect to biomedical imaging and bioengineering research, [$316,582,000] $325,925,000. (Department of Health and Human Services Appropriations Act, 2010.)

national center for research resources

For carrying out section 301 and title IV of the Public Health Service Act with respect to research resources and general research support grants, [$1,268,896,000] $1,308,741,000. (Department of Health and Human Services Appropriations Act, 2010.)

national center for complementary and alternative medicine

For carrying out section 301 and title IV of the Public Health Service Act with respect to complementary and alternative medicine, [$128,844,000] $132,004,000. (Department of Health and Human Services Appropriations Act, 2010.)

national center on minority health and health disparities

For carrying out section 301 and title IV of the Public Health Service Act with respect to minority health and health disparities research, [$211,572,000] $219,046,000. (Department of Health and Human Services Appropriations Act, 2010.)

john e. fogarty international center

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the Public Health Service Act), [$70,051,000] $73,027,000. (Department of Health and Human Services Appropriations Act, 2010.)

national library of medicine

For carrying out section 301 and title IV of the Public Health Service Act ("PHS Act'') with respect to health information communications, [$339,716,000] $364,802,000, of which $4,000,000 shall be available until expended for improvement of information systems: Provided, That in fiscal year [2010] 2011, the National Library of Medicine may enter into personal services contracts for the provision of services in facilities owned, operated, or constructed under the jurisdiction of the National Institutes of Health: Provided further, That in addition to amounts provided herein, $8,200,000 shall be available from amounts available under section 241 of the PHS Act to carry out the purposes of the National Information Center on Health Services Research and Health Care Technology established under section 478A of the PHS Act and related health services. (Department of Health and Human Services Appropriations Act, 2010.)

office of the director

For carrying out the responsibilities of the Office of the Director, National Institutes of Health ("NIH''), [$1,177,300,000] $1,220,478,000, of which up to $25,000,000 shall be used to carry out section [214] 212 of this Act: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That the NIH is authorized to collect third party payments for the cost of clinical services that are incurred in NIH research facilities and that such payments shall be credited to the NIH Management Fund: Provided further, That all funds credited to such Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: Provided further, That up to [$193,880,000] $194,400,000 shall be available for continuation of the National Children's Study: Provided further, That [$544,109,000] $561,629,000 shall be available for the Common Fund established under section 402A(c)(1) of the Public Health Service Act ("PHS Act''): Provided further, That of the funds provided $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act. (Department of Health and Human Services Appropriations Act, 2010.)

buildings and facilities

For the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by the National Institutes of Health, including the acquisition of real property, [$100,000,000] $125,581,000, to remain available until expended. (Department of Health and Human Services Appropriations Act, 2010.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-9915-0-1-552 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year



01.99 Balance, start of year
Receipts:
02.20 Cooperative Research and Development Agreements, NIH 13 16 16



02.99 Total receipts and collections 13 16 16



04.00 Total: Balances and collections 13 16 16
Appropriations:
05.00 National Institutes of Health -13 -16 -16



05.99 Total appropriations -13 -16 -16



07.99 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75-9915-0-1-552 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 National Cancer Institute 4,967 5,102 5,265
00.02 National Heart, Lung, and Blood Institute 3,015 3,096 3,188
00.03 National Institute of Dental and Craniofacial Research 402 413 423
00.04 National Institute of Diabetes and Digestive and Kidney Disease 1,912 1,958 2,008
00.05 National Institute of Neurological Disorders and Stroke 1,591 1,636 1,681
00.06 National Institute of Allergy and Infectious Diseases 4,400 4,817 4,977
00.07 National Institute of General Medical Sciences 1,994 2,051 2,125
00.08 National Institute of Child Health and Human Development 1,293 1,329 1,369
00.09 National Eye Institute 687 707 724
00.10 National Institute of Environmental Health Sciences 746 690 789
00.11 National Institute on Aging 1,079 1,110 1,142
00.12 National Institute of Arthritis and Musculoskeletal and Skin Disease 524 539 556
00.13 National Institute on Deafness and Other Communication Disorder 407 419 429
00.14 National Institute of Mental Health 1,454 1,490 1,541
00.15 National Institute on Drug Abuse 1,040 1,060 1,094
00.16 Natinal Institute on Alcohol Abuse and Alcoholism 450 462 475
00.17 National Institute of Nursing Research 142 146 150
00.18 National Human Genome Research Institute 507 516 534
00.19 National Institute of Biomedical Imaging and Bioengineering 308 317 326
00.20 National Center for Research Resources 1,225 1,269 1,309
00.21 National Center for Complementary and Alternative Medicine 125 129 132
00.22 National Center on Minority Health and Health Disparities 206 212 219
00.23 John E. Fogarty International Center 69 70 73
00.24 National Library of Medicine 330 347 365
00.25 Office of the Director 1,247 1,177 1,220
00.26 Buildings and facilities 89 212 126
00.27 Cooperative Research and Development Agreements 10 16 16
00.28 ARRA Funds 5,001 5,399
09.00 Reimbursable program 3,147 3,241 3,197



10.00 Total new obligations 38,367 39,930 35,453

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 420 5,924 492
22.00 New budget authority (gross) 43,807 34,498 35,452
22.10 Resources available from recoveries of prior year obligations 67



23.90 Total budgetary resources available for obligation 44,294 40,422 35,944
23.95 Total new obligations -38,367 -39,930 -35,453
23.98 Unobligated balance expiring or withdrawn -3



24.40 Unobligated balance carried forward, end of year 5,924 492 491

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 30,395 30,784 32,089
40.00 Appropriation 10,000
41.00 Transferred to other accounts -300
42.00 Transferred from other accounts 401 305



43.00 Appropriation (total discretionary) 40,496 31,089 32,089
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 2,597 3,243 3,197
58.10 Change in uncollected customer payments from Federal sources (unexpired) 551



58.90 Spending authority from offsetting collections (total discretionary) 3,148 3,243 3,197
Mandatory:
60.00 Appropriation 150 150 150
60.20 Appropriation (special fund) 13 16 16



62.50 Appropriation (total mandatory) 163 166 166



70.00 Total new budget authority (gross) 43,807 34,498 35,452

Change in obligated balances:
72.40 Obligated balance, start of year 30,184 35,139 40,019
73.10 Total new obligations 38,367 39,930 35,453
73.20 Total outlays (gross) -33,000 -35,050 -40,386
73.40 Adjustments in expired accounts (net) -363
73.45 Recoveries of prior year obligations -67
74.00 Change in uncollected customer payments from Federal sources (unexpired) -551
74.10 Change in uncollected customer payments from Federal sources (expired) 569



74.40 Obligated balance, end of year 35,139 40,019 35,086

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 10,557 11,197 11,348
86.93 Outlays from discretionary balances 22,378 23,687 28,872
86.97 Outlays from new mandatory authority 25 52 52
86.98 Outlays from mandatory balances 40 114 114



87.00 Total outlays (gross) 33,000 35,050 40,386

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -3,059 -3,243 -3,197
88.40 Non-Federal sources -94



88.90 Total, offsetting collections (cash) -3,153 -3,243 -3,197
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -551
88.96 Portion of offsetting collections (cash) credited to expired accounts 556

Net budget authority and outlays:
89.00 Budget authority 40,659 31,255 32,255
90.00 Outlays 29,847 31,807 37,189

DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT (in millions of dollars)


2009 2010 2011

Distribution of budget authority by account:
National Cancer Institute 4,967 5,103 5,265
National Heart, Lung, and Blood Institute 3,015 3,097 3,188
National Institute of Dental and Craniofacial Research 402 413 424
National Institute of Diabetes and Digestive and Kidney Diseases 1,912 1,958 2,008
National Institute of Neurological Disorder and Stroke 1,591 1,636 1,681
National Institute of Allergy and Infectious Diseases 4,400 4,818 4,977
National Institute of General Medical Sciences 1,995 2,052 2,125
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,293 1,330 1,369
National Eye Institute 687 707 724
National Institute of Environmental Health Sciences 746 769 789
National Institute on Aging 1,079 1,110 1,142
National Institute of Arthritis and Musculoskeletal and Skin Diseases 524 539 556
National Institute on Deafness and Other Communication Disorders 407 419 429
National Institute of Nursing Research 142 146 150
National Institute on Alcohol Abuse and Alcoholism 450 462 475
National Institute on Drug Abuse 1,040 1,060 1,094
National Institute of Mental Health 1,454 1,490 1,540
National Center for Research Resources 1,225 1,269 1,309
National Human Genome Research Institute 507 516 534
National Institute of Biomedical Imaging and Bioengineering 308 317 326
National Center for Complementary and Alternative Medicine 125 129 132
National Center for Minority Health and Health Disparities 206 212 219
John E. Fogarty International Center 69 70 73
National Library of Medicine 331 340 365
Office of the Director 1,247 1,177 1220
Buildings and Facilities 126 100 126

ARRA Funds 10,400 0 0



Subtotal 40,646 31,239 32,239

Cooperative Research and Development Agreements 13 16 16




Total Budget Authority, NIH 40,659 31,255 32,255




(in millions of dollars)


2009 2010 2011

Distribution of outlays by account:
National Cancer Institute 4,961 4,780 5,073
National Heart, Lung, and Blood Institute 2,926 3,031 3,065
National Institute of Dental and Craniofacial Research 388 405 414
National Institute of Diabetes and Digestive and Kidney Diseases 1,841 1,850 1,956
National Institute of Neurological Disorders and Stroke 1,529 1,559 1,640
National Institute of Allergy and Infectious Diseases 4,482 4,181 4,744
National Institute of General Medical Sciences 1,933 1,968 2,058
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,279 1,270 1,334
National Eye Institute 679 667 707
National Institute of Environmental Health Sciences 756 722 772
National Institute on Aging 1,105 1,036 1,132
National Institute of Arthritis and Musculoskeletal and Skin Diseases 513 515 540
National Institute on Deafness and Other Communication Disorders 398 404 419
National Institute of Nursing Research 144 135 145
National Institute on Alcohol Abuse and Alcoholism 420 457 462
National Institute on Drug Abuse 1,039 1,003 1,050
National Institute of Mental Health 1,405 1,452 1,497
National Center for Research Resources 1,250 987 1,260
National Human Genome Research Institute 516 494 522
National Institute of Biomedical Imaging and Bioengineering 306 302 319
National Center for Complementary and Alternative Medicine 125 109 128
National Center for Minority Health and Health Disparities 200 203 215
John E. Fogarty International Center 65 69 71
National Library of Medicine 346 318 351
Office of the Director 1,012 1,290 1,188
Buildings and Facilities 161 88 139

ARRA Funds 109 2,497 5,989



Subtotal Outlays 29,886 31,791 37,189

Cooperative Research and Development Agreements 19 16 16




Total Outlays, NIH 29,905 31,807 37,205




This program funds biomedical research and research training. These accounts will continue to be appropriated separately, and are displayed in a consolidated format to improve the readability of the presentation. Detailed information is available through the Department of Health and Human Services.

Object Classification (in millions of dollars)


Identification code 75-9915-0-1-552 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 821 855 917
11.3 Other than full-time permanent 444 460 493
11.5 Other personnel compensation 58 46 48
11.7 Military personnel 23 24 26
11.8 Special personal services payments 181 183 196



11.9 Total personnel compensation 1,527 1,568 1,680
12.1 Civilian personnel benefits 360 373 401
12.2 Military personnel benefits 16 17 18
21.0 Travel and transportation of persons 54 53 54
22.0 Transportation of things 6 6 6
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 37 32 32
24.0 Printing and reproduction 10 10 10
25.1 Advisory and assistance services 133 105 103
25.2 Other services 790 845 722
25.3 Other purchases of goods and services from Government accounts 3,238 2,799 2,844
25.4 Operation and maintenance of facilities 273 706 279
25.5 Research and development contracts 2,339 2,730 2,361
25.6 Medical care 15 14 15
25.7 Operation and maintenance of equipment 80 76 78
26.0 Supplies and materials 219 200 204
31.0 Equipment 197 182 166
41.0 Grants, subsidies, and contributions 25,925 26,973 23,282



99.0 Direct obligations 35,220 36,690 32,256
99.0 Reimbursable obligations 3,147 3,240 3,197



99.9 Total new obligations 38,367 39,930 35,453

Employment Summary


Identification code 75-9915-0-1-552 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 12,418 12,263 13,157
1101 Military average strength employment 242 243 243
Reimbursable:
2001 Civilian full-time equivalent employment 5,148 5,255 5,255
2101 Military average strength employment 114 125 125

Substance Abuse and Mental Health Services Administration

Federal Funds

substance abuse and mental health services

For carrying out titles III, V, and XIX of the Public Health Service Act ("PHS Act'') with respect to substance abuse and mental health services and the Protection and Advocacy for Individuals with Mental Illness Act, [$3,431,624,000, of which $14,518,000 shall be used for the projects, and in the amounts, specified under the heading "Substance Abuse and Mental Health Services'' in the statement of the managers on the conference report accompanying this Act] $3,541,362,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A are available for carrying out section 1971 of the PHS Act: [Provided further, That $795,000 shall be available until expended for reimbursing the General Services Administration for environmental testing and remediation on the federally owned facilities at St. Elizabeths Hospital, including but not limited to testing and remediation conducted prior to fiscal year 2010:] Provided further, That in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS Act: (1) [$79,200,000] $79,200,000 to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX; (2) [$21,039,000] $21,039,000 to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1920(b) activities shall not exceed 5 percent of the amounts appropriated for subpart I of part B of title XIX; (3) [$22,750,000] $23,399,000 to carry out national surveys on drug abuse and mental health; and (4) [$8,596,000] $8,596,000 to collect and analyze data and evaluate substance abuse treatment programs: Provided further, That section 520E(b)(2) of the PHS Act shall not apply to funds appropriated under this Act for fiscal year [2010] 2011. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-1362-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.02 Mental health block grant 400 400 400
00.03 Substance abuse block grant 1,699 1,720 1,720
00.05 Program management 77 79 112
00.06 St. Elizabeths Hospital 1 1
00.07 Data evaluation 3
00.10 Children's mental health 108 121 126
00.11 PATH homeless State grants 60 65 70
00.12 Protection and advocacy 36 36 36
00.13 Mental health programs of regional and national significance 344 362 374
00.18 Prevention programs of regional and national significance 201 202 223
00.19 Treatment programs of regional and national significance 403 444 478
00.20 Prescription drug monitoring (NASPER) 2 2 2



01.00 Total, direct program 3,334 3,432 3,541
09.02 Reimbursable program: PHS Evaluation 132 132 132
09.49 Reimbursable program 127 138 142



10.00 Total new obligations 3,593 3,702 3,815

Budgetary resources available for obligation:
22.00 New budget authority (gross) 3,595 3,702 3,815
23.95 Total new obligations -3,593 -3,702 -3,815
23.98 Unobligated balance expiring or withdrawn -1

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 3,335 3,432 3,541
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 98 270 274
58.10 Change in uncollected customer payments from Federal sources (unexpired) 162



58.90 Spending authority from offsetting collections (total discretionary) 260 270 274



70.00 Total new budget authority (gross) 3,595 3,702 3,815

Change in obligated balances:
72.40 Obligated balance, start of year 2,656 2,605 2,688
73.10 Total new obligations 3,593 3,702 3,815
73.20 Total outlays (gross) -3,543 -3,619 -3,731
73.40 Adjustments in expired accounts (net) -30
74.00 Change in uncollected customer payments from Federal sources (unexpired) -162
74.10 Change in uncollected customer payments from Federal sources (expired) 91



74.40 Obligated balance, end of year 2,605 2,688 2,772

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 1,500 1,643 1,690
86.93 Outlays from discretionary balances 2,043 1,976 2,041



87.00 Total outlays (gross) 3,543 3,619 3,731

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources -174 -270 -274
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -162
88.96 Portion of offsetting collections (cash) credited to expired accounts 76

Net budget authority and outlays:
89.00 Budget authority 3,335 3,432 3,541
90.00 Outlays 3,369 3,349 3,457

This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective substance abuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance abuse or mental illness. SAMHSA builds partnerships with states, communities, tribal and private not-for-profit organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.

Object Classification (in millions of dollars)


Identification code 75-1362-0-1-551 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 42 46 47
11.3 Other than full-time permanent 2 2 2
11.5 Other personnel compensation 1 1 1
11.7 Military personnel 4 4 4



11.9 Total personnel compensation 49 53 54
12.1 Civilian personnel benefits 11 12 12
12.2 Military personnel benefits 2 2 2
21.0 Travel and transportation of persons 2 2 2
23.1 Rental payments to GSA 6 7 7
23.3 Communications, utilities, and miscellaneous charges 1 1 1
24.0 Printing and reproduction 4 5 5
25.1 Advisory and assistance services 27 28 31
25.2 Other services 208 218 257
25.3 Other purchases of goods and services from Government accounts 102 105 113
25.7 Operation and maintenance of equipment 1 1 1
41.0 Grants, subsidies, and contributions 2,919 2,997 3,055
42.0 Insurance claims and indemnities 2 1 1



99.0 Direct obligations 3,334 3,432 3,541
99.0 Reimbursable obligations 259 270 274



99.9 Total new obligations 3,593 3,702 3,815

Employment Summary


Identification code 75-1362-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 424 444 447
1101 Military average strength employment 50 50 51
Reimbursable:
2001 Civilian full-time equivalent employment 38 38 38
2101 Military average strength employment 16 17 17

Agency for Healthcare Research and Quality

Federal Funds

healthcare research and quality

For carrying out titles III and IX of the Public Health Service Act ("PHS Act''), part A of title XI of the Social Security Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall remain available until expended: Provided, That the amount made available pursuant to section 937(c) of the PHS Act shall not exceed [$397,053,000] $610,912,000. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-1700-0-1-552 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Recovery Act 6 694
00.02 Mandatory Appropriations: MIPPA 2 1
09.01 Reimbursable program 19 19 19
09.02 Reimbursable program: PHS evaluation 372 397 611



10.00 Total new obligations 399 1,111 630

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 8 703 8
22.00 New budget authority (gross) 1,093 416 630
22.10 Resources available from recoveries of prior year obligations 1



23.90 Total budgetary resources available for obligation 1,102 1,119 638
23.95 Total new obligations -399 -1,111 -630



24.40 Unobligated balance carried forward, end of year 703 8 8

New budget authority (gross), detail:
Discretionary:
40.00 Appropriation 1,100
41.00 Transferred to other accounts -400



43.00 Appropriation (total discretionary) 700
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 135 416 630
58.10 Change in uncollected customer payments from Federal sources (unexpired) 255



58.90 Spending authority from offsetting collections (total discretionary) 390 416 630
Mandatory:
60.00 Appropriation 3



70.00 Total new budget authority (gross) 1,093 416 630

Change in obligated balances:
72.40 Obligated balance, start of year 9 94 648
73.10 Total new obligations 399 1,111 630
73.20 Total outlays (gross) -331 -557 -947
73.40 Adjustments in expired accounts (net) -23
73.45 Recoveries of prior year obligations -1
74.00 Change in uncollected customer payments from Federal sources (unexpired) -255
74.10 Change in uncollected customer payments from Federal sources (expired) 296



74.40 Obligated balance, end of year 94 648 331

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 111 416 630
86.93 Outlays from discretionary balances 220 139 316
86.98 Outlays from mandatory balances 2 1



87.00 Total outlays (gross) 331 557 947

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources -411 -416 -630
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -255
88.96 Portion of offsetting collections (cash) credited to expired accounts 276

Net budget authority and outlays:
89.00 Budget authority 703
90.00 Outlays -80 141 317

This activity supports the development of scientific evidence and tools to improve the quality, safety, and effectiveness of all aspects of the health care system, and initiatives to disseminate and translate scientific findings into health care practice. The American Recovery and Reinvestment Act (P.L. 111-5) included additional funding for AHRQ for comparative effectiveness research available in fiscal years 2009 and 2010.

Object Classification (in millions of dollars)


Identification code 75-1700-0-1-552 2009 actual 2010 est. 2011 est.

Direct obligations:
11.3 Personnel compensation: Other than full-time permanent 5
12.1 Civilian personnel benefits 2
25.3 Other purchases of goods and services from Government accounts 7
25.5 Research and development contracts 8 329
41.0 Grants, subsidies, and contributions 352



99.0 Direct obligations 8 695
99.0 Reimbursable obligations 391 416 630



99.9 Total new obligations 399 1,111 630

Employment Summary


Identification code 75-1700-0-1-552 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 38
Reimbursable:
2001 Civilian full-time equivalent employment 275 286 301
2101 Military average strength employment 14 14 14

Centers for Medicare and Medicaid Services

Federal Funds

grants to states for medicaid

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$220,962,473,000] $173,143,799,000, to remain available until expended.

For making, after May 31, [2010] 2011, payments to States or in the case of section 1928 on behalf of States under title XIX of the Social Security Act for the last quarter of fiscal year [2010] 2011 for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary.

For making payments to States or in the case of section 1928 on behalf of States under title XIX of the Social Security Act for the first quarter of fiscal year [2011, $86,789,382,000] 2012, $86,445,289,000, to remain available until expended.

Payment under title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0512-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Medicaid vendor payments 248,549 260,645 254,227
00.02 State and local administration 12,169 11,071 13,567
00.03 Vaccines for Children 3,383 3,652 3,651
00.04 Incurred by providers but not yet reported 508 2,899 2,899
09.01 Medicare Part B premiums 449 563 150



10.00 Total new obligations 265,058 278,830 274,494

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 8,989 8,179 14,411
21.45 Adjustments to unobligated balance carried forward, start of year -8,163
22.00 New budget authority (gross) 255,339 293,225 260,083
22.10 Resources available from recoveries of prior year obligations 8,909



23.90 Total budgetary resources available for obligation 273,237 293,241 274,494
23.95 Total new obligations -265,058 -278,830 -274,494



24.40 Unobligated balance carried forward, end of year 8,179 14,411

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation Medicaid 149,335 220,962 173,144
60.00 Appropriation Medicaid, Indefinite 38,262



62.50 Appropriation (total mandatory) 187,597 220,962 173,144
65.00 Advance appropriation 67,293 71,700 86,789
69.00 Offsetting collections (cash) 449 150
69.00 Offsetting collections (cash) 413 150



69.90 Spending authority from offsetting collections (total mandatory) 449 563 150



70.00 Total new budget authority (gross) 255,339 293,225 260,083

Change in obligated balances:
72.40 Obligated balance, start of year 20,714 25,490 28,389
73.10 Total new obligations 265,058 278,830 274,494
73.20 Total outlays (gross) -251,373 -275,931 -271,596
73.45 Recoveries of prior year obligations -8,909



74.40 Obligated balance, end of year 25,490 28,389 31,287

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 242,334 267,931 260,056
86.98 Outlays from mandatory balances 9,039 8,000 11,540



87.00 Total outlays (gross) 251,373 275,931 271,596

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -449 -150
88.00 Federal sources -413 -150



88.90 Total, offsetting collections (cash) -449 -563 -150

Net budget authority and outlays:
89.00 Budget authority 254,890 292,662 259,933
90.00 Outlays 250,924 275,368 271,446

Summary of Budget Authority and Outlays (in millions of dollars)


2009 actual 2010 est. 2011 est.

Enacted/requested:
Budget Authority 254,890 292,662 259,933
Outlays 250,924 275,368 271,446
Legislative proposal, not subject to PAYGO:
Budget Authority -115
Outlays -115
Legislative proposal, subject to PAYGO:
Budget Authority 15 25,395
Outlays 15 25,395
Total:
Budget Authority 254,890 292,677 285,213
Outlays 250,924 275,383 296,726

Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under title XIX of the Social Security Act to States with approved plans.

Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).

Authorized as part of Title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children. VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.

Vaccines for Children (in millions of dollars)


Obligations 2009 2010 2011

Vaccine Purchase 3,037 3,348 3,368
Vaccine Stockpile 213 136 130
Ordering, Distribution, and Operations 89 124 109
Vaccine Management Contract Support 6 5 4

Evaluation Activities 38 39 40



Total Obligations 3,383 3,652 3,651

Object Classification (in millions of dollars)


Identification code 75-0512-0-1-551 2009 actual 2010 est. 2011 est.

41.0 Direct obligations: Grants, subsidies, and contributions 264,609 278,267 274,344



99.0 Reimbursable obligations: reimbursable obligations 449 563 150



99.9 Total new obligations 265,058 278,830 274,494

Grants to States for Medicaid

(Legislative proposal, not subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75-0512-2-1-551 2009 actual 2010 est. 2011 est.

Budgetary resources available for obligation:
22.00 New budget authority (gross) -115



24.40 Unobligated balance carried forward, end of year -115

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation Medicaid -115

Change in obligated balances:
73.20 Total outlays (gross) 115



74.40 Obligated balance, end of year 115

Outlays (gross), detail:
86.97 Outlays from new mandatory authority -115

Net budget authority and outlays:
89.00 Budget authority -115
90.00 Outlays -115

Please see the narratives in the Limitation on Administrative Expenses and Health Care Fraud and Abuse Control accounts for a description of the program integrity proposals reflected here.

Grants to States for Medicaid

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75-0512-4-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 ARRA FMAP Extension 25,500
00.02 Program Integrity -120
00.03 Other Proposals 15 15



10.00 Total new obligations (object class 41.0) 15 25,395

Budgetary resources available for obligation:
22.00 New budget authority (gross) 15 25,395
23.95 Total new obligations -15 -25,395



24.40 Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation Medicaid 15 25,395

Change in obligated balances:
73.10 Total new obligations 15 25,395
73.20 Total outlays (gross) -15 -25,395



74.40 Obligated balance, end of year

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 15 25,395

Net budget authority and outlays:
89.00 Budget authority 15 25,395
90.00 Outlays 15 25,395

This schedule reflects the Administration's Medicaid proposals.

State Grants and Demonstrations

Program and Financing (in millions of dollars)


Identification code 75-0516-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.10 Ticket to Work grants 68 80 72
00.11 Emergency health services for undocumented aliens 144 75 80
00.12 Medicaid integrity program 83 81 75
00.13 Funding for PACE outliers 10
00.14 Drug surveys and reports
00.15 Partnerships for long-term care 3 3
00.16 Grants to establish alternate non-emergency services 24
00.17 Psychiatric residential treatment demonstration 9 75 99
00.18 Money Follows the Person (MFP) demonstration 251 450 723
00.19 MFP evaluations and technical support 2 1
00.20 Medicaid transformation grants
00.21 Katrina relief
00.23 Grants to improve outreach and enrollment 43 13 42
00.24 Application of Prospective Payment System 5



10.00 Total new obligations 625 794 1,092

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 976 981 673
22.00 New budget authority (gross) 609 583 629
22.10 Resources available from recoveries of prior year obligations 26



23.90 Total budgetary resources available for obligation 1,611 1,564 1,302
23.95 Total new obligations -625 -794 -1,092
23.98 Unobligated balance expiring or withdrawn -5 -97 -154



24.40 Unobligated balance carried forward, end of year 981 673 56

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation (Ticket to Work) 46 47 47
60.00 Appropriation (Emergency health services for undocumented aliens)
60.00 Appropriation (Federal upper payment limit for multiple source drugs) 5 5
60.00 Appropriation (Expansion of long term care partnerships) 3 3
60.00 Appropriation (Psychiatric residential treatment demonstration) 49 53 57
60.00 Appropriation (Money Follows the Person (MFP) demonstration) 349 399 449
60.00 Appropriation (MFP research & evaluation) 1 1 1
60.00 Appropriation (Medicaid transformation grants)
60.00 Appropriation (Medicaid integrity program) 75 75 75
60.00 Appropriation (Grants to improve outreach and enrollment) 100
60.00 Appropriation (Application of Prospective Payment System) 5
60.35 Appropriation permanently reduced -22



62.50 Appropriation (total mandatory) 611 583 629
69.00 Offsetting collections (cash) -2



70.00 Total new budget authority (gross) 609 583 629

Change in obligated balances:
72.40 Obligated balance, start of year 790 892 706
73.10 Total new obligations 625 794 1,092
73.20 Total outlays (gross) -496 -980 -1,036
73.40 Adjustments in expired accounts (net) -1 -4
73.45 Recoveries of prior year obligations -26



74.40 Obligated balance, end of year 892 706 758

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 2 95 96
86.98 Outlays from mandatory balances 494 885 940



87.00 Total outlays (gross) 496 980 1,036

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources 2

Net budget authority and outlays:
89.00 Budget authority 611 583 629
90.00 Outlays 498 980 1,036

State Grants and Demonstrations provides funding for grant programs established under several legislative authorities, including the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170), the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173), the Deficit Reduction Act of 2005 (P.L. 109-171), and the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3).

Object Classification (in millions of dollars)


Identification code 75-0516-0-1-551 2009 actual 2010 est. 2011 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent-Medicaid Integrity Program 10 9 9
12.1 Civilian personnel benefits-Medicaid Integrity Program 6 6
41.0 Grants, subsidies, and contributions - Ticket to Work 68 80 72
41.0 Grants, subsidies, and contributions - Fed'l Reimb. - Emer Svcs, Undoc. Aliens 144 75 80
41.0 Grants, subsidies, and contributions-Medicaid Integrity Program 73 66 60
41.0 Grants, subsidies, and contributions-Funding for PACE Outliers 10
41.0 Grants, subsidies, and contributions-Partnership for Long Term Care 3 3
41.0 Grants, subsidies, and contributions-Alternate Non-Emergency Network Providers 24
41.0 Grants, subsidies, and contributions-Psychiatric Residential Treatment Demonstration 9 75 99
41.0 Grants, subsidies, and contributions-Money follows the Person (MFP) Demonstration 251 450 723
41.0 Grants, subsidies, and contributions-MFP Evaluations & Technical Support 2 1
41.0 Grants, subsidies, and contributions-Medicaid Transformation Grants
41.0 Grants, subsidies, and contributions-Katrina Relief
41.0 Grants, subsidies, and contributions-Grants to Improve Outreach and Enrollment 43 13 42
41.0 Grants, subsidies, and contributions-Application of Prospective Payment System 5



99.9 Total new obligations 625 794 1,092

Employment Summary


Identification code 75-0516-0-1-551 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 94 100 100

payments to health care trust funds

For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d) of Public Law 97-248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, [$207,286,070,000] $229,664,000,000.

In addition, for making matching payments under section 1844, and benefit payments under section 1860D-16 of the Social Security Act, not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0580-0-1-571 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Federal contribution to match premiums (SMI) 150,748 160,364 173,873
00.02 Part D benefits (Rx Drug) 43,287 47,794 54,393
00.03 Part D Federal administration (Rx Drug) 396 398 382
00.04 General Fund Transfers to HI 895 570 1,016
00.05 Quinquennial adjustment for military service credits (HI) 968
00.06 Federal Bureau of Investigation (HCFAC) 126 126 126
00.07 Federal payments from taxation of OASDI benefits (HI) 12,376 15,005 17,471
00.08 Criminal fines (HCFAC) 621 168 217
00.09 Civil monetary penalties and damages (HCFAC - DOJ and CMS administration) 17 14 14



10.00 Total new obligations 209,434 224,439 247,492

Budgetary resources available for obligation:
22.00 New budget authority (gross) 213,023 229,903 247,492
22.30 Expired unobligated balance transfer to unexpired account 197



23.90 Total budgetary resources available for obligation 213,023 230,100 247,492
23.95 Total new obligations -209,434 -224,439 -247,492
23.98 Unobligated balance expiring or withdrawn -3,590 -5,661

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation (definite, annual) 195,383 207,286 229,664
60.00 Appropriation (indefinite, annual) 4,500 7,304
60.00 Appropriation (indefinite, permanent) 12,376 15,187 17,702
60.00 Appropriation (HCFAC for FBI) 126 126 126
60.00 Appropriation (indefinite for HCFAC) 638



62.50 Appropriation (total mandatory) 213,023 229,903 247,492

Change in obligated balances:
73.10 Total new obligations 209,434 224,439 247,492
73.20 Total outlays (gross) -209,447 -224,439 -247,492
73.40 Adjustments in expired accounts (net) 13

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 209,434 224,439 247,492
86.98 Outlays from mandatory balances 13



87.00 Total outlays (gross) 209,447 224,439 247,492

Offsets:
Against gross budget authority and outlays:
88.00 Offsetting collections (cash) from: Federal sources -177
Against gross budget authority only:
88.96 Portion of offsetting collections (cash) credited to expired accounts 177

Net budget authority and outlays:
89.00 Budget authority 213,023 229,903 247,492
90.00 Outlays 209,270 224,439 247,492

Summary of Budget Authority and Outlays (in millions of dollars)


2009 actual 2010 est. 2011 est.

Enacted/requested:
Budget Authority 213,023 229,903 247,492
Outlays 209,270 224,439 247,492
Amounts included in baseline projection of current policy:
Budget Authority
Outlays
Legislative proposal, not subject to PAYGO:
Budget Authority -103
Outlays -103
Total:
Budget Authority 213,023 229,903 247,389
Outlays 209,270 224,439 247,389

Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries and certain other qualified individuals.

Object Classification (in millions of dollars)


Identification code 75-0580-0-1-571 2009 actual 2010 est. 2011 est.

Direct obligations:
41.0 Grants, subsidies, and contributions 208,143 223,837 246,655
42.0 Insurance claims and indemnities 614 275
94.0 Financial transfers (Federal admin) 677 602 562



99.0 Direct obligations 209,434 224,439 247,492



99.9 Total new obligations 209,434 224,439 247,492

Payments to Health Care Trust Funds

(Legislative proposal, not subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75-0580-2-1-571 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Federal contribution to match premiums (SMI) -103



10.00 Total new obligations (object class 41.0) -103

Budgetary resources available for obligation:
22.00 New budget authority (gross) -103
23.95 Total new obligations 103

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation (definite, annual) -103

Change in obligated balances:
73.10 Total new obligations -103
73.20 Total outlays (gross) 103

Outlays (gross), detail:
86.97 Outlays from new mandatory authority -103

Net budget authority and outlays:
89.00 Budget authority -103
90.00 Outlays -103

program management

For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the Public Health Service Act ("PHS Act''), and the Clinical Laboratory Improvement Amendments of 1988, not to exceed [$3,470,242,000] $3,601,147,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353 of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary of Health and Human Services pursuant to section 302 of the Tax Relief and Health Care Act of 2006; and such sums as may be collected from authorized user fees and the sale of data, which shall be credited to this account and remain available until expended: Provided, That all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the PHS Act shall be credited to and available for carrying out the purposes of this appropriation: Provided further, That [$35,681,000] $37,687,000, to remain available through September 30, [2011] 2012, shall be for contract costs for the Healthcare Integrated General Ledger Accounting System: Provided further, That [$65,600,000] $9,120,000, to remain available through September 30, [2011] 2012, shall be for the Centers for Medicare and Medicaid Services ("CMS'') Medicare contracting reform activities: [Provided further, That $55,000,000 shall be available for the State high risk health insurance pool program as authorized by the State High Risk Pool Funding Extension Act of 2006:] Provided further, That $110,000,000, to remain available through September 30, 2012, shall be for the Centers for Medicare and Medicaid Service's Health Care Data Improvement Initiative: Provided further, That the Secretary is directed to collect fees in fiscal year [2010] 2011 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act[: Provided further, That $3,100,000 shall be used for the projects, and in the amounts, specified under the heading "Program Management'' in the statement of the managers on the conference report accompanying this Act]. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-0511-0-1-550 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Medicare operations 2,383 2,592 2,394
00.02 Federal administration 645 703 726
00.03 State survey and certification 293 347 362
00.04 Research, demonstrations, and evaluation projects 30 36 47
00.05 Health care data improvement initiative 110
00.06 High-risk pool grants 75 55
00.07 ARRA Medicare/Medicaid HIT 4 123 175



01.00 Total direct program 3,430 3,856 3,814
09.01 Clinical laboratory improvement amendments 51 43 43
09.02 Sale of data 3 2 2
09.03 Coordination of benefits 53 51 52
09.04 Medicare advantage/Prescription drug plan 70 74 73
09.05 Recovery audit contractors 2 259 259
09.06 Other reimbursables 30



09.09 Total reimbursable program 209 429 429



10.00 Total new obligations 3,639 4,285 4,243

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 293 492 282
22.00 New budget authority (gross) 3,844 4,075 4,207
22.10 Resources available from recoveries of prior year obligations 14



23.90 Total budgetary resources available for obligation 4,151 4,567 4,489
23.95 Total new obligations -3,639 -4,285 -4,243
23.98 Unobligated balance expiring or withdrawn -20



24.40 Unobligated balance carried forward, end of year 492 282 246

New budget authority (gross), detail:
Discretionary:
Spending authority from offsetting collections:
58.00 Offsetting collections (cash) 2,024 3,674 3,860
58.00 Offsetting collections (cash) 188 171 169
58.10 Change in uncollected customer payments from Federal sources (unexpired) 1,227



58.90 Spending authority from offsetting collections (total discretionary) 3,439 3,845 4,029
Mandatory:
60.00 Appropriation 145 140 143
69.00 Offsetting collections (cash) 33 90 35
69.10 Change in uncollected customer payments from Federal sources (unexpired) 227



69.90 Spending authority from offsetting collections (total mandatory) 260 90 35



70.00 Total new budget authority (gross) 3,844 4,075 4,207

Change in obligated balances:
72.40 Obligated balance, start of year -179 -268
73.10 Total new obligations 3,639 4,285 4,243
73.20 Total outlays (gross) -3,324 -4,072 -4,212
73.40 Adjustments in expired accounts (net) -72
73.45 Recoveries of prior year obligations -14
74.00 Change in uncollected customer payments from Federal sources (unexpired) -1,454
74.10 Change in uncollected customer payments from Federal sources (expired) 1,136 55



74.40 Obligated balance, end of year -268 31

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 1,970 3,845 4,029
86.93 Outlays from discretionary balances 1,266 2
86.97 Outlays from new mandatory authority 11 90 38
86.98 Outlays from mandatory balances 77 135 145



87.00 Total outlays (gross) 3,324 4,072 4,212

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00 Federal sources -3,146 -3,764 -3,895
88.40 Non-Federal sources -188 -171 -169



88.90 Total, offsetting collections (cash) -3,334 -3,935 -4,064
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -1,454
88.96 Portion of offsetting collections (cash) credited to expired accounts 1,089

Net budget authority and outlays:
89.00 Budget authority 145 140 143
90.00 Outlays -10 137 148

Program management activities include funding for research, Medicare operations, survey and certification, health care data improvements, Clinical Laboratory Improvement Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and administrative costs, and includes budget authority, obligations, outlays and staffing attributable to the American Recovery and Reinvestment Act (ARRA) in fiscal years 2009 through 2011.

Object Classification (in millions of dollars)


Identification code 75-0511-0-1-550 2009 actual 2010 est. 2011 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 391 437 457
11.3 Other than full-time permanent 14 13 13
11.5 Other personnel compensation 9 8 9
11.7 Military personnel 8 8 9



11.9 Total personnel compensation 422 466 488
12.1 Civilian personnel benefits 104 111 119
12.2 Military personnel benefits 4 4 5
21.0 Travel and transportation of persons 8 9 9
22.0 Transportation of things 1
23.1 Rental payments to GSA 17 25 27
23.3 Communications, utilities, and miscellaneous charges 54
24.0 Printing and reproduction 20 4 3
25.1 Advisory and assistance services 26
25.2 Other services 1,659 220 380
25.3 Other purchases of goods and services from Government accounts 78 2 1
25.5 Research and development contracts 30 30 45
25.6 Medical care 687 2,912 2,722
25.7 Operation and maintenance of equipment 174
26.0 Supplies and materials 2 1 1
31.0 Equipment 5
32.0 Land and structures 11 11
41.0 Grants, subsidies, and contributions 139 61 3



99.0 Direct obligations 3,430 3,856 3,814
99.0 Reimbursable obligations 209 429 429



99.9 Total new obligations 3,639 4,285 4,243

Employment Summary


Identification code 75-0511-0-1-550 2009 actual 2010 est. 2011 est.

Direct:
1001 Civilian full-time equivalent employment 4,024 4,276 4,366
1101 Military average strength employment 99 100 100
Reimbursable:
2001 Civilian full-time equivalent employment 104 126 128

Children's Health Insurance Fund

Program and Financing (in millions of dollars)


Identification code 75-0515-0-1-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Grants to States and U.S. Territories 9,532 12,520 13,459
00.02 Performance Bonus Payment 73 240
00.03 Child Health Quality Improvement 2 30 45



10.00 Total new obligations (object class 41.0) 9,534 12,623 13,744

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 122 3,390 5,300
22.00 New budget authority (gross) 13,834 13,529 13,504
22.30 Expired unobligated balance transfer to unexpired account 38 1,004



23.90 Total budgetary resources available for obligation 13,994 17,923 18,804
23.95 Total new obligations -9,534 -12,623 -13,744
23.98 Unobligated balance expiring or withdrawn -1,070



24.40 Unobligated balance carried forward, end of year 3,390 5,300 5,060

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation 10,564 13,484 13,459
60.00 Appropriation 3,225
60.00 Appropriation 45 45 45



62.50 Appropriation (total mandatory) 13,834 13,529 13,504

Change in obligated balances:
72.40 Obligated balance, start of year 3,702 5,445 9,165
73.10 Total new obligations 9,534 12,623 13,744
73.20 Total outlays (gross) -7,547 -8,903 -10,285
73.40 Adjustments in expired accounts (net) -244



74.40 Obligated balance, end of year 5,445 9,165 12,624

Outlays (gross), detail:
86.97 Outlays from new mandatory authority 5,004 5,630 6,045
86.98 Outlays from mandatory balances 2,543 3,273 4,240



87.00 Total outlays (gross) 7,547 8,903 10,285

Net budget authority and outlays:
89.00 Budget authority 13,834 13,529 13,504
90.00 Outlays 7,547 8,903 10,285

Note.—The FY 2009 and FY 2010 total CHIP appropriations do not fully reflect the appropriation of $40 million for Territories because of adjustments made to the CHIP account to properly account for funds as part of the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The total available appropriation for 2009 is $10,602 million.

The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income families. States are able to use Title XXI funds for obtaining health benefit coverage for uninsured children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3) reauthorized the CHIP program through FY 2013 and made some modifications to the program including increased funding for States and territories, bonus payments for States that exceed enrollment targets, a contingency fund to assist States who spend above their available allocated CHIP funds, and support for child health quality and outreach activities.

Child Enrollment Contingency Fund

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-5551-0-2-551 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year



01.99 Balance, start of year
Receipts:
02.40 Interest, Child Enrollment Contingency Fund 1 73 82



02.99 Total receipts and collections 1 73 82



04.00 Total: Balances and collections 1 73 82
Appropriations:
05.00 Child Enrollment Contingency Fund -1 -73 -82



05.99 Total appropriations -1 -73 -82



07.99 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75-5551-0-2-551 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Grants to States and US Territories 200 200



10.00 Total new obligations (object class 41.0) 200 200

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 2,113 1,986
22.00 New budget authority (gross) 2,113 73 82



23.90 Total budgetary resources available for obligation 2,113 2,186 2,068
23.95 Total new obligations -200 -200



24.40 Unobligated balance carried forward, end of year 2,113 1,986 1,868

New budget authority (gross), detail:
Mandatory:
60.00 Appropriation 2,112
60.20 Appropriation (special fund) 1 73 82



62.50 Appropriation (total mandatory) 2,113 73 82

Change in obligated balances:
73.10 Total new obligations 200 200
73.20 Total outlays (gross) -200 -200

Outlays (gross), detail:
86.98 Outlays from mandatory balances 200 200

Net budget authority and outlays:
89.00 Budget authority 2,113 73 82
90.00 Outlays 200 200

Memorandum (non-add) entries:
92.01 Total investments, start of year: Federal securities: Par value 2,114 1,986
92.02 Total investments, end of year: Federal securities: Par value 2,114 1,986 1,868

The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 established the Child Enrollment Contingency Fund under Title XXI. Beginning in FY 2009, a State may qualify for a contingency fund payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average number of enrollees for the fiscal year.

The fund received an initial appropriation equal to 20 percent of the FY 2009 national allotment ($2.1 billion). In fiscal years 2009-2013, the bill appropriates the amount necessary to make payments to eligible States, but not to exceed 20 percent of the total annual appropriation for CHIP allotments to States. Any amounts in excess of this aggregate cap will be made available for CHIP performance bonus payments. Also, the contingency fund will be invested in interest bearing securities of the United States. The income derived from these investments constitutes a part of the fund.

Medicare Advantage Stabilization Fund

Program and Financing (in millions of dollars)


Identification code 75-0520-0-1-571 2009 actual 2010 est. 2011 est.

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 64 108 145
22.00 New budget authority (gross) 44 37 68



23.90 Total budgetary resources available for obligation 108 145 213



24.40 Unobligated balance carried forward, end of year 108 145 213

New budget authority (gross), detail:
Mandatory:
69.10 Change in uncollected customer payments from Federal sources (unexpired) 44 37 68

Change in obligated balances:
72.40 Obligated balance, start of year -64 -108 -145
74.00 Change in uncollected customer payments from Federal sources (unexpired) -44 -37 -68



74.40 Obligated balance, end of year -108 -145 -213

Offsets:
Against gross budget authority only:
88.95 Change in uncollected customer payments from Federal sources (unexpired) -44 -37 -68

Net budget authority and outlays:
89.00 Budget authority
90.00 Outlays

The Medicare Advantage (MA) Regional Stabilization Fund finances incentives, both to have MA regional plans offered in each MA region and to retain MA plans in certain regions with below national average MA market penetration. The Medicare Improvements for Patients and Providers Act of 2008 amended this fund.

Trust Funds

Federal Hospital Insurance Trust Fund

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75-8005-0-7-571 2009 actual 2010 est. 2011 est.

01.00 Balance, start of year 296,462 285,374 256,472



01.99 Balance, start of year 296,462 285,374 256,472
Receipts:
02.00 FHI Trust Fund, Transfers from General Fund (FICA Taxes) 175,443 165,986 177,988
02.01 FHI Trust Fund, Transfers from General Fund (FICA Taxes) - legislative proposal subject to PAYGO 10 116
02.02 FHI Trust Fund, Transfers from General Fund (FICA Taxes) -65
02.03 FHI Trust Fund, Receipts from Railroad Retirement Board 496 481 473
02.04 FHI Trust Fund, Transfers from General Fund (SECA Taxes) 14,724 13,997 13,934
02.05 FHI Trust Fund, Civil Penalties and Damages 482 405 329
02.20 FHI Trust Fund, Other Proprietary Interest from the Public 2 2 2
02.21 FHI Trust Fund, Basic Premium, Medicare Advantage 111 119 122
02.22 FHI Trust Fund, Medicare Refunds 5,368 5,400 5,550
02.23 FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible 2,817 3,252 3,331
02.40 FHI Trust Fund, Federal Employer Contributions (FICA) 3,120 3,295 3,397
02.41 FHI Trust Fund, Postal Service Employer Contributions (FICA) 815 745 739
02.42 FHI Trust Fund, Interest Received by Trust Funds 15,873 14,647 13,161
02.43 FHI Trust Fund, Taxation on OASDI Benefits 12,376 15,005 17,471
02.44 FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account 126 126 126
02.45 FHI Trust Fund, Transfers from General Fund (criminal Fines) 621 168 217
02.46 FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties) 17 13 16
02.47 FHI Trust Fund, Interest Payments by Railroad Retirement Board 28 26 30
02.48 FHI Trust Fund, Payments from the General Fund (uninsured and Program Management) 896 569 1,017
02.49 FHI Trust Fund, Payments for Pre-1957 Military Service (Quinquennial Adjustment) 968



02.99 Total receipts and collections 234,283 224,246 237,954



04.00 Total: Balances and collections 530,745 509,620 494,426
Appropriations:
05.00 Federal Hospital Insurance Trust Fund -134
05.01 Federal Hospital Insurance Trust Fund -2,086 -2,245 -2,360
05.02 Federal Hospital Insurance Trust Fund -230,923 -220,479 -233,809
05.03 Federal Hospital Insurance Trust Fund -10,913 -28,915 -32,511
05.04 Health Care Fraud and Abuse Control Account -198 -311 -561
05.05 Health Care Fraud and Abuse Control Account -1,161 -1,200 -1,173
05.06 Health Care Fraud and Abuse Control Account - legislative proposal not subject to PAYGO 733



05.99 Total appropriations -245,415 -253,150 -269,681
06.10 Federal Hospital Insurance Trust Fund 20
06.11 Health Care Fraud and Abuse Control Account 24 2 2



07.99 Balance, end of year 285,374 256,472 224,747

Program and Financing (in millions of dollars)


Identification code 75-8005-0-7-571 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Benefit payments, HI 241,093 249,031 265,794
00.02 Stabilization fund 21 20 35
00.03 Administration, HI 2,505 2,474 2,539
00.04 Quality improvement organizations, HI 433 114 312
00.05 Employment tax adjustment 12



10.00 Total new obligations 244,064 251,639 268,680

Budgetary resources available for obligation:
22.00 New budget authority (gross) 243,922 251,639 268,680
22.10 Resources available from recoveries of prior year obligations 28
23.33 Adjustment for changes in allocation 134



23.90 Total budgetary resources available for obligation 244,084 251,639 268,680
23.95 Total new obligations -244,064 -251,639 -268,680
23.98 Unobligated balance expiring or withdrawn -20
24.41 Special and trust fund receipts returned to Schedule N 20

New budget authority (gross), detail:
Discretionary:
40.26 Appropriation (trust fund) 2,086 2,245 2,360
Mandatory:
60.26 Appropriation (trust fund) 230,923 220,479 233,809
60.28 Appropriation (previously unavailable) 10,913 28,915 32,511



62.50 Appropriation (total mandatory) 241,836 249,394 266,320



70.00 Total new budget authority (gross) 243,922 251,639 268,680

Change in obligated balances:
72.40 Obligated balance, start of year 22,019 23,761 23,592
73.10 Total new obligations 244,064 251,639 268,680
73.20 Total outlays (gross) -242,294 -251,808 -268,628
73.45 Recoveries of prior year obligations -28



74.40 Obligated balance, end of year 23,761 23,592 23,644

Outlays (gross), detail:
86.90 Outlays from new discretionary authority 1,531 1,805 1,872
86.93 Outlays from discretionary balances 552 423 446
86.97 Outlays from new mandatory authority 219,230 227,257 242,994
86.98 Outlays from mandatory balances 20,981 22,323 23,316



87.00 Total outlays (gross) 242,294 251,808 268,628

Net budget authority and outlays:
89.00 Budget authority 243,922 251,639 268,680
90.00 Outlays 242,294 251,808 268,628

Memorandum (non-add) entries:
92.01 Total investments, start of year: Federal securities: Par value 318,741 309,702 280,658
92.02 Total investments, end of year: Federal securities: Par value 309,702 280,658 248,537

The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible disabled people.

The status of the trust fund is as follows.

Status of Funds (in millions of dollars)


Identification code 75-8005-0-7-571 2009 actual 2010 est. 2011 est.

Unexpended balance, start of year:
0100 Balance, start of year 318,930 309,836 280,568
Adjustments:
0190 Adjustments



0199 Total balance, start of year 318,930 309,836 280,568
Cash income during the year:
Current law:
Receipts:
1200 FHI Trust Fund, Transfers from General Fund (FICA Taxes) 175,443 165,986 177,988
1203 FHI Trust Fund, Receipts from Railroad Retirement Board 496 481 473
1204 FHI Trust Fund, Transfers from General Fund (SECA Taxes) 14,724 13,997 13,934
1205 FHI Trust Fund, Civil Penalties and Damages 482 405 329
Offsetting receipts (proprietary):
1220 FHI Trust Fund, Other Proprietary Interest from the Public 2 2 2
1221 FHI Trust Fund, Basic Premium, Medicare Advantage 111 119 122
1222 FHI Trust Fund, Medicare Refunds 5,368 5,400 5,550
1223 FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible 2,817 3,252 3,331
Offsetting receipts (intragovernmental):
1240 FHI Trust Fund, Federal Employer Contributions (FICA) 3,120 3,295 3,397
1241 FHI Trust Fund, Postal Service Employer Contributions (FICA) 815 745 739
1242 FHI Trust Fund, Interest Received by Trust Funds 15,873 14,647 13,161
1243 FHI Trust Fund, Taxation on OASDI Benefits 12,376 15,005 17,471
1244 FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account 126 126 126
1245 FHI Trust Fund, Transfers from General Fund (criminal Fines) 621 168 217
1246 FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties) 17 13 16
1247 FHI Trust Fund, Interest Payments by Railroad Retirement Board 28 26 30
1248 FHI Trust Fund, Payments from the General Fund (uninsured and Program Management) 896 569 1,017
1249 FHI Trust Fund, Payments for Pre-1957 Military Service (Quinquennial Adjustment) 968
1299 Income under present law 234,283 224,236 237,903
Proposed legislation:
Receipts:
2201 FHI Trust Fund, Transfers from General Fund (FICA Taxes) 10 116
2202 FHI Trust Fund, Transfers from General Fund (FICA Taxes) -65
2299 Income under proposed legislation 10 51



3299 Total cash income 234,283 224,246 237,954
Cash outgo during year:
Current law:
4500 Federal Hospital Insurance Trust Fund -242,294 -251,808 -268,628
4501 Health Care Fraud and Abuse Control Account -1,083 -1,706 -1,734
4599 Outgo under current law (-) -243,377 -253,514 -270,362
Proposed legislation:
5500 Health Care Fraud and Abuse Control Account 733
5599 Outgo under proposed legislation (-) 733



6599 Total cash outgo (-) -243,377 -253,514 -269,629
Unexpended balance, end of year:
8700 Uninvested balance (net), end of year 134 -90 356
8701 Invested balance, end of year 309,702 280,658 248,537



8799 Total balance, end of year 309,836 280,568 248,893

Object Classification (in millions of dollars)


Identification code 75-8005-0-7-571 2009 actual 2010 est. 2011 est.

Direct obligations:
41.0 Payment for Quality Improvement Organization (QIO) activities 433 114 312
42.0 Insurance claims and indemnities (benefits) 241,114 249,051 265,829
44.0 Refunds (Employment Tax Adjustment) 12
94.0 Financial transfers 2,505 2,474 2,539



99.0 Direct obligations 244,064 251,639 268,680



99.9 Total new obligations 244,064 251,639 268,680

Health Care Fraud and Abuse Control Account

In addition to amounts otherwise available for program integrity and program management, [$311,000,000] $561,000,000, to remain available through September 30, [2011] 2012, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act, of which [$220,320,000] $376,167,000 shall be for [the Medicare Integrity Program at the] Centers for Medicare and Medicaid Services Program Integrity Activities, including administrative costs, to conduct oversight activities for Medicare Advantage and the Medicare Prescription Drug Program authorized in title XVIII of the Social Security Act [and], for activities listed in section 1893 of such Act and for Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities; of which [$29,790,000] $94,830,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act[; of which $31,100,000 shall be for the Medicaid and Children's Health Insurance Program ("CHIP'') program integrity activities]; and of which [$29,790,000] $90,003,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act: Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year [2010] 2011 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and CHIP programs for the funds provided by this appropriation. (Department of Health and Human Services Appropriations Act, 2010.)

Program and Financing (in millions of dollars)


Identification code 75-8393-0-7-571 2009 actual 2010 est. 2011 est.

Obligations by program activity:
00.01 Medicare integrity program 768 780 780
00.02 FBI fraud and abuse control 133 132 126
00.03 Other fraud and abuse control 262 288 267



00.91 Total Mandatory 1,163 1,200 1,173
01.01 CMS - Discretionary 159 251 376
01.02 Other Discretionary 38 60 185



01.91 Total Discretionary 197 311 561



02.00 Total Direct Obligations 1,360 1,511 1,734
09.01 Reimbursable (OIG) 2



10.00 Total new obligations 1,362 1,511 1,734

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year 11 11
22.00 New budget authority (gross) 1,359 1,511 1,734
22.10 Resources available from recoveries of prior year obligations 13
22.30 Expired unobligated balance transfer to unexpired account 2