<h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES </h1>

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; [$3,699,611,000] $4,256,673,000: Provided, That of the amount provided under this heading, [$667,057,000] $856,041,000 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 [2012] 2013 but collected in fiscal year [2011] 2012; [$61,860,000] $67,118,000 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; [$19,448,000] $21,768,000 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; [$5,397,000]$5,706,000 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] [$450,000,000] $477,000,000 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[:]; $12,364,000 shall be derived from food and feed recall fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as added by the FDA Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; $14,700,000 shall be derived from food reinspection fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act, as added by the FDA Food Safety Modernization Act, and shall be credited to this account and remain available until expended; and $71,066,000 shall be derived from voluntary qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act, as added by the FDA Food Safety Modernization Act, 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] 2012 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 [2011] 2012 received during fiscal year [2011] 2012, including any such fees assessed prior to fiscal year [2011] 2012 but credited for fiscal year [2011] 2012, shall be subject to the fiscal year [2011] 2012 limitations: 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.

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.

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] $13,055,000, to remain available until expended. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–9911–0–1–554		2010 actual	CR	2012 est.

0100	Balance, start of year			1
	Receipts:
0220	Cooperative Research and Development Agreements, FDA	2	3	3

0299	Total receipts and collections	2	3	3

0400	Total: Balances and collections	2	3	4
	Appropriations:
0500	Salaries and Expenses	–2	–2	–2

0599	Total appropriations	–2	–2	–2

0799	Balance, end of year		1	2


Identification code 75–9911–0–1–554		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Foods	783	781	955
0002	Drugs	801	802	872
0003	Devices and radiological products	313	314	329
0004	National Center for Toxicological Research	59	59	60
0005	Other activities	141	141	198
0006	Other rent and rent related activities	104	104	150
0007	Rental payments	145	145	167
0008	Buildings and facilities	22	16	13
0009	CRADAs	3	3	3

0091	Direct program activities, subtotal	2,371	2,365	2,747
0801	Reimbursable program	816	1,011	1,556

0900	Total new obligations	3,187	3,376	4,303

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	258	587	293
1020	Adjustment of unobligated bal brought forward, Oct 1		–293

1050	Unobligated balance (total)	258	294	293
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,364	2,362	2,744
	Appropriations, mandatory:
1201	Appropriation (special fund)	2	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	890	1,011	1,554
1701	Change in uncollected payments, Federal sources	25
1702	Offsetting collections (previously unavailable)	270	333	333
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–35	–333	–333

1750	Spending auth from offsetting collections, disc (total)	1,150	1,011	1,554
1900	Budget authority (total)	3,516	3,375	4,300
1930	Total budgetary resources available	3,774	3,669	4,593
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	587	293	290

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,226	1,364	1,391
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–109	–51	–51

3020	Obligated balance, start of year (net)	1,117	1,313	1,340
3030	Obligations incurred, unexpired accounts	3,187	3,376	4,303
3040	Outlays (gross)	–3,021	–3,349	–4,161
3050	Change in uncollected pymts, Fed sources, unexpired	–25
3051	Change in uncollected pymts, Fed sources, expired	83
3081	Recoveries of prior year unpaid obligations, expired	–28
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,364	1,391	1,533
3091	Uncollected pymts, Fed sources, end of year	–51	–51	–51

3100	Obligated balance, end of year (net)	1,313	1,340	1,482

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,514	3,373	4,298
	Outlays, gross:
4010	Outlays from new discretionary authority	2,192	2,618	3,420
4011	Outlays from discretionary balances	804	729	739

4020	Outlays, gross (total)	2,996	3,347	4,159
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–34		–67
4033	Non-Federal sources	–869
4034	Offsetting governmental collections		–1,011	–1,487

4040	Offsets against gross budget authority and outlays (total)	–903	–1,011	–1,554
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–25
4052	Offsetting collections credited to expired accounts	13

4060	Additional offsets against budget authority only (total)	–12

4070	Budget authority, net (discretionary)	2,599	2,362	2,744
4080	Outlays, net (discretionary)	2,093	2,336	2,605
	Mandatory:
4090	Budget authority, gross	2	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority	25	2	2
4180	Budget authority, net (total)	2,601	2,364	2,746
4190	Outlays, net (total)	2,118	2,338	2,607

	Memorandum (non-add) entries:
5090	Unavailable balance, SOY: Offsetting collections	301	66	66
5091	Unavailable balance, EOY: Offsetting collections	66	66	66


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	2,601	2,364	2,746
	Outlays	2,118	2,338	2,607
Legislative proposal, not subject to PAYGO:
	Budget Authority
	Outlays
Total:
	Budget Authority	2,601	2,364	2,746
	Outlays	2,118	2,338	2,607


	2010	2011	2012

Distribution of discretionary budget authority by account:
Salaries and expenses	2348	2346	2731
Buildings and facilities	16	16	13
Distribution of discretionary outlays by account:
Salaries and expenses	2082	2322	2592
Buildings and facilities	11	14	13

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, developing medical countermeasures, and headquarters consolidation in White Oak, Maryland.

The Budget includes a number of new and current user fees. The Budget proposes user fees to support activities related to generic human drug reviews and inspection-related activities at domestic courier facilities. Additionally, the Budget includes fees related to food recall and reinspection activities, export certification, and the voluntary qualified importer program, all of which were authorized in the newly enacted Food Safety Modernization Act.


Identification code 75–9911–0–1–554		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	700	743	797
11.3	Other than full-time permanent	107	113	122
11.5	Other personnel compensation	55	58	62
11.7	Military personnel	56	60	65
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	919	975	1,047
12.1	Civilian personnel benefits	238	253	271
12.2	Military personnel benefits	30	32	34
21.0	Travel and transportation of persons	49	41	51
22.0	Transportation of things	5	5	6
23.1	Rental payments to GSA	145	146	168
23.2	Rental payments to others	5	53	73
23.3	Communications, utilities, and miscellaneous charges	70	71	84
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	54	69	81
25.2	Other services from non-federal sources	321	244	379
25.3	Other goods and services from federal sources	158	129	136
25.4	Operation and maintenance of facilities	93	95	120
25.5	Research and development contracts	46	36	40
25.7	Operation and maintenance of equipment	15	15	19
26.0	Supplies and materials	46	46	56
31.0	Equipment	98	88	110
32.0	Land and structures	14	7	7
41.0	Grants, subsidies, and contributions	60	52	60
42.0	Insurance claims and indemnities	2	2	2

99.0	Direct obligations	2,371	2,362	2,747
99.0	Reimbursable obligations	816	1,014	1,556

99.9	Total new obligations	3,187	3,376	4,303


Identification code 75–9911–0–1–554		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	8,686	8,686	9,074
1101	Direct military average strength employment	682	682	682
2001	Reimbursable civilian full-time equivalent employment	2,837	2,837	4,351
2101	Reimbursable military average strength employment	224	224	224
3001	Allocation account civilian full-time equivalent employment	56	56	56
3101	Allocation account military average strength employment	6	6	6

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] $40,122,000, 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 to charge reinspection fees for products other than food, the Secretary shall charge fees for such reinspections: Provided, That such fees, in an amount not to exceed $14,108,000, 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.]

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge fees for international express courier import activities: Provided, That such fees, in an amount not to exceed $5,338,000, shall be credited to this account, to remain available until expended for international express couriers import activities.


Identification code 75–9911–2–1–554		2010 actual	CR	2012 est.

	Obligations by program activity:
0810	Generic Drug User Fee			40
0811	Reinspection User Fee (Medical)			14
0812	International Courier User Fee			6

0900	Total new obligations			60

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			60
1930	Total budgetary resources available			60

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts			60
3040	Outlays (gross)			–60
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			60
	Outlays, gross:
4010	Outlays from new discretionary authority			60
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources			–60

4070	Budget authority, net (discretionary)
4080	Outlays, net (discretionary)
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 75–9911–2–1–554		2010 actual	CR	2012 est.

99.0	Reimbursable obligations			60

99.9	Total new obligations			60


Identification code 75–9911–2–1–554		2010 actual	CR	2012 est.

2001	Reimbursable civilian full-time equivalent employment			150


Identification code 75–4309–0–3–554		2010 actual	CR	2012 est.

	Obligations by program activity:
0801	Reimbursable program	7	8	8

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1	2	2
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	8	8
1930	Total budgetary resources available	9	10	10
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2	2	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	3	3	2
3030	Obligations incurred, unexpired accounts	7	8	8
3040	Outlays (gross)	–7	–9	–9
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	3	2	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	6	8	8
4101	Outlays from mandatory balances	1	1	1

4110	Outlays, gross (total)	7	9	9
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–8	–8

4160	Budget authority, net (mandatory)
4170	Outlays, net (mandatory)	–1	1	1
4180	Budget authority, net (total)
4190	Outlays, net (total)	–1	1	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.


Identification code 75–4309–0–3–554		2010 actual	CR	2012 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 from non-federal sources	1	1	1
26.0	Supplies and materials		1	1

99.0	Reimbursable obligations	7	8	8

99.9	Total new obligations	7	8	8


Identification code 75–4309–0–3–554		2010 actual	CR	2012 est.

2001	Reimbursable civilian full-time equivalent employment	38	38	38

Federal Funds

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, and the Patient Protection and Affordable Care Act, [$7,501,658,000] $6,801,262,000, of which [$41,200,000]$26,200,000 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 for Medicare rural hospital flexibility grants, [$1,000,000]$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 sections 340G-1(d)(1) and (d)(2), 747(c)(2), 751(j)(2), and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply to funds made available in this paragraph: 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]$96,077,000 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, [$327,356,000]$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, [$1,962,865,000]$2,037,865,000 shall remain available to the Secretary of HHS through September 30, [2013]2014, for parts A and B of title XXVI of the PHS Act, of which not less than $880,000,000 shall be for State AIDS Drug Assistance Programs under section 2616 of such Act: Provided further, That within the amounts designated in the previous proviso to carry out Parts A and B of title XXVI of the PHS Act, $60,000,000 shall be available for allocation to State AIDS Drug Assistance Programs under section 2620 or section 311(c) 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, [2013,]2014, and shall be available to qualifying jurisdictions, within 30 days of enactment, for increasing supplemental grants for fiscal year [2011]2012 to metropolitan and transitional areas that received grant funding in fiscal year [2010] 2011 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 [2010]2011, 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 [2010]2011, 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 $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, (1) [$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, and (2) $255,423,000 to carry out titles VII and VIII and section 340G of the PHS Act: Provided further, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not to exceed [$93,999,263]$74,712,263 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and [$11,810,915]$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 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, for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of HHS may waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act: 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 399BB(g) of the PHS Act, funds made available under this heading for section 399BB of the PHS Act are for carrying out the program as authorized under section 399BB(a)-(f) of such 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 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 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 shall be available for State Health Access Grants to expand access to affordable health care coverage for the uninsured populations in such States,] Provided further, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided further, That fees pursuant to the 340B Drug Pricing Program shall be collected by manufacturers at the time of sale, and shall be credited to this account, to remain available until expended. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0350–0–1–550		2010 actual	CR	2012 est.

	Obligations by program activity:
0010	Health centers	2,141	2,146	2,022
0011	National Health Service Corps	41	41	25
0012	National Health Service Corps Recruitment	100	101	99
0013	Hansen's Disease Center	16	16	16
0014	Payment to Hawaii for the Treatment of Hansen's Disease	2	2	2
0015	Black Lung Clinics	7	7	7
0016	Nursing Education Loan Repayment and Scholarships	94	94	94
0017	Health Professions	406	408	468
0018	Maternal and Child Health Block Grant	661	662	654
0019	Healthy Start	105	105	105
0020	Poison Control Centers	29	29	29
0021	EMS for Children	22	22	22
0022	Universal Newborn Hearing Screening	19	19	19
0023	HIV/AIDS	2,286	2,266	2,375
0024	Organ Transplantation	26	26	26
0025	Bone Marrow Donor Registry	24	24	27
0026	Rural Health Policy Development	10	10	10
0027	Rural Health Outreach Grants	56	56	57
0028	Rural Health Flexibility Grants	41	41	26
0029	Denali Commission	10	10
0030	Telehealth	12	12	12
0031	Program Management	147	147	171
0032	Family Planning	316	317	327
0033	Loan Repayment/Faculty Fellowship	1	1	1
0034	Public Health Improvement (Facilities & Other Projects)	337	338
0035	Health Centers Tort Claim Fund	58	44	96
0036	Heritable Disorders	10	10	10
0037	Congenital Disabilities		1	1
0038	Childrens' GME	317	317
0039	State Health Access Grants	75	75
0040	Delta Health Initiative	35	35
0041	State Offices of Rural Health	10	10	10
0042	Rural and Community Access to Emergency Devices	3	3
0043	Radiogenic Diseases	2	2	2
0044	Traumatic Brain Injury	10	10	10
0045	Autism and Other Developmental Disorders	48	48	55
0046	Cord Blood Stem Cell Bank	12	12	14
0047	Free Clinics Medical Malpractice	1
0048	Sickle Cell	5	5	5
0049	Drug Pricing Program	2	2	5
0050	Family to Family Health Information Centers	5	5	5
0062	Primary Care Training and Enhancement Prevention Fund	198
0063	Healthy Weight Collaborative Prevention Fund	5		5
0064	Nurse Managed Health Centers Prevention Fund	15
0065	Advanced Education Nursing Prevention Fund	32
0066	State Health Care Workforce Dev. Grants Prev. Fund	6
0067	Public Health/Preventive Medicine Prevention Fund	15		15
0069	GME Payments Teaching Health Centers		7	22
0071	ARRA	908	74
0072	Infrastructure to Expand Access to Care		100

0091	Direct program activities, subtotal	8,681	7,660	6,849

0300	Total direct programs	8,681	7,660	6,849
0801	Reimbursable program	77	75	85
0802	Reimbursable program: PHS evaluation	25	25	280

0899	Total reimbursable obligations	102	100	365

0900	Total new obligations	8,783	7,760	7,214

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,049	223	271
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	1,050	223	271
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	7,474	7,474	6,801
1121	Appropriations transferred from other accounts	9

1160	Appropriation, discretionary (total)	7,483	7,474	6,801
	Appropriations, mandatory:
1200	Appropriation	105	235	5
1221	Appropriations transferred from other accounts	271		20

1260	Appropriations, mandatory (total)	376	235	25
	Spending authority from offsetting collections, discretionary:
1700	Collected	61	82	100
1701	Change in uncollected payments, Federal sources	21

1750	Spending auth from offsetting collections, disc (total)	82	82	100
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	17	17	17
1900	Budget authority (total)	7,958	7,808	6,943
1930	Total budgetary resources available	9,008	8,031	7,214
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	223	271

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	6,457	6,863	6,180
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–37	–50	–50

3020	Obligated balance, start of year (net)	6,420	6,813	6,130
3030	Obligations incurred, unexpired accounts	8,783	7,760	7,214
3031	Obligations incurred, expired accounts	1
3040	Outlays (gross)	–8,265	–8,443	–7,834
3050	Change in uncollected pymts, Fed sources, unexpired	–21
3051	Change in uncollected pymts, Fed sources, expired	8
3080	Recoveries of prior year unpaid obligations, unexpired	–1
3081	Recoveries of prior year unpaid obligations, expired	–112
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	6,863	6,180	5,560
3091	Uncollected pymts, Fed sources, end of year	–50	–50	–50

3100	Obligated balance, end of year (net)	6,813	6,130	5,510

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	7,565	7,556	6,901
	Outlays, gross:
4010	Outlays from new discretionary authority	3,211	3,221	2,957
4011	Outlays from discretionary balances	5,031	5,023	4,636

4020	Outlays, gross (total)	8,242	8,244	7,593
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–28	–54	–67
4033	Non-Federal sources	–40	–28	–33

4040	Offsets against gross budget authority and outlays (total)	–68	–82	–100
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–21
4052	Offsetting collections credited to expired accounts	7

4060	Additional offsets against budget authority only (total)	–14

4070	Budget authority, net (discretionary)	7,483	7,474	6,801
4080	Outlays, net (discretionary)	8,174	8,162	7,493
	Mandatory:
4090	Budget authority, gross	393	252	42
	Outlays, gross:
4100	Outlays from new mandatory authority	4	26	27
4101	Outlays from mandatory balances	19	173	214

4110	Outlays, gross (total)	23	199	241
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–17	–17	–17
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts

4160	Budget authority, net (mandatory)	376	235	25
4170	Outlays, net (mandatory)	6	182	224
4180	Budget authority, net (total)	7,859	7,709	6,826
4190	Outlays, net (total)	8,180	8,344	7,717

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


Identification code 75–0350–0–1–550		2010 actual	CR	2012 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	2.72	2.67
232002	Health centers: Managed care network development loan guarantee	0.00	9.13	9.62
232003	Health centers: Managed care plan loan guarantee levels	0.00	5.69	5.76

232999	Weighted average subsidy rate	0.00	4.35	4.40

233999	Total subsidy budget authority		1	1
	Guaranteed loan subsidy outlays:
234001	Health centers: Facilities renovation loan guarantee levels		1

234999	Total subsidy outlays		1

Resources displayed here support categorical grants and contracts managed by Health Resources and Services Administration (HRSA). These activities include support for Federally Qualified Health Centers, treatment and care for those living with HIV/AIDS, health professions training, maternal and child health care services, promotion of organ and bone marrow donation, and the medical malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program. The FY 2012 Budget proposes a new user fee for this program to improve administration and oversight of this activity.

HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL), Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the programs revolving account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If the programs revolving account has excess funds that will not be used to provide new loans, these excess funds are returned to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects Academic Year 2009–2010 data reported in the Annual Operating Report.


Program	Account Balance

HPSL	$362,160,100
NSL	$165,315,300
PCL	$253,049,300

LDS	$111,847,000


Total	$892,371,700


Identification code 75–0350–0–1–550		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	120	133	126
11.3	Other than full-time permanent	9	5	5
11.5	Other personnel compensation	5	5	5
11.7	Military personnel	19	18	18

11.9	Total personnel compensation	153	161	154
12.1	Civilian personnel benefits	34	37	35
12.2	Military personnel benefits	10	10	10
13.0	Benefits for former personnel	2	2	2
21.0	Travel and transportation of persons	4	4	3
23.1	Rental payments to GSA	14	17	46
23.2	Rental payments to others	2	2	2
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	38	48	41
25.2	Other services from non-federal sources	148	123	113
25.3	Other goods and services from federal sources	225	222	188
25.4	Operation and maintenance of facilities	3	3	2
25.6	Medical care	4	4	4
25.7	Operation and maintenance of equipment	7	6	5
26.0	Supplies and materials	1	1	1
31.0	Equipment	5	4	4
41.0	Grants, subsidies, and contributions	7,976	6,976	6,147
42.0	Insurance claims and indemnities	53	38	90

99.0	Direct obligations	8,681	7,660	6,849
99.0	Reimbursable obligations	102	100	365

99.9	Total new obligations	8,783	7,760	7,214


Identification code 75–0350–0–1–550		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	1,299	1,299	1,181
1101	Direct military average strength employment	193	196	199
2001	Reimbursable civilian full-time equivalent employment	86	90	96
2101	Reimbursable military average strength employment	7	7	7


Identification code 75–0352–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0010	Health Center		1,000	1,200
0011	Health Centers Construction		1,491	4
0012	National Health Service Corps		290	295
0013	School-Based Health Centers		100	50

0900	Total new obligations		2,881	1,549

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		50	9
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	50	2,840	1,545
1930	Total budgetary resources available	50	2,890	1,554
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	50	9	5

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			2,272
3030	Obligations incurred, unexpired accounts		2,881	1,549
3040	Outlays (gross)		–609	–1,928
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		2,272	1,893

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	50	2,840	1,545
	Outlays, gross:
4100	Outlays from new mandatory authority		606	570
4101	Outlays from mandatory balances		3	1,358

4110	Outlays, gross (total)		609	1,928
4180	Budget authority, net (total)	50	2,840	1,545
4190	Outlays, net (total)		609	1,928

P.L. 111–148 provides resources to the Community Health Center and National Health Service Corps Fund through FY 2015 and to School Based Health Centers through FY 2013. These activities are administered by HRSA.


Identification code 75–0352–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent		11	15
11.7	Military personnel			1

11.9	Total personnel compensation		11	16
12.1	Civilian personnel benefits		3	3
21.0	Travel and transportation of persons		3	3
25.2	Other services from non-federal sources		113	79
41.0	Grants, subsidies, and contributions		2,751	1,448

99.9	Total new obligations		2,881	1,549


Identification code 75–0352–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		113	162
1101	Direct military average strength employment		3	14


Identification code 75–0320–0–1–551		2010 actual	CR	2012 est.

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12	12	12
1930	Total budgetary resources available	12	12	12
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	12	12	12
4180	Budget authority, net (total)
4190	Outlays, net (total)

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 2012 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.


Identification code 75–0343–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Claims		1	1
0103	Admin Expense		4	4

0900	Total new obligations		5	5

	Budgetary Resources:
	Unobligated balance:
1011	Unobligated balance transferred from other accounts		5	5
1930	Total budgetary resources available		5	5
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		5	5
4180	Budget authority, net (total)
4190	Outlays, net (total)

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.


Identification code 75–0343–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
25.3	Other goods and services from federal sources		3	2
42.0	Insurance claims and indemnities		1	2

99.9	Total new obligations		5	5


Identification code 75–0343–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		4	7
1101	Direct military average strength employment		1	1


Identification code 75–0321–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	100	250	350

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	100	250	350
1930	Total budgetary resources available	100	250	350

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		99	202
3030	Obligations incurred, unexpired accounts	100	250	350
3040	Outlays (gross)	–1	–147	–322
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	99	202	230

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	100	250	350
	Outlays, gross:
4100	Outlays from new mandatory authority	1	105	147
4101	Outlays from mandatory balances		42	175

4110	Outlays, gross (total)	1	147	322
4180	Budget authority, net (total)	100	250	350
4190	Outlays, net (total)	1	147	322

P.L. 111–148 provides resources to Maternal, infant and early childhood home visiting program through FY 2014 to provide comprehensive services for at risk communities. These activities are administered by HRSA.


Identification code 75–0321–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		2	3
12.1	Civilian personnel benefits		1	1
25.1	Advisory and assistance services		22	25
41.0	Grants, subsidies, and contributions	100	225	321

99.0	Direct obligations	100	250	350

99.9	Total new obligations	100	250	350


Identification code 75–0321–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	3	22	27
1101	Direct military average strength employment		1	1


Identification code 75–4442–0–3–551		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal		1	1

0900	Total new obligations		1	1

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	2	1
1930	Total budgetary resources available	2	2	1
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2	1

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		1	1
4180	Financing authority, net (total)
4190	Financing disbursements, net (total)


Identification code 75–4442–0–3–551		2010 actual	CR	2012 est.

	Position with respect to appropriations act limitation on commitments:
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	65	65	71
2231	Disbursements of new guaranteed loans		17	17
2251	Repayments and prepayments		–10	–10
2263	Adjustments: Terminations for default that result in claim payments		–1	–1

2290	Outstanding, end of year	65	71	77

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	59	57	62

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.


Identification code 75–4442–0–3–551		2009 actual	2010 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	2	4
2207	Downward Reestimate	2

2999	Total liabilities	4	4

4999	Total liabilities and net position	4	4

Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0340–0–1–552		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0707	Reestimates of loan guarantee subsidy		13
0708	Interest on reestimates of loan guarantee subsidy		14
0709	Administrative expenses	3	3

0900	Total new obligations	3	30

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3	3
	Appropriations, mandatory:
1200	Appropriation		27
1900	Budget authority (total)	3	30
1930	Total budgetary resources available	3	30

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2	2	2
3030	Obligations incurred, unexpired accounts	3	30
3040	Outlays (gross)	–3	–30
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2	2	2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3	3
	Outlays, gross:
4010	Outlays from new discretionary authority	2	3
4011	Outlays from discretionary balances	1

4020	Outlays, gross (total)	3	3
	Mandatory:
4090	Budget authority, gross		27
	Outlays, gross:
4100	Outlays from new mandatory authority		27
4180	Budget authority, net (total)	3	30
4190	Outlays, net (total)	3	30

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


Identification code 75–0340–0–1–552		2010 actual	CR	2012 est.

	Guaranteed loan upward reestimates:
235001	HEAL Loan guarantee		26

235999	Total upward reestimate budget authority		26
	Guaranteed loan downward reestimates:
237001	HEAL Loan guarantee	–10

237999	Total downward reestimate subsidy budget authority	–10

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

Consistent with the FY 2011 President's Budget, in FY 2012 the Department of Education will assume responsibility for the program. 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.


Identification code 75–0340–0–1–552		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1
25.3	Other goods and services from federal sources	2	29

99.9	Total new obligations	3	30


Identification code 75–0340–0–1–552		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	14	14


Identification code 75–4304–0–3–552		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal	10	13
0712	Default claim payments on interest	2	3
0742	Downward reestimate paid to receipt account	5
0743	Interest on downward reestimates	5

0900	Total new obligations	22	16

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	61	49	67
1010	Unobligated balance transferred to other accounts			–67

1050	Unobligated balance (total)	61	49
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	1
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	34
1900	Financing authority(total)	10	34
1930	Total budgetary resources available	71	83
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	49	67

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	22	16
3040	Financing disbursements (gross)	–23	–16

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross	10	34
	Financing disbursements:
4110	Financing disbursements, gross	23	16
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources - upward reestimates and interest		–27
4122	Interest on uninvested funds	–3	–3
4123	Recoveries of defaulted loans	–6	–4

4130	Offsets against gross financing auth and disbursements (total)	–9	–34

4160	Financing authority, net (mandatory)	1
4170	Financing disbursements, net (mandatory)	14	–18
4180	Financing authority, net (total)	1
4190	Financing disbursements, net (total)	14	–18


Identification code 75–4304–0–3–552		2010 actual	CR	2012 est.

	Position with respect to appropriations act limitation on commitments:
2150	Total guaranteed loan commitments

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	729	627	597
2251	Repayments and prepayments	–90	–14
	Adjustments:
2261	Terminations for default that result in loans receivable	–11	–11
2263	Terminations for default that result in claim payments	–1	–5
2264	Other adjustments, net			–597

2290	Outstanding, end of year	627	597

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	627	597

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	170	171	177
2331	Disbursements for guaranteed loan claims	11	11
2351	Repayments of loans receivable	–6	–4
2361	Write-offs of loans receivable	–4	–1
2364	Other adjustments, net			–177

2390	Outstanding, end of year	171	177


Identification code 75–4304–0–3–552		2009 actual	2010 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	61	49
	Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501	Defaulted guaranteed loans receivable, gross	170	171
1505	Allowance for subsidy cost (-)	–121	–126

1599	Net present value of assets related to defaulted guaranteed loans	49	45

1999	Total assets	110	94
	LIABILITIES:
	Non-Federal liabilities:
2204	Liabilities for loan guarantees	100	94
2207	Other, downward reestimate	10

2999	Total liabilities	110	94

4999	Total liabilities and net position	110	94


Identification code 75–4305–0–3–552		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0710	Direct loan obligations	3	3

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1	1
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	10
1820	Capital transfer of spending authority from offsetting collections to general fund	–7	–8

1850	Spending auth from offsetting collections, mand (total)	2	2
1900	Budget authority (total)	3	3
1930	Total budgetary resources available	3	3

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts	3	3
3040	Outlays (gross)	–3	–3
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	3	3
	Outlays, gross:
4100	Outlays from new mandatory authority	3	3
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–9	–10

4160	Budget authority, net (mandatory)	–6	–7
4170	Outlays, net (mandatory)	–6	–7
4180	Budget authority, net (total)	–6	–7
4190	Outlays, net (total)	–6	–7


Identification code 75–4305–0–3–552		2010 actual	CR	2012 est.

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	124	103	85
2251	Repayments and prepayments	–18	–15
	Adjustments:
2261	Terminations for default that result in loans receivable	–2	–2
2263	Terminations for default that result in claim payments	–1	–1
2264	Other adjustments, net			–85

2290	Outstanding, end of year	103	85

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	103	85

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	421	379	371
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	–19		–371

2390	Outstanding, end of year	379	371


Identification code 75–4305–0–3–552		2009 actual	2010 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	1	1
1701	Defaulted guaranteed loans, gross	421	379
1703	Allowance for estimated uncollectible loans and interest (-)	–1	–1

1704	Defaulted guaranteed loans and interest receivable, net	420	378

1799	Value of assets related to loan guarantees	420	378

1999	Total assets	421	379
	LIABILITIES:
2104	Federal liabilities: Resources payable to Treasury	421	379

2999	Total liabilities	421	379

4999	Total liabilities and net position	421	379


Identification code 75–4305–0–3–552		2010 actual	CR	2012 est.

	Direct obligations:
33.0	Investments and loans	2	2
42.0	Insurance claims and indemnities	1	1

99.9	Total new obligations	3	3


Identification code 75–9931–0–3–551		2010 actual	CR	2012 est.

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1	1	1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1	1	1
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 75–9931–0–3–551		2010 actual	CR	2012 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	7	7	7
1251	Repayments: Repayments and prepayments

1290	Outstanding, end of year	7	7	7

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.


Identification code 75–9931–0–3–551		2009 actual	2010 actual

	ASSETS:
1601	Direct loans, gross	9	7

1999	Total assets	9	7
	LIABILITIES:
2201	Non-Federal liabilities: Accounts payable	9	7

2999	Total liabilities	9	7

4999	Total liabilities and net position	9	7

Trust Funds

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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–8175–0–7–551		2010 actual	CR	2012 est.

0100	Balance, start of year	2,893	2,960	3,019
	Adjustments:
0191	Rounding adjustment	–8

0199	Balance, start of year	2,885	2,960	3,019
	Receipts:
0200	Deposits, Vaccine Injury Compensation Trust Fund	218	228	237
0240	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	64	71	97

0299	Total receipts and collections	282	299	334

0400	Total: Balances and collections	3,167	3,259	3,353
	Appropriations:
0500	Vaccine Injury Compensation Program Trust Fund	–20	–20	–20
0501	Vaccine Injury Compensation Program Trust Fund	–187	–220	–235

0599	Total appropriations	–207	–240	–255

0799	Balance, end of year	2,960	3,019	3,098


Identification code 75–8175–0–7–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	188	220	235
0103	Claims processing (Claims Court)	5	5	5
0104	Claims processing (HRSA)	7	7	7
0105	Claims processing (Dept. of Justice)	8	8	8

0191	Total, administrative expenses	20	20	20
0801	Reimbursable program activity	5

0900	Total new obligations	213	240	255

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1
	Budget authority:
	Appropriations, discretionary:
1102	Appropriation (trust fund)	20	20	20
	Appropriations, mandatory:
1202	Appropriation (Vaccine Injury Trust fund)	187	220	235
	Spending authority from offsetting collections, mandatory:
1800	Collected	5
1900	Budget authority (total)	212	240	255
1930	Total budgetary resources available	213	240	255
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	12	16	6
3030	Obligations incurred, unexpired accounts	213	240	255
3040	Outlays (gross)	–209	–250	–261
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	16	6

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	20	20	20
	Outlays, gross:
4010	Outlays from new discretionary authority	10	20	20
4011	Outlays from discretionary balances	7	10	6

4020	Outlays, gross (total)	17	30	26
	Mandatory:
4090	Budget authority, gross	192	220	235
	Outlays, gross:
4100	Outlays from new mandatory authority	192	220	235
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–5

4160	Budget authority, net (mandatory)	187	220	235
4170	Outlays, net (mandatory)	187	220	235
4180	Budget authority, net (total)	207	240	255
4190	Outlays, net (total)	204	250	261

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	2,884	2,939	2,990
5001	Total investments, EOY: Federal securities: Par value	2,939	2,990	3,062

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.


Identification code 75–8175–0–7–551		2010 actual	CR	2012 est.

	Direct obligations:
25.2	Other services from non-federal sources	9
25.3	Other goods and services from federal sources	12	20	20
42.0	Insurance claims and indemnities	187	220	235

99.0	Direct obligations	208	240	255
99.0	Reimbursable obligations	5

99.9	Total new obligations	213	240	255

Federal Funds

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, [$3,961,187,000] $4,166,139,000 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 [$862,765,000] $948,646,000 for contract medical care, including [$53,000,000] $58,000,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: Provided further, That of the funding provided for information technology activities and, notwithstanding any other provision of law, [$4,000,000] $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 [$36,000,000] $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] $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] 2013: 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 [$444,332,000] $461,837,000 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 [2011] 2012, of which not to exceed [$10,000,000] $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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0390–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Clinical services	2,984	2,954	3,376
0002	Preventive health	144	144	157
0003	Urban health	43	43	47
0004	Indian health professions	46	41	42
0005	Tribal management	3	3	3
0006	Direct operations	69	69	74
0007	Self-governance	6	6	6
0008	Contract support costs	398	398	462
0009	Diabetes funds	166	166	166

0091	Direct program activities, subtotal	3,859	3,824	4,333
0801	Reimbursable program	1,166	1,182	1,182

0900	Total new obligations	5,025	5,006	5,515

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	392	433	372
1021	Recoveries of prior year unpaid obligations	189

1050	Unobligated balance (total)	581	433	372
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,658	3,658	4,166
1120	Appropriations transferred to other accounts	–43
1121	Appropriations transferred from other accounts	43

1160	Appropriation, discretionary (total)	3,658	3,658	4,166
	Appropriations, mandatory:
1200	Appropriation	150	150	150
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,121	1,137	1,137
1701	Change in uncollected payments, Federal sources	–44

1750	Spending auth from offsetting collections, disc (total)	1,077	1,137	1,137
1900	Budget authority (total)	4,885	4,945	5,453
1930	Total budgetary resources available	5,466	5,378	5,825
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8
1941	Unexpired unobligated balance, end of year	433	372	310

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,035	1,076	913
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–295	–232	–232

3020	Obligated balance, start of year (net)	740	844	681
3030	Obligations incurred, unexpired accounts	5,025	5,006	5,515
3031	Obligations incurred, expired accounts	57
3040	Outlays (gross)	–4,815	–5,169	–5,439
3050	Change in uncollected pymts, Fed sources, unexpired	44
3051	Change in uncollected pymts, Fed sources, expired	19
3080	Recoveries of prior year unpaid obligations, unexpired	–189
3081	Recoveries of prior year unpaid obligations, expired	–37
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,076	913	989
3091	Uncollected pymts, Fed sources, end of year	–232	–232	–232

3100	Obligated balance, end of year (net)	844	681	757

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,735	4,795	5,303
	Outlays, gross:
4010	Outlays from new discretionary authority	4,050	4,137	4,553
4011	Outlays from discretionary balances	621	882	733

4020	Outlays, gross (total)	4,671	5,019	5,286
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–365	–370	–370
4033	Non-Federal sources	–756	–767	–767

4040	Offsets against gross budget authority and outlays (total)	–1,121	–1,137	–1,137
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	44
4052	Offsetting collections credited to expired accounts

4060	Additional offsets against budget authority only (total)	44

4070	Budget authority, net (discretionary)	3,658	3,658	4,166
4080	Outlays, net (discretionary)	3,550	3,882	4,149
	Mandatory:
4090	Budget authority, gross	150	150	150
	Outlays, gross:
4100	Outlays from new mandatory authority	144	144	144
4101	Outlays from mandatory balances		6	9

4110	Outlays, gross (total)	144	150	153
4180	Budget authority, net (total)	3,808	3,808	4,316
4190	Outlays, net (total)	3,694	4,032	4,302

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.634 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2012.


Identification code 75–0390–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	394	394	394
11.3	Other than full-time permanent	24	24	24
11.5	Other personnel compensation	58	58	58
11.7	Military personnel	80	80	80

11.9	Total personnel compensation	556	556	556
12.1	Civilian personnel benefits	130	130	130
12.2	Military personnel benefits	37	37	37
13.0	Benefits for former personnel	2	2	6
21.0	Travel and transportation of persons	15	15	16
21.0	Patient travel	30	30	30
22.0	Transportation of things	8	8	10
23.1	Rental payments to GSA	9	9	14
23.2	Rental payments to others	2	2	2
23.3	Communications, utilities, and miscellaneous charges	14	14	18
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	23	23	10
25.2	Other services from non-federal sources	119	96	163
25.3	Other goods and services from federal sources	52	52	74
25.4	Operation and maintenance of facilities	4	4	5
25.6	Medical care	292	292	600
25.7	Operation and maintenance of equipment	12	12	7
25.8	Subsistence and support of persons	3	3	3
26.0	Supplies and materials	120	120	153
31.0	Equipment	50	40	50
41.0	Grants, subsidies, and contributions	2,379	2,377	2,447
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	3,859	3,824	4,333
99.0	Reimbursable obligations	1,166	1,182	1,182

99.9	Total new obligations	5,025	5,006	5,515


Identification code 75–0390–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	7,173	7,274	7,374
1101	Direct military average strength employment	1,097	1,115	1,130
2001	Reimbursable civilian full-time equivalent employment	5,481	5,481	5,481
2101	Reimbursable military average strength employment	839	839	839

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, [$445,242,000] $457,699,000, 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 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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0391–0–1–551		2010 actual	CR	2012 est.

0100	Balance, start of year
	Receipts:
0220	Rent and Charges for Quarters, Indian Health Service	8	8	8

0400	Total: Balances and collections	8	8	8
	Appropriations:
0500	Indian Health Facilities	–8	–8	–8

0799	Balance, end of year


Identification code 75–0391–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Sanitation and health facilities	329	125	165
0002	Maintenance	100	54	57
0003	Facilities and environmental health	174	193	211
0004	Equipment	32	23	25

0091	Direct program activities, subtotal	635	395	458

0100	Total direct program	635	395	458
0801	Reimbursable program	8	8	8

0900	Total new obligations	643	403	466

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	346	180	186
1021	Recoveries of prior year unpaid obligations	67

1050	Unobligated balance (total)	413	180	186
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	395	395	458
	Appropriations, mandatory:
1201	Appropriation (special fund)	8	8	8
	Spending authority from offsetting collections, discretionary:
1700	Collected	5	6	6
1701	Change in uncollected payments, Federal sources	7

1750	Spending auth from offsetting collections, disc (total)	12	6	6
	Spending authority from offsetting collections, mandatory:
1801	Change in uncollected payments, Federal sources	–5
1900	Budget authority (total)	410	409	472
1930	Total budgetary resources available	823	589	658
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	180	186	192

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	645	551	529
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–6	–8	–8

3020	Obligated balance, start of year (net)	639	543	521
3030	Obligations incurred, unexpired accounts	643	403	466
3040	Outlays (gross)	–670	–425	–575
3050	Change in uncollected pymts, Fed sources, unexpired	–2
3080	Recoveries of prior year unpaid obligations, unexpired	–67
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	551	529	420
3091	Uncollected pymts, Fed sources, end of year	–8	–8	–8

3100	Obligated balance, end of year (net)	543	521	412

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	407	401	464
	Outlays, gross:
4010	Outlays from new discretionary authority	225	125	143
4011	Outlays from discretionary balances	436	292	424

4020	Outlays, gross (total)	661	417	567
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–4	–6	–6
4033	Non-Federal sources	–1

4040	Offsets against gross budget authority and outlays (total)	–5	–6	–6
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7

4070	Budget authority, net (discretionary)	395	395	458
4080	Outlays, net (discretionary)	656	411	561
	Mandatory:
4090	Budget authority, gross	3	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	3	8	8
4101	Outlays from mandatory balances	6

4110	Outlays, gross (total)	9	8	8
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	5

4160	Budget authority, net (mandatory)	8	8	8
4170	Outlays, net (mandatory)	9	8	8
4180	Budget authority, net (total)	403	403	466
4190	Outlays, net (total)	665	419	569

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


Identification code 75–0391–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	55	55	44
11.3	Other than full-time permanent	6	6	3
11.5	Other personnel compensation	3	3	2
11.7	Military personnel	26	26	22

11.9	Total personnel compensation	90	90	71
12.1	Civilian personnel benefits	17	17	12
12.2	Military personnel benefits	9	9	9
21.0	Travel and transportation of persons	4	4	4
22.0	Transportation of things	4	4	3
23.1	Rental payments to GSA	3	3	2
23.2	Rental payments to others	1	1
23.3	Communications, utilities, and miscellaneous charges	13	13	22
25.1	Advisory and assistance services			1
25.2	Other services from non-federal sources	48	40	56
25.3	Other goods and services from federal sources	4	4	2
25.4	Operation and maintenance of facilities	17	14	4
25.7	Operation and maintenance of equipment	2	2	1
25.8	Subsistence and support of persons			65
26.0	Supplies and materials	8	8	4
31.0	Equipment	21	21	8
32.0	Land and structures	145	15	24
41.0	Grants, subsidies, and contributions	249	150	170

99.0	Direct obligations	635	395	458
99.0	Reimbursable obligations	8	8	8

99.9	Total new obligations	643	403	466


Identification code 75–0391–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	966	1,016	1,023
1101	Direct military average strength employment	239	241	244
2001	Reimbursable civilian full-time equivalent employment	29	29	29

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.

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.

Federal Funds

To carry out titles II, III, VII, XI, XV, XVII, XIX, XXI, XXIII, 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, sections 4001, 4004, and 4201 of the Patient Protection and Affordable Care Act, section 103(a)(4)(H) of the Afghanistan Freedom Support Act of 2002, 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, [$6,265,806,000]$5,817,412,000, of which [$0]$30,000,000 shall remain available until expended for acquisition of real property, equipment, construction and renovation of facilities; of which [$523,533,000]$625,000,000 shall remain available until expended for the Strategic National Stockpile under section 319F-2 of the PHS Act; [;] of which [$118,092,000]$118,023,000 for international HIV/AIDS shall remain available through September 30, 2013[2]; of which $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under Federal or State quarantine laws: [and of which] [$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 and [: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program] shall be available [through September 30, 2011]until expended: 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) [$161,883,000]$161,883,000 to carry out the National Center for Health Statistics surveys; (3) [$30,880,000 for Public Health Informatics]$55,791,000 to carry out Public Health Scientific Services; and (4) [$17,151,000 for Health Marketing; (5) $31,170,000 to carry out Public Health Research; and (6) $91,724,000] $259,934,000 to carry out research activities within the National Institute for Occupational [Research Agenda]Safety and Health: Provided further, That Centers for Disease Control and Prevention and State grant recipients may transfer up to 5 percent of funds appropriated for Centers for Disease Control and Prevention HIV/AIDS, sexually transmitted disease, hepatitis, and tuberculosis activities to address the overlapping epidemics of these diseases by improving program collaboration and providing integrated services in accordance with priorities identified by the Centers for Disease Control and Prevention: Provided further, That, with respect to the previous proviso, grantees shall submit a plan in writing to the Centers for Disease Control and Prevention and obtain the approval of the Centers for Disease Control and Prevention to transfer such funds: 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]funds appropriated to the Centers for Disease Control and Prevention may be available for making grants under section 1509 of the PHS Act for [to] up to[not less than] 21 States, tribes, or tribal organizations: [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]$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: 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.] Provided further, That funds made available for the Epidemiology-Laboratory Capacity Grants program shall be available notwithstanding paragraphs (1)-(3) of subsection (b) of section 2821 of the PHS Act. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0943–0–1–999		2010 actual	CR	2012 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, Centers for Disease Control	2	2	2

0400	Total: Balances and collections	2	2	2
	Appropriations:
0500	Disease Control, Research, and Training	–2	–2	–2

0799	Balance, end of year


Identification code 75–0943–0–1–999		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Infectious Diseases	1,994	1,996
0002	Health Promotion	1,073	1,075
0003	Health Information and Service	71	72
0004	Environmental Health and Injury Prevention	335	336
0005	Occupational Safety and Health	209	211
0006	Global Health	325	328	381
0007	Public Health Improvement and Leadership	209	211
0008	Business Services Support	367	370	418
0009	Terrorism	952	953
0010	Prev. Health and Health Services Block Grant	102	102
0011	Buildings and Facilities	106	69	30
0012	Individual Learning Accounts (ILAs)	8
0013	Strategic National Stockpile (SNS)	593	596	625
0014	9/11 Follow-up Activities (World Trade Center)	120	71
0015	Energy Employee Occupational Comp.	54	55	55
0016	Pandemic Influenza Supplemental (H1N1)	82
0017	Recovery Act - Section 317 Immunization	146
0018	Recovery Act CPPW	650
0019	Health Reform Prevent. & Public Health Fund	192		752
0020	Immunization and Resp Diseases			647
0021	HIV/AIDS, V Hepatitis, STD and TB			1,157
0022	Emerging & Zoonotic Infectious Diseases			289
0023	Chronic Disease & Hlth Promotion			725
0024	Birth Defects, Dev Disabilities, Disability & Hlth			144
0025	Environmental Hlth			129
0026	Injury Prevention and Control			148
0027	Public Health Scientific Services			206
0028	Public Hlth Leadership & Support			121
0029	Public Hlth Preparedness & Response			798

0091	Direct program activities, subtotal	7,588	6,445	6,625
0801	Recovery Act - Section 317 Receivable	2
0802	Other Reimbursable Programs	563	575	712

0809	Reimbursable program activities, subtotal	565	575	712

0899	Total reimbursable obligations	565	575	712

0900	Total new obligations	8,153	7,020	7,337

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	560	284	286
1011	Unobligated balance transferred from other accounts	650
1021	Recoveries of prior year unpaid obligations	8

1050	Unobligated balance (total)	1,218	284	286
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,390	6,390	5,817
1120	Appropriations transferred to other accounts	–1
1121	Appropriations transferred from other accounts	1

1160	Appropriation, discretionary (total)	6,390	6,390	5,817
	Appropriations, mandatory:
1200	Appropriation	80	55	55
1201	Appropriation (special fund)	2	2	2
1221	Appropriations transferred from other accounts	192		752

1260	Appropriations, mandatory (total)	274	57	809
	Spending authority from offsetting collections, discretionary:
1700	Collected	282	575	712
1701	Change in uncollected payments, Federal sources	283

1750	Spending auth from offsetting collections, disc (total)	565	575	712
1900	Budget authority (total)	7,229	7,022	7,338
1930	Total budgetary resources available	8,447	7,306	7,624
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–10
1941	Unexpired unobligated balance, end of year	284	286	287

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	6,214	6,850	6,786
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–483	–486	–486

3020	Obligated balance, start of year (net)	5,731	6,364	6,300
3030	Obligations incurred, unexpired accounts	8,153	7,020	7,337
3031	Obligations incurred, expired accounts	74
3040	Outlays (gross)	–7,424	–7,084	–7,246
3050	Change in uncollected pymts, Fed sources, unexpired	–283
3051	Change in uncollected pymts, Fed sources, expired	280
3080	Recoveries of prior year unpaid obligations, unexpired	–8
3081	Recoveries of prior year unpaid obligations, expired	–159
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	6,850	6,786	6,877
3091	Uncollected pymts, Fed sources, end of year	–486	–486	–486

3100	Obligated balance, end of year (net)	6,364	6,300	6,391

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,955	6,965	6,529
	Outlays, gross:
4010	Outlays from new discretionary authority	2,755	2,662	2,411
4011	Outlays from discretionary balances	4,609	4,290	4,415

4020	Outlays, gross (total)	7,364	6,952	6,826
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–536	–565	–703
4033	Non-Federal sources	–8	–10	–9

4040	Offsets against gross budget authority and outlays (total)	–544	–575	–712
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–283
4052	Offsetting collections credited to expired accounts	262

4060	Additional offsets against budget authority only (total)	–21

4070	Budget authority, net (discretionary)	6,390	6,390	5,817
4080	Outlays, net (discretionary)	6,820	6,377	6,114
	Mandatory:
4090	Budget authority, gross	274	57	809
	Outlays, gross:
4100	Outlays from new mandatory authority	43	46	302
4101	Outlays from mandatory balances	17	86	118

4110	Outlays, gross (total)	60	132	420
4180	Budget authority, net (total)	6,664	6,447	6,626
4190	Outlays, net (total)	6,880	6,509	6,534

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 Stockpile activities include resources directed at enhancing preparedness. The Budget will finance a portion of 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 Servcies Emergency Fund for pandemic influenza preparedness and response activities.


Identification code 75–0943–0–1–999		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	651	668	624
11.3	Other than full-time permanent	78	80	74
11.5	Other personnel compensation	37	38	35
11.7	Military personnel	66	69	63
11.8	Special personal services payments	2	1	3

11.9	Total personnel compensation	834	856	799
12.1	Civilian personnel benefits	216	222	208
12.2	Military personnel benefits	50	52	49
21.0	Travel and transportation of persons	62	57	56
22.0	Transportation of things	15	14	13
23.1	Rental payments to GSA	27	45	51
23.2	Rental payments to others	2	10	10
23.3	Communications, utilities, and miscellaneous charges	44	41	43
24.0	Printing and reproduction	7	6	7
25.1	Advisory and assistance services	578	462	543
25.2	Other services from non-federal sources	243	215	345
25.3	Other goods and services from federal sources	396	337	289
25.4	Operation and maintenance of facilities	89	58	63
25.5	Research and development contracts	47	43	41
25.6	Medical care	15	14	11
25.7	Operation and maintenance of equipment	44	41	40
25.8	Subsistence and support of persons (Includes 1259)	22	20	20
26.0	Supplies and materials	822	674	672
31.0	Equipment	66	62	51
32.0	Land and structures	91	85	20
41.0	Grants, subsidies, and contributions	3,919	3,131	3,294

99.0	Direct obligations	7,589	6,445	6,625
99.0	Reimbursable obligations	564	575	712

99.9	Total new obligations	8,153	7,020	7,337


Identification code 75–0943–0–1–999		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	8,009	8,118	7,815
1101	Direct military average strength employment	760	793	793
2001	Reimbursable civilian full-time equivalent employment	1,024	1,028	1,381
2101	Reimbursable military average strength employment	82	86	86

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, [$76,337,000]$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 2012[2011], and existing profiles may be updated as necessary. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0944–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Agncy for Toxic Substances & Disease Registry	76	77	76
0801	Reimbursable program	16	6	6

0900	Total new obligations	92	83	82

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		24	24
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	77	77	76
	Appropriations, mandatory:
1200	Appropriation	23
	Spending authority from offsetting collections, discretionary:
1700	Collected	4	6	6
1701	Change in uncollected payments, Federal sources	12

1750	Spending auth from offsetting collections, disc (total)	16	6	6
1900	Budget authority (total)	116	83	82
1930	Total budgetary resources available	116	107	106
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	24	24	24

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	34	43	17
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–4	–14	–14

3020	Obligated balance, start of year (net)	30	29	3
3030	Obligations incurred, unexpired accounts	92	83	82
3031	Obligations incurred, expired accounts	1
3040	Outlays (gross)	–82	–109	–96
3050	Change in uncollected pymts, Fed sources, unexpired	–12
3051	Change in uncollected pymts, Fed sources, expired	2
3081	Recoveries of prior year unpaid obligations, expired	–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	43	17	3
3091	Uncollected pymts, Fed sources, end of year	–14	–14	–14

3100	Obligated balance, end of year (net)	29	3	–11

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	93	83	82
	Outlays, gross:
4010	Outlays from new discretionary authority	57	81	80
4011	Outlays from discretionary balances	25	25	7

4020	Outlays, gross (total)	82	106	87
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–5	–6	–6
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–12
4052	Offsetting collections credited to expired accounts	1

4060	Additional offsets against budget authority only (total)	–11

4070	Budget authority, net (discretionary)	77	77	76
4080	Outlays, net (discretionary)	77	100	81
	Mandatory:
4090	Budget authority, gross	23
	Outlays, gross:
4101	Outlays from mandatory balances		3	9
4180	Budget authority, net (total)	100	77	76
4190	Outlays, net (total)	77	103	90

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.


Identification code 75–0944–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	23	23	21
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	29	29	27
12.1	Civilian personnel benefits	7	7	6
12.2	Military personnel benefits	2	2	1
21.0	Travel and transportation of persons	1	1	1
23.3	Communications, utilities, and miscellaneous charges	12	12	11
25.1	Advisory and assistance services	2	2	2
25.2	Other services from non-federal sources	5	5	10
25.3	Other goods and services from federal sources	3	4	1
25.5	Research and development contracts			2
26.0	Supplies and materials	1	1
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	13	13	14

99.0	Direct obligations	76	77	76
99.0	Reimbursable obligations	16	6	6

99.9	Total new obligations	92	83	82


Identification code 75–0944–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	247	247	247
1101	Direct military average strength employment	43	43	43
2001	Reimbursable civilian full-time equivalent employment	20	19	19
2101	Reimbursable military average strength employment	1	2	2

Federal Funds

For carrying out section 301 and title IV of the Public Health Service Act with respect to cancer, [$5,264,643,000] $5,196,136,000, 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.

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, [$3,187,516,000] $3,147,992,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to dental disease, [$423,511,000] $420,369,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to diabetes and digestive and kidney disease, [$1,857,589,000] $1,837,957,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to neurological disorders and stroke, [$1,681,333,000] $1,664,253,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to allergy and infectious diseases, [$4,977,070,000] $4,915,970,000: 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.

For carrying out section 301 and title IV of the Public Health Service Act with respect to general medical sciences, [$2,125,090,000] $2,102,300,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to child health and human development, [$1,368,894,000] $1,352,189,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to eye diseases and visual disorders, [$724,360,000] $719,059,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to environmental health sciences, [$707,339,000] $700,537,000.

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, [$81,763,000] $81,085,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to aging, [$1,142,337,000] $1,129,987,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to arthritis and musculoskeletal and skin diseases, [$555,715,000] $547,891,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to deafness and other communication disorders, [$429,007,000] $426,043,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to nursing research, [$150,198,000] $148,114,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to alcohol abuse and alcoholism, [$474,649,000] $469,197,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to drug abuse, [$1,094,078,000] $1,080,018,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to mental health, [$1,540,345,000] $1,517,006,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to human genome research, [$533,959,000] $524,807,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to biomedical imaging and bioengineering research, [$325,925,000] $322,106,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to research resources and general research support grants, [$1,308,741,000] $1,297,900,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to complementary and alternative medicine, [$132,004,000] $131,002,000.

For carrying out section 301 and title IV of the Public Health Service Act with respect to minority health and health disparities research, [$219,046,000] $214,608,000.

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), [$73,027,000] $71,328,000.

For carrying out section 301 and title IV of the Public Health Service Act ("PHS Act'') with respect to health information communications, [$364,802,000] $387,153,000, of which $4,000,000 shall be available until expended for improvement of information systems: Provided, That in fiscal year [2011]2012, 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.

For carrying out the responsibilities of the Office of the Director, National Institutes of Health ("NIH''), [$1,220,478,000] $1,298,412,000, of which up to $25,000,000 shall be used to carry out section 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 [$194,400,000] $193,880,000 shall be available for continuation of the National Children's Study: Provided further, That [$561,629,000] $556,890,000 shall be available for the Common Fund established under section 402A(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: Provided further, That up to $100,000,000 shall be available to implement section 402C of the PHS Act, relating to the Cures Acceleration Network.

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, [$125,581,000] $125,581,000, to remain available until expended. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–9915–0–1–552		2010 actual	CR	2012 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, NIH	16	16	16

0299	Total receipts and collections	16	16	16

0400	Total: Balances and collections	16	16	16
	Appropriations:
0500	National Institutes of Health	–16	–16	–16

0599	Total appropriations	–16	–16	–16

0799	Balance, end of year


Identification code 75–9915–0–1–552		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	National Cancer Institute	5,098	5,103	5,196
0002	National Heart, Lung, and Blood Institute	3,094	3,097	3,148
0003	National Institute of Dental and Craniofacial Research	412	413	420
0004	National Institute of Diabetes and Digestive and Kidney Disease	1,958	1,808	1,838
0005	National Institute of Neurological Disorders and Stroke	1,634	1,636	1,664
0006	National Institute of Allergy and Infectious Diseases	4,515	4,514	4,916
0007	National Institute of General Medical Sciences	2,048	2,052	2,102
0008	National Institute of Child Health and Human Development	1,327	1,330	1,352
0009	National Eye Institute	706	707	719
0010	National Institute of Environmental Health Sciences	773	769	782
0011	National Institute on Aging	1,108	1,110	1,129
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease	538	539	548
0013	National Institute on Deafness and Other Communication Disorder	418	419	426
0014	National Institute of Mental Health	1,494	1,489	1,517
0015	National Institute on Drug Abuse	1,066	1,060	1,080
0016	Natinal Institute on Alcohol Abuse and Alcoholism	462	462	469
0017	National Institute of Nursing Research	145	146	148
0018	National Human Genome Research Institute	524	516	525
0019	National Institute of Biomedical Imaging and Bioengineering	316	317	322
0020	National Center for Research Resources	1,267	1,269	1,298
0021	National Center for Complementary and Alternative Medicine	128	129	131
0022	National Institute on Minority Health and Health Disparities	211	212	215
0023	John E. Fogarty International Center	71	70	71
0024	National Library of Medicine	340	340	387
0025	Office of the Director	1,176	1,177	1,298
0026	Buildings and facilities	203	100	126
0027	Cooperative Research and Development Agreements	16	16	16
0028	ARRA Funds	5,601
0029	Royalties	8	8	8
0031	Type 1 Diabetes		150	150

0091	Direct program activities, subtotal	36,657	30,958	32,001
0801	Reimbursable program activity	3,306	3,338	3,624

0809	Reimbursable program activities, subtotal	3,306	3,338	3,624

0900	Total new obligations	39,963	34,296	35,625

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5,922	344	347
1021	Recoveries of prior year unpaid obligations	177	9	15
1029	Other balances withdrawn	–1

1050	Unobligated balance (total)	6,098	353	362
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	30,784	30,785	31,829
1120	Appropriations transferred to other accounts	–305
1121	Appropriations transferred from other accounts	305	1

1160	Appropriation, discretionary (total)	30,784	30,786	31,829
	Appropriations, mandatory:
1200	Appropriation	150	150	150
1201	Appropriation (special fund)	16	16	16

1260	Appropriations, mandatory (total)	166	166	166
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,743	3,338	3,624
1701	Change in uncollected payments, Federal sources	518

1750	Spending auth from offsetting collections, disc (total)	3,261	3,338	3,624
1900	Budget authority (total)	34,211	34,290	35,619
1930	Total budgetary resources available	40,309	34,643	35,981
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	344	347	356

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	36,375	39,713	37,445
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,235	–1,248	–1,248

3020	Obligated balance, start of year (net)	35,140	38,465	36,197
3030	Obligations incurred, unexpired accounts	39,963	34,296	35,625
3031	Obligations incurred, expired accounts	118
3040	Outlays (gross)	–36,284	–36,555	–37,442
3050	Change in uncollected pymts, Fed sources, unexpired	–518
3051	Change in uncollected pymts, Fed sources, expired	505
3080	Recoveries of prior year unpaid obligations, unexpired	–177	–9	–15
3081	Recoveries of prior year unpaid obligations, expired	–282
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	39,713	37,445	35,613
3091	Uncollected pymts, Fed sources, end of year	–1,248	–1,248	–1,248

3100	Obligated balance, end of year (net)	38,465	36,197	34,365

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	34,045	34,124	35,453
	Outlays, gross:
4010	Outlays from new discretionary authority	9,397	11,219	11,772
4011	Outlays from discretionary balances	26,696	25,142	25,488

4020	Outlays, gross (total)	36,093	36,361	37,260
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,122	–3,338	–3,624
4033	Non-Federal sources	–94

4040	Offsets against gross budget authority and outlays (total)	–3,216	–3,338	–3,624
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–518
4052	Offsetting collections credited to expired accounts	473

4060	Additional offsets against budget authority only (total)	–45

4070	Budget authority, net (discretionary)	30,784	30,786	31,829
4080	Outlays, net (discretionary)	32,877	33,023	33,636
	Mandatory:
4090	Budget authority, gross	166	166	166
	Outlays, gross:
4100	Outlays from new mandatory authority	4	52	52
4101	Outlays from mandatory balances	187	142	130

4110	Outlays, gross (total)	191	194	182
4180	Budget authority, net (total)	30,950	30,952	31,995
4190	Outlays, net (total)	33,068	33,217	33,818

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


	2010	2011	2012

Distribution of budget authority by account:
National Cancer Institute	5,103	5,103	5,196
National Heart, Lung, and Blood Institute	3,097	3,097	3,148
National Institute of Dental and Craniofacial Research	413	413	420
National Institute of Diabetes and Digestive and Kidney Diseases	1,958	1,958	1,988
National Institute of Neurological Disorder and Stroke	1,636	1,636	1,664
National Institute of Allergy and Infectious Diseases	4,818	4,5141	4,916
National Institute of General Medical Sciences	2,052	2,052	2,102
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,330	1,330	1,352
National Eye Institute	707	707	719
National Institute of Environmental Health Sciences	769	769	782
National Institute on Aging	1,110	1,110	1,130
National Institute of Arthritis and Musculoskeletal and Skin Diseases	539	539	548
National Institute on Deafness and Other Communication Disorders	419	419	426
National Institute of Nursing Research	146	146	148
National Institute on Alcohol Abuse and Alcoholism	462	462	469
National Institute on Drug Abuse	1,060	1,060	1,080
National Institute of Mental Health	1,489	1,489	1,517
National Center for Research Resources	1,269	1,269	1,298
National Human Genome Research Institute	516	516	525
National Institute of Biomedical Imaging and Bioengineering	317	317	322
National Center for Complementary and Alternative Medicine	129	129	131
National Institute on Minority Health and Health Disparities	212	212	215
John E. Fogarty International Center	70	70	71
National Library of Medicine	340	340	387
Office of the Director	1,177	1,177	1,298
Buildings and Facilities	100	100	126

ARRA Funds	0	0	0

Subtotal	31,238	30,934	31,978

Cooperative Research and Development Agreements	16	16	16


Total Budget Authority, NIH	31,254	30,950	31,994


	2010	2011	2012

Distribution of outlays by account:
National Cancer Institute	5,012	4,835	5,074
National Heart, Lung, and Blood Institute	2,991	3,057	3,071
National Institute of Dental and Craniofacial Research	385	428	415
National Institute of Diabetes and Digestive and Kidney Diseases	1,852	1,932	1,960
National Institute of Neurological Disorders and Stroke	1,537	1,645	1,641
National Institute of Allergy and Infectious Diseases	4,379	4,165	4,526
National Institute of General Medical Sciences	1,979	2,026	2,060
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,275	1,316	1,335
National Eye Institute	686	678	709
National Institute of Environmental Health Sciences	754	737	773
National Institute on Aging	1,072	1,055	1,135
National Institute of Arthritis and Musculoskeletal and Skin Diseases	532	516	540
National Institute on Deafness and Other Communication Disorders	399	419	420
National Institute of Nursing Research	143	134	146
National Institute on Alcohol Abuse and Alcoholism	447	526	463
National Institute on Drug Abuse	1,046	1,015	1,054
National Institute of Mental Health	1,438	1484	1,496
National Center for Research Resources	1,264	971	1,268
National Human Genome Research Institute	523	492	520
National Institute of Biomedical Imaging and Bioengineering	311	303	320
National Center for Complementary and Alternative Medicine	124	105	133
National Institute on Minority Health and Health Disparities	212	197	216
John E. Fogarty International Center	67	71	71
National Library of Medicine	349	308	363
Office of the Director	1,050	1,423	1,193
Buildings and Facilities	115	65	113

ARRA Funds	3,070	3,263	2,703

Subtotal Outlays	33,012	33,166	33,718

Cooperative Research and Development Agreements	16	16	16


Total Outlays, NIH	33,028	33,182	33,734

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.


Identification code 75–9915–0–1–552		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	862	872	872
11.3	Other than full-time permanent	472	476	476
11.5	Other personnel compensation	46	46	46
11.7	Military personnel	23	24	24
11.8	Special personal services payments	183	188	187

11.9	Total personnel compensation	1,586	1,606	1,605
12.1	Civilian personnel benefits	386	391	391
12.2	Military personnel benefits	16	17	17
21.0	Travel and transportation of persons	59	58	59
22.0	Transportation of things	6	6	6
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	27	24	25
24.0	Printing and reproduction	8	8	9
25.1	Advisory and assistance services	109	98	103
25.2	Other services from non-federal sources	995	720	746
25.3	Other goods and services from federal sources	3,100	3,046	3,333
25.4	Operation and maintenance of facilities	595	178	195
25.5	Research and development contracts	2,484	2,249	2,323
25.6	Medical care	20	18	19
25.7	Operation and maintenance of equipment	82	73	75
26.0	Supplies and materials	270	216	220
31.0	Equipment	186	141	145
41.0	Grants, subsidies, and contributions	26,723	22,107	22,728
42.0	Insurance claims and indemnities	4

99.0	Direct obligations	36,657	30,957	32,000
99.0	Reimbursable obligations	3,306	3,339	3,625

99.9	Total new obligations	39,963	34,296	35,625


Identification code 75–9915–0–1–552		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	12,550	12,573	12,573
1101	Direct military average strength employment	220	235	235
2001	Reimbursable civilian full-time equivalent employment	5,463	5,467	5,467
2101	Reimbursable military average strength employment	125	133	133

Federal Funds

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, [$3,541,362,000]$3,386,903,000: 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 in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS Act: (1) [$79,200,000]$74,711,000 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) [$23,399,000]$45,428,000 to carry out national surveys on drug abuse and mental health; and (4) [$8,596,000]$28,567,000 to collect and analyze data, conduct public awareness and technical assistance activites, 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 [2011]2012: Provided further, That section 1922(a)(1) of the PHS Act shall not apply to amounts provided herein. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1362–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0002	Mental Health Block Grant	400	400	414
0003	Substance Abuse Block Grant	1,376	1,376	1,420
0004	State Prevention Grants	480	481	485
0005	Program Management	79	79	82
0006	St. Elizabeths Hospital	1	1
0010	Children's Mental Health	121	121	121
0011	PATH Homeless State Grants	65	65	65
0012	Protection and Advocacy	37	37	36
0013	Innovation and Emerging Issues	829	809	745
0014	Public Education and Support	14	14
0020	Prescription Drug Monitoring (NASPER)	2	2	2
0022	Performance and Quality Information Systems	31	31
0023	Regulatory and Oversight Functions	16	16	17

0091	Direct program activities, subtotal	3,451	3,432	3,387

0100	Total, direct program	3,451	3,432	3,387
0802	Reimbursable program: PHS Evaluation	242	242	285

0900	Total new obligations	3,693	3,674	3,672

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,431	3,432	3,387
	Appropriations, mandatory:
1221	Appropriations transferred from other accounts	20		93
	Spending authority from offsetting collections, discretionary:
1700	Collected	227	242	285
1701	Change in uncollected payments, Federal sources	15

1750	Spending auth from offsetting collections, disc (total)	242	242	285
1900	Budget authority (total)	3,693	3,674	3,765
1930	Total budgetary resources available	3,693	3,674	3,765
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year			93

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,803	2,828	2,828
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–198	–152	–137

3020	Obligated balance, start of year (net)	2,605	2,676	2,691
3030	Obligations incurred, unexpired accounts	3,693	3,674	3,672
3031	Obligations incurred, expired accounts	1
3040	Outlays (gross)	–3,614	–3,674	–3,698
3050	Change in uncollected pymts, Fed sources, unexpired	–15
3051	Change in uncollected pymts, Fed sources, expired	61	15
3081	Recoveries of prior year unpaid obligations, expired	–55
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2,828	2,828	2,802
3091	Uncollected pymts, Fed sources, end of year	–152	–137	–137

3100	Obligated balance, end of year (net)	2,676	2,691	2,665

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,673	3,674	3,672
	Outlays, gross:
4010	Outlays from new discretionary authority	1,584	1,615	1,640
4011	Outlays from discretionary balances	2,030	2,059	2,058

4020	Outlays, gross (total)	3,614	3,674	3,698
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–158	–242	–285
4033	Non-Federal sources	–131

4040	Offsets against gross budget authority and outlays (total)	–289	–242	–285
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–15
4052	Offsetting collections credited to expired accounts	62

4060	Additional offsets against budget authority only (total)	47

4070	Budget authority, net (discretionary)	3,431	3,432	3,387
4080	Outlays, net (discretionary)	3,325	3,432	3,413
	Mandatory:
4090	Budget authority, gross	20		93
4180	Budget authority, net (total)	3,451	3,432	3,480
4190	Outlays, net (total)	3,325	3,432	3,413

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.


Identification code 75–1362–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	45	45	46
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	52	52	53
12.1	Civilian personnel benefits	12	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	7	7	7
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	29	29	27
25.2	Other services from non-federal sources	230	230	211
25.3	Other goods and services from federal sources	104	104	97
25.7	Operation and maintenance of equipment	1	1	1
41.0	Grants, subsidies, and contributions	3,007	2,988	2,970
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	3,451	3,432	3,387
99.0	Reimbursable obligations	242	242	285

99.9	Total new obligations	3,693	3,674	3,672


Identification code 75–1362–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	435	436	436
1101	Direct military average strength employment	47	51	51
2001	Reimbursable civilian full-time equivalent employment	38	38	45
2101	Reimbursable military average strength employment	17	12	12

Federal Funds

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, $366,397,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act: Provided, That, in addition, 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 $610,912,000]. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1700–0–1–552		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Recovery Act	693
0002	Mandatory Appropriations: MIPPA	2
0003	Prevention and Public Health Fund	5

0091	Direct program activities, subtotal	700
0801	Reimbursable program	21	21	21
0802	Reimbursable program: PHS evaluation	397	397	366

0899	Total reimbursable obligations	418	418	387

0900	Total new obligations	1,118	418	387

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	703	5	5
	Budget authority:
	Appropriations, mandatory:
1221	Appropriations transferred from other accounts	5
	Spending authority from offsetting collections, discretionary:
1700	Collected	146	418	387
1701	Change in uncollected payments, Federal sources	269

1750	Spending auth from offsetting collections, disc (total)	415	418	387
1900	Budget authority (total)	420	418	387
1930	Total budgetary resources available	1,123	423	392
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5	5	5

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	465	1,165	1,063
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–370	–451	–451

3020	Obligated balance, start of year (net)	95	714	612
3030	Obligations incurred, unexpired accounts	1,118	418	387
3031	Obligations incurred, expired accounts	16
3040	Outlays (gross)	–428	–520	–676
3050	Change in uncollected pymts, Fed sources, unexpired	–269
3051	Change in uncollected pymts, Fed sources, expired	188
3081	Recoveries of prior year unpaid obligations, expired	–6
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,165	1,063	774
3091	Uncollected pymts, Fed sources, end of year	–451	–451	–451

3100	Obligated balance, end of year (net)	714	612	323

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	415	418	387
	Outlays, gross:
4010	Outlays from new discretionary authority	127	418	387
4011	Outlays from discretionary balances	301	100	287

4020	Outlays, gross (total)	428	518	674
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–348	–418	–387
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–269
4052	Offsetting collections credited to expired accounts	202

4060	Additional offsets against budget authority only (total)	–67

4070	Budget authority, net (discretionary)
4080	Outlays, net (discretionary)	80	100	287
	Mandatory:
4090	Budget authority, gross	5
	Outlays, gross:
4101	Outlays from mandatory balances		2	2
4180	Budget authority, net (total)	5
4190	Outlays, net (total)	80	102	289

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.


Identification code 75–1700–0–1–552		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.3	Other than full-time permanent	1
11.3	Other than full-time permanent	1

11.9	Total personnel compensation	2
12.1	Civilian personnel benefits	1
25.5	Research and development contracts	293
41.0	Grants, subsidies, and contributions	404

99.0	Direct obligations	700
99.0	Reimbursable obligations	418	418	387

99.9	Total new obligations	1,118	418	387


Identification code 75–1700–0–1–552		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	12
2001	Reimbursable civilian full-time equivalent employment	286	286	290
2101	Reimbursable military average strength employment	14	14	14

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$173,143,799,000]$184,279,110,000, to remain available until expended.

For making, after May 31, [2011]2012, 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 [2011]2012 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 [2012]2013, [$86,445,289,000]$90,614,082,000, 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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0512–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Medicaid vendor payments	274,214	262,368	252,525
0002	State and local administration	11,971	12,856	12,808
0003	Vaccines for Children	3,761	3,906	4,031
0004	Incurred by providers but not yet reported		1,539	1,360

0091	Direct program activities, subtotal	289,946	280,669	270,724
0801	Medicare Part B premiums	515	630	165

0900	Total new obligations	290,461	281,299	270,889

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	8,179	17,006
1020	Adjustment of unobligated bal brought forward, Oct 1	–8,163
1021	Recoveries of prior year unpaid obligations	14,017	2,880

1050	Unobligated balance (total)	14,033	19,886
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid	220,962	173,144	184,280
1200	Appropriation Medicaid, Indefinite		850

1260	Appropriations, mandatory (total)	220,962	173,994	184,280
	Advance appropriations, mandatory:
1270	Advance appropriation	71,700	86,789	86,445
	Spending authority from offsetting collections, mandatory:
1800	Collected	772	480	165
1800	Collected		150

1850	Spending auth from offsetting collections, mand (total)	772	630	165
1900	Budget authority (total)	293,434	261,413	270,890
1930	Total budgetary resources available	307,467	281,299	270,890
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	17,006		1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	25,490	28,391	29,931
3030	Obligations incurred, unexpired accounts	290,461	281,299	270,889
3040	Outlays (gross)	–273,543	–276,879	–269,530
3080	Recoveries of prior year unpaid obligations, unexpired	–14,017	–2,880
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	28,391	29,931	31,290

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	293,434	261,413	270,890
	Outlays, gross:
4100	Outlays from new mandatory authority	273,062	259,873	269,530
4101	Outlays from mandatory balances	481	17,006

4110	Outlays, gross (total)	273,543	276,879	269,530
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–515	–630	–165
4123	Non-Federal sources	–257

4130	Offsets against gross budget authority and outlays (total)	–772	–630	–165

4160	Budget authority, net (mandatory)	292,662	260,783	270,725
4170	Outlays, net (mandatory)	272,771	276,249	269,365
4180	Budget authority, net (total)	292,662	260,783	270,725
4190	Outlays, net (total)	272,771	276,249	269,365


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	292,662	260,783	270,725
	Outlays	272,771	276,249	269,365
Legislative proposal, not subject to PAYGO:
	Budget Authority			–602
	Outlays			–602
Legislative proposal, subject to PAYGO:
	Budget Authority			305
	Outlays			305
Total:
	Budget Authority	292,662	260,783	270,428
	Outlays	272,771	276,249	269,068

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.


Obligations	2010	2011	2012

Vaccine Purchase	3,458	3,615	3,726
Vaccine Stockpile	135	138	137
Ordering, Distribution, and Operations	123	109	125
Vaccine Management Contract Support	5	4	2

Evaluation Activities	39	40	41

Total Obligations	3,761	3,906	4,031


Identification code 75–0512–0–1–551		2010 actual	CR	2012 est.

41.0	Direct obligations: Grants, subsidies, and contributions	289,946	280,669	270,724

99.0	Reimbursable obligations: reimbursable obligations	515	630	165

99.9	Total new obligations	290,461	281,299	270,889


Identification code 75–0512–2–1–551		2010 actual	CR	2012 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid			–107
1900	Budget authority (total)			–107
1930	Total budgetary resources available			–107

	Change in obligated balance:
3040	Outlays (gross)			107
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			107

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–107
	Outlays, gross:
4100	Outlays from new mandatory authority			–107
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–495

4160	Budget authority, net (mandatory)			–602
4170	Outlays, net (mandatory)			–602
4180	Budget authority, net (total)			–602
4190	Outlays, net (total)			–602

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.


Identification code 75–0512–4–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Program Integrity			–155
0003	Other Proposals			–35

0091	Direct program activities, subtotal			–190
0801	Medicare Part B premiums			495

0900	Total new obligations			305

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid			–190
	Spending authority from offsetting collections, mandatory:
1800	Collected			495
1900	Budget authority (total)			305
1930	Total budgetary resources available			305

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			305
3040	Outlays (gross)			–305

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			305
	Outlays, gross:
4100	Outlays from new mandatory authority			305
4180	Budget authority, net (total)			305
4190	Outlays, net (total)			305


Identification code 75–0512–4–1–551		2010 actual	CR	2012 est.

41.0	Direct obligations: Grants, subsidies, and contributions			–190

99.0	Reimbursable obligations: reimbursable obligations			495

99.9	Total new obligations			305


Identification code 75–0516–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0010	Ticket to Work grants	82	70
0011	Emergency health services for undocumented aliens	100	80	53
0012	Medicaid integrity program	71	92	77
0015	Partnerships for long-term care	3	3	3
0017	Psychiatric residential treatment demonstration	28	60
0018	Money follows the person (MFP) demonstration	118	175	250
0019	MFP evaluations and technical support	2	1	1
0023	Grants to improve outreach and enrollment	12	49	37
0024	PPS for FQHCs and rural health clinics	2	3
0025	Medicaid Emergency Psychiatric Demo		15	15
0026	Incentives for Prevention of Chronic Diseases in Medicaid		20	20

0900	Total new obligations	418	568	456

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	982	1,207	1,261
1021	Recoveries of prior year unpaid obligations	36
1029	Other balances withdrawn		–92

1050	Unobligated balance (total)	1,018	1,115	1,261
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (Ticket to Work)	46	47
1200	Appropriation (Drug surveys and reports)	5
1200	Appropriation (Expansion of long-term care partnerships)	3	3	3
1200	Appropriation (Psychiatric residential treatment demonstration)	53	57
1200	Appropriation (Money follows the person (MFP) demonstration)	399	449	449
1200	Appropriation (MFP research & evaluation)	1	1	1
1200	Appropriation (Medicaid integrity program)	75	76	77
1200	Appropriation (Grants to improve outreach and enrollment)	40
1200	Appropriation (Medicaid Emergency Psychiatric Demo)		75
1200	Appropriation (Incentives for Prevention of Chronic Diseases in Medicaid)		100

1260	Appropriations, mandatory (total)	622	808	530
1900	Budget authority (total)	622	808	530
1930	Total budgetary resources available	1,640	1,923	1,791
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–15	–94
1941	Unexpired unobligated balance, end of year	1,207	1,261	1,335

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	892	738	691
3030	Obligations incurred, unexpired accounts	418	568	456
3040	Outlays (gross)	–531	–615	–518
3080	Recoveries of prior year unpaid obligations, unexpired	–36
3081	Recoveries of prior year unpaid obligations, expired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	738	691	629

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	622	808	530
	Outlays, gross:
4100	Outlays from new mandatory authority		97	128
4101	Outlays from mandatory balances	531	518	390

4110	Outlays, gross (total)	531	615	518
4180	Budget authority, net (total)	622	808	530
4190	Outlays, net (total)	531	615	518


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	622	808	530
	Outlays	531	615	518
Legislative proposal, subject to PAYGO:
	Budget Authority			20
	Outlays			20
Total:
	Budget Authority	622	808	550
	Outlays	531	615	538

State Grants and Demonstrations includes funding for grant programs enacted in 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), the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), and the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152).


Identification code 75–0516–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent-Medicaid Integrity Program	8	9	9
12.1	Civilian personnel benefits-Medicaid Integrity Program	2	6	6
41.0	Grants, subsidies, and contributions - Ticket to Work	82	70
41.0	Grants, subsidies, and contributions - Fed'l Reimb. - Emer Svcs, Undoc. Aliens	100	80	53
41.0	Grants, subsidies, and contributions-Medicaid Integrity Program	61	77	62
41.0	Grants, subsidies, and contributions-Partnership for long-term care		3	3
41.0	Grants, subsidies, and contributions-Psychiatric Residential Treatment Demonstration	3	60
41.0	Grants, subsidies, and contributions-Money follows the Person (MFP) Demonstration		175	250
41.0	Grants, subsidies, and contributions-MFP Evaluations & Technical Support	28	1	1
41.0	Grants, subsidies, and contributions-Grants to improve outreach and enrollment	130	49	37
41.0	Grants, subsidies, and contributions-Application of prospective payment system	4	3
41.0	Grants, subsidies, and contributions-Medicaid Emergency Psychiatric Demo		15	15
41.0	Grants, subsidies, and contributions-Incentives for Prevention of Chronic Diseases in Medicaid		20	20

99.9	Total new obligations	418	568	456


Identification code 75–0516–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	86	94	105


Identification code 75–0516–4–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0027	Wireless Innovation Fund			20

0900	Total new obligations (object class 41.0)			20

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Wireless Innovation Fund			20
1930	Total budgetary resources available			20

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			20
3040	Outlays (gross)			–20

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			20
	Outlays, gross:
4100	Outlays from new mandatory authority			20
4180	Budget authority, net (total)			20
4190	Outlays, net (total)			20

The President's Wireless Innovation and Infrastructure Initiative (WI3) proposes to reallocate a total of 500 megahertz of Federal agency and commercial spectrum bands over the next 10 years in order to increase Americans' access to wireless broadband. The auctions of reallocated spectrum licenses are expected to raise more than $27 billion by 2021. Repurposing spectrum will greatly facilitate access for smart phones, portable computers, and innovative technologies that are on the horizon. This effort will also enhance America's public safety, infrastructure, and competitiveness by investing some of the expected receipts in the creation of a broadband network for public safety, expanding access to wireless broadband in rural America, and a Wireless Innovation (WIN) Fund to help develop cutting edge wireless technologies. As part of this initiative, the Centers for Medicare & Medicaid Services will participate in the WIN Fund by providing $100 million in grants that increase and improve use of wireless technologies in health care, for example, for health software applications and telemedicine, with special emphasis on technologies used in conjunction with innovative delivery systems.

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, [$229,664,000,000]$231,012,000,000.

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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0580–0–1–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	161,109	165,338	178,041
0002	Part D benefits (Rx Drug)	52,341	55,548	51,431
0003	Part D Federal administration (Rx Drug)	300	404	475
0004	General Fund Transfers to HI	59	815	1,065
0006	Federal Bureau of Investigation (HCFAC)	126	128	130
0007	Federal payments from taxation of OASDI benefits (HI)	13,760	14,874	15,303
0008	Criminal fines (HCFAC)	1,206	217	221
0009	Civil monetary penalties and damages (HCFAC - DOJ and CMS administration)	19	16	16

0900	Total new obligations	228,920	237,340	246,682

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	207,286	222,105	231,012
1200	Appropriation (indefinite, annual)	8,100
1200	Appropriation (indefinite, permanent)	13,761	15,107	15,540
1200	Appropriation (HCFAC for FBI)	126	128	130
1200	Appropriation (indefinite for HCFAC)	1,224

1260	Appropriations, mandatory (total)	230,497	237,340	246,682
1930	Total budgetary resources available	230,497	237,340	246,682
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1,577

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	228,920	237,340	246,682
3040	Outlays (gross)	–228,920	–237,340	–246,682

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	230,497	237,340	246,682
	Outlays, gross:
4100	Outlays from new mandatory authority	228,920	237,340	246,682
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–42
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	42

4160	Budget authority, net (mandatory)	230,497	237,340	246,682
4170	Outlays, net (mandatory)	228,878	237,340	246,682
4180	Budget authority, net (total)	230,497	237,340	246,682
4190	Outlays, net (total)	228,878	237,340	246,682


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	230,497	237,340	246,682
	Outlays	228,878	237,340	246,682
Legislative proposal, not subject to PAYGO:
	Budget Authority			–417
	Outlays			–417
Total:
	Budget Authority	230,497	237,340	246,265
	Outlays	228,878	237,340	246,265

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.


Identification code 75–0580–0–1–571		2010 actual	CR	2012 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	228,419	236,432	245,723
42.0	Insurance claims and indemnities		275	262
94.0	Financial transfers (Federal admin)	501	633	697

99.0	Direct obligations	228,920	237,340	246,682

99.9	Total new obligations	228,920	237,340	246,682


Identification code 75–0580–2–1–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			–32
0002	Part D benefits (Rx Drug)			–385

0900	Total new obligations (object class 41.0)			–417

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)			–417
1930	Total budgetary resources available			–417

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–417
3040	Outlays (gross)			417

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–417
	Outlays, gross:
4100	Outlays from new mandatory authority			–417
4180	Budget authority, net (total)			–417
4190	Outlays, net (total)			–417

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'')[,]; the Patient Protection and Affordable Care Act; and the Clinical Laboratory Improvement Amendments of 1988, not to exceed [$3,601,147,000]$4,396,973,000, 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, funds retained by the Secretary pursuant to the Patient Protection and Affordable Care Act[;], 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 [$37,687,000]$34,000,000, to remain available through September 30, [2012] 2013, shall be for contract costs for the Healthcare Integrated General Ledger Accounting System: [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 [2011]2012 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. [Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.] Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0511–0–1–550		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Program operations	2,404	2,689	3,245
0002	Federal administration	697	767	925
0003	State survey and certification	366	469	417
0004	Research, demonstrations, and evaluation projects	39	602	90
0006	High-risk pool grants	55	55	44
0007	ARRA Medicare/Medicaid HIT	88	191	201
0008	Consumer Assistance Grants	1	29

0091	Direct program activities, subtotal	3,650	4,802	4,922

0100	Total direct program	3,650	4,802	4,922
0801	Clinical laboratory improvement amendments	54	43	43
0802	Sale of data	8	2	2
0803	Coordination of benefits	42	52	59
0804	Medicare advantage/Prescription drug plan	71	73	72
0805	Recovery audit contractors	26	259	500
0806	Other reimbursables	29

0809	Reimbursable program activities, subtotal	230	429	676

0899	Total reimbursable obligations	230	429	676

0900	Total new obligations	3,880	5,231	5,598

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	492	849	483
1021	Recoveries of prior year unpaid obligations	19

1050	Unobligated balance (total)	511	849	483
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	392	403	253
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,070	3,899	5,073
1701	Change in uncollected payments, Federal sources	1,587

1750	Spending auth from offsetting collections, disc (total)	3,657	3,899	5,073
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	563	64
1801	Change in uncollected payments, Federal sources	177

1850	Spending auth from offsetting collections, mand (total)	185	563	64
1900	Budget authority (total)	4,234	4,865	5,390
1930	Total budgetary resources available	4,745	5,714	5,873
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–16
1941	Unexpired unobligated balance, end of year	849	483	275

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,182	2,481	2,346
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–2,449	–2,866	–2,866

3020	Obligated balance, start of year (net)	–267	–385	–520
3030	Obligations incurred, unexpired accounts	3,880	5,231	5,598
3031	Obligations incurred, expired accounts	93
3040	Outlays (gross)	–3,430	–5,366	–5,617
3050	Change in uncollected pymts, Fed sources, unexpired	–1,764
3051	Change in uncollected pymts, Fed sources, expired	1,347
3080	Recoveries of prior year unpaid obligations, unexpired	–19
3081	Recoveries of prior year unpaid obligations, expired	–225
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2,481	2,346	2,327
3091	Uncollected pymts, Fed sources, end of year	–2,866	–2,866	–2,866

3100	Obligated balance, end of year (net)	–385	–520	–539

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,657	3,899	5,073
	Outlays, gross:
4010	Outlays from new discretionary authority	1,886	3,899	5,073
4011	Outlays from discretionary balances	1,377	2

4020	Outlays, gross (total)	3,263	3,901	5,073
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,148	–3,470	–4,397
4033	Non-Federal sources	–189	–429	–676

4040	Offsets against gross budget authority and outlays (total)	–3,337	–3,899	–5,073
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–1,587
4052	Offsetting collections credited to expired accounts	1,267

4060	Additional offsets against budget authority only (total)	–320

4070	Budget authority, net (discretionary)
4080	Outlays, net (discretionary)	–74	2
	Mandatory:
4090	Budget authority, gross	577	966	317
	Outlays, gross:
4100	Outlays from new mandatory authority	3	649	191
4101	Outlays from mandatory balances	164	816	353

4110	Outlays, gross (total)	167	1,465	544
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–18	–563	–64
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–177
4142	Offsetting collections credited to expired accounts	10

4150	Additional offsets against budget authority only (total)	–167

4160	Budget authority, net (mandatory)	392	403	253
4170	Outlays, net (mandatory)	149	902	480
4180	Budget authority, net (total)	392	403	253
4190	Outlays, net (total)	75	904	480

Program management activities include funding for research, program operations, survey and certification, Clinical Laboratory Improvement Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and administrative costs, and include costs attributable to the Affordable Care Act.


Identification code 75–0511–0–1–550		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	407	429	515
11.3	Other than full-time permanent	14	14	14
11.5	Other personnel compensation	9	10	11
11.7	Military personnel	9	10	12

11.9	Total personnel compensation	439	463	552
12.1	Civilian personnel benefits	112	114	141
12.2	Military personnel benefits	5	5	6
21.0	Travel and transportation of persons	9	10	13
22.0	Transportation of things	1
23.1	Rental payments to GSA	17	25	35
23.3	Communications, utilities, and miscellaneous charges	61		5
24.0	Printing and reproduction	27	3	3
25.1	Advisory and assistance services	246	94	210
25.2	Other services from non-federal sources	1,703	1,934	1,985
25.3	Other goods and services from federal sources	85	6	7
25.5	Research and development contracts	41
25.6	Medical care	610	1,450	1,562
25.7	Operation and maintenance of equipment	144		26
26.0	Supplies and materials	2	1	1
31.0	Equipment	14		275
32.0	Land and structures		11	11
41.0	Grants, subsidies, and contributions	133	686	90

99.0	Direct obligations	3,649	4,802	4,922
99.0	Reimbursable obligations	230	429	676
99.5	Below reporting threshold	1

99.9	Total new obligations	3,880	5,231	5,598


Identification code 75–0511–0–1–550		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	4,081	4,302	4,985
1101	Direct military average strength employment	103	109	129
2001	Reimbursable civilian full-time equivalent employment	106	115	118


Identification code 75–0515–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Grants to States and U.S. Territories	10,601	8,476	8,476
0002	Performance Bonus Payment	75	206	130
0003	Child Health Quality Improvement	41	48	51

0900	Total new obligations (object class 41.0)	10,717	8,730	8,657

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,390	4,330	9,104
1012	Expired unobligated bal transferred to unexpired accts	1,092

1050	Unobligated balance (total)	4,482	4,330	9,104
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	12,520	13,459	14,982
1200	Appropriation	45	45	45
1220	Appropriations transferred to other accounts	–2

1260	Appropriations, mandatory (total)	12,563	13,504	15,027
1930	Total budgetary resources available	17,045	17,834	24,131
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1,998
1941	Unexpired unobligated balance, end of year	4,330	9,104	15,474

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	5,445	8,195	7,856
3030	Obligations incurred, unexpired accounts	10,717	8,730	8,657
3031	Obligations incurred, expired accounts	4
3040	Outlays (gross)	–7,887	–9,069	–9,781
3081	Recoveries of prior year unpaid obligations, expired	–84
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	8,195	7,856	6,732

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	12,563	13,504	15,027
	Outlays, gross:
4100	Outlays from new mandatory authority	3,713	4,241	4,445
4101	Outlays from mandatory balances	4,174	4,828	5,336

4110	Outlays, gross (total)	7,887	9,069	9,781
4180	Budget authority, net (total)	12,563	13,504	15,027
4190	Outlays, net (total)	7,887	9,069	9,781

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, and support for child health quality and outreach activities. A contingency fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding for CHIP, providing appropriations through FY 2015.


Identification code 75–0522–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Administration		33	47
0002	Innovation Activities		780	965

0900	Total new obligations		813	1,012

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		5	9,192
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5	10,000
1930	Total budgetary resources available	5	10,005	9,192
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5	9,192	8,180

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			267
3030	Obligations incurred, unexpired accounts		813	1,012
3040	Outlays (gross)		–546	–801
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		267	478

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	5	10,000
	Outlays, gross:
4100	Outlays from new mandatory authority		543
4101	Outlays from mandatory balances		3	801

4110	Outlays, gross (total)		546	801
4180	Budget authority, net (total)	5	10,000
4190	Outlays, net (total)		546	801


Identification code 75–0522–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		9	11
12.1	Civilian personnel benefits		2	3
42.0	Insurance claims and indemnities		769	951
94.0	Financial transfers		33	47

99.9	Total new obligations		813	1,012


Identification code 75–0522–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	4	81	100


Identification code 75–5551–0–2–551		2010 actual	CR	2012 est.

0100	Balance, start of year
	Receipts:
0240	Interest, Child Enrollment Contingency Fund	1	4	16

0400	Total: Balances and collections	1	4	16
	Appropriations:
0500	Child Enrollment Contingency Fund	–1	–4	–16

0799	Balance, end of year


Identification code 75–5551–0–2–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Grants to States and US Territories		100	200

0900	Total new obligations (object class 41.0)		100	200

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2,113	2,114	2,018
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special fund)	1	4	16
1930	Total budgetary resources available	2,114	2,118	2,034
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,114	2,018	1,834

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		100	200
3040	Outlays (gross)		–100	–200

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1	4	16
	Outlays, gross:
4101	Outlays from mandatory balances		100	200
4180	Budget authority, net (total)	1	4	16
4190	Outlays, net (total)		100	200

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	2,114	2,119	2,018
5001	Total investments, EOY: Federal securities: Par value	2,119	2,018	1,834

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 Patient Protection and Affordable Care Act of 2010 extended the contingency fund through FY 2015.

The fund received an initial appropriation equal to 20 percent of the FY 2009 national allotment ($2.1 billion). In fiscal years 2010 through 2015, the statute 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. The contingency fund will be invested in interest bearing securities of the United States, and the income derived from these investments constitutes a part of the fund.


Identification code 75–0520–0–1–571		2010 actual	CR	2012 est.

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	108
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1801	Change in uncollected payments, Federal sources	–108
1930	Total budgetary resources available
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–108
3050	Change in uncollected pymts, Fed sources, unexpired	108

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	–108
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	108

4160	Budget authority, net (mandatory)
4180	Budget authority, net (total)
4190	Outlays, net (total)

The Medicare Advantage (MA) Regional Stabilization Fund was repealed under the Affordable Care Act.


Identification code 75–0508–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0801	Reimbursable program activity (Incentive Payments to Hospitals)		450	1,860
0802	Reimbursable program activity Incentive Payments to Eligible Providers)		190	970

0900	Total new obligations (object class 42.0)		640	2,830

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected		450	1,860
1800	Collected		190	970

1850	Spending auth from offsetting collections, mand (total)		640	2,830
1930	Total budgetary resources available		640	2,830

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		640	2,830
3040	Outlays (gross)		–640	–2,830

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		640	2,830
	Outlays, gross:
4100	Outlays from new mandatory authority		640	2,830
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–640	–2,830

4160	Budget authority, net (mandatory)
4170	Outlays, net (mandatory)
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 75–0112–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	46	56	51

0900	Total new obligations (object class 41.0)	46	56	51

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		204	148
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	250
1930	Total budgetary resources available	250	204	148
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	204	148	97

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		46	31
3030	Obligations incurred, unexpired accounts	46	56	51
3040	Outlays (gross)		–71	–66
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	46	31	16

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	250
	Outlays, gross:
4101	Outlays from mandatory balances		71	66
4180	Budget authority, net (total)	250
4190	Outlays, net (total)		71	66

The Affordable Care Act (P.L. 111–148) amends Section 2794 of the Public Health Service Act and provides that the Secretary shall carry out a program to award grants to States for a five year period beginning in fiscal year 2010. The Grants to States for Health Insurance Premium Review program will allow States to improve the oversight of proposed health insurance premium increases and provide the Secretary with trend information about premium increases in health insurance coverage. The program provides $250,000,000 over the five year period beginning with fiscal year 2010, and States may receive no less than $1,000,000 and no more than $5,000,000 in any one grant year.


Identification code 75–0113–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	222	1,430	1,561
0801	Reimbursable program activity		41	122

0900	Total new obligations	222	1,471	1,683

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		4,778	3,348
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,000
	Spending authority from offsetting collections, mandatory:
1800	Collected		41	122
1900	Budget authority (total)	5,000	41	122
1930	Total budgetary resources available	5,000	4,819	3,470
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4,778	3,348	1,787

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		218	218
3030	Obligations incurred, unexpired accounts	222	1,471	1,683
3040	Outlays (gross)	–4	–1,471	–1,684
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	218	218	217

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	5,000	41	122
	Outlays, gross:
4100	Outlays from new mandatory authority	4	41	122
4101	Outlays from mandatory balances		1,430	1,562

4110	Outlays, gross (total)	4	1,471	1,684
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources		–41	–122

4160	Budget authority, net (mandatory)	5,000
4170	Outlays, net (mandatory)	4	1,430	1,562
4180	Budget authority, net (total)	5,000
4190	Outlays, net (total)	4	1,430	1,562

This account funds the Pre-Existing Condition Insurance Plan Program (PCIP), which makes health insurance available to people who have been unable to get insurance due to a pre-existing condition. Enrollees pay cost-sharing and monthly premiums similar to those charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions. The budget authority for this program, including operating costs, is provided by the Affordable Care Act (P.L. 111–148).


Identification code 75–0113–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		3	3
12.1	Civilian personnel benefits		1	1
25.2	Other services from non-federal sources	222	50	46
25.3	Other goods and services from federal sources		53	53
41.0	Grants, subsidies, and contributions		1,322	1,457

99.0	Direct obligations	222	1,429	1,560
99.0	Reimbursable obligations		41	122
99.5	Below reporting threshold		1	1

99.9	Total new obligations	222	1,471	1,683


Identification code 75–0113–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	1	29	33


Identification code 75–0114–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	36	3,568	1,376
0002	Direct program activity	590

0900	Total new obligations	626	3,568	1,376

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		4,374	1,396
1020	Adjustment of unobligated bal brought forward, Oct 1		590

1050	Unobligated balance (total)		4,964	1,396
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,000
1930	Total budgetary resources available	5,000	4,964	1,396
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4,374	1,396	20

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		625	19
3001	Adjustments to unpaid obligations, brought forward, Oct 1		–590

3020	Obligated balance, start of year (net)		35	19
3030	Obligations incurred, unexpired accounts	626	3,568	1,376
3040	Outlays (gross)	–1	–3,584	–1,386
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	625	19	9

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	5,000
	Outlays, gross:
4100	Outlays from new mandatory authority	1
4101	Outlays from mandatory balances		3,584	1,386

4110	Outlays, gross (total)	1	3,584	1,386
4180	Budget authority, net (total)	5,000
4190	Outlays, net (total)	1	3,584	1,386

The Affordable Care Act (P.L. 111–148) authorized and appropritated $5 billion for the Early Retiree Reinsurance Program (ERRP). ERRP provides reimbursement to participating sponsors of certified plans that provide health benefits to early retirees (ages 55–64), their spouses, and surviving spouses and dependents. Reimbursement is equal to 80 percent of the actual cost of health expenses paid for an individual between a cost threshold of $15,000 and cost limit of $90,000 beginning in 2010. The cost threshold and cost limit will be adjusted for inflation in future years by the consumer price index. Savings to sponsors shall be used to reduce employer health care costs, provide premium and cost sharing relief to workers and families, or both.


Identification code 75–0114–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
25.2	Other services from non-federal sources	36	37	32
42.0	Insurance claims and indemnities	590	3,530	1,342

99.0	Direct obligations	626	3,568	1,375
99.5	Below reporting threshold			1

99.9	Total new obligations	626	3,568	1,376


Identification code 75–0114–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		8	11


Identification code 75–0115–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	49	201	400

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	49	201	400
1930	Total budgetary resources available	49	201	400

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		48
3030	Obligations incurred, unexpired accounts	49	201	400
3040	Outlays (gross)	–1	–249	–400
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	48

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	49	201	400
	Outlays, gross:
4100	Outlays from new mandatory authority	1	201	400
4101	Outlays from mandatory balances		48

4110	Outlays, gross (total)	1	249	400
4180	Budget authority, net (total)	49	201	400
4190	Outlays, net (total)	1	249	400

The American Health Benefit Exchange Program, commonly known as the Health Insurance Exchanges, provides funding for Planning and Establishment Grants to implement State Exchanges. The Exchanges will facilitate the purchase of qualified health plans in the individual market and provide for the establishment of a Small Business Health Options Program to allow small businesses to offer qualified health plans to their employees. Section 1311 of the Affordable Care Act (P.L. 111–148) provides amounts necessary to enable the Secretary to award grants to States beginning no later than March 23, 2011, and funds grants through January 1, 2015, at which time the Exchanges are to be self-sustaining.


Identification code 75–0115–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		6	7
12.1	Civilian personnel benefits		2	2
41.0	Grants, subsidies, and contributions	49	190	388

99.0	Direct obligations	49	198	397
99.5	Below reporting threshold		3	3

99.9	Total new obligations	49	201	400


Identification code 75–0115–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	1	65	70


Identification code 75–0118–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0701	Direct loan subsidy			376
0709	Administrative expenses		10	12

0900	Total new obligations		10	388

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		6,000	5,990
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	6,000
1930	Total budgetary resources available	6,000	6,000	5,990
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	6,000	5,990	5,602

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		10	388
3040	Outlays (gross)		–10	–388

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	6,000
	Outlays, gross:
4101	Outlays from mandatory balances		10	388
4180	Budget authority, net (total)	6,000
4190	Outlays, net (total)		10	388

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


Identification code 75–0118–0–1–551		2010 actual	CR	2012 est.

	Direct loan levels supportable by subsidy budget authority:
115002	Startup Loans			208
115003	Solvency Grants			382
115004	Planning Grants			3

115999	Total direct loan levels			593
	Direct loan subsidy (in percent):
132002	Startup Loans	0.00	0.00	60.00
132003	Solvency Grants	0.00	0.00	65.00
132004	Planning Grants	0.00	0.00	100.00

132999	Weighted average subsidy rate	0.00	0.00	63.42
	Direct loan subsidy budget authority:
133002	Startup Loans			125
133003	Solvency Grants			248
133004	Planning Grants			3

133999	Total subsidy budget authority			376
	Direct loan subsidy outlays:
134002	Startup Loans			125
134003	Solvency Grants			248
134004	Planning Grants			3

134999	Total subsidy outlays			376

	Administrative expense data:
3510	Budget authority		10	12
3580	Outlays from balances		10	12

The Consumer Operated and Oriented Plan (CO-OP) Program was authorized in Section 1322 of the Affordable Care Act (P.L. 111–148). The CO-OP Program fosters the creation of qualified nonprofit health insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group markets in the States. The Secretary shall award to qualified nonprofit issuers loans for start-up costs and grants to enable qualified issuers to meet state solvency requirements. The Secretary may also award grants for the purposes of encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section 1322. $6 billion has been appropriated to carry out Section 1322 of the Affordable Care Act.

As required by the Federal Credit Reform Act of 1990, this account records, for this program, the subsidy costs associated with CO-OP Program grants and loans, as well as administrative expenses of this program. The subsidy amounts are estimated on a present value basis; the administrative expenses are estimated on a cash basis.


Identification code 75–0118–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			1
25.2	Other services from non-federal sources		10	11
41.0	Grants, subsidies, and contributions			376

99.0	Direct obligations		10	388

99.9	Total new obligations		10	388


Identification code 75–0118–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		5	9


Identification code 75–4418–0–3–551		2010 actual	CR	2012 est.

	Obligations by program activity:
	Credit program obligations:
0710	Direct loan obligations			593
0713	Payment of interest to Treasury			4

0900	Total new obligations			597

	Budgetary Resources:
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority			221
	Spending authority from offsetting collections, mandatory:
1800	Collected			376
1900	Financing authority(total)			597
1930	Total budgetary resources available			597

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			597
3040	Financing disbursements (gross)			–597

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross			597
	Financing disbursements:
4110	Financing disbursements, gross			597
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources			–376

4160	Financing authority, net (mandatory)			221
4170	Financing disbursements, net (mandatory)			221
4180	Financing authority, net (total)			221
4190	Financing disbursements, net (total)			221


Identification code 75–4418–0–3–551		2010 actual	CR	2012 est.

	Position with respect to appropriations act limitation on obligations:
1131	Direct loan obligations exempt from limitation			593

1150	Total direct loan obligations			593

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year
1231	Disbursements: Direct loan disbursements			593
1251	Repayments: Repayments and prepayments

1290	Outstanding, end of year			593

As required by the Federal Credit Reform Act of 1990, this non-budgetary account records all cash flows to and from the Government resulting from direct loans obligated in 1992 and beyond (including modifications of direct loans that resulted from obligations in any year). The amounts in this account are a means of financing and are not included in the budget totals.

Trust Funds


Identification code 75–8005–0–7–571		2010 actual	CR	2012 est.

0100	Balance, start of year	285,374	255,722	215,933
	Adjustments:
0191	Adjustment - Treasury reconciliation	19

0199	Balance, start of year	285,393	255,722	215,933
	Receipts:
0200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	165,547	173,902	186,855
0201	FHI Trust Fund, Transfers from General Fund (FICA Taxes) - legislative proposal subject to PAYGO		2	–308
0202	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			1
0203	FHI Trust Fund, Receipts from Railroad Retirement Board	507	480	498
0204	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	14,014	12,819	14,185
0205	FHI Trust Fund, Civil Penalties and Damages	612	329	336
0220	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
0221	FHI Trust Fund, Basic Premium, Medicare Advantage	189	204	204
0222	FHI Trust Fund, Medicare Refunds	4,638	5,550	5,700
0223	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,314	3,352	3,448
0224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible - legislative proposal subject to PAYGO			–6
0240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,292	3,387	3,361
0241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	750	646	626
0242	FHI Trust Fund, Interest Received by Trust Funds	14,576	13,016	11,288
0243	FHI Trust Fund, Interest Received by Trust Funds - legislative proposal not subject to PAYGO			7
0244	FHI Trust Fund, Taxation on OASDI Benefits	13,760	14,874	15,303
0245	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	126	128	130
0246	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,206	217	221
0247	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	22	16	17
0248	FHI Trust Fund, Interest Payments by Railroad Retirement Board	28	25	25
0249	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	60	816	1,066

0299	Total receipts and collections	222,641	229,765	242,959

0400	Total: Balances and collections	508,034	485,487	458,892
	Appropriations:
0500	Federal Hospital Insurance Trust Fund	–2,354	–2,348	–2,737
0501	Federal Hospital Insurance Trust Fund	–218,848	–225,706	–238,681
0502	Federal Hospital Insurance Trust Fund	–30,917	–39,791	–29,432
0503	Federal Hospital Insurance Trust Fund - legislative proposal not subject to PAYGO			–7
0504	Federal Hospital Insurance Trust Fund - legislative proposal not subject to PAYGO			7
0505	Federal Hospital Insurance Trust Fund - legislative proposal subject to PAYGO			6
0506	Federal Hospital Insurance Trust Fund - legislative proposal subject to PAYGO			314
0507	Health Care Fraud and Abuse Control Account	–311	–311	–581
0508	Health Care Fraud and Abuse Control Account	–1,173	–1,398	–1,272
0509	Health Care Fraud and Abuse Control Account - legislative proposal not subject to PAYGO			788

0599	Total appropriations	–253,603	–269,554	–271,595
0610	Federal Hospital Insurance Trust Fund	–4
0611	Health Care Fraud and Abuse Control Account	19
0620	Federal Hospital Insurance Trust Fund	22
0795	Adjustment for outstanding reconciliation	1,254

0799	Balance, end of year	255,722	215,933	187,297


Identification code 75–8005–0–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Benefit payments, HI	250,084	264,285	265,616
0002	HIT Incentive Payments		450	1,860
0003	Administration, HI	2,640	2,798	2,920
0004	Quality improvement organizations, HI	132	312	454

0091	Direct program activities, subtotal	252,856	267,845	270,850
0812	Reimbursable program activity	256

0900	Total new obligations	253,112	267,845	270,850

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	755
1026	Adjustment in unobligated balances for change in allocation	–22
1029	Other balances withdrawn	4

1050	Unobligated balance (total)	737
	Budget authority:
	Appropriations, discretionary:
1102	Appropriation (trust fund)	2,354	2,348	2,737
	Appropriations, mandatory:
1202	Appropriation (trust fund)	218,848	225,706	238,681
1203	Appropriation (previously unavailable)	30,917	39,791	29,432

1260	Appropriations, mandatory (total)	249,765	265,497	268,113
	Spending authority from offsetting collections, mandatory:
1800	Collected	256
1900	Budget authority (total)	252,375	267,845	270,850
1930	Total budgetary resources available	253,112	267,845	270,850
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year
	Special and non-revolving trust funds:
1950	Other balances withdrawn	–4

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	23,763	23,423	23,689
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–1	–1	–1

3020	Obligated balance, start of year (net)	23,762	23,422	23,688
3030	Obligations incurred, unexpired accounts	253,112	267,845	270,850
3040	Outlays (gross)	–252,697	–267,579	–270,669
3080	Recoveries of prior year unpaid obligations, unexpired	–755
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	23,423	23,689	23,870
3091	Uncollected pymts, Fed sources, end of year	–1	–1	–1

3100	Obligated balance, end of year (net)	23,422	23,688	23,869

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,354	2,348	2,737
	Outlays, gross:
4010	Outlays from new discretionary authority	1,498	1,844	2,127
4011	Outlays from discretionary balances	499	462	502

4020	Outlays, gross (total)	1,997	2,306	2,629
	Mandatory:
4090	Budget authority, gross	250,021	265,497	268,113
	Outlays, gross:
4100	Outlays from new mandatory authority	228,347	242,753	243,768
4101	Outlays from mandatory balances	22,353	22,520	24,272

4110	Outlays, gross (total)	250,700	265,273	268,040
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–256

4160	Budget authority, net (mandatory)	249,765	265,497	268,113
4170	Outlays, net (mandatory)	250,444	265,273	268,040
4180	Budget authority, net (total)	252,119	267,845	270,850
4190	Outlays, net (total)	252,441	267,579	270,669

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	309,702	279,475	239,694
5001	Total investments, EOY: Federal securities: Par value	279,475	239,694	209,819


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	252,119	267,845	270,850
	Outlays	252,441	267,579	270,669
Legislative proposal, subject to PAYGO:
	Budget Authority			–320
	Outlays			–320
Total:
	Budget Authority	252,119	267,845	270,530
	Outlays	252,441	267,579	270,349

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


Identification code 75–8005–0–7–571		2010 actual	CR	2012 est.

	Unexpended balance, start of year:
0100	Balance, start of year	309,836	280,119	240,665
	Adjustments:
0190	To TCS	22

0199	Total balance, start of year	309,858	280,119	240,665
	Cash income during the year:
	Current law:
	Receipts:
1200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	165,547	173,902	186,855
1203	FHI Trust Fund, Receipts from Railroad Retirement Board	507	480	498
1204	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	14,014	12,819	14,185
1205	FHI Trust Fund, Civil Penalties and Damages	612	329	336
	Offsetting receipts (proprietary):
1220	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
1221	FHI Trust Fund, Basic Premium, Medicare Advantage	189	204	204
1222	FHI Trust Fund, Medicare Refunds	4,638	5,550	5,700
1223	FHI Trust Fund, Premiums Collected for Uninsured Individuals not	3,314	3,352	3,448
	Offsetting receipts (intragovernmental):
1240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,292	3,387	3,361
1241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	750	646	626
1242	FHI Trust Fund, Interest Received by Trust Funds	14,576	13,016	11,288
1244	FHI Trust Fund, Taxation on OASDI Benefits	13,760	14,874	15,303
1245	FHI Trust Fund, Payment from the General Fund for Health Care Fr	126	128	130
1246	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,206	217	221
1247	FHI Trust Fund, Transfers from General Fund (civil Monetary Pena	22	16	17
1248	FHI Trust Fund, Interest Payments by Railroad Retirement Board	28	25	25
1249	FHI Trust Fund, Payments from the General Fund (uninsured and Pr	60	816	1,066
	Offsetting collections:
1280	Federal Hospital Insurance Trust Fund	256
1299	Income under present law	222,897	229,763	243,265
	Proposed legislation:
	Receipts:
2201	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		2	–308
2202	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			1
	Offsetting receipts (proprietary receipts):
2224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not			–6
	Offsetting receipts (intragovernmental):
2243	FHI Trust Fund, Interest Received by Trust Funds			7
2299	Income under proposed legislation		2	–306

3299	Total cash income	222,897	229,765	242,959
	Cash outgo during year:
	Current law:
4500	Federal Hospital Insurance Trust Fund	–252,697	–267,579	–270,669
4500	Health Care Fraud and Abuse Control Account	–1,193	–1,640	–1,875
4599	Outgo under current law (-)	–253,890	–269,219	–272,544
	Proposed legislation:
5500	Federal Hospital Insurance Trust Fund			320
5500	Health Care Fraud and Abuse Control Account			788
5599	Outgo under proposed legislation (-)			1,108

6599	Total cash outgo (-)	–253,890	–269,219	–271,436
	Manual Adjustments:
7690	Manual Adjustments	1,254

7699	Total adjustments	1,254
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	644	971	2,042
8701	Federal Hospital Insurance Trust Fund	279,475	239,694	209,819
8701	Federal Hospital Insurance Trust Fund			7
8701	Federal Hospital Insurance Trust Fund			320

8799	Total balance, end of year	280,119	240,665	212,188
	Commitments against unexpended balance, end of year:
9899	Total commitments (-)


Identification code 75–8005–0–7–571		2010 actual	CR	2012 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activities	132	312	454
42.0	Insurance claims and indemnities (benefits)	250,084	264,735	267,476
94.0	Financial transfers	2,640	2,798	2,920

99.0	Direct obligations	252,856	267,845	270,850
	Allocation Account - reimbursable:
42.0	Insurance claims and indemnities	256

99.0	Allocation account - reimbursable	256

99.9	Total new obligations	253,112	267,845	270,850


Identification code 75–8005–2–7–571		2010 actual	CR	2012 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)			7
1203	Appropriation (previously unavailable)			–7

1260	Appropriations, mandatory (total)
1930	Total budgetary resources available

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross
4180	Budget authority, net (total)
4190	Outlays, net (total)

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value
5001	Total investments, EOY: Federal securities: Par value			7


Identification code 75–8005–4–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Benefit payments, HI			–320

0900	Total new obligations (object class 42.0)			–320

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)			–6
1203	Appropriation (previously unavailable)			–314

1260	Appropriations, mandatory (total)			–320
1930	Total budgetary resources available			–320

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–320
3040	Outlays (gross)			320

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–320
	Outlays, gross:
4100	Outlays from new mandatory authority			–320
4180	Budget authority, net (total)			–320
4190	Outlays, net (total)			–320

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value
5001	Total investments, EOY: Federal securities: Par value			320

In addition to amounts otherwise available for program integrity and program management, [$561,000,000]$580,580,000, to remain available through September 30, [2012]2013, 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 [$376,167,000]$389,938,260 shall be for 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 , for activities listed in section 1893 of such Act and for Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities; of which [$94,830,000]$97,556,404 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; and of which [$90,003,000]$93,085,336 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 [2011]2012 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. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–8393–0–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Medicare integrity program	756	872	851
0002	FBI fraud and abuse control	133	128	130
0003	Other fraud and abuse control	275	297	291
0004	Predictive Modeling		41	22

0091	Total Mandatory	1,164	1,338	1,294
0101	CMS - Discretionary	199	251	390
0102	Other Discretionary	60	60	191

0191	Total Discretionary	259	311	581

0900	Total new obligations	1,423	1,649	1,875

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10	65	160
1021	Recoveries of prior year unpaid obligations	18	35	25

1050	Unobligated balance (total)	28	100	185
	Budget authority:
	Appropriations, discretionary:
1102	Appropriation (trust fund)	311	311	581
	Appropriations, mandatory:
1202	Appropriation (trust fund)	1,173	1,398	1,272
1900	Budget authority (total)	1,484	1,709	1,853
1930	Total budgetary resources available	1,512	1,809	2,038
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–24
1941	Unexpired unobligated balance, end of year	65	160	163
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	24
1952	Expired unobligated balance, start of year	14	36	36
1953	Expired unobligated balance, end of year	12	36	36
1954	Unobligated balance canceling	19

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	679	873	847
3030	Obligations incurred, unexpired accounts	1,423	1,649	1,875
3031	Obligations incurred, expired accounts	9
3040	Outlays (gross)	–1,193	–1,640	–1,875
3080	Recoveries of prior year unpaid obligations, unexpired	–18	–35	–25
3081	Recoveries of prior year unpaid obligations, expired	–27
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	873	847	822

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	311	311	581
	Outlays, gross:
4010	Outlays from new discretionary authority	37	311	581
4011	Outlays from discretionary balances	142

4020	Outlays, gross (total)	179	311	581
	Mandatory:
4090	Budget authority, gross	1,173	1,398	1,272
	Outlays, gross:
4100	Outlays from new mandatory authority	751	956	884
4101	Outlays from mandatory balances	263	373	410

4110	Outlays, gross (total)	1,014	1,329	1,294
4180	Budget authority, net (total)	1,484	1,709	1,853
4190	Outlays, net (total)	1,193	1,640	1,875


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	1,484	1,709	1,853
	Outlays	1,193	1,640	1,875
Legislative proposal, not subject to PAYGO:
	Budget Authority			–788
	Outlays			–788
Total:
	Budget Authority	1,484	1,709	1,065
	Outlays	1,193	1,640	1,087

P.L. 104–191 established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds, from the Trust Fund to the HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services (HHS), the Department of Justice, and other agencies.

This schedule reflects the estimated distribution of the account for 2012. As required by statute, actual 2012 agency distributions will be determined by the Secretary of HHS and the Attorney General consistent with the Administration's priorities.


	2010 actual	2011 actual	2012 est.

Department of Justice, DOJ	55	62	60
Office of the Inspector General, HHS	177	198	194

Other specific HHS fraud and abuse projects	34	38	37

Total	266	298	291

* Numbers may not add due to rounding.

The Budget includes a discretionary request for efforts to safeguard Medicare, Medicaid, and CHIP that will supplement the mandatory funds made available by P.L. 104–191. The 2012 discretionary investment is a part of a multi-year fraud and abuse proposal in the Budget; similar funding has been enacted for the past three years.

It is important that these cost increases and new enforcement investments be fully funded. The Administration is proposing to fund them as contingent appropriations. To ensure full funding of the new enforcement investments, the Administration proposes to employ a budget enforcement mechanism that allows for an adjustment by the Budget Committees to the section 302(a) allocation to the Appropriations Committees found in the concurrent resolution on the budget. These adjustments would only be permissible if the use of these funds was clearly restricted to the specified purpose. The maximum allowable adjustment to the 302(a) allocation would be $581 million for 2012. See additional discussion in the Budget Process chapter in the Analytical Perspectives volume.

The HCFAC entities will develop a comprehensive plan for Medicare, Medicaid and CHIP program integrity activities. The plan will indicate how program integrity appropriations from all sources will be allocated to address program integrity priorities. These priorities include reducing the improper payment rate, identifying and recouping excessive payments, pinpointing potential weaknesses in program integrity oversight, and establishing new processes and safeguards to correct programmatic vulnerabilities.


Identification code 75–8393–0–7–571		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent (CMS)	11	11	14
12.1	Civilian personnel benefits (CMS)	2	2	2
23.3	Communications, utilities, and miscellaneous charges	2	2	2
25.1	Advisory and assistance services(Predictive Modeling)		41	22
25.2	Other services (CMS)	13	13	14
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)	88	85	154
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)	217	207	291
25.3	Other purchases of goods and services from Government accounts (HHS/AoA)	4	4	13
25.3	Other purchases of goods and services from Government accounts (HHS/OGC)	9	9	9
25.3	Other goods and services from federal sources (Other HHS)	3
25.3	Other goods and services from Government accounts (HHS/FDA)		2	2
25.3	Other goods and services from Government accounts (HHS/ASPA)		1	1
25.3	Other goods and services from Government accounts (HHS/ASPE)		1	1
25.6	Medical care (CMS)	941	1,143	1,220
94.0	Financial transfers (FBI)	133	128	130

99.9	Total new obligations	1,423	1,649	1,875


Identification code 75–8393–0–7–571		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	106	150	175


Identification code 75–8393–2–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Medicare integrity program			–788

0900	Total new obligations (object class 25.6)			–788

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)			–788
1930	Total budgetary resources available			–788

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–788
3040	Outlays (gross)			788

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross			–788
	Outlays, gross:
4100	Outlays from new mandatory authority			–788
4180	Budget authority, net (total)			–788
4190	Outlays, net (total)			–788


Identification code 75–8004–0–7–571		2010 actual	CR	2012 est.

0100	Balance, start of year	34,241	45,630	38,055
	Adjustments:
0191	Adjustment - Treasury reconciliation	28

0199	Balance, start of year	34,269	45,630	38,055
	Receipts:
0200	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI		2,250	2,770
0220	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
0221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,363	2,896	3,539
0222	Premiums Collected for Medicare Prescription Drug Account, FSMI - legislative proposal subject to PAYGO			–32
0223	Payments from States, Medicare Prescription Drug Account, FSMI	4,493	6,825	8,315
0224	Payments from States, Medicare Prescription Drug Account, FSMI - legislative proposal subject to PAYGO			–74
0225	Basic Premium, Medicare Advantage, FSMI Trust Fund	168	200	210
0226	Medicare Refunds, SMI	4,063	4,150	4,300
0227	Premiums Collected for the Aged, FSMI Fund	45,832	47,299	51,409
0228	Premiums Collected for the Aged, FSMI Fund - legislative proposal subject to PAYGO			–18
0229	Premiums Collected for the Disabled, FSMI Fund	8,948	8,979	9,940
0230	Premiums Collected for the Disabled, FSMI Fund - legislative proposal subject to PAYGO			–4
0240	Federal Contributions, FSMI Fund	161,110	165,338	178,041
0241	Federal Contributions, FSMI Fund - legislative proposal not subject to PAYGO			–32
0242	Interest Received by Trust Fund, FSMI Fund	2,989	3,277	3,683
0243	Interest Received by Trust Fund, FSMI Fund - legislative proposal not subject to PAYGO		–66	–410
0244	Interest, Medicare Prescription Drug Account, FSMI	9	7	11
0245	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	258	404	475
0246	Federal Contributions for Benefits, Prescription Drug Account, SMI	52,341	55,548	51,431
0247	Federal Contributions for Benefits, Prescription Drug Account, SMI - legislative proposal not subject to PAYGO			–385
0248	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1

0299	Total receipts and collections	282,576	297,111	313,173

0400	Total: Balances and collections	316,845	342,741	351,228
	Appropriations:
0500	Federal Supplementary Medical Insurance Trust Fund	–3,099	–2,890	–3,530
0501	Federal Supplementary Medical Insurance Trust Fund	–221,586	–227,820	–247,553
0502	Federal Supplementary Medical Insurance Trust Fund		–7,509
0503	Federal Supplementary Medical Insurance Trust Fund	11,248		24,374
0504	Federal Supplementary Medical Insurance Trust Fund - legislative proposal not subject to PAYGO		442	1,254
0505	Federal Supplementary Medical Insurance Trust Fund - legislative proposal not subject to PAYGO		–442	–1,749
0506	Federal Supplementary Medical Insurance Trust Fund - legislative proposal subject to PAYGO			22
0507	Federal Supplementary Medical Insurance Trust Fund - legislative proposal subject to PAYGO			–18,272
0508	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–482	–385	–476
0509	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–57,491	–66,082	–62,569
0510	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund - legislative proposal subject to PAYGO			489

0599	Total appropriations	–271,410	–304,686	–308,010
0610	Federal Supplementary Medical Insurance Trust Fund	–7
0611	Transitional Drug Assistance, Federal Supplementary Medical Insurance Trust Fund	30
0612	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	58
0620	Federal Supplementary Medical Insurance Trust Fund	73
0795	Adjustment for outstanding reconciliation	41

0799	Balance, end of year	45,630	38,055	43,218


Identification code 75–8004–0–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Benefit payments, SMI	209,761	234,229	221,873
0002	Transfer to Medicaid for payment of SMI premiums	515	630	165
0003	HIT Incentive Payments		190	970
0004	Administration, SMI	3,222	3,092	3,588
0005	Quality Improvement Organizations, SMI	32	78	113

0091	Direct program activities, subtotal	213,530	238,219	226,709
0801	Reimbursable program activity	23

0900	Total new obligations	213,553	238,219	226,709

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1
1021	Recoveries of prior year unpaid obligations	159
1026	Adjustment in unobligated balances for change in allocation	–73
1029	Other balances withdrawn	7

1050	Unobligated balance (total)	93
	Budget authority:
	Appropriations, discretionary:
1102	Appropriation (trust fund)	3,099	2,890	3,530
	Appropriations, mandatory:
1202	Appropriation (trust fund)	221,586	227,820	247,553
1203	Appropriation (previously unavailable)		7,509
1235	Appropriations precluded from obligation	–11,248		–24,374

1260	Appropriations, mandatory (total)	210,338	235,329	223,179
	Spending authority from offsetting collections, mandatory:
1800	Collected	23
1900	Budget authority (total)	213,460	238,219	226,709
1930	Total budgetary resources available	213,553	238,219	226,709
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year
	Special and non-revolving trust funds:
1950	Other balances withdrawn	–7

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	21,256	22,184	22,223
3030	Obligations incurred, unexpired accounts	213,553	238,219	226,709
3040	Outlays (gross)	–212,466	–238,180	–226,515
3080	Recoveries of prior year unpaid obligations, unexpired	–159
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	22,184	22,223	22,417

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,099	2,890	3,530
	Outlays, gross:
4010	Outlays from new discretionary authority	1,752	2,162	2,555
4011	Outlays from discretionary balances	975	754	766

4020	Outlays, gross (total)	2,727	2,916	3,321
	Mandatory:
4090	Budget authority, gross	210,361	235,329	223,179
	Outlays, gross:
4100	Outlays from new mandatory authority	190,305	214,571	201,076
4101	Outlays from mandatory balances	19,434	20,693	22,118

4110	Outlays, gross (total)	209,739	235,264	223,194
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–23

4160	Budget authority, net (mandatory)	210,338	235,329	223,179
4170	Outlays, net (mandatory)	209,716	235,264	223,194
4180	Budget authority, net (total)	213,437	238,219	226,709
4190	Outlays, net (total)	212,443	238,180	226,515

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	61,764	70,982	63,581
5001	Total investments, EOY: Federal securities: Par value	70,982	63,581	69,306


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	213,437	238,219	226,709
	Outlays	212,443	238,180	226,515
Legislative proposal, not subject to PAYGO:
	Budget Authority			495
	Outlays			495
Legislative proposal, subject to PAYGO:
	Budget Authority			18,250
	Outlays			18,250
Total:
	Budget Authority	213,437	238,219	245,454
	Outlays	212,443	238,180	245,260

The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician and certain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees. SMI costs are generally financed by premium payments from enrollees and contributions from the general revenues.


Identification code 75–8004–0–7–571		2010 actual	CR	2012 est.

	Unexpended balance, start of year:
0100	Balance, start of year	61,407	71,977	64,512

0199	Total balance, start of year	61,407	71,977	64,512
	Cash income during the year:
	Current law:
	Receipts:
1200	Fee on Branded Prescription Pharmaceutical Manufacturers and Imp		2,250	2,770
	Offsetting receipts (proprietary):
1220	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
1221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,363	2,896	3,539
1223	Payments from States, Medicare Prescription Drug Account, FSMI	4,493	6,825	8,315
1225	Basic Premium, Medicare Advantage, FSMI Trust Fund	168	200	210
1226	Medicare Refunds, SMI	4,063	4,150	4,300
1227	Premiums Collected for the Aged, FSMI Fund	45,832	47,299	51,409
1229	Premiums Collected for the Disabled, FSMI Fund	8,948	8,979	9,940
	Offsetting receipts (intragovernmental):
1240	Federal Contributions, FSMI Fund	161,110	165,338	178,041
1242	Interest Received by Trust Fund, FSMI Fund	2,989	3,277	3,683
1244	Interest, Medicare Prescription Drug Account, FSMI	9	7	11
1245	Federal Contribution for Admin. Contribution for Admin. Costs, P	258	404	475
1246	Federal Contributions for Benefits, Prescription Drug Account, S	52,341	55,548	51,431
1248	Miscellaneous Federal Payments, Federal Supplementary Medical in	1	1	1
	Offsetting collections:
1280	Federal Supplementary Medical Insurance Trust Fund	23
1281	Medicare Prescription Drug Account, Federal Supplementary Insura	468
1299	Income under present law	283,067	297,177	314,128
	Proposed legislation:
	Offsetting receipts (proprietary receipts):
2222	Premiums Collected for Medicare Prescription Drug Account, FSMI			–32
2224	Payments from States, Medicare Prescription Drug Account, FSMI			–74
2228	Premiums Collected for the Aged, FSMI Fund			–18
2230	Premiums Collected for the Disabled, FSMI Fund			–4
	Offsetting receipts (intragovernmental):
2241	Federal Contributions, FSMI Fund			–32
2243	Interest Received by Trust Fund, FSMI Fund		–66	–410
2247	Federal Contributions for Benefits, Prescription Drug Account, S			–385
2299	Income under proposed legislation		–66	–955

3299	Total cash income	283,067	297,111	313,173
	Cash outgo during year:
	Current law:
4500	Federal Supplementary Medical Insurance Trust Fund	–212,466	–238,180	–226,515
4500	Medicare Prescription Drug Account, Federal Supplementary Insura	–60,031	–66,396	–63,038
4599	Outgo under current law (-)	–272,497	–304,576	–289,553
	Proposed legislation:
5500	Federal Supplementary Medical Insurance Trust Fund			–495
5500	Federal Supplementary Medical Insurance Trust Fund			–18,250
5500	Medicare Prescription Drug Account, Federal Supplementary Insura			489
5599	Outgo under proposed legislation (-)			–18,256

6599	Total cash outgo (-)	–272,497	–304,576	–307,809

7699	Total adjustments
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	995	931	19,315
8701	Federal Supplementary Medical Insurance Trust Fund	70,982	63,581	69,306
8701	Federal Supplementary Medical Insurance Trust Fund			–495
8701	Federal Supplementary Medical Insurance Trust Fund			–18,250

8799	Total balance, end of year	71,977	64,512	69,876
	Commitments against unexpended balance, end of year:
9899	Total commitments (-)


Identification code 75–8004–0–7–571		2010 actual	CR	2012 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activity	32	78	113
42.0	Insurance claims and indemnities	210,276	235,049	223,008
94.0	Financial transfers	3,222	3,092	3,588

99.0	Direct obligations	213,530	238,219	226,709
	Allocation Account - reimbursable:
42.0	Insurance claims and indemnities	23

99.0	Allocation account - reimbursable	23

99.9	Total new obligations	213,553	238,219	226,709


Identification code 75–8004–2–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0002	Transfer to Medicaid for payment of SMI premiums			495

0900	Total new obligations (object class 42.0)			495

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)		–442	–1,254
1235	Appropriations precluded from obligation		442	1,749

1260	Appropriations, mandatory (total)			495
1930	Total budgetary resources available			495

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			495
3040	Outlays (gross)			–495

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			495
	Outlays, gross:
4100	Outlays from new mandatory authority			495
4180	Budget authority, net (total)			495
4190	Outlays, net (total)			495

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value
5001	Total investments, EOY: Federal securities: Par value			–495


Identification code 75–8004–4–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Benefit payments, SMI			18,250

0900	Total new obligations (object class 42.0)			18,250

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)			–22
1235	Appropriations precluded from obligation			18,272

1260	Appropriations, mandatory (total)			18,250
1930	Total budgetary resources available			18,250

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			18,250
3040	Outlays (gross)			–18,250

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			18,250
	Outlays, gross:
4100	Outlays from new mandatory authority			18,250
4180	Budget authority, net (total)			18,250
4190	Outlays, net (total)			18,250

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value
5001	Total investments, EOY: Federal securities: Par value			–18,250


Identification code 75–8307–0–7–571		2010 actual	CR	2012 est.

	Memorandum (non-add) entries:
	Special and non-revolving trust funds:
1954	Unobligated balance canceling	30

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	30
3081	Recoveries of prior year unpaid obligations, expired	–30
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)
4180	Budget authority, net (total)
4190	Outlays, net (total)


Identification code 75–8308–0–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	57,531	65,992	62,564
0002	Administrative Costs	264	475	481

0091	Direct program activities, subtotal	57,795	66,467	63,045
0801	Reimbursable program (Prescription Drug Benefits)	468

0900	Total new obligations	58,263	66,467	63,045

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1
1021	Recoveries of prior year unpaid obligations	42

1050	Unobligated balance (total)	42
	Budget authority:
	Appropriations, discretionary:
1102	Appropriation (trust fund)	482	385	476
	Appropriations, mandatory:
1202	Appropriation (trust fund)	57,491	66,082	62,569
	Spending authority from offsetting collections, mandatory:
1800	Collected	468
1900	Budget authority (total)	58,441	66,467	63,045
1930	Total budgetary resources available	58,483	66,467	63,045
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–220
1941	Unexpired unobligated balance, end of year
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	220
1952	Expired unobligated balance, start of year	342	536	536
1953	Expired unobligated balance, end of year	316	536	536
1954	Unobligated balance canceling	58

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	5,508	3,626	3,697
3030	Obligations incurred, unexpired accounts	58,263	66,467	63,045
3031	Obligations incurred, expired accounts	110
3040	Outlays (gross)	–60,031	–66,396	–63,038
3080	Recoveries of prior year unpaid obligations, unexpired	–42
3081	Recoveries of prior year unpaid obligations, expired	–182
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	3,626	3,697	3,704

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	482	385	476
	Outlays, gross:
4010	Outlays from new discretionary authority	240	307	375
4011	Outlays from discretionary balances	16	81	81

4020	Outlays, gross (total)	256	388	456
	Mandatory:
4090	Budget authority, gross	57,959	66,082	62,569
	Outlays, gross:
4100	Outlays from new mandatory authority	57,959	62,545	59,069
4101	Outlays from mandatory balances	1,816	3,463	3,513

4110	Outlays, gross (total)	59,775	66,008	62,582
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–468
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts

4160	Budget authority, net (mandatory)	57,491	66,082	62,569
4170	Outlays, net (mandatory)	59,307	66,008	62,582
4180	Budget authority, net (total)	57,973	66,467	63,045
4190	Outlays, net (total)	59,563	66,396	63,038


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	57,973	66,467	63,045
	Outlays	59,563	66,396	63,038
Legislative proposal, subject to PAYGO:
	Budget Authority			–489
	Outlays			–489
Total:
	Budget Authority	57,973	66,467	62,556
	Outlays	59,563	66,396	62,549

Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug benefit.


Identification code 75–8308–0–7–571		2010 actual	CR	2012 est.

	Direct obligations:
25.2	Other services from non-federal sources	264	475	481
42.0	Insurance claims and indemnities	57,531	65,992	62,564

99.0	Direct obligations	57,795	66,467	63,045
	Allocation Account - reimbursable:
42.0	Insurance claims and indemnities	468

99.0	Allocation account - reimbursable	468

99.9	Total new obligations	58,263	66,467	63,045


Identification code 75–8308–4–7–571		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Prescription Drug Benefits			–489

0900	Total new obligations (object class 42.0)			–489

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)			–489
1930	Total budgetary resources available			–489

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–489
3040	Outlays (gross)			489

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–489
	Outlays, gross:
4100	Outlays from new mandatory authority			–489
4180	Budget authority, net (total)			–489
4190	Outlays, net (total)			–489

Note.—Obligations incurred under allocations from other accounts are included in the schedule of the parent appropriation as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."

Federal Funds


Identification code 75–1552–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	State family assistance grant	16,487	16,487	16,485
0002	Territories - family assistance grants	78	78	78
0004	Supplemental Grants 2011		211
0005	ARRA - Supplemental grants for population increases	319
0006	Tribal work programs	8	8	8
0009	Healthy marriage and responsible fatherhood grants	149	150	150

0900	Total new obligations	17,041	16,934	16,721

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	17,059	16,951	16,740
1930	Total budgetary resources available	17,059	16,951	16,740
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–18	–17	–19

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	5,250	4,777	4,685
3030	Obligations incurred, unexpired accounts	17,041	16,934	16,721
3040	Outlays (gross)	–17,513	–17,026	–16,863
3081	Recoveries of prior year unpaid obligations, expired	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	4,777	4,685	4,543

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	17,059	16,951	16,740
	Outlays, gross:
4100	Outlays from new mandatory authority	13,679	13,376	13,378
4101	Outlays from mandatory balances	3,834	3,650	3,485

4110	Outlays, gross (total)	17,513	17,026	16,863
4180	Budget authority, net (total)	17,059	16,951	16,740
4190	Outlays, net (total)	17,513	17,026	16,863


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	17,059	16,951	16,740
	Outlays	17,513	17,026	16,863
Legislative proposal, subject to PAYGO:
	Budget Authority		108	319
	Outlays		22	342
Total:
	Budget Authority	17,059	17,059	17,059
	Outlays	17,513	17,048	17,205

This account provides funding for activities authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171) and the Claims Resolution Act of 2010 (P.L. 111–291), including the Temporary Assistance for Needy Families block grant.


Identification code 75–1552–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	21	21	21
25.3	Other goods and services from federal sources	3	3	3
41.0	Grants, subsidies, and contributions	17,012	16,905	16,692

99.9	Total new obligations	17,041	16,934	16,721


Identification code 75–1552–0–1–609		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	21	24	24


Identification code 75–1552–4–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0004	Supplemental Grants 2011		108	319

0900	Total new obligations (object class 41.0)		108	319

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		108	319
1930	Total budgetary resources available		108	319

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			86
3030	Obligations incurred, unexpired accounts		108	319
3040	Outlays (gross)		–22	–342
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		86	63

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		108	319
	Outlays, gross:
4100	Outlays from new mandatory authority		22	256
4101	Outlays from mandatory balances			86

4110	Outlays, gross (total)		22	342
4180	Budget authority, net (total)		108	319
4190	Outlays, net (total)		22	342


Identification code 75–1522–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Contingency fund	212	334	612
0002	ARRA- Emergency Contingency Fund for State TANF Programs	4,383

0900	Total new obligations (object class 41.0)	4,595	334	612

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,596	1	1
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		506	612
1231	Appropriations permanently reduced		–172

1260	Appropriations, mandatory (total)		334	612
1930	Total budgetary resources available	4,596	335	613
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	765	2,453	358
3030	Obligations incurred, unexpired accounts	4,595	334	612
3040	Outlays (gross)	–2,907	–2,429	–844
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2,453	358	126

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		334	612
	Outlays, gross:
4100	Outlays from new mandatory authority		322	600
4101	Outlays from mandatory balances	2,907	2,107	244

4110	Outlays, gross (total)	2,907	2,429	844
4180	Budget authority, net (total)		334	612
4190	Outlays, net (total)	2,907	2,429	844

This account provides funding for the TANF Contingency Fund authorized by section 403(b) of the Social Security Act that currently provides money to qualifying States (but not Territories or Tribes) during an economic downturn.

For making payments to States or other non-Federal entities under titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, [$2,482,814,000]$2,305,035,000, to remain available until expended; and for such purposes for the first quarter of fiscal year [2012]2013, [$1,200,000,000]$1,100,000,000, to remain available until expended.

For making payments to each State for carrying out the program of Aid to Families with Dependent Children under title IV-A of the Social Security Act before the effective date of the program of Temporary Assistance for Needy Families with respect to such State, such sums as may be necessary: Provided, That the sum of the amounts available to a State with respect to expenditures under such title IV-A in fiscal year 1997 under this appropriation and under such title IV-A as amended by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 shall not exceed the limitations under section 116(b) of such Act.

For making, after May 31 of the current fiscal year, payments to States or other non-Federal entities under titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1501–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	State child support administrative costs	4,480	3,908	3,142
0002	Child support incentive payments	504	513	519
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,994	4,431	3,671
0102	Payments to territories	33	33	33
0103	Repatriation	8	1	1

0191	Subtotal, other payments	41	34	34

0799	Total direct obligations	5,035	4,465	3,705
0801	Offset obligations (CSE grants to States)	9	10	11

0900	Total new obligations	5,044	4,475	3,716

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	369	400	200
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3,666	2,965	2,305
	Advance appropriations, mandatory:
1270	Advance appropriation	1,000	1,100	1,200
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	10	11
1900	Budget authority (total)	4,675	4,075	3,516
1930	Total budgetary resources available	5,044	4,475	3,716
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	887	1,130	1,576
3030	Obligations incurred, unexpired accounts	5,044	4,475	3,716
3040	Outlays (gross)	–4,432	–3,629	–3,547
3080	Recoveries of prior year unpaid obligations, unexpired	–369	–400	–200
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,130	1,576	1,545

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,675	4,075	3,516
	Outlays, gross:
4100	Outlays from new mandatory authority	3,737	3,088	2,769
4101	Outlays from mandatory balances	695	541	778

4110	Outlays, gross (total)	4,432	3,629	3,547
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–9	–10	–11

4160	Budget authority, net (mandatory)	4,666	4,065	3,505
4170	Outlays, net (mandatory)	4,423	3,619	3,536
4180	Budget authority, net (total)	4,666	4,065	3,505
4190	Outlays, net (total)	4,423	3,619	3,536


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	4,666	4,065	3,505
	Outlays	4,423	3,619	3,536
Legislative proposal, subject to PAYGO:
	Budget Authority			305
	Outlays			244
Total:
	Budget Authority	4,666	4,065	3,810
	Outlays	4,423	3,619	3,780

This account provides for payments to States for child support enforcement and other family support programs, including access and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt account.


Identification code 75–1501–0–1–609		2010 actual	CR	2012 est.

41.0	Direct obligations: Grants, subsidies, and contributions	5,035	4,465	3,705

99.0	Reimbursable obligations: reimbursable obligations	9	10	11

99.9	Total new obligations	5,044	4,475	3,716


Identification code 75–1501–4–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	State child support administrative costs			5
0002	Child support incentive payments			300

0900	Total new obligations (object class 41.0)			305

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			305
1900	Budget authority (total)			305
1930	Total budgetary resources available			305

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts			305
3040	Outlays (gross)			–244
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			61

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			305
	Outlays, gross:
4100	Outlays from new mandatory authority			244
4180	Budget authority, net (total)			305
4190	Outlays, net (total)			244

For making payments under subsections (b), (d), and (e) of section 2602 of the Low Income Home Energy Assistance Act of 1981, [$3,300,000,000]$2,569,551,000, of which [$2,510,000,000]$1,980,000,000 shall be for payments under subsections (b) and (d) of such section; and of which [$790,000,000]$589,551,000, to remain available until expended, shall be for payments under subsection (e) of such section, to be made notwithstanding the designation requirements of such subsection: Provided, That [notwithstanding section 2605(b)(2)(B)(ii) of such Act, a State may use any amount of an allotment from prior appropriations Acts that is available to that State for providing assistance in fiscal year 2011, and any allotment from funds appropriated in this Act or any other appropriations Act for fiscal year 2011, to provide assistance to households whose income does not exceed 75 percent of the State median income]notwithstanding section 2609(A)(a), of the amounts appropriated under section 2602(b), not more than $3,000,000 of such amounts may be reserved by the Secretary of Health and Human Services for technical assistance, training, and monitoring of program activities for compliance with internal controls, policies and procedures. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1502–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	LIHEAP	5,100	5,100	2,570

0900	Total new obligations (object class 41.0)	5,100	5,100	2,570

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,100	5,100	2,570
1120	Appropriations transferred to other accounts	–1

1160	Appropriation, discretionary (total)	5,099	5,100	2,570
1930	Total budgetary resources available	5,100	5,100	2,570
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,214	1,714	1,680
3030	Obligations incurred, unexpired accounts	5,100	5,100	2,570
3040	Outlays (gross)	–4,598	–5,134	–3,257
3081	Recoveries of prior year unpaid obligations, expired	–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,714	1,680	993

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	5,099	5,100	2,570
	Outlays, gross:
4010	Outlays from new discretionary authority	3,527	3,588	1,817
4011	Outlays from discretionary balances	1,071	1,546	1,440

4020	Outlays, gross (total)	4,598	5,134	3,257
4180	Budget authority, net (total)	5,099	5,100	2,570
4190	Outlays, net (total)	4,598	5,134	3,257

This program makes grants to States and Indian Tribes to aid low-income households with high energy costs through payments to eligible households, energy suppliers, and weatherization providers. Obligation estimates for the contingency fund are based on average historical obligation rates.

For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality Act and section 501 of the Refugee Education Assistance Act of 1980, for carrying out section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000, for costs associated with the care and placement of unaccompanied alien children, and for carrying out the Torture Victims Relief Act of 1998, [$877,602,000]$824,694,000, of which up to $9,814,000 shall be available to carry out the Trafficking Victims Protection Act of 2000: Provided, That funds appropriated under this heading pursuant to section 414(a) of the Immigration and Nationality Act, section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000 for fiscal year [2011]2012 shall be available for the costs of assistance provided and other activities to remain available through September 30, [2013]2014[:]. [Provided further, That of the amounts provided herein, $25,000,000 shall be available until expended for the costs of furnishing transitional and medical services under title IV of the Immigration and Nationality Act.] Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1503–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Refugee and entrant assistance	563	609	637
0002	Assistance for treatment of torture victims	11	11	11
0003	Unaccompanied alien children	163	188	177

0900	Total new obligations	737	808	825

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	84	77
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	731	731	825
1930	Total budgetary resources available	815	808	825
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	77

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	591	575	743
3030	Obligations incurred, unexpired accounts	737	808	825
3040	Outlays (gross)	–749	–640	–867
3081	Recoveries of prior year unpaid obligations, expired	–4
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	575	743	701

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	731	731	825
	Outlays, gross:
4010	Outlays from new discretionary authority	295	292	330
4011	Outlays from discretionary balances	454	348	537

4020	Outlays, gross (total)	749	640	867
4180	Budget authority, net (total)	731	731	825
4190	Outlays, net (total)	749	640	867

This program provides funds to States and non-governmental organizations for administering the refugee and entrant assistance program. Funds also are provided to assist in the rehabilitation of victims of torture, trafficking victims, and the care and placement of unaccompanied alien children.


Identification code 75–1503–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	4	4	4
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
21.0	Travel and transportation of persons	1
23.1	Rental payments to GSA	2	2	2
25.1	Advisory and assistance services	29	31	31
25.3	Other goods and services from federal sources	14	15	15
41.0	Grants, subsidies, and contributions	685	754	771

99.9	Total new obligations	737	808	825


Identification code 75–1503–0–1–609		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	33	32	32
1101	Direct military average strength employment	1	1	1

For carrying out section 436 of the Social Security Act, [$345,000,000]$365,000,000, and, in addition, for carrying out section 437 of such Act, $63,311,000. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1512–0–1–506		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Grants to States and Tribes	408	408	388
0002	Research, training and technical assistance	8	8	8
0003	State court improvement activities	12	12	32
0004	Family Connection Grants	15	15	15
0005	PREP	56	93	75
0006	Abstinence Education	35	50	50

0900	Total new obligations	534	586	568

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		18
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	63	63	63
	Appropriations, mandatory:
1200	Appropriation	505	505	505
1900	Budget authority (total)	568	568	568
1930	Total budgetary resources available	568	586	568
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–16
1941	Unexpired unobligated balance, end of year	18

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	428	552	598
3030	Obligations incurred, unexpired accounts	534	586	568
3040	Outlays (gross)	–406	–540	–558
3081	Recoveries of prior year unpaid obligations, expired	–4
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	552	598	608

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	63	63	63
	Outlays, gross:
4010	Outlays from new discretionary authority	19	19	19
4011	Outlays from discretionary balances	36	43	45

4020	Outlays, gross (total)	55	62	64
	Mandatory:
4090	Budget authority, gross	505	505	505
	Outlays, gross:
4100	Outlays from new mandatory authority	106	135	135
4101	Outlays from mandatory balances	245	343	359

4110	Outlays, gross (total)	351	478	494
4180	Budget authority, net (total)	568	568	568
4190	Outlays, net (total)	406	540	558

This program provides funds for a broad range of child welfare services, including family preservation and family support services. Additionally, this account includes funding for the Personal Responsibility Education Program (PREP) and Abstinence Education which were made available by the Patient Protection and Affordable Care Act (P.L. 111–148).


Identification code 75–1512–0–1–506		2010 actual	CR	2012 est.

	Direct obligations:
25.1	Advisory and assistance services	11	12	12
25.3	Other goods and services from federal sources	2	2	2
41.0	Grants, subsidies, and contributions	521	572	554

99.0	Direct obligations	534	586	568

99.9	Total new obligations	534	586	568


Identification code 75–1512–0–1–506		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	3	6	6


Identification code 75–1550–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Mandatory child care	1,178	1,178	1,178
0002	Matching child care	1,703	1,674	1,674
0003	Training and technical assistance	7	7	7
0004	Child care tribal grants	58	58	58

0900	Total new obligations	2,946	2,917	2,917

	Budgetary Resources:
	Unobligated balance:
1012	Expired unobligated bal transferred to unexpired accts	29
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,917	2,917	2,917
1900	Budget authority (total)	2,917	2,917	2,917
1930	Total budgetary resources available	2,946	2,917	2,917
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	615	806	982
3030	Obligations incurred, unexpired accounts	2,946	2,917	2,917
3040	Outlays (gross)	–2,723	–2,741	–3,096
3081	Recoveries of prior year unpaid obligations, expired	–32
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	806	982	803

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross	2,917	2,917	2,917
	Outlays, gross:
4100	Outlays from new mandatory authority	2,235	2,258	2,258
4101	Outlays from mandatory balances	488	483	838

4110	Outlays, gross (total)	2,723	2,741	3,096
4180	Budget authority, net (total)	2,917	2,917	2,917
4190	Outlays, net (total)	2,723	2,741	3,096


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	2,917	2,917	2,917
	Outlays	2,723	2,741	3,096
Legislative proposal, subject to PAYGO:
	Budget Authority			500
	Outlays			381
Total:
	Budget Authority	2,917	2,917	3,417
	Outlays	2,723	2,741	3,477

This account provides child care subsidies for low-income working families and was established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171) and the Claims Resolution Act of 2010 (P.L. 111–291).


Identification code 75–1550–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
25.1	Advisory and assistance services	1	1	1
25.2	Other services from non-federal sources	6	6	6
41.0	Grants, subsidies, and contributions	2,939	2,910	2,910

99.9	Total new obligations	2,946	2,917	2,917


Identification code 75–1550–4–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0002	Matching child care			480
0003	Training and technical assistance			10
0004	Child care tribal grants			10

0900	Total new obligations			500

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			500
1900	Budget authority (total)			500
1930	Total budgetary resources available			500

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts			500
3040	Outlays (gross)			–381
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			119

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross			500
	Outlays, gross:
4100	Outlays from new mandatory authority			381
4180	Budget authority, net (total)			500
4190	Outlays, net (total)			381


Identification code 75–1550–4–1–609		2010 actual	CR	2012 est.

	Direct obligations:
25.1	Advisory and assistance services			9
25.2	Other services from non-federal sources			1
41.0	Grants, subsidies, and contributions			490

99.9	Total new obligations			500

For carrying out the Child Care and Development Block Grant Act of 1990, [$2,927,081,000]$2,926,757,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That [$26,090,899]$25,712,061 shall be available for child care resource and referral and school-aged child care activities, of which $1,000,000 shall be for the Child Care Aware toll-free hotline: Provided further, That, in addition to the amounts required to be reserved by the States under section 658G, [$373,475,533]$373,434,193 shall be reserved by the States for activities authorized under section 658G, of which [$136,968,964]$136,953,802 shall be for activities that improve the quality of infant and toddler care: Provided further, That $9,910,000 shall be for use by the Secretary of Health and Human Services for child care research, demonstration, and evaluation activities. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1515–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Block grant payments to States	2,117	2,117	2,917
0004	Research and evaluation fund	10	10	10
0005	Block grant payments to States, Recovery Act	10

0900	Total new obligations	2,137	2,127	2,927

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,127	2,127	2,927
1930	Total budgetary resources available	2,137	2,127	2,927
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,242	1,240	663
3030	Obligations incurred, unexpired accounts	2,137	2,127	2,927
3040	Outlays (gross)	–3,136	–2,704	–2,822
3081	Recoveries of prior year unpaid obligations, expired	–3
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,240	663	768

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,127	2,127	2,927
	Outlays, gross:
4010	Outlays from new discretionary authority	1,614	1,670	2,257
4011	Outlays from discretionary balances	1,522	1,034	565

4020	Outlays, gross (total)	3,136	2,704	2,822
4180	Budget authority, net (total)	2,127	2,127	2,927
4190	Outlays, net (total)	3,136	2,704	2,822

This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality.


Identification code 75–1515–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			1
25.1	Advisory and assistance services	10	11	12
25.3	Other goods and services from federal sources	1	1	1
41.0	Grants, subsidies, and contributions	2,126	2,115	2,912

99.0	Direct obligations	2,137	2,127	2,926
99.5	Below reporting threshold			1

99.9	Total new obligations	2,137	2,127	2,927


Identification code 75–1515–0–1–609		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment			10

For making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph for a State to carry out State programs pursuant to title XX of such Act shall be 10 percent. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1534–0–1–506		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,700	1,700	1,700
0002	Healthcare Workforce Demonstration Projects	84	85	85

0900	Total new obligations	1,784	1,785	1,785

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		29	29
1021	Recoveries of prior year unpaid obligations	29

1050	Unobligated balance (total)	29	29	29
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,785	1,785	1,785
1930	Total budgetary resources available	1,814	1,814	1,814
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	29	29	29

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	891	611	385
3030	Obligations incurred, unexpired accounts	1,784	1,785	1,785
3040	Outlays (gross)	–2,035	–2,011	–1,802
3080	Recoveries of prior year unpaid obligations, unexpired	–29
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	611	385	368

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,785	1,785	1,785
	Outlays, gross:
4100	Outlays from new mandatory authority	1,432	1,483	1,483
4101	Outlays from mandatory balances	603	528	319

4110	Outlays, gross (total)	2,035	2,011	1,802
4180	Budget authority, net (total)	1,785	1,785	1,785
4190	Outlays, net (total)	2,035	2,011	1,802


Identification code 75–1534–0–1–506		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
25.1	Advisory and assistance services	13	17	16
41.0	Grants, subsidies, and contributions	1,771	1,767	1,768

99.9	Total new obligations	1,784	1,785	1,785


Identification code 75–1534–0–1–506		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		7	7

For carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Developmental Disabilities Assistance and Bill of Rights Act, the Head Start Act, the Child Abuse Prevention and Treatment Act, sections 310 and 316 of the Family Violence Prevention and Services Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), the Abandoned Infants Assistance Act of 1988, [sections 261 and 291 of the Help America Vote Act of 2002,] part B-1 of title IV and sections 413, 1110, and 1115 of the Social Security Act; for making payments under the Community Services Block Grant Act ("CSBG Act''), sections 439(i), 473B, and 477(i) of the Social Security Act, and the Assets for Independence Act; and for necessary administrative expenses to carry out such Acts and titles I, IV, V, X, XI, XIV, XVI, and XX of the Social Security Act, the Act of July 5, 1960, the Low Income Home Energy Assistance Act of 1981, title IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act of 1980, [$10,312,070,000]$9,794,598,000, of which [$42,000,000]$49,875,000, to remain available through September 30, 2013[2012], shall be for grants to States for adoption incentive payments, as authorized by section 473A of the Social Security Act and may be made for adoptions completed before September 30, 2012: [2011]Provided, That [$8,223,958,000]$8,099,783,000 shall be for making payments under the Head Start Act: [Provided further, That for purposes of allocating funds described by the immediately preceding proviso, the following provisions shall apply: (1) the term "base grant" as used in section 640(a)(7)(A) of such Act with respect to funding provided to a Head Start agency (including each Early Head Start agency) for fiscal year 2010 shall be deemed to include funds appropriated in the American Recovery and Reinvestment Act of 2009 (Public Law 111–5) and provided to such agency for carrying out expansion of Head Start programs, as that phrase is used in subsection (a)(4)(D) of such section 640(a), and provided to such agency as the ongoing funding level for operations in the 12 month budget period beginning in fiscal year 2010; (2) the amount reserved under subsection (a)(1)(C) of such section shall be less than the amount that would be reserved under such subparagraph absent this proviso by a sum of $5,131,935; and (3) the text of paragraph (4)(B)(i) of such section shall be applied by substituting the following language: "Under the circumstances described in clause (ii), from the balance, the Secretary shall reserve remaining amounts, to be allotted to each Head Start agency (including each Early Head Start agency) in an amount that bears the same ratio to such remaining amounts as the funds appropriated in the American Recovery and Reinvestment Act of 2009 and provided to such agency for carrying out quality improvement of Head Start programs, as that phrase is used in paragraph (5) of this section (which funds shall be referred to in this proviso as such agency's "ARRA quality improvement funds") bear to the total of all such agencies' ARRA quality improvement funds, to carry out such quality improvement activities.":] Provided further, That [$736,000,000] $370,000,000 shall be for making payments under the CSBG Act, of which $20,000,000 shall be for section 680(a)(2) of the CSBG Act: Provided further, That in addition to amounts provided herein, [$5,762,000] $5,762,000 shall be available from amounts available under section 241 of the PHS Act to carry out the provisions of section 1110 of the Social Security Act: Provided further, That to the extent Community Services Block Grant funds are distributed as grant funds by a State to an eligible entity as provided under the CSBG Act, and have not been expended by such entity, they shall remain with such entity for carryover into the next fiscal year for expenditure by such entity consistent with program purposes: Provided further, That the Secretary of Health and Human Services shall establish procedures regarding the disposition of intangible assets and program income that permit such assets acquired with, and program income derived from, grant funds authorized under section 680 of the CSBG Act to become the sole property of such grantees after a period of not more than 12 years after the end of the grant period for any activity consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That intangible assets in the form of loans, equity investments and other debt instruments, and program income may be used by grantees for any eligible purpose consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That these procedures shall apply to such grant funds made available after November 29, 1999: Provided further, That funds appropriated for section 680(a)(2) of the CSBG Act shall be available for financing construction and rehabilitation and loans or investments in private business enterprises owned by community development corporations: [Provided further, That $17,410,000 shall be for activities authorized by the Help America Vote Act of 2002, of which $12,154,000 shall be for payments to States to promote access for voters with disabilities, and of which $5,256,000 shall be for payments to States for protection and advocacy systems for voters with disabilities:] Provided further, That [$2,000,000]$2,000,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national case management contract and Federal costs of administering the system: Provided further, That up to $2,000,000[$2,000,000] shall be for improving the Public Assistance Reporting Information System, including grants to States to support data collection for a study of the system's effectiveness: Provided further, That section 303(a)(2)(A)(i) of the Family Violence Prevention and Services Act shall not apply to amounts provided herein. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1536–0–1–506		2010 actual	CR	2012 est.

	Obligations by program activity:
0101	Head start	7,234	7,235	8,100
0103	Runaway and homeless youth (basic centers)	54	54	59
0104	Transitional living	44	44	44
0106	Education grants to reduce sexual abuse of runaway youth	18	18	18
0108	Mentoring children of prisoners	49	49	25
0109	Child abuse State grants	27	27	27
0110	Child abuse discretionary activities	29	29	29
0111	Community-based child abuse prevention	41	41	41
0112	Child welfare services	282	282	282
0113	Child welfare training, research, or demonstration projects	27	27	27
0114	Adoption opportunities	26	26	39
0115	Abandoned infants assistance	12	12	12
0116	Adoption incentives	40	40	50
0117	Independent living training vouchers	45	45	45
0118	Children's health act programs	13	13
0119	State councils on developmental disabilities	75	75	75
0120	Protection and advocacy	41	41	41
0121	Projects of national significance	14	14	8
0122	University centers for excellence	39	39	39
0123	Voting access for individuals with disabilities	17	17
0124	Native American programs	49	49	49
0125	Social services and income maintenance research	20	20	3
0128	Federal administration	208	209	225
0129	Center for faith-based and community initiatives	1	1	1
0131	Disaster human services case management	2	2	2
0132	Regular Head Start ARRA funding	431
0133	Early Head Start ARRA funding	1,092
0134	CSBG ARRA funding	8
0135	Strengthening Communities Fund (ARRA)	2

0191	Subtotal	9,940	8,409	9,241
0301	Community services block grant	700	700	350
0303	Rural communtiy facilities	10	10
0304	Community services discretionary (JOLI & CED)	38	39	20
0306	Assets for independence	24	24	24
0308	Domestic violence hotline	3	3	5
0309	Family violence prevention and services	130	130	135
0310	Strengthening Communities Fund			20

0391	Subtotal	905	906	554

0400	Total, direct program	10,845	9,315	9,795

0799	Total direct obligations	10,845	9,315	9,795
0801	Reimbursable program	28	30	30

0900	Total new obligations	10,873	9,345	9,825

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,536	3	3
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	9,315	9,315	9,795
1120	Appropriations transferred to other accounts	–1

1160	Appropriation, discretionary (total)	9,314	9,315	9,795
	Spending authority from offsetting collections, discretionary:
1700	Collected	18	30	30
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	28	30	30
1900	Budget authority (total)	9,342	9,345	9,825
1930	Total budgetary resources available	10,878	9,348	9,828
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	3	3	3

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	7,909	7,809	5,754
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–19	–15	–15

3020	Obligated balance, start of year (net)	7,890	7,794	5,739
3030	Obligations incurred, unexpired accounts	10,873	9,345	9,825
3040	Outlays (gross)	–10,885	–11,400	–9,379
3050	Change in uncollected pymts, Fed sources, unexpired	–10
3051	Change in uncollected pymts, Fed sources, expired	14
3081	Recoveries of prior year unpaid obligations, expired	–88
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	7,809	5,754	6,200
3091	Uncollected pymts, Fed sources, end of year	–15	–15	–15

3100	Obligated balance, end of year (net)	7,794	5,739	6,185

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	9,342	9,345	9,825
	Outlays, gross:
4010	Outlays from new discretionary authority	3,875	4,358	4,615
4011	Outlays from discretionary balances	7,009	7,029	4,763

4020	Outlays, gross (total)	10,884	11,387	9,378
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–14	–30	–30
4033	Non-Federal sources	–18

4040	Offsets against gross budget authority and outlays (total)	–32	–30	–30
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	14

4060	Additional offsets against budget authority only (total)	4

4070	Budget authority, net (discretionary)	9,314	9,315	9,795
4080	Outlays, net (discretionary)	10,852	11,357	9,348
	Mandatory:
4090	Budget authority, gross
	Outlays, gross:
4101	Outlays from mandatory balances	1	13	1
4180	Budget authority, net (total)	9,314	9,315	9,795
4190	Outlays, net (total)	10,853	11,370	9,349

The request prioritizes investments in early learning to improve outcomes for children. A total of $8.099 billion is requested to maintain the number of children served in Head Start. This Budget also requests additional funds for runaway and homeless youth, family violence prevention, to improve the capacity of non-profits to serve their neighborhoods, and bonus payments to states that increase the number of children adopted from their public foster care systems. The Budget redirects funding for Children's Health Act programs to the Adoption Opportunities program.


Identification code 75–1536–0–1–506		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	111	116	129
11.3	Other than full-time permanent	5	6	7
11.5	Other personnel compensation	3	3	3

11.9	Total personnel compensation	119	125	139
12.1	Civilian personnel benefits	28	31	31
21.0	Travel and transportation of persons	5	5	4
23.1	Rental payments to GSA	15	20	20
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	4	5	5
24.0	Printing and reproduction	1	2	2
25.1	Advisory and assistance services	263	248	251
25.2	Other services from non-federal sources	2	15	15
25.3	Other goods and services from federal sources	71	49	49
25.4	Operation and maintenance of facilities	3	3	3
25.5	Research and development contracts	1	1	1
26.0	Supplies and materials	1	1	1
31.0	Equipment	1
41.0	Grants, subsidies, and contributions	10,330	8,809	9,273

99.0	Direct obligations	10,845	9,315	9,795
99.0	Reimbursable obligations	28	30	30

99.9	Total new obligations	10,873	9,345	9,825


Identification code 75–1536–0–1–506		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	1,197	1,228	1,242
1101	Direct military average strength employment	5	5	5


Identification code 75–1553–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Training and technical assistance	13	14	12
0002	Federal parent locator service	24	27	25
0003	Child welfare study	6	6
0004	Welfare research	15	15	15

0091	Direct program activities, subtotal	58	62	52
0801	Reimbursable program	23	26	26

0900	Total new obligations	81	88	78

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	5
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	58	58	52
	Spending authority from offsetting collections, mandatory:
1800	Collected	22	25	26
1801	Change in uncollected payments, Federal sources	1

1850	Spending auth from offsetting collections, mand (total)	23	25	26
1900	Budget authority (total)	81	83	78
1930	Total budgetary resources available	86	88	78
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	55	58	61
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–5	–6	–6

3020	Obligated balance, start of year (net)	50	52	55
3030	Obligations incurred, unexpired accounts	81	88	78
3040	Outlays (gross)	–77	–85	–79
3050	Change in uncollected pymts, Fed sources, unexpired	–1
3081	Recoveries of prior year unpaid obligations, expired	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	58	61	60
3091	Uncollected pymts, Fed sources, end of year	–6	–6	–6

3100	Obligated balance, end of year (net)	52	55	54

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	81	83	78
	Outlays, gross:
4100	Outlays from new mandatory authority	35	48	49
4101	Outlays from mandatory balances	42	37	30

4110	Outlays, gross (total)	77	85	79
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–3	–4	–5
4123	Non-Federal sources	–19	–21	–21

4130	Offsets against gross budget authority and outlays (total)	–22	–25	–26
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1

4160	Budget authority, net (mandatory)	58	58	52
4170	Outlays, net (mandatory)	55	60	53
4180	Budget authority, net (total)	58	58	52
4190	Outlays, net (total)	55	60	53


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	58	58	52
	Outlays	55	60	53
Legislative proposal, subject to PAYGO:
	Budget Authority			6
	Outlays			2
Total:
	Budget Authority	58	58	58
	Outlays	55	60	55

This account provides funding for research and technical assistance activities established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171) and the Claims Resolution Act of 2010 (P.L. 111–291).


Identification code 75–1553–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	8	8	7
12.1	Civilian personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	3	3	3
25.1	Advisory and assistance services	23	25	19
25.2	Other services from non-federal sources	12	13	5
25.3	Other goods and services from federal sources	6	7	6
25.7	Operation and maintenance of equipment	1	1	7
41.0	Grants, subsidies, and contributions	2	2	2

99.0	Direct obligations	58	62	52
99.0	Reimbursable obligations	23	26	26

99.9	Total new obligations	81	88	78


Identification code 75–1553–0–1–609		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	67	67	67


Identification code 75–1553–4–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0003	Child welfare study			6

0900	Total new obligations (object class 41.0)			6

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			6
1900	Budget authority (total)			6
1930	Total budgetary resources available			6

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts			6
3040	Outlays (gross)			–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			4

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			6
	Outlays, gross:
4100	Outlays from new mandatory authority			2
4180	Budget authority, net (total)			6
4190	Outlays, net (total)			2

For making payments to States or other non-Federal entities under title IV-E of the Social Security Act, [$5,366,000,000]$5,153,000,000.

For making payments to States or other non-Federal entities under title IV-E of the Social Security Act, for the first quarter of fiscal year [2012]2013, [$1,850,000,000]$2,100,000,000.

For making, after May 31 of the current fiscal year, payments to States or other non-Federal entities under section 474 of title IV-E of the Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–1545–0–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Foster care	4,603	3,967	4,288
0002	Independent living	140	140	140
0004	Adoption assistance	2,438	2,480	2,495
0005	Kinship guardianship	11	32	80
0006	Tribal T&TA	3	3	3

0900	Total new obligations	7,195	6,622	7,006

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,532	4,772	5,156
	Advance appropriations, mandatory:
1270	Advance appropriation	1,803	1,850	1,850
1900	Budget authority (total)	7,335	6,622	7,006
1930	Total budgetary resources available	7,335	6,622	7,006
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–140

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,128	1,216	946
3030	Obligations incurred, unexpired accounts	7,195	6,622	7,006
3031	Obligations incurred, expired accounts	22
3040	Outlays (gross)	–6,972	–6,892	–7,016
3081	Recoveries of prior year unpaid obligations, expired	–157
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,216	946	936

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross	7,335	6,622	7,006
	Outlays, gross:
4100	Outlays from new mandatory authority	6,264	5,852	6,207
4101	Outlays from mandatory balances	708	1,040	809

4110	Outlays, gross (total)	6,972	6,892	7,016
4180	Budget authority, net (total)	7,335	6,622	7,006
4190	Outlays, net (total)	6,972	6,892	7,016


		2010 actual	CR	2012 est.

Enacted/requested:
	Budget Authority	7,335	6,622	7,006
	Outlays	6,972	6,892	7,016
Legislative proposal, subject to PAYGO:
	Budget Authority			250
	Outlays			220
Total:
	Budget Authority	7,335	6,622	7,256
	Outlays	6,972	6,892	7,236

The Budget includes a proposal designed to reward States that achieve improved outcomes for children in foster care and those at risk of entering or re-entering foster care; and encourage efficient and effective use of Federal foster care resources that lead to savings.

Foster care._The proposed level will support eligible low-income children who must be placed outside the home. An average of 166,800 children per month are estimated to be served in FY 2012.

Adoption assistance._The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 470,400 children per month are estimated to be served in FY 2012.

Guardianship Assistance._The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been in foster care. An average of 13,900 children per month are estimated to be served in FY 2012.


Identification code 75–1545–0–1–609		2010 actual	CR	2012 est.

	Direct obligations:
25.1	Advisory and assistance services	20	20	20
25.3	Other goods and services from federal sources	1	1	1
41.0	Grants, subsidies, and contributions	7,174	6,601	6,985

99.9	Total new obligations	7,195	6,622	7,006


Identification code 75–1545–0–1–609		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 75–1545–4–1–609		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Foster care			250

0900	Total new obligations (object class 41.0)			250

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			250
1900	Budget authority (total)			250
1930	Total budgetary resources available			250

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)
3030	Obligations incurred, unexpired accounts			250
3040	Outlays (gross)			–220
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			30

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross			250
	Outlays, gross:
4100	Outlays from new mandatory authority			220
4180	Budget authority, net (total)			250
4190	Outlays, net (total)			220

Federal Funds

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), [as amended,] section 398 and title XXIX of the Public Health Service Act, [and] section 119 of the Medicare Improvements for Patients and Providers Act of 2008, subtitle B of title XX of the Social Security Act, and for necessary administrative expenses to carry out titles XVII and XXXII of the Public Health Service Act, [$1,624,733,000]$2,190,984,000, together with $46,960,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to carry out section 4360 of the Omnibus Budget Reconciliation Act of 1990: [of which $202,220,000]Provided, That, of the amount appropriated under this heading, $192,220,000 shall be for carrying out part E of title III[sections 371 through 374] of the [Older Americans Act of 1965]OAA and [$8,389,000]$8,388,000 shall be for carrying out section 631 of such Act: Provided further, That amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease prevention and health promotion programs and activities that have been demonstrated to the satisfaction of the Secretary of Health and Human Services to be evidence-based and effective: Provided further, That, notwithstanding section 206(g) of the OAA, up to 1 percent of amounts appropriated to carry out programs authorized under title III of such Act shall be available for conducting evaluations, training and technical assistance: Provided further, That amounts available under this heading for the cost of administering the program under title XXXII of the Public Health Service Act shall be in addition to any amounts available under such title for such purposes: Provided further, That, of the amount under this heading, $450,000,000 shall be available for carrying out title V of the OAA: Provided further, That, with respect to the previous proviso, such funds shall be available through June 30, 2013, and may be recaptured and reobligated in accordance with section 517(c) of the OAA. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0142–0–1–506		2010 actual	CR	2012 est.

	Obligations by program activity:
0101	Home and community-based supportive services	368	368	416
0102	Preventive health services	21	21	21
0103	National family caregiver support program	154	154	192
0104	Native American caregiver support program	6	6	8
0105	Congregate nutrition services	441	441	441
0106	Home-delivered nutrition services	218	218	218
0107	Nutrition services incentive program	158	161	161
0108	Native American nutrition and supportive services	28	28	28
0109	Program innovations	19	19	12
0110	Aging network support activities	44	44	8
0111	Long-term care ombudsmen program	17	17	22
0112	Prevention of elder abuse and neglect	5	5	5
0113	Alzheimer's disease demonstration grants	11	11	11
0114	Program administration	20	20	24
0115	Lifespan respite care program	3	3	10
0117	Aging and Disability Resource Centers (ADRC)	10	10	13
0118	Chronic Disease Self-Management Program			10
0120	Adult Protective Services			17
0121	Senior Medicare Patrol program			10
0122	Elder Rights Support Activities			4
0123	CLASS Program Administration			120
0125	Community Service Employment for Older Americans			450
0126	State Health Insurance Assistance Program (SHIPs)			47

0191	Subtotal, annual appropriations	1,523	1,526	2,248

0300	Total, direct program	1,523	1,526	2,248
0801	Reimbursable program	4	3	3
0803	MIPPA	30

0899	Total reimbursable obligations	34	3	3

0900	Total new obligations	1,557	1,529	2,251

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,516	1,516	2,237
1120	Appropriations transferred to other accounts	–3

1160	Appropriation, discretionary (total)	1,513	1,516	2,237
	Appropriations, mandatory:
1200	Appropriation	10	10	10
	Spending authority from offsetting collections, discretionary:
1700	Collected		3	3
1701	Change in uncollected payments, Federal sources	1

1750	Spending auth from offsetting collections, disc (total)	1	3	3
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	26
1801	Change in uncollected payments, Federal sources	26	–26

1850	Spending auth from offsetting collections, mand (total)	34
1900	Budget authority (total)	1,558	1,529	2,250
1930	Total budgetary resources available	1,558	1,530	2,251
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	715	746	758
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–25	–49	–23

3020	Obligated balance, start of year (net)	690	697	735
3030	Obligations incurred, unexpired accounts	1,557	1,529	2,251
3040	Outlays (gross)	–1,521	–1,517	–1,969
3050	Change in uncollected pymts, Fed sources, unexpired	–27	26
3051	Change in uncollected pymts, Fed sources, expired	3
3081	Recoveries of prior year unpaid obligations, expired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	746	758	1,040
3091	Uncollected pymts, Fed sources, end of year	–49	–23	–23

3100	Obligated balance, end of year (net)	697	735	1,017

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,514	1,519	2,240
	Outlays, gross:
4010	Outlays from new discretionary authority	916	928	1,368
4011	Outlays from discretionary balances	597	588	591

4020	Outlays, gross (total)	1,513	1,516	1,959
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1	–3	–3
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–1
4052	Offsetting collections credited to expired accounts	1

4060	Additional offsets against budget authority only (total)

4070	Budget authority, net (discretionary)	1,513	1,516	2,237
4080	Outlays, net (discretionary)	1,512	1,513	1,956
	Mandatory:
4090	Budget authority, gross	44	10	10
	Outlays, gross:
4100	Outlays from new mandatory authority	1	1	1
4101	Outlays from mandatory balances	7		9

4110	Outlays, gross (total)	8	1	10
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–8	–26
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–26	26

4160	Budget authority, net (mandatory)	10	10	10
4170	Outlays, net (mandatory)		–25	10
4180	Budget authority, net (total)	1,523	1,526	2,247
4190	Outlays, net (total)	1,512	1,488	1,966

Note.—The reimbursable program (HCFAC) in the Administration on Aging (AoA) reflects the estimated distribution of the allocation account for 2011. Actual 2011 distributions will be determined by the Secretary of HHS and the Attorney General.

This account provides funding to help predominantly older Americans, with the assistance of their caregivers, maintain their dignity and independence in their homes and communities. The Senior Community Service Employment Program (SCSEP), authorized by Title V of the Older Americans Act, is a federally-sponsored community service employment and training program for unemployed low-income individuals, ages 55 and older. The program offers participants work-based community service training so that they can gain on-the-job experience and prepare to enter or re-enter the workforce. The 2012 Budget proposes transferring SCSEP from the Department of Labor to improve coordination between SCSEP and other senior-serving programs and to help the program better fulfill its dual goals of fostering individual economic self-sufficiency and promoting useful opportunities in community service. Further, this account provides for the carrying out of a voluntary program to provide a self-directed resource for participants to purchase community living assistance services and supports.


Identification code 75–0142–0–1–506		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	11	11	15
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	12	12	16
12.1	Civilian personnel benefits	3	3	6
23.1	Rental payments to GSA	2	2	3
25.1	Advisory and assistance services	9	9	134
25.3	Other goods and services from federal sources	7	7	18
41.0	Grants, subsidies, and contributions	1,490	1,493	2,071

99.0	Direct obligations	1,523	1,526	2,248
99.0	Reimbursable obligations	34	3	3

99.9	Total new obligations	1,557	1,529	2,251


Identification code 75–0142–0–1–506		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	93	103	168
2001	Reimbursable civilian full-time equivalent employment	7	8	8

Trust Funds


Identification code 75–8160–0–7–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity			200

0900	Total new obligations			200

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			200
1930	Total budgetary resources available			200

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			200
3040	Outlays (gross)			–200

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			200
	Outlays, gross:
4100	Outlays from new mandatory authority			200
4180	Budget authority, net (total)			200
4190	Outlays, net (total)			200

This account provides for administrative expenses related to the management of the CLASS program from the CLASS Independence Fund. The account is funded by premiums collected from individuals who voluntarily enroll in the CLASS Independence Benefit Plan. Their premiums are deposited into the CLASS Independence Fund, a trust fund held by the CLASS Independence Fund Board of Trustees. This program provides a self-directed resource for eligible participants to purchase community living assistance services and supports. This account also accrues interest earned on investment of the CLASS Independence Fund.


	2010	CR	2012

Start of Year Fund Balance	........	........	........
Premiums	........	........	5,500
Interest	........	........	90

Appropriations	........	........	(200)

End of Year Fund Balance	........	........	5,390

Federal Funds

For necessary expenses, not otherwise provided, for general departmental management, including hire of six sedans, and for carrying out titles III, IV, XVII[, XX], [and] XXI, and XXVII of the Public Health Service Act ("PHS Act''), the United States-Mexico Border Health Commission Act, and research studies under section 1110 of the Social Security Act, [$537,149,000] $363,644,000, and [$65,211,000]$126,702,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation activities: [Provided, That of this amount, $53,891,000 shall be for minority AIDS prevention and treatment activities: Provided further, That none of the funds made available under this heading shall be available for carrying out activities specified under section 2003(b) (2) or (3) of Title XX of the PHS Act: Provided further, That of the funds made available under this heading, $129,218,000 shall be for making competitive contracts and grants to public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy and for the Federal costs associated with administering and evaluating such contracts and grants, of which not less than $85,000,000 shall be for replicating programs that have been proven effective through rigorous evaluation to reduce teenage pregnancy, behavioral risk factors underlying teenage pregnancy, or other associated risk factors, of which not less than $28,000,000 shall be available for research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy, and of which any remaining amounts shall be available for training and technical assistance, evaluation, outreach, and additional program support activities:] Provided, [further]That of the amounts provided under this heading from amounts available under section 241 of the PHS Act, [$4,455,000]$8,455,000 shall be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches, and $53,891,000 shall be available for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $7,000,000 is for strengthening the Department's acquisition workforce capacity and capabilities: Provided further, That, with respect to the previous proviso, such funds shall be available for training, recruitment, retention, and hiring members of the acquisition workforce as defined by the Office of Federal Procurement Policy Act, as amended (41 U.S.C. 401 et seq.): Provided further, That, with respect to the second proviso, such funds shall be available for information technology in support of acquisition workforce effectiveness or for management solutions to improve acquisition management: Provided further, That funds provided in this Act for embryo adoption activities may be used to provide, to individuals adopting embryos, through grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4)[: Provided further, That $10,000,000 of the funds made available under this heading shall be available for health and wellness pilot initiatives for Federal employees, of which up to $5,000,000 may be transferred to other agencies, with the approval of the Director of the Office of Management and Budget, to assist those agencies in the implementation of such initiatives]. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–9912–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	General departmental management	559	493	364
0003	CHIPRA evaluation	3
0004	Prevention and Public Health Fund			135

0091	Direct program activities, subtotal	562	493	499
0801	General departmental management	91	91	91
0802	HCFAC	9	9	9
0803	PHS evaluation	65	65	127

0899	Total reimbursable obligations	165	165	227

0900	Total new obligations	727	658	726

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	10	14	74
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	493	493	364
1120	Appropriations transferred to other accounts	–1	–1

1160	Appropriation, discretionary (total)	492	492	364
	Appropriations, mandatory:
1200	Appropriation	10
1221	Appropriations transferred from other accounts	12		135

1260	Appropriations, mandatory (total)	22		135
	Spending authority from offsetting collections, discretionary:
1700	Collected	96	217	226
1701	Change in uncollected payments, Federal sources	119

1750	Spending auth from offsetting collections, disc (total)	215	217	226
	Spending authority from offsetting collections, mandatory:
1800	Collected		9
1801	Change in uncollected payments, Federal sources	9

1850	Spending auth from offsetting collections, mand (total)	9	9
1900	Budget authority (total)	738	718	725
1930	Total budgetary resources available	748	732	799
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–7
1941	Unexpired unobligated balance, end of year	14	74	73

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	443	542	537
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–247	–346	–346

3020	Obligated balance, start of year (net)	196	196	191
3030	Obligations incurred, unexpired accounts	727	658	726
3031	Obligations incurred, expired accounts	4
3040	Outlays (gross)	–622	–663	–772
3050	Change in uncollected pymts, Fed sources, unexpired	–128
3051	Change in uncollected pymts, Fed sources, expired	29
3081	Recoveries of prior year unpaid obligations, expired	–10
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	542	537	491
3091	Uncollected pymts, Fed sources, end of year	–346	–346	–346

3100	Obligated balance, end of year (net)	196	191	145

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	707	709	590
	Outlays, gross:
4010	Outlays from new discretionary authority	319	512	444
4011	Outlays from discretionary balances	291	130	193

4020	Outlays, gross (total)	610	642	637
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–128	–217	–226
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–119
4052	Offsetting collections credited to expired accounts	32

4060	Additional offsets against budget authority only (total)	–87

4070	Budget authority, net (discretionary)	492	492	364
4080	Outlays, net (discretionary)	482	425	411
	Mandatory:
4090	Budget authority, gross	31	9	135
	Outlays, gross:
4100	Outlays from new mandatory authority	9	9	135
4101	Outlays from mandatory balances	3	12

4110	Outlays, gross (total)	12	21	135
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–9
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–9

4160	Budget authority, net (mandatory)	22		135
4170	Outlays, net (mandatory)	12	12	135
4180	Budget authority, net (total)	514	492	499
4190	Outlays, net (total)	494	437	546

Note.—The reimbursable HCFAC program in General Departmental Management reflects the estimated distribution from the allocation account for 2011 and 2012.

General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the Prevention and Public Health Fund. This includes funding the continuation of grants for medically accurate and age appropriate programs to reduce teen pregnancy, including funds for research, demonstration grants, and replication of programs that have been proven effective through rigorous evaluation to reduce teen pregnancy.


Identification code 75–9912–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	82	82	94
11.3	Other than full-time permanent	9	8	8
11.5	Other personnel compensation	3	9	9
11.7	Military personnel	4	9	7
11.8	Special personal services payments	1

11.9	Total personnel compensation	99	108	118
12.1	Civilian personnel benefits	23	26	27
12.2	Military personnel benefits	3	5	4
21.0	Travel and transportation of persons	5	7	7
22.0	Transportation of things	1
23.1	Rental payments to GSA		25	24
23.3	Communications, utilities, and miscellaneous charges	24	6	1
24.0	Printing and reproduction	2	5	5
25.1	Advisory and assistance services	49	58	44
25.2	Other services from non-federal sources	31	50	42
25.3	Other goods and services from federal sources	51	58	34
25.4	Operation and maintenance of facilities	4	10	11
25.5	Research and development contracts	1
25.7	Operation and maintenance of equipment	1	3	4
26.0	Supplies and materials	2	3	8
31.0	Equipment	3	6	6
41.0	Grants, subsidies, and contributions	263	123	164

99.0	Direct obligations	562	493	499
99.0	Reimbursable obligations	165	165	227

99.9	Total new obligations	727	658	726


Identification code 75–9912–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	890	897	980
1101	Direct military average strength employment	66	47	48
2001	Reimbursable civilian full-time equivalent employment	363	400	386
2101	Reimbursable military average strength employment	18	26	25

For expenses necessary for the Office for Civil Rights, [$44,382,000]$46,717,000. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0135–0–1–751		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	38	38	47
0801	Reimbursable program	3	3

0900	Total new obligations	41	41	47

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	38	38	47
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	3
1900	Budget authority (total)	41	41	47
1930	Total budgetary resources available	41	41	47

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	12	12	12
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–1	–1	–1

3020	Obligated balance, start of year (net)	11	11	11
3030	Obligations incurred, unexpired accounts	41	41	47
3040	Outlays (gross)	–40	–41	–46
3081	Recoveries of prior year unpaid obligations, expired	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	12	12	13
3091	Uncollected pymts, Fed sources, end of year	–1	–1	–1

3100	Obligated balance, end of year (net)	11	11	12

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	41	41	47
	Outlays, gross:
4010	Outlays from new discretionary authority	32	33	38
4011	Outlays from discretionary balances	8	8	8

4020	Outlays, gross (total)	40	41	46
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3	–3
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts

4070	Budget authority, net (discretionary)	38	38	47
4080	Outlays, net (discretionary)	37	38	46
4180	Budget authority, net (total)	38	38	47
4190	Outlays, net (total)	37	38	46

The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination and health information privacy and security compliance programs.


Identification code 75–0135–0–1–751		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	23	23	28
12.1	Civilian personnel benefits	6	6	7
21.0	Travel and transportation of persons			1
23.1	Rental payments to GSA	3	3	3
25.2	Other services from non-federal sources	6	6	8

99.0	Direct obligations	38	38	47
99.0	Reimbursable obligations	3	3

99.9	Total new obligations	41	41	47


Identification code 75–0135–0–1–751		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	226	262	276
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	3	3	3

For expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology, [$78,334,000.]$57,013,000: Provided, That in addition to amounts provided herein, $21,400,000 shall be available from amounts available under section 241 of the Public Health Service Act. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0130–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Health information technology	42	42	57
0002	Recovery Act activities	1,820	158

0091	Direct program activities, subtotal	1,862	200	57
0801	Reimbursable program	17	13	12
0802	Reimbursable program: PHS evaluation	19	19	21

0899	Total reimbursable obligations	36	32	33

0900	Total new obligations	1,898	232	90

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,979	158
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	42	42	57
	Spending authority from offsetting collections, discretionary:
1700	Collected	19	32	33
1701	Change in uncollected payments, Federal sources	17

1750	Spending auth from offsetting collections, disc (total)	36	32	33
1900	Budget authority (total)	78	74	90
1930	Total budgetary resources available	2,057	232	90
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	158

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	70	1,813	1,473
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–37	–34	–34

3020	Obligated balance, start of year (net)	33	1,779	1,439
3030	Obligations incurred, unexpired accounts	1,898	232	90
3040	Outlays (gross)	–153	–572	–433
3050	Change in uncollected pymts, Fed sources, unexpired	–17
3051	Change in uncollected pymts, Fed sources, expired	20
3081	Recoveries of prior year unpaid obligations, expired	–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,813	1,473	1,130
3091	Uncollected pymts, Fed sources, end of year	–34	–34	–34

3100	Obligated balance, end of year (net)	1,779	1,439	1,096

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	78	74	90
	Outlays, gross:
4010	Outlays from new discretionary authority	48	53	62
4011	Outlays from discretionary balances	105	519	371

4020	Outlays, gross (total)	153	572	433
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–27	–32	–33
4033	Non-Federal sources	–11

4040	Offsets against gross budget authority and outlays (total)	–38	–32	–33
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–17
4052	Offsetting collections credited to expired accounts	19

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	42	42	57
4080	Outlays, net (discretionary)	115	540	400
4180	Budget authority, net (total)	42	42	57
4190	Outlays, net (total)	115	540	400

This program supports coordination, leadership, and development of Federal health information technology activities and Federal initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation with participants in the health sector. The Office of the National Coordinator for Health Information Technology was established in the Health Information Technology for Economic and Clinical Health Act (P.L. 111–5, Title XIII), for the purpose of addressing strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private adoption of health information technology.

Through this program, activities related to and supporting the President's Health Information Technology Initiative are coordinated across several HHS organizations, as shown in the following consolidated table.

Health Information Technology Funding (Program level - in millions of dollars)


	2010 actual	2011 est.	2012 est.

Distribution of funding by account:
National Coordinator for Health Information Technology	61	61	78
General Departmental Management	2	1	1
Agency for Healthcare Research and Quality	28	28	28
HIT Initiative Total	91	90	107
Federal Health Architecture	8	13	12


Identification code 75–0130–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	8	9	14
12.1	Civilian personnel benefits	2	2	4
23.1	Rental payments to GSA	2	2	3
25.1	Advisory and assistance services	29	24	27
25.2	Other services from non-federal sources	115	100	2
25.3	Other goods and services from federal sources	10	2	6
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	1,695	60

99.0	Direct obligations	1,862	200	57
99.0	Reimbursable obligations	36	32	33

99.9	Total new obligations	1,898	232	90


Identification code 75–0130–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	71	148	188
1101	Direct military average strength employment	1	1	1

For expenses necessary for administrative law judges responsible for hearing cases under title XVIII of the Social Security Act (and related provisions of title XI of such Act), [$77,798,000] $81,019,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0139–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	70	71	81

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	71	71	81
1930	Total budgetary resources available	71	71	81
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	14	20	20
3030	Obligations incurred, unexpired accounts	70	71	81
3040	Outlays (gross)	–64	–71	–81
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	20	20	20

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	71	71	81
	Outlays, gross:
4010	Outlays from new discretionary authority	58	71	81
4011	Outlays from discretionary balances	6

4020	Outlays, gross (total)	64	71	81
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–71	–71	–81

4070	Budget authority, net (discretionary)
4080	Outlays, net (discretionary)	–7
4180	Budget authority, net (total)
4190	Outlays, net (total)	–7

This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides the forum through which individuals and organizations who are dissatisfied with Medicare determinations affecting their rights to, or their participation in, the Medicare program may administratively appeal those determinations, in accordance with the requirements of the Administrative Procedures Act and the Social Security Act.


Identification code 75–0139–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	34	34	41
11.5	Other personnel compensation		1	1

11.9	Total personnel compensation	34	35	42
12.1	Civilian personnel benefits	9	9	12
23.1	Rental payments to GSA	8	7	7
23.3	Communications, utilities, and miscellaneous charges	1	1	2
25.1	Advisory and assistance services	9	8	6
25.2	Other services from non-federal sources	4	3	4
25.3	Other goods and services from federal sources	4	8	7
26.0	Supplies and materials	1		1

99.0	Direct obligations	70	71	81

99.9	Total new obligations	70	71	81


Identification code 75–0139–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	368	395	424

For expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical, and cybersecurity threats to civilian populations, and for other public health emergencies, [$623,734,000]$585,023,000; of which [$44,153,000]$15,000,000 shall remain available until expended to support emergency operations[shall be to support preparedness and emergency operations, of which $15,000,000, to support expenses due to response efforts, shall remain available until expended]; and of which [$10,000,000]$5,000,000, to remain available through September 30, [2012]2013, shall be to support the delivery of medical countermeasures: Provided, That of the amount made available herein for the delivery of medical countermeasures, up to [$8,000,000]$4,000,000 may be [transferred] made available to the U.S. Postal Service to support delivery of medical countermeasures.

From funds transferred to this account pursuant to the fourth paragraph under this heading in Public Law 111–117, up to [$476,194,000]$665,000,000 shall be available for expenses necessary to support advanced research and development pursuant to section 319L of the Public Health Service Act ("PHS Act''), [Act]and other administrative expenses of the Biomedical Advanced Research and Development Authority[: Provided, That the Secretary may increase this limitation 15 days after notifying the Committees on Appropriations of the House of Representatives and the Senate of the intent to do so] to support additional advanced research and development [pursuant to section 319L of the PHS Act].

[For expenses necessary to prepare for and respond to an influenza pandemic, $65,578,000.]

For expenses necessary [for fit-out and other costs related to a competitive lease procurement to renovate or replace the existing headquarters building for Public Health Service agencies and other components of the Department of Health and Human Services, $35,000,000, to remain available until expended; and, in addition,] for fit-out and other costs related to the consolidation of office space for the Office of the Assistant Secretary for Preparedness and Response, [$10,000,000]$10,000,000, to remain available until expended.

Of the remaining balances of funds transferred to this account pursuant to the fourth paragraph under this heading in Public Law 111–117, up to $100,000,000 shall be available for the purpose of funding a strategic investment corporation established to further the purposes of section 319L of the PHS Act (42 U.S.C. 247d-7e) to foster innovation in the development of medical countermeasures. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0140–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	1,772	2,952	1,859
0002	Recovery Act, PHSSEF	46

0091	Direct program activities, subtotal	1,818	2,952	1,859
0801	Reimbursable program	44	60	60

0900	Total new obligations	1,862	3,012	1,919

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,561	6,617	4,700
1010	Unobligated balance transferred to other accounts	–242	–5	–5
1021	Recoveries of prior year unpaid obligations	146

1050	Unobligated balance (total)	4,465	6,612	4,695
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,262	1,040	595
1120	Appropriations transferred to other accounts	–2
1121	Appropriations transferred from other accounts	2,729
1131	Unobligated balance of appropriations permanently reduced	–7

1160	Appropriation, discretionary (total)	3,982	1,040	595
	Spending authority from offsetting collections, discretionary:
1700	Collected	13	60	60
1701	Change in uncollected payments, Federal sources	23

1750	Spending auth from offsetting collections, disc (total)	36	60	60
1900	Budget authority (total)	4,018	1,100	655
1930	Total budgetary resources available	8,483	7,712	5,350
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–4
1941	Unexpired unobligated balance, end of year	6,617	4,700	3,431

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	7,087	3,835	2,420
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–520	–461	–461

3020	Obligated balance, start of year (net)	6,567	3,374	1,959
3030	Obligations incurred, unexpired accounts	1,862	3,012	1,919
3031	Obligations incurred, expired accounts	24
3040	Outlays (gross)	–4,981	–4,427	–2,815
3050	Change in uncollected pymts, Fed sources, unexpired	–23
3051	Change in uncollected pymts, Fed sources, expired	82
3080	Recoveries of prior year unpaid obligations, unexpired	–146
3081	Recoveries of prior year unpaid obligations, expired	–11
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	3,835	2,420	1,524
3091	Uncollected pymts, Fed sources, end of year	–461	–461	–461

3100	Obligated balance, end of year (net)	3,374	1,959	1,063

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,018	1,100	655
	Outlays, gross:
4010	Outlays from new discretionary authority	219	220	158
4011	Outlays from discretionary balances	4,762	4,207	2,657

4020	Outlays, gross (total)	4,981	4,427	2,815
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–91	–60	–60
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–23
4052	Offsetting collections credited to expired accounts	78

4060	Additional offsets against budget authority only (total)	55

4070	Budget authority, net (discretionary)	3,982	1,040	595
4080	Outlays, net (discretionary)	4,890	4,367	2,755
4180	Budget authority, net (total)	3,982	1,040	595
4190	Outlays, net (total)	4,890	4,367	2,755

The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized by the Pandemic and All-Hazards Preparedness Act. Funds will be used for hospital preparedness and other emergency preparedness activities including the National Disaster Medical System. The PHSSEF also supports the HHS Cyber Security program, the Medical Reserve Corps, and the Office of Security and Strategic Information.

The PHSSEF also continues to support the advanced development of biodefense countermeasures. These resources will be derived from available funds appropriated for the BioShield Special Reserve Fund. Included will be all administrative expenses of the Biomedical Advanced Research and Development Authority (BARDA).

Resources are also being provided to consolidate the offices of the Assistant Secretary for Preparedness and Response.

A Strategic Investor corporation will be created to make investments in the private sector with specific focus on disruptive technologies including novel antimicrobials and multi-use platform technologies for diagnostics and medical countermeasures, which will be funded from available resources appropriated for the BioShield Special Reserve Fund.


Identification code 75–0140–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	51	55	65
11.3	Other than full-time permanent	9	14	14
11.7	Military personnel	7	9	8

11.9	Total personnel compensation	67	78	87
12.1	Civilian personnel benefits	14	14	17
12.2	Military personnel benefits	4	4	4
21.0	Travel and transportation of persons	12	14	14
22.0	Transportation of things	4	1	1
23.1	Rental payments to GSA	10	13	13
23.3	Communications, utilities, and miscellaneous charges	19	6	4
25.1	Advisory and assistance services	354	163	332
25.2	Other services from non-federal sources	42	64	129
25.3	Other goods and services from federal sources	415	235	343
25.4	Operation and maintenance of facilities	2	1	3
25.5	Research and development contracts	56	1,289	260
25.6	Medical care	3
25.7	Operation and maintenance of equipment	8	24	36
26.0	Supplies and materials	320	113	249
31.0	Equipment	3	3	6
32.0	Land and structures	70	518
41.0	Grants, subsidies, and contributions	415	412	361

99.0	Direct obligations	1,818	2,952	1,859
99.0	Reimbursable obligations	44	60	60

99.9	Total new obligations	1,862	3,012	1,919


Identification code 75–0140–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	643	643	643
1101	Direct military average strength employment	73	73	73


Identification code 75–0145–0–1–552		2010 actual	CR	2012 est.

	Obligations by program activity:
0801	AHRQ		8	24
0802	Office of the Secretary		2	6

0900	Total new obligations		10	30

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected		10	30
1930	Total budgetary resources available		10	30

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			9
3030	Obligations incurred, unexpired accounts		10	30
3040	Outlays (gross)		–1	–9
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		9	30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		10	30
	Outlays, gross:
4100	Outlays from new mandatory authority		1	5
4101	Outlays from mandatory balances			4

4110	Outlays, gross (total)		1	9
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–10	–30

4160	Budget authority, net (mandatory)
4170	Outlays, net (mandatory)		–9	–21
4180	Budget authority, net (total)
4190	Outlays, net (total)		–9	–21

Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of 20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research and build research and data capacity for comparative clinical effectiveness research. Transferred funds will be distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out these activities.


Identification code 75–0145–0–1–552		2010 actual	CR	2012 est.

99.0	Reimbursable obligations: reimbursable obligations		2	6
	Allocation Account - reimbursable:
25.5	Research and development contracts		8	24

99.0	Allocation account - reimbursable		8	24

99.9	Total new obligations		10	30


Identification code 75–0144–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	9

0900	Total new obligations (object class 41.0)	9

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	659
1010	Unobligated balance transferred to other accounts	–650

1050	Unobligated balance (total)	9
1930	Total budgetary resources available	9
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	40	39	31
3030	Obligations incurred, unexpired accounts	9
3040	Outlays (gross)	–10	–8	–31
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	39	31

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	10	8	31
4180	Budget authority, net (total)
4190	Outlays, net (total)	10	8	31

The Prevention and Wellness Fund is authorized under the American Recovery and Reinvestment Act (ARRA), (P.L. 111–5). The Prevention and Wellness Fund administers evidence-based clinical and community-based prevention and wellness strategies.

The Nonrecurring Expenses Fund is a no-year account that captures expired unobligated balances from discretionary accounts prior to cancellation. The Fund will be used for nonrecurring expenses that are difficult to accomodate or arise outside of the normal budget process. Beginning with 2008 appropriations, transfers will occur up to five years after expiration, when it is certain that original obligations have been fully paid and closed out. Advance notification of a proposed use of the Fund will be submitted to the relevant Committees on Appropriations of the House of Representatives and the Senate, with justification for the proposed areas/projects.


Identification code 75–0119–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	128	790	82

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		872	82
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,000
1930	Total budgetary resources available	1,000	872	82
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	872	82

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		107	447
3030	Obligations incurred, unexpired accounts	128	790	82
3040	Outlays (gross)	–21	–450	–420
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	107	447	109

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,000
	Outlays, gross:
4100	Outlays from new mandatory authority	21
4101	Outlays from mandatory balances		450	420

4110	Outlays, gross (total)	21	450	420
4180	Budget authority, net (total)	1,000
4190	Outlays, net (total)	21	450	420

Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriates $1,000,000,000 to the Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.


Identification code 75–0119–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	4	85
11.7	Military personnel		3

11.9	Total personnel compensation	4	88
12.1	Civilian personnel benefits	1	30
12.2	Military personnel benefits		1
21.0	Travel and transportation of persons	1	4
22.0	Transportation of things	1	1
23.1	Rental payments to GSA	1	1
24.0	Printing and reproduction	1	2
25.1	Advisory and assistance services	64	356
25.2	Other services from non-federal sources	6	9
25.3	Other goods and services from federal sources	14	21
25.4	Operation and maintenance of facilities	1	2
25.7	Operation and maintenance of equipment	4	7
25.8	Subsistence and support of persons	6	10
26.0	Supplies and materials	1	2
31.0	Equipment	1	3
33.0	Investments and loans	1	1

99.0	Direct obligations	107	538
	Allocation Account - direct:
11.1	Personnel compensation: Full-time permanent	4	71	52
12.1	Civilian personnel benefits	1	26	15
21.0	Travel and transportation of persons	1	6
23.1	Rental payments to GSA		1
23.3	Communications, utilities, and miscellaneous charges	1	4
24.0	Printing and reproduction		5
25.1	Advisory and assistance services	4	83	10
25.2	Other services from non-federal sources	10	9
25.3	Other goods and services from federal sources		3
25.4	Operation and maintenance of facilities		1
26.0	Supplies and materials		1
31.0	Equipment		40	5
32.0	Land and structures		2

99.0	Allocation account - direct	21	252	82

99.9	Total new obligations	128	790	82


Identification code 75–0119–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	87	703
1101	Direct military average strength employment		20


Identification code 75–0116–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity		750

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	500	750	1,000
1220	Appropriations transferred to other accounts	–500		–1,000

1260	Appropriations, mandatory (total)		750
1930	Total budgetary resources available		750

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			682
3030	Obligations incurred, unexpired accounts		750
3040	Outlays (gross)		–68	–600
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		682	82

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		750
	Outlays, gross:
4100	Outlays from new mandatory authority		68
4101	Outlays from mandatory balances			600

4110	Outlays, gross (total)		68	600
4180	Budget authority, net (total)		750
4190	Outlays, net (total)		68	600

The Patient Protection and Affordable Care Act, (P.L. 111–148) establishes the Prevention and Public Health Fund as a mandatory appropriation for prevention and public health activities. For FY 2012, the law appropriates $1 billion into the Fund, which the Secretary then has authority to transfer to accounts within HHS. The Prevention and Public Health Fund increases and sustains investments in a range of public health efforts intended to prevent disease and reduce health care costs.


Identification code 75–0116–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
25.5	Research and development contracts		150
41.0	Grants, subsidies, and contributions		600

99.9	Total new obligations		750


Identification code 75–0117–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program activity	25	25	25

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	25	25	25
1930	Total budgetary resources available	25	25	25

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		22	27
3030	Obligations incurred, unexpired accounts	25	25	25
3040	Outlays (gross)	–3	–20	–25
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	22	27	27

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	25	25	25
	Outlays, gross:
4100	Outlays from new mandatory authority	1	1	1
4101	Outlays from mandatory balances	2	19	24

4110	Outlays, gross (total)	3	20	25
4180	Budget authority, net (total)	25	25	25
4190	Outlays, net (total)	3	20	25

For awarding competitive grants to States to assist pregnant and parenting teens and women.


Identification code 75–0117–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
25.3	Other goods and services from federal sources	1	1	1
41.0	Grants, subsidies, and contributions	24	24	24

99.9	Total new obligations	25	25	25


Identification code 75–0146–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	WTC		70	313
0840	WTC Reimbursables		7	31

0900	Total new obligations		77	344

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		70	313
	Spending authority from offsetting collections, mandatory:
1800	Collected		7	31
1900	Budget authority (total)		77	344
1930	Total budgetary resources available		77	344

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			7
3030	Obligations incurred, unexpired accounts		77	344
3040	Outlays (gross)		–70	–332
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		7	19

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross
	Mandatory:
4090	Budget authority, gross		77	344
	Outlays, gross:
4100	Outlays from new mandatory authority		70	325
4101	Outlays from mandatory balances			7

4110	Outlays, gross (total)		70	332
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources		–7	–31

4160	Budget authority, net (mandatory)		70	313
4170	Outlays, net (mandatory)		63	301
4180	Budget authority, net (total)		70	313
4190	Outlays, net (total)		63	301

The World Trade Center Program is authorized under P.L. 111 347, the James Zadroga 9/11 Health and Compensation Act of 2010. The Department of Health and Human Services, including NIOSH, will administer the program. The program will provide medical monitoring and treatment services to response workers who responded to the September 11, 2001, Word Trade Center Emergency in New York and to individuals who lived or worked in the vicinity of the World Trade Center during that time.


Identification code 75–0146–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	3
12.1	Civilian personnel benefits			1
25.1	Advisory and assistance services			5
25.6	Medical care		63	280
41.0	Grants, subsidies, and contributions		6	24

99.0	Direct obligations		70	313
99.0	Reimbursable obligations		7	31

99.9	Total new obligations		77	344


Identification code 75–0146–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment		10	25

Federal Funds

For retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0379–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Retirement payments	344	386	418
0002	Survivors' benefits	24	28	32
0003	Medical care	73	104	115

0900	Total new obligations	441	518	565

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	461	518	565
1930	Total budgetary resources available	461	518	565
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–20

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	49	42	67
3001	Adjustments to unpaid obligations, brought forward, Oct 1		20

3020	Obligated balance, start of year (net)	49	62	67
3030	Obligations incurred, unexpired accounts	441	518	565
3040	Outlays (gross)	–447	–513	–561
3081	Recoveries of prior year unpaid obligations, expired	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	42	67	71

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	461	518	565
	Outlays, gross:
4100	Outlays from new mandatory authority	406	471	514
4101	Outlays from mandatory balances	41	42	47

4110	Outlays, gross (total)	447	513	561
4180	Budget authority, net (total)	461	518	565
4190	Outlays, net (total)	447	513	561

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2010	2011	2012

Active Duty:
HHS	4982	5086	5118
DOJ, BOP	782	800	820
Homeland Security	492	471	471
EPA	76	76	76

All Other	292	389	435

Total Active Duty	6584	6822	6920

Retirees & Survivors:
Retirees	5317	5476	5495

Retiree family members and survivors	945	950	985

Total Retirement Pay	6262	6426	6480

Total Beneficiaries (active duty, retirees, survivors)	12846	13248	13400

This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned Corps.


Identification code 75–0379–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
13.0	Benefits for former personnel	368	414	450
25.6	Medical care	73	104	115

99.9	Total new obligations	441	518	565


Identification code 75–0170–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Medicare eligible accruals	36	38	39

0900	Total new obligations (object class 12.2)	36	38	39

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	36	38	39
1930	Total budgetary resources available	36	38	39

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	36	38	39
3040	Outlays (gross)	–36	–38	–39

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	36	38	39
	Outlays, gross:
4010	Outlays from new discretionary authority	36	38	39
4180	Budget authority, net (total)	36	38	39
4190	Outlays, net (total)	36	38	39

The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).


Identification code 75–9913–0–1–552		2010 actual	CR	2012 est.

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1	1	1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1	1	1
4180	Budget authority, net (total)
4190	Outlays, net (total)

This display shows activities in support of St. Elizabeths Hospital and scientific activities overseas that were supported by foreign currencies by the United States abroad.


Identification code 75–9941–0–4–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0801	Program support center	884	1,099	1,044
0802	OS activities	53	68	65

0900	Total new obligations	937	1,167	1,109

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	191	180	180
1021	Recoveries of prior year unpaid obligations	32

1050	Unobligated balance (total)	223	180	180
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	850	1,167	1,109
1701	Change in uncollected payments, Federal sources	44

1750	Spending auth from offsetting collections, disc (total)	894	1,167	1,109
1930	Total budgetary resources available	1,117	1,347	1,289
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	180	180	180

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	307	384	384
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–396	–440	–440

3020	Obligated balance, start of year (net)	–89	–56	–56
3030	Obligations incurred, unexpired accounts	937	1,167	1,109
3040	Outlays (gross)	–828	–1,167	–1,109
3050	Change in uncollected pymts, Fed sources, unexpired	–44
3080	Recoveries of prior year unpaid obligations, unexpired	–32
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	384	384	384
3091	Uncollected pymts, Fed sources, end of year	–440	–440	–440

3100	Obligated balance, end of year (net)	–56	–56	–56

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	894	1,167	1,109
	Outlays, gross:
4010	Outlays from new discretionary authority	642	1,167	1,109
4011	Outlays from discretionary balances	186

4020	Outlays, gross (total)	828	1,167	1,109
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–844	–1,167	–1,109
4033	Non-Federal sources	–6

4040	Offsets against gross budget authority and outlays (total)	–850	–1,167	–1,109
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–44

4070	Budget authority, net (discretionary)
4080	Outlays, net (discretionary)	–22
4180	Budget authority, net (total)
4190	Outlays, net (total)	–22

HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support, information technology, financial management operations, and administrative services, including acquisitions management, building and property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational Health Service. The Office of Secretary activities include the fund manager, departmental contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization, small business, grants tracking, the physical access aspects of the Department's implementation of Homeland Security Presidential Directive 12, and commercial services management.

Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either through an allocation account or by directly citing that agency's appropriation.


Identification code 75–9941–0–4–551		2010 actual	CR	2012 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	106	120	124
11.3	Other than full-time permanent	4	5	5
11.5	Other personnel compensation	3	3	4
11.7	Military personnel	9	10	11
11.8	Special personal services payments	10	11	11

11.9	Total personnel compensation	132	149	155
12.1	Civilian personnel benefits	30	37	38
12.2	Military personnel benefits	5	8	6
21.0	Travel and transportation of persons	2	5	4
22.0	Transportation of things	4	4	4
23.1	Rental payments to GSA	17	19	20
23.3	Communications, utilities, and miscellaneous charges	39	46	46
24.0	Printing and reproduction	2	1	1
25.1	Advisory and assistance services	32	44	34
25.2	Other services from non-federal sources	477	599	572
25.3	Other goods and services from federal sources	52	86	55
25.4	Operation and maintenance of facilities	5	6	6
25.6	Medical care	19	24	24
25.7	Operation and maintenance of equipment	69	88	89
25.8	Subsistence and support of persons	6
26.0	Supplies and materials	34	38	41
31.0	Equipment	10	10	11
41.0	Grants, subsidies, and contributions	2	3	3

99.0	Reimbursable obligations	937	1,167	1,109

99.9	Total new obligations	937	1,167	1,109


Identification code 75–9941–0–4–551		2010 actual	CR	2012 est.

2001	Reimbursable civilian full-time equivalent employment	1,243	1,267	1,267
2101	Reimbursable military average strength employment	117	117	117
3101	Allocation account military average strength employment	782	800	820
3101	Allocation account military average strength employment	744	860	906

Trust Funds


Identification code 75–9971–0–7–551		2010 actual	CR	2012 est.

0100	Balance, start of year	45
	Adjustments:
0191	Adjustment - correction of prior budget entries	–45

0199	Balance, start of year
	Receipts:
0220	Contributions, Indian Health Facilities	72	33	33
0221	Contributions, N.I.H., Unconditional Gift Fund	1	7	7
0222	Centers for Disease Control, Gifts and Donations	13	6	6
0223	Contributions, N.I.H., Conditional Gift Fund	51	34	34
0224	Gifts and Contributions, Miscellaneous Trust Funds	10
0240	Interest, Miscellaneous Trust Funds		2	2

0299	Total receipts and collections	147	82	82

0400	Total: Balances and collections	147	82	82
	Appropriations:
0500	Miscellaneous Trust Funds	–149	–82	–82

0599	Total appropriations	–149	–82	–82
0795	Rounding adjustment	2

0799	Balance, end of year


Identification code 75–9971–0–7–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0002	Gifts	44	49	49
0003	Contributions, Indian Health Facilities	82	33	33

0091	Direct program activities, subtotal	126	82	82
0801	Reimbursable program activity	64

0900	Total new obligations	190	82	82

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	116	149	149
1021	Recoveries of prior year unpaid obligations	10

1050	Unobligated balance (total)	126	149	149
	Budget authority:
	Appropriations, mandatory:
1202	Appropriation (trust fund)	149	82	82
	Spending authority from offsetting collections, mandatory:
1800	Collected	58	6
1801	Change in uncollected payments, Federal sources	6	–6

1850	Spending auth from offsetting collections, mand (total)	64
1900	Budget authority (total)	213	82	82
1930	Total budgetary resources available	339	231	231
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	149	149	149

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	163	171	171
3010	Uncollected pymts, Fed sources, brought forward, Oct 1		–6

3020	Obligated balance, start of year (net)	163	165	171
3030	Obligations incurred, unexpired accounts	190	82	82
3040	Outlays (gross)	–172	–82	–82
3050	Change in uncollected pymts, Fed sources, unexpired	–6	6
3080	Recoveries of prior year unpaid obligations, unexpired	–10
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	171	171	171
3091	Uncollected pymts, Fed sources, end of year	–6

3100	Obligated balance, end of year (net)	165	171	171

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	213	82	82
	Outlays, gross:
4100	Outlays from new mandatory authority	5	8	8
4101	Outlays from mandatory balances	167	74	74

4110	Outlays, gross (total)	172	82	82
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–58	–6
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–6	6
4142	Offsetting collections credited to expired accounts

4150	Additional offsets against budget authority only (total)	–6	6

4160	Budget authority, net (mandatory)	149	82	82
4170	Outlays, net (mandatory)	114	76	82
4180	Budget authority, net (total)	149	82	82
4190	Outlays, net (total)	114	76	82

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	49	39	41
5001	Total investments, EOY: Federal securities: Par value	39	41	41


	2010	2011	2012

Distribution of budget authority by account:
Gifts	44	49	49
Contributions, Indian Health Facilities	105	33	33
Distribution of outlays by account:
Gifts	34	45	49
Contributions, Indian Health Facilities	80	31	33

Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction, improvement, extension, and provision of sanitation facilities.


Identification code 75–9971–0–7–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	2	2	2
11.3	Other than full-time permanent	1	1	1
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	4	4	4
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	2	1	1
25.1	Advisory and assistance services	3	4	4
25.2	Other services from non-federal sources	54	19	19
25.3	Other goods and services from federal sources	1	2	2
25.4	Operation and maintenance of facilities		2	2
25.5	Research and development contracts	5	12	12
25.6	Medical care	1	1	1
26.0	Supplies and materials	6	4	4
31.0	Equipment	1	2	2
32.0	Land and structures		1	1
41.0	Grants, subsidies, and contributions	48	29	29

99.0	Direct obligations	126	82	82
99.0	Reimbursable obligations	64

99.9	Total new obligations	190	82	82


Identification code 75–9971–0–7–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	28	28	28

Federal Funds

For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations, in carrying out the provisions of the Inspector General Act of 1978, [$51,754,000] $53,329,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary of Health and Human Services and investigating non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228: Provided further, That, in addition to amounts provided herein, $10,000,000 shall be available from amounts available under section 241 of the Public Health Services Act to, consistent with the independence accorded by the Inspector General Act of 1978 (5 U.S.C. App.), carry out the responsibilities of the Inspector General to prevent and detect fraud and abuse and promote economy and efficiency in the Department of Health and Human Services programs and operations. Note.—A full-year 2011 appropriation for this account was not enacted at the time the budget was prepared; therefore, this account is operating under a continuing resolution (P.L. 111–242, as amended). The amounts included for 2011 reflect the annualized level provided by the continuing resolution.


Identification code 75–0128–0–1–551		2010 actual	CR	2012 est.

	Obligations by program activity:
0001	Direct program	88	87	69
0801	HCFAC Reimbursable program	189	207	208
0802	Direct Reimbursable program	17	21	30
0803	HCFAC Discretionary allocation adjustment	18	30	98

0899	Total reimbursable obligations	224	258	336

0900	Total new obligations	312	345	405

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	82	68	40
1012	Expired unobligated bal transferred to unexpired accts	3	9	7

1050	Unobligated balance (total)	85	77	47
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	50	50	53
	Appropriations, mandatory:
1200	Appropriation	25
	Spending authority from offsetting collections, discretionary:
1700	Collected	14	51	128
1701	Change in uncollected payments, Federal sources	21

1750	Spending auth from offsetting collections, disc (total)	35	51	128
	Spending authority from offsetting collections, mandatory:
1800	Collected	176	207	208
1801	Change in uncollected payments, Federal sources	10

1850	Spending auth from offsetting collections, mand (total)	186	207	208
1900	Budget authority (total)	296	308	389
1930	Total budgetary resources available	381	385	436
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	68	40	31

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	75	76	56
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–32	–40	–40

3020	Obligated balance, start of year (net)	43	36	16
3030	Obligations incurred, unexpired accounts	312	345	405
3031	Obligations incurred, expired accounts	1
3040	Outlays (gross)	–304	–365	–398
3050	Change in uncollected pymts, Fed sources, unexpired	–31
3051	Change in uncollected pymts, Fed sources, expired	23
3081	Recoveries of prior year unpaid obligations, expired	–8
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	76	56	63
3091	Uncollected pymts, Fed sources, end of year	–40	–40	–40

3100	Obligated balance, end of year (net)	36	16	23

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	85	101	181
	Outlays, gross:
4010	Outlays from new discretionary authority	63	94	173
4011	Outlays from discretionary balances	19	29	12

4020	Outlays, gross (total)	82	123	185
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–17	–51	–128
4033	Non-Federal sources	–10

4040	Offsets against gross budget authority and outlays (total)	–27	–51	–128
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–21
4052	Offsetting collections credited to expired accounts	13

4060	Additional offsets against budget authority only (total)	–8

4070	Budget authority, net (discretionary)	50	50	53
4080	Outlays, net (discretionary)	55	72	57
	Mandatory:
4090	Budget authority, gross	211	207	208
	Outlays, gross:
4100	Outlays from new mandatory authority	164	207	208
4101	Outlays from mandatory balances	58	35	5

4110	Outlays, gross (total)	222	242	213
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–155	–195	–196
4123	Non-Federal sources	–31	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–186	–207	–208
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–10
4142	Offsetting collections credited to expired accounts	10

4160	Budget authority, net (mandatory)	25
4170	Outlays, net (mandatory)	36	35	5
4180	Budget authority, net (total)	75	50	53
4190	Outlays, net (total)	91	107	62

The Office of Inspector General (OIG) is an independent oversight organization within the U.S. Department of Health and Human Services (HHS) that promotes economy, efficiency, and effectiveness through the elimination of fraud, waste, and abuse in the Department's programs and operations. OIG fulfills its mission through a broad range of audits, evaluations, investigations, and enforcement and compliance activities. In addition to discretionary and supplemental appropriations, OIG receives funds through the Health Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996. The following table shows total appropriated funding for OIG:


	2010 actual	2011 est.	2012 est.

Discretionary Appropriation	50	50	53
PHS Evaluation Funds	0	0	10
HCFAC - Mandatory	177	198	193
HCFAC - Discretionary Allocation Adjustment	30	30	98

DRA - Medicaid Integrity Program1	25	0	0

Total	282	278	354


Identification code 75–0128–0–1–551		2010 actual	CR	2012 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	45	46	31
11.3	Other than full-time permanent	1	2	1
11.5	Other personnel compensation	1	1	1

11.9	Total personnel compensation	47	49	33
12.1	Civilian personnel benefits	15	15	10
21.0	Travel and transportation of persons	4	3	3
23.1	Rental payments to GSA	5	5	5
23.3	Communications, utilities, and miscellaneous charges	1	1	2
25.2	Other services from non-federal sources	2	2	2
25.3	Other goods and services from federal sources	7	6	7
25.4	Operation and maintenance of facilities	1	1	1
26.0	Supplies and materials	1	1	1
31.0	Equipment	5	4	5

99.0	Direct obligations	88	87	69
99.0	Reimbursable obligations	224	258	336

99.9	Total new obligations	312	345	405


Identification code 75–0128–0–1–551		2010 actual	CR	2012 est.

1001	Direct civilian full-time equivalent employment	515	477	334
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	1,066	1,233	1,640
2101	Reimbursable military average strength employment		1	1


		2010 actual	CR	2012 est.

Offsetting receipts from the public:
75–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	113	90	90
75–274530	Health Education Assistance Loans, Downward Reestimates of Subsidies	10
75–310700	Federal Share of Child Support Collections	806	846	835
75–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	44	56	56
General Fund Offsetting receipts from the public		973	992	981


Intragovernmental payments:
75–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	86

General Fund Intragovernmental payments		86

Note.—Obligations incurred under allocations from other accounts are included in the schedules of the parent appropriations as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."

(1) The Secretary of Health and Human Services may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department Basic Authorities Act of 1956. The Secretary of Health and Human Services shall consult with the Secretary of State and relevant Chief of Mission to ensure that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act of 1980 and other applicable statutes administered by the Department of State.

(2) The Secretary of Health and Human Services is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States for the use of the Department of Health and Human Services. The Department of State shall cooperate fully with the Secretary of Health and Human Services to ensure that the Department of Health and Human Services has secure, safe, functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements and serve the purposes established by this Act. The Secretary of Health and Human Services is authorized, in consultation with the Secretary of State, through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases, chronic and environmental diseases, and other health activities abroad.

(3) The Secretary of Health and Human Services is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through 4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign Service Act of 1980, to individuals serving in the Foreign Service.

(b) Peer Review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the Public Health Service Act.

(b) TRANSFER OF FUNCTIONS, ASSETS, AND LIABILITIES. The functions, assets, and liabilities of the Secretary of Health and Human Services relating to such program shall be transferred to the Secretary of Education;

(c) USE OF AUTHORITIES UNDER HIGHER EDUCATION ACT OF 1965—In servicing, collecting, and enforcing the loans described in subsection (a), the Secretary of Education shall have available any and all authorities available to such Secretary in servicing, collecting, or enforcing a loan made, insured, or guaranteed under part B of title IV of the Higher Education Act of 1965;

() (d) CONFORMING AMENDMENTS. Effective as of the date on which the transfer of the HEAL program under subsection (a) takes effect, section 719 of the Public Health Service Act (42 U.S.C. 292) is amended by adding at the end the following new paragraph: "(6) The term "Secretary" means the Secretary of Education.".

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

salaries and expenses

buildings and facilities

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

health resources and services

Primary Health Care Access

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Health Center Guaranteed Loan Financing Account

health education assistance loans program account

Health Education Assistance Loans Financing Account

Health Education Assistance Loans Liquidating Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

vaccine injury compensation program trust fund

Indian Health Services

Federal Funds

indian health services

indian health facilities

ADMINISTRATIVE PROVISIONS

administrative provisions, indian health service

Centers for Disease Control and Prevention

Federal Funds

disease control, research, and training

Agency for Toxic Substances and Disease Registry

toxic substances and environmental public health

National Institutes of Health

Federal Funds

National Institutes of Health

national cancer institute

national heart, lung, and blood institute

national institute of dental and craniofacial research

national institute of diabetes and digestive and kidney diseases

national institute of neurological disorders and stroke

national institute of allergy and infectious diseases

(including transfer of funds)

national institute of general medical sciences

eunice kennedy shriver national institute of child health and human development

national eye institute

national institute of environmental health sciences

national institute on aging

national institute of arthritis and musculoskeletal and skin diseases

national institute on deafness and other communication disorders

national institute of nursing research

national institute on alcohol abuse and alcoholism

national institute on drug abuse

national institute of mental health

national human genome research institute

national institute of biomedical imaging and bioengineering

national center for research resources

national center for complementary and alternative medicine

national institute [ center ] on minority health and health disparities

john e. fogarty international center

national library of medicine

office of the director

buildings and facilities

Substance Abuse and Mental Health Services Administration

Federal Funds

substance abuse and mental health services

Agency for Healthcare Research and Quality

Federal Funds

healthcare research and quality

Centers for Medicare and Medicaid Services

Federal Funds

grants to states for medicaid

Grants to States for Medicaid

(Legislative proposal, not subject to PAYGO)

Grants to States for Medicaid

(Legislative proposal, subject to PAYGO)

State Grants and Demonstrations

State Grants and Demonstrations

(Legislative proposal, subject to PAYGO)

payments to health care trust funds