DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; [$3,788,336,000] $3,083,408,000: Provided, That, of the amount provided under this heading, [$702,172,000 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 2013 but collected in fiscal year 2012; $57,605,000 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; $21,768,000] $30,530,000 shall be derived from animal drug user fees authorized by section 740 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-12), and shall be credited to this account and remain available until expended; [$5,706,000] $7,595,000 shall be derived from animal generic drug user fees authorized by section 741 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-21), and shall be credited to this account and shall remain available until expended; [$477,000,000] $505,000,000 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] $12,925,000 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 amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; [$14,700,000] $15,367,000 shall be derived from food reinspection fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), 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] animal drug user fees and animal generic drug user fees that exceed the respective fiscal year [2012] 2013 limitations 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 [,] and animal generic drug[, and tobacco product] assessments for fiscal year [2012] 2013 received during fiscal year [2012] 2013, including any such fees assessed prior to fiscal year [2012] 2013 but credited for fiscal year [2012] 2013, shall be subject to the fiscal year [2012] 2013 limitations: Provided further, That [none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: Provided further, That of the total amount appropriated: (1) $882,747,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs; (2) $978,705,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs, of which no less than $52,947,000 shall be available for the Office of Generic Drugs; (3) $329,136,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $166,365,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $356,909,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $60,039,000 shall be for the National Center for Toxicological Research; (7) $454,751,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $131,639,000 shall be for Rent and Related activities, of which $43,981,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) not to exceed $205,472,000 shall be for payments to the General Services Administration for rent; and (10) $222,573,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Foods, the Office of Medical and Tobacco Products, the Office of Global and Regulatory Policy, the Office of Operations, the Office of the Chief Scientist, and central services for these offices:] the Secretary may, prior to the due date for such fees, accept payment of animal drug user fees and animal generic drug user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner[: Provided further, That funds may be transferred from one specified activity to another with the prior approval of the Committees on Appropriations of both Houses of Congress].

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

Buildings and Facilities

For plans, construction, repair, improvement, extension, alteration, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided, [$8,788,000] $5,320,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2012.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9911–0–1–554 2011 actual 2012 est. 2013 est.

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



0400 Total: Balances and collections 1 3 4
Appropriations:
0500 Salaries and Expenses –1 –2 –2



0799 Balance, end of year 1 2

Program and Financing (in millions of dollars)


Identification code 75–9911–0–1–554 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Foods 836 1,004 992
0002 Drugs 829 690 683
0003 Devices and radiological products 322 322 319
0004 National Center for Toxicological Research 61 60 60
0005 Other activities 149 154 163
0006 Other rent and rent related activities 99 106 127
0007 Rental payments 151 161 169
0008 Buildings and facilities 13 9 5
0009 CRADAs 2 3 3



0799 Total direct obligations 2,462 2,509 2,521
0801 Reimbursable program 919 1,321 675



0900 Total new obligations 3,381 3,830 3,196

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 587 582 814
1020 Adjustment of unobligated bal brought forward, Oct 1 –293



1050 Unobligated balance (total) 294 582 814
Budget authority:
Appropriations, discretionary:
1100 Appropriation 2,462 2,506 2,517
1130 Appropriations permanently reduced –5



1160 Appropriation, discretionary (total) 2,457 2,506 2,517
Appropriations, mandatory:
1201 Appropriation (special or trust fund) 1 2 2



1260 Appropriations, mandatory (total) 1 2 2
Spending authority from offsetting collections, discretionary:
1700 Collected 1,239 1,554 675
1701 Change in uncollected payments, Federal sources 26
1702 Offsetting collections (previously unavailable) 386 333 333
1725 Spending authority from offsetting collections precluded from obligation (limitation on obligations) –440 –333 –333



1750 Spending auth from offsetting collections, disc (total) 1,211 1,554 675
1900 Budget authority (total) 3,669 4,062 3,194
1930 Total budgetary resources available 3,963 4,644 4,008
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 582 814 812

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 1,363 1,460 1,163
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –52 –46 –46



3020 Obligated balance, start of year (net) 1,311 1,414 1,117
3030 Obligations incurred, unexpired accounts 3,381 3,830 3,196
3031 Obligations incurred, expired accounts 9
3040 Outlays (gross) –3,253 –4,127 –3,173
3050 Change in uncollected pymts, Fed sources, unexpired –26
3051 Change in uncollected pymts, Fed sources, expired 32
3081 Recoveries of prior year unpaid obligations, expired –40
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 1,460 1,163 1,186
3091 Uncollected pymts, Fed sources, end of year –46 –46 –46



3100 Obligated balance, end of year (net) 1,414 1,117 1,140

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,668 4,060 3,192
Outlays, gross:
4010 Outlays from new discretionary authority 2,398 3,158 2,286
4011 Outlays from discretionary balances 854 967 885



4020 Outlays, gross (total) 3,252 4,125 3,171
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –81 –67 –67
4033 Non-Federal sources –1,187 –1,487 –608



4040 Offsets against gross budget authority and outlays (total) –1,268 –1,554 –675
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –26
4052 Offsetting collections credited to expired accounts 29



4060 Additional offsets against budget authority only (total) 3



4070 Budget authority, net (discretionary) 2,403 2,506 2,517
4080 Outlays, net (discretionary) 1,984 2,571 2,496
Mandatory:
4090 Budget authority, gross 1 2 2
Outlays, gross:
4100 Outlays from new mandatory authority 1 2 2
4180 Budget authority, net (total) 2,404 2,508 2,519
4190 Outlays, net (total) 1,985 2,573 2,498

Memorandum (non-add) entries:
5090 Unavailable balance, SOY: Offsetting collections 65 119 119
5091 Unavailable balance, EOY: Offsetting collections 119 119 119

[In millions of dollars]


2011 2012 2013

Distribution of discretionary budget authority by account:
Salaries and expenses 2447 2497 2511
Buildings and facilities 10 9 5
Distribution of discretionary outlays by account:
Salaries and expenses 1975 2563 2491
Buildings and facilities 9 8 4

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.

Object Classification (in millions of dollars)


Identification code 75–9911–0–1–554 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 749 760 764
11.3 Other than full-time permanent 105 106 107
11.5 Other personnel compensation 59 60 60
11.7 Military personnel 58 59 61
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 972 986 993
12.1 Civilian personnel benefits 260 264 265
12.2 Military personnel benefits 29 30 31
13.0 Benefits for former personnel 2
21.0 Travel and transportation of persons 50 51 51
22.0 Transportation of things 5 5 5
23.1 Rental payments to GSA 151 161 169
23.2 Rental payments to others 2 2 2
23.3 Communications, utilities, and miscellaneous charges 56 57 57
24.0 Printing and reproduction 2 2 2
25.1 Advisory and assistance services 42 43 43
25.2 Other services from non-Federal sources 423 434 430
25.3 Other goods and services from Federal sources 113 114 113
25.4 Operation and maintenance of facilities 106 107 107
25.5 Research and development contracts 34 34 34
25.7 Operation and maintenance of equipment 31 31 31
26.0 Supplies and materials 46 46 46
31.0 Equipment 57 57 57
32.0 Land and structures 6 6 6
41.0 Grants, subsidies, and contributions 75 77 77
42.0 Insurance claims and indemnities 2 2



99.0 Direct obligations 2,462 2,509 2,521
99.0 Reimbursable obligations 919 1,321 675



99.9 Total new obligations 3,381 3,830 3,196

Employment Summary


Identification code 75–9911–0–1–554 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 9,103 9,335 7,584
1101 Direct military average strength employment 692 692 492
2001 Reimbursable civilian full-time equivalent employment 3,191 3,300 2,621
2101 Reimbursable military average strength employment 243 243 172
3001 Allocation account civilian full-time equivalent employment 65 67 54
3101 Allocation account military average strength employment 1 1 1

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Contingent upon the enactment of legislation authorizing user fees with respect to biosimilar biological products and human generic drugs, such fees shall be credited to this account and remain available until expended: Provided, That, with respect to such fees authorized for fiscal year 2014, the Secretary may, prior to the due date for such fees, accept payment of such fees and such payments shall be credited to this account for fiscal year 2014.

In addition, contingent upon the enactment of legislation authorizing user fees with respect to food inspections and food facility registrations, food contact notification activities, reinspection of medical product facilities, cosmetic activities, and international express courier import activities, such fees shall be credited to this account and remain available until expended.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities and medical device review activities: Provided, That fees of $712,808,000, for prescription drug reviews, shall be credited to this account and remain available until expended; and $69,700,000, for medical device reviews, 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 and medical device user fees that exceed the respective fiscal year 2013 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug reviews and medical device reviews for fiscal year 2013 received during fiscal year 2013, including any such fees assessed prior to fiscal year 2013 but credited for fiscal year 2013, shall be subject to the fiscal year 2013 limitations: Provided further, That the Secretary may, prior to the due date for such fees, accept payment of prescription drug user fees and medical device user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading.

Program and Financing (in millions of dollars)


Identification code 75–9911–2–1–554 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0801 PDUFA 713
0802 MDUFMA 70
0803 Generic Drug User Fee 299
0804 Biosimilar User Fees 20
0805 Reinspection (Drugs) 15
0806 Food Inspection and Registration Fee 220
0807 International Courier User Fee 6
0808 Cosmetic and Food Contact Notification User Fee 5
0810 Cosmetic User Fee 19



0900 Total new obligations 1,367

Budgetary Resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700 Collected 1,367



1750 Spending auth from offsetting collections, disc (total) 1,367
1930 Total budgetary resources available 1,367

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 1,367
3040 Outlays (gross) –1,367

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 1,367
Outlays, gross:
4010 Outlays from new discretionary authority 1,367
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033 Non-Federal sources –1,367

The 2013 Budget includes a number of new and current user fees. Legislation will be proposed to allow FDA to collect fees to support human generic drug review as well as for the evaluation of biosimilar biological product applications. The additional resources, estimated at $299 million for the human generic drug program, would enable FDA to reduce review times and respond to the growing number of generic drug applications. The fees collected for biosimilars would ensure sound funding for the review of biosimilar applications including the development-phase FDA consultation and review work. The Budget also proposes user fees to support activities related to cosmetics and food contact notification activities. In addition, the Budget reproposes user fees to support inspection-related activities at domestic courier facilities and reinspections at medical product facilities.

Lastly, the Budget includes a total of $712 million in prescription drug user fees and $70 million in medical device user fees. The FDA transmitted proposed legislation to reauthorize PDUFA and establish new generic drug and biosimilar user fees to Congress on January 13, 2012. The proposed legislation authorizes the collection and spending of these fees subject to appropriations.

Object Classification (in millions of dollars)


Identification code 75–9911–2–1–554 2011 actual 2012 est. 2013 est.

99.9 Total new obligations 1,367

Employment Summary


Identification code 75–9911–2–1–554 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 2,648
1101 Direct military average strength employment 200
2001 Reimbursable civilian full-time equivalent employment 928
2101 Reimbursable military average strength employment 71
3001 Allocation account civilian full-time equivalent employment 19
3101 Allocation account military average strength employment

Revolving Fund for Certification and Other Services

Program and Financing (in millions of dollars)


Identification code 75–4309–0–3–554 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0801 Reimbursable program 8 8 8

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 2 2 2
Budget authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 8 8 8



1850 Spending auth from offsetting collections, mand (total) 8 8 8
1930 Total budgetary resources available 10 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 8 8 8
3040 Outlays (gross) –8 –9 –9
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 3 2 1



3100 Obligated balance, end of year (net) 3 2 1

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



4110 Outlays, gross (total) 8 9 9
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –8 –8 –8
4190 Outlays, net (total) 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.

Object Classification (in millions of dollars)


Identification code 75–4309–0–3–554 2011 actual 2012 est. 2013 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 1



99.9 Total new obligations 8 8 8

Employment Summary


Identification code 75–4309–0–3–554 2011 actual 2012 est. 2013 est.

2001 Reimbursable civilian full-time equivalent employment 37 37 38

Health Resources and Services Administration

Federal Funds

Health Resources and Services

Primary Health Care

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,598,957,000] $1,579,975,000, of which [$129,000] $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: Provided, That no more than $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 [$95,073,000] $94,893,000 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 (referred to in this Act as "HHS'') pertaining to administrative claims made under such law.

Health Workforce

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$734,402,000] $522,187,000: Provided, That sections 747(c)(2), [751(j)(2)] 340G-1(b) and (d), 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 under this heading: [Provided further, That for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as "Secretary'') may waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act:] 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 such 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 fees collected for the disclosure of information under the information reporting requirement program authorized by section 1921 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 funds transferred to this account to carry out 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 such sections: Provided further, That, in addition to amounts appropriated under this heading, $35,000,000 shall be available under section 241 of the PHS Act to carry out titles VII and VIII of the PHS Act: Provided further, That, of the amount appropriated under this heading, $88,000,000 shall be for payments to children's hospitals pursuant to section 340E of the PHS Act, all of which shall be for payments for direct graduate medical education as described in section 340E(c).

Maternal and Child Health

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social Security Act, and section 712 of the American Jobs Creation Act of 2004, [$863,607,000] $854,807,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than [$79,586,000] $78,641,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and [$10,400,000] $10,276,000 shall be available for projects described in paragraphs (A) through (F) of section 501(a)(3) of such Act.

Ryan White Hiv/Aids Program

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, [$2,326,665,000] $2,446,772,000, of which [$1,995,670,000] $2,093,599,000 shall remain available to the Secretary [of Health and Human Services] through September 30, 2014, for parts A and B of title XXVI of the PHS Act[, and of which] : Provided, That of the funds available for parts A and B of title XXVI of the PHS Act, not less than [$900,000,000] $1,000,000,000 shall be for State AIDS Drug Assistance Programs [under the authority of] pursuant to section 2616 or 311(c) of such Act: Provided further, That in addition to amounts provided herein, $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 Special Projects of National Significance under section 2691.

Health Care Systems

For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, [$83,526,000] $82,534,000: Provided, 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.

Rural Health

For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act, the Cardiac Arrest Survival Act of 2000, and sections 711 and 1820 of the Social Security Act, [$139,832,000] $122,232,000, of which [$41,118,000] $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: Provided, That, of the funds made available under this heading for Medicare rural hospital flexibility grants, [$15,000,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and] $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) 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 electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, [$10,055,000] $10,036,000 shall be available for State Offices of Rural Health.

Family Planning

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, [$297,400,000] $296,838,000: Provided, 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.

Program Management

For program support in the Health Resources and Services Administration, [$161,815,000] $162,517,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care'', "Health Workforce'', "Maternal and Child Health'', "Ryan White HIV/AIDS Program'', "Health Care Systems'', and "Rural Health'': Provided further, That the Administrator may transfer funds between any of the accounts of HRSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0350–0–1–550 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0010 Health Centers 1,481 1,467 1,467
0012 National Health Service Corps Recruitment 25
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 93 83 83
0017 Health Professions 405 376 345
0018 Maternal and Child Health Block Grant 656 639 640
0019 Healthy Start 104 103 103
0020 Poison Control Centers 22 19 19
0021 EMS for Children 21 21 21
0022 Universal Newborn Hearing Screening 19 19 19
0023 HIV/AIDS 2,310 2,375 2,447
0024 Organ Transplantation 25 24 24
0025 Bone Marrow Donor Registry 23 23 23
0026 Rural Health Policy Development 10 10 10
0027 Rural Health Outreach Grants 56 56 56
0028 Rural Health Flexibility Grants 41 41 26
0030 Telehealth 12 12 12
0031 Program Management 162 160 162
0032 Family Planning 298 294 297
0033 Loan Repayment/Faculty Fellowship 1 1 1
0035 Health Centers Tort Claim Fund 89 113 95
0036 Heritable Disorders 10 10 10
0038 Childrens' GME 268 265 88
0041 State Offices of Rural Health 10 10 10
0043 Radiogenic Diseases 2 2 2
0044 Traumatic Brain Injury 10 10 10
0045 Autism and Other Developmental Disorders 48 47 47
0046 Cord Blood Stem Cell Bank 12 12 12
0047 Free Clinics Medical Malpractice 1 2
0048 Sickle Cell 5 5 5
0049 Drug Pricing Program 4 4 4
0050 Family to Family Health Information Centers ACA 5 5
0052 Health Center Loan Subsidy 1
0067 Prevention Fund 20 75 10
0071 ARRA 74
0072 Infrastructure to Expand Access to Care ACA 100
0073 Health Centers ACA 998 1,150 1,200
0074 Health Centers Construction ACA 742 758
0075 National Health Service Corps ACA 289 296 300
0076 School Based Health Centers ACA 98 15 87
0077 GME Payments THC ACA 4 18 43
0079 Rural Health AED 1
0080 Pediatric Loan Repayment 5



0300 Total direct programs 8,579 8,546 7,708



0799 Total direct obligations 8,579 8,546 7,708
0801 Reimbursable program 62 66 72
0802 Reimbursable program: PHS evaluation 22 25 60



0899 Total reimbursable obligations 84 91 132



0900 Total new obligations 8,663 8,637 7,840

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 272 1,060 345
1021 Recoveries of prior year unpaid obligations 3



1050 Unobligated balance (total) 275 1,060 345
Budget authority:
Appropriations, discretionary:
1100 Appropriation 6,275 6,207 6,068
1121 Appropriations transferred from other accts [75–9915] 9
1121 Appropriations transferred from other accts [75–1362] 1
1121 Appropriations transferred from other accts [75–0943] 1
1130 Appropriations permanently reduced –13
1143 Approp permanently reduced (Sec 527, HR 2055) –12



1160 Appropriation, discretionary (total) 6,262 6,206 6,068
Appropriations, mandatory:
1200 Appropriation 3,075 1,550 1,850
1221 Appropriations transferred from other accts [75–0116] 20 75 10



1260 Appropriations, mandatory (total) 3,095 1,625 1,860
Spending authority from offsetting collections, discretionary:
1700 Collected 54 75 116
1701 Change in uncollected payments, Federal sources 24



1750 Spending auth from offsetting collections, disc (total) 78 75 116
Spending authority from offsetting collections, mandatory:
1800 Offsetting collections (cash)(HPSL&NSL) 16 16 16



1850 Spending auth from offsetting collections, mand (total) 16 16 16
1900 Budget authority (total) 9,451 7,922 8,060
1930 Total budgetary resources available 9,726 8,982 8,405
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3
1941 Unexpired unobligated balance, end of year 1,060 345 565

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 6,864 6,837 6,598
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –50 –42 –42



3020 Obligated balance, start of year (net) 6,814 6,795 6,556
3030 Obligations incurred, unexpired accounts 8,663 8,637 7,840
3031 Obligations incurred, expired accounts 1
3040 Outlays (gross) –8,582 –8,876 –8,168
3050 Change in uncollected pymts, Fed sources, unexpired –24
3051 Change in uncollected pymts, Fed sources, expired 32
3080 Recoveries of prior year unpaid obligations, unexpired –3
3081 Recoveries of prior year unpaid obligations, expired –106
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 6,837 6,598 6,270
3091 Uncollected pymts, Fed sources, end of year –42 –42 –42



3100 Obligated balance, end of year (net) 6,795 6,556 6,228

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 6,340 6,281 6,184
Outlays, gross:
4010 Outlays from new discretionary authority 2,589 2,521 2,508
4011 Outlays from discretionary balances 5,120 4,139 3,821



4020 Outlays, gross (total) 7,709 6,660 6,329
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –52 –52 –82
4033 Non-Federal sources –28 –23 –34



4040 Offsets against gross budget authority and outlays (total) –80 –75 –116
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –24
4052 Offsetting collections credited to expired accounts 26



4060 Additional offsets against budget authority only (total) 2



4070 Budget authority, net (discretionary) 6,262 6,206 6,068
4080 Outlays, net (discretionary) 7,629 6,585 6,213
Mandatory:
4090 Budget authority, gross 3,111 1,641 1,876
Outlays, gross:
4100 Outlays from new mandatory authority 818 863 870
4101 Outlays from mandatory balances 55 1,353 969



4110 Outlays, gross (total) 873 2,216 1,839
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –16 –16 –16
4180 Budget authority, net (total) 9,357 7,831 7,928
4190 Outlays, net (total) 8,486 8,785 8,036

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


Identification code 75–0350–0–1–550 2011 actual 2012 est. 2013 est.

Guaranteed loan levels supportable by subsidy budget authority:
215001 Health centers: Facilities renovation loan guarantee levels 32 8 8
215002 Health centers: Managed care network development loan guarantee 2 1
215003 Health centers: Managed care plan loan guarantee levels 5 3



215999 Total loan guarantee levels 32 15 12
Guaranteed loan subsidy (in percent):
232001 Health centers: Facilities renovation loan guarantee levels 2.72 2.67 2.16
232002 Health centers: Managed care network development loan guarantee 0.00 9.62 9.73
232003 Health centers: Managed care plan loan guarantee levels 0.00 5.76 5.79



232999 Weighted average subsidy rate 2.72 4.63 3.70
Guaranteed loan subsidy budget authority:
233001 Health centers: Facilities renovation loan guarantee levels 1



233999 Total subsidy budget authority 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 2013 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 2010–2011 data reported in the Annual Operating Report.

Health Professions Revolving Loan Programs Federal Capital Contribution


Program Account Balance

HPSL $370,561,960
NSL $168,761,018
PCL $249,867,755

LDS $129,792,459


Total $918,984,192


Object Classification (in millions of dollars)


Identification code 75–0350–0–1–550 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 148 147 151
11.3 Other than full-time permanent 5 6 6
11.5 Other personnel compensation 4 4 4
11.7 Military personnel 19 20 20
11.8 Special personal services payments 1



11.9 Total personnel compensation 177 177 181
12.1 Civilian personnel benefits 45 42 44
12.2 Military personnel benefits 8 11 11
21.0 Travel and transportation of persons 4 4 4
23.1 Rental payments to GSA 25 25 25
23.2 Rental payments to others 1 2 2
23.3 Communications, utilities, and miscellaneous charges 2 1 1
24.0 Printing and reproduction 1 1 1
25.1 Advisory and assistance services 38 38 38
25.2 Other services from non-Federal sources 180 156 156
25.3 Other goods and services from Federal sources 182 197 197
25.4 Operation and maintenance of facilities 2 1 1
25.6 Medical care 3 3 3
25.7 Operation and maintenance of equipment 13 14 14
26.0 Supplies and materials 1 1 1
31.0 Equipment 4 4 4
41.0 Grants, subsidies, and contributions 7,810 7,780 6,936
42.0 Insurance claims and indemnities 83 89 89



99.0 Direct obligations 8,579 8,546 7,708
99.0 Reimbursable obligations 84 91 132



99.9 Total new obligations 8,663 8,637 7,840

Employment Summary


Identification code 75–0350–0–1–550 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 1,539 1,528 1,505
1101 Direct military average strength employment 202 202 202
2001 Reimbursable civilian full-time equivalent employment 76 76 82
2101 Reimbursable military average strength employment 6 6 6

Vaccine Injury Compensation

Program and Financing (in millions of dollars)


Identification code 75–0320–0–1–551 2011 actual 2012 est. 2013 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

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.

Covered Countermeasure Process Fund

Program and Financing (in millions of dollars)


Identification code 75–0343–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Claims 2 1
0103 Admin Expense 3 3 4



0900 Total new obligations 3 5 5

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 2
1011 Unobligated balance transfer from other accts [75–0140] 5 3 5



1050 Unobligated balance (total) 5 5 5
1930 Total budgetary resources available 5 5 5
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 2

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 2 7
3030 Obligations incurred, unexpired accounts 3 5 5
3040 Outlays (gross) –1
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 2 7 12



3100 Obligated balance, end of year (net) 2 7 12

Budget authority and outlays, net:
Discretionary:
Outlays, gross:
4011 Outlays from discretionary balances 1
4190 Outlays, net (total) 1

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

Object Classification (in millions of dollars)


Identification code 75–0343–0–1–551 2011 actual 2012 est. 2013 est.

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



99.9 Total new obligations 3 5 5

Employment Summary


Identification code 75–0343–0–1–551 2011 actual 2012 est. 2013 est.

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

Maternal, Infant, and Early Childhood Home Visiting Programs

Program and Financing (in millions of dollars)


Identification code 75–0321–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0010 Maternal, Infant, and Early Childhood Home Visiting Programs 250 350 400

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation 250 350 400



1260 Appropriations, mandatory (total) 250 350 400
1930 Total budgetary resources available 250 350 400

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 99 313 577
3030 Obligations incurred, unexpired accounts 250 350 400
3040 Outlays (gross) –36 –86 –359
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 313 577 618



3100 Obligated balance, end of year (net) 313 577 618

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 250 350 400
Outlays, gross:
4100 Outlays from new mandatory authority 17 25 28
4101 Outlays from mandatory balances 19 61 331



4110 Outlays, gross (total) 36 86 359
4180 Budget authority, net (total) 250 350 400
4190 Outlays, net (total) 36 86 359

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.

Object Classification (in millions of dollars)


Identification code 75–0321–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 2 2 2
12.1 Civilian personnel benefits 1 1 1
25.1 Advisory and assistance services 15 15 15
41.0 Grants, subsidies, and contributions 232 332 382



99.9 Total new obligations 250 350 400

Employment Summary


Identification code 75–0321–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 16 16 16
1101 Direct military average strength employment 3 3 3

Health Center Guaranteed Loan Financing Account

Program and Financing (in millions of dollars)


Identification code 75–4442–0–3–551 2011 actual 2012 est. 2013 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 3 2
Financing authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 1



1850 Spending auth from offsetting collections, mand (total) 1
1930 Total budgetary resources available 3 3 2
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 3 2 1

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



3100 Obligated balance, end of year (net) 1 2

Financing authority and disbursements, net:
Mandatory:
4090 Financing authority, gross 1
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120 Federal sources –1
4190 Financing disbursements, net (total) –1

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4442–0–3–551 2011 actual 2012 est. 2013 est.

Position with respect to appropriations act limitation on commitments:
2121 Limitation available from carry-forward 60 28 13
2143 Uncommitted limitation carried forward –28 –13



2150 Total guaranteed loan commitments 32 15 13
2199 Guaranteed amount of guaranteed loan commitments 26 13 10

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 65 80 82
2231 Disbursements of new guaranteed loans 25 13 10
2251 Repayments and prepayments –10 –10 –10
2263 Adjustments: Terminations for default that result in claim payments –1 –1



2290 Outstanding, end of year 80 82 81

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 72 69 68

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

Balance Sheet (in millions of dollars)


Identification code 75–4442–0–3–551 2010 actual 2011 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 4 3


1999 Total assets 4 3
LIABILITIES:
2204 Non-Federal liabilities: Liabilities for loan guarantees 4 3


4999 Total liabilities and net position 4 3

Health Education Assistance Loans Program Account

Such sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the PHS Act.

In addition, [For] for administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, [$2,841,000] $2,807,000. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0340–0–1–552 2011 actual 2012 est. 2013 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 2 3



0900 Total new obligations 29 3

Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3 3 3
1120 Appropriations transferred to other accts [91–0202] –3



1160 Appropriation, discretionary (total) 3 3
Appropriations, mandatory:
1200 Appropriation 26



1260 Appropriations, mandatory (total) 26
1900 Budget authority (total) 29 3
1930 Total budgetary resources available 29 3

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 29 3
3040 Outlays (gross) –29 –3
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 2 2 2



3100 Obligated balance, end of year (net) 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 26
Outlays, gross:
4100 Outlays from new mandatory authority 26
4180 Budget authority, net (total) 29 3
4190 Outlays, net (total) 29 3

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


Identification code 75–0340–0–1–552 2011 actual 2012 est. 2013 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 –12



237999 Total downward reestimate subsidy budget authority –12

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

In FY 2013 the Department of Education will assume responsibility for the program. Legislative language that would effect this transfer is included under General Provisions. The authority to administer, service, collect, and enforce the program as well as the functions, assets, and liabilities of the Secretary of Health and Human Services will be permanently transferred to the Secretary of Education.

Object Classification (in millions of dollars)


Identification code 75–0340–0–1–552 2011 actual 2012 est. 2013 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 2 3
25.3 Other goods and services from Federal sources 1
41.0 Grants, subsidies, and contributions 26



99.9 Total new obligations 29 3

Employment Summary


Identification code 75–0340–0–1–552 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 13 13

Health Education Assistance Loans Financing Account

Program and Financing (in millions of dollars)


Identification code 75–4304–0–3–552 2011 actual 2012 est. 2013 est.

Obligations by program activity:
Credit program obligations:
0711 Default claim payments on principal 15 14
0742 Downward reestimate paid to receipt account 5
0743 Interest on downward reestimates 7



0900 Total new obligations 15 26

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 49 70 52
1010 Unobligated balance transfer to other accts [91–4300] –52



1050 Unobligated balance (total) 49 70
Financing authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 36 8



1850 Spending auth from offsetting collections, mand (total) 36 8
1900 Financing authority(total) 36 8
1930 Total budgetary resources available 85 78
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 70 52

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 15 26
3040 Financing disbursements (gross) –15 –26

Financing authority and disbursements, net:
Mandatory:
4090 Financing authority, gross 36 8
Financing disbursements:
4110 Financing disbursements, gross 15 26
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120 Federal sources - upward reestimates and interest –26
4122 Interest on uninvested funds –4 –4
4123 Recoveries of defaulted loans –6 –4



4130 Offsets against gross financing auth and disbursements (total) –36 –8
4170 Financing disbursements, net (mandatory) –21 18
4190 Financing disbursements, net (total) –21 18

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4304–0–3–552 2011 actual 2012 est. 2013 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 627 526 499
2251 Repayments and prepayments –86 –13
Adjustments:
2261 Terminations for default that result in loans receivable –14 –10
2263 Terminations for default that result in claim payments –1 –4
2264 Other adjustments, net –499



2290 Outstanding, end of year 526 499

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 526 499

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 171 175 181
2331 Disbursements for guaranteed loan claims 14 10
2351 Repayments of loans receivable –6 –4
2361 Write-offs of loans receivable –1
2364 Other adjustments, net –3 –181



2390 Outstanding, end of year 175 181

Balance Sheet (in millions of dollars)


Identification code 75–4304–0–3–552 2010 actual 2011 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 49 70
Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501 Defaulted guaranteed loans receivable, gross 171 175
1505 Allowance for subsidy cost (-) –126 –126


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


1999 Total assets 94 119
LIABILITIES:
2204 Non-Federal liabilities: Liabilities for loan guarantees 94 119


4999 Total liabilities and net position 94 119

Health Education Assistance Loans Liquidating Account

Program and Financing (in millions of dollars)


Identification code 75–4305–0–3–552 2011 actual 2012 est. 2013 est.

Obligations by program activity:
Credit program obligations:
0711 Default claim payments on principal 3 2



0900 Total new obligations (object class 33.0) 3 2

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation 1 1



1260 Appropriations, mandatory (total) 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 –9



1850 Spending auth from offsetting collections, mand (total) 2 1
1900 Budget authority (total) 3 2
1930 Total budgetary resources available 3 2

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 3 2
3040 Outlays (gross) –3 –2

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 3 2
Outlays, gross:
4100 Outlays from new mandatory authority 3 2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –9 –10
4180 Budget authority, net (total) –6 –8
4190 Outlays, net (total) –6 –8

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4305–0–3–552 2011 actual 2012 est. 2013 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 103 83 69
2251 Repayments and prepayments –17 –12
Adjustments:
2261 Terminations for default that result in loans receivable –3 –2
2264 Other adjustments, net –69



2290 Outstanding, end of year 83 69

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 83 68

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 379 362 346
2331 Disbursements for guaranteed loan claims 3 3
2351 Repayments of loans receivable –9 –8
2361 Write-offs of loans receivable –21 –21
2364 Other adjustments, net 10 10 –346



2390 Outstanding, end of year 362 346

Balance Sheet (in millions of dollars)


Identification code 75–4305–0–3–552 2010 actual 2011 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 1 1
1701 Defaulted guaranteed loans, gross 379 362
1703 Allowance for estimated uncollectible loans and interest (-) –250 –238


1799 Value of assets related to loan guarantees 129 124


1999 Total assets 130 125
LIABILITIES:
2104 Federal liabilities: Resources payable to Treasury 122 119
2204 Non-Federal liabilities: Liabilities for loan guarantees 8 6


2999 Total liabilities 130 125


4999 Total liabilities and net position 130 125

Medical Facilities Guarantee and Loan Fund

Program and Financing (in millions of dollars)


Identification code 75–9931–0–3–551 2011 actual 2012 est. 2013 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



3100 Obligated balance, end of year (net) 1 1 1

Status of Direct Loans (in millions of dollars)


Identification code 75–9931–0–3–551 2011 actual 2012 est. 2013 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.

Balance Sheet (in millions of dollars)


Identification code 75–9931–0–3–551 2010 actual 2011 actual

ASSETS:
1601 Direct loans, gross 7 7


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


4999 Total liabilities and net position 7 7

Trust Funds

Vaccine Injury Compensation Program Trust Fund

For payments from the Vaccine Injury Compensation Program Trust Fund ("Trust Fund''), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed [$6,489,000] $6,477,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2012.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–8175–0–7–551 2011 actual 2012 est. 2013 est.

0100 Balance, start of year 2,960 3,115 3,205
Adjustments:
0190 Adjustment - rounding –1



0199 Balance, start of year 2,959 3,115 3,205
Receipts:
0200 Deposits, Vaccine Injury Compensation Trust Fund 278 274 283
0240 Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund 126 70 74



0299 Total receipts and collections 404 344 357



0400 Total: Balances and collections 3,363 3,459 3,562
Appropriations:
0500 Vaccine Injury Compensation Program Trust Fund –19 –19 –19
0501 Vaccine Injury Compensation Program Trust Fund –229 –235 –242



0599 Total appropriations –248 –254 –261



0799 Balance, end of year 3,115 3,205 3,301

Program and Financing (in millions of dollars)


Identification code 75–8175–0–7–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Compensation: Claims for post - FY 1989 injuries 231 235 242
0103 Claims processing (Claims Court) 5 5 5
0104 Claims processing (HRSA) 6 6 6
0105 Claims processing (Dept. of Justice) 6 8 8



0191 Total, administrative expenses 17 19 19



0799 Total direct obligations 248 254 261
0801 Reimbursable program activity (claims) 3



0900 Total new obligations 251 254 261

Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1101 Appropriation (special or trust fund) 19 19 19



1160 Appropriation, discretionary (total) 19 19 19
Appropriations, mandatory:
1201 Appropriation (special or trust fund) 229 235 242



1260 Appropriations, mandatory (total) 229 235 242
Spending authority from offsetting collections, mandatory:
1800 Collected 3



1850 Spending auth from offsetting collections, mand (total) 3
1900 Budget authority (total) 251 254 261
1930 Total budgetary resources available 251 254 261

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 16 19 9
3030 Obligations incurred, unexpired accounts 251 254 261
3040 Outlays (gross) –248 –264 –269
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 19 9 1



3100 Obligated balance, end of year (net) 19 9 1

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 19 19 19
Outlays, gross:
4010 Outlays from new discretionary authority 19 19
4011 Outlays from discretionary balances 13 10 8



4020 Outlays, gross (total) 13 29 27
Mandatory:
4090 Budget authority, gross 232 235 242
Outlays, gross:
4100 Outlays from new mandatory authority 232 235 242
4101 Outlays from mandatory balances 3



4110 Outlays, gross (total) 235 235 242
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –3
4180 Budget authority, net (total) 248 254 261
4190 Outlays, net (total) 245 264 269

Memorandum (non-add) entries:
5000 Total investments, SOY: Federal securities: Par value 2,939 3,108 3,452
5001 Total investments, EOY: Federal securities: Par value 3,108 3,452 3,809

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

Object Classification (in millions of dollars)


Identification code 75–8175–0–7–551 2011 actual 2012 est. 2013 est.

Direct obligations:
25.3 Other goods and services from Federal sources 17 19 19
42.0 Insurance claims and indemnities 231 235 242



99.0 Direct obligations 248 254 261
99.0 Reimbursable obligations 3



99.9 Total new obligations 251 254 261

Indian Health Service

Federal Funds

Indian Health Service

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, [$3,872,377,000,] $3,978,974,000, 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 [$844,927,000] $897,562,000 for contract medical care, including $51,500,000 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 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 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 notwithstanding any other provision of law, the amounts made available within this account for the methamphetamine and suicide prevention and treatment initiative and for the domestic violence prevention initiative shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 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 [$472,193,000] $476,446,000 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 2012, of which not to exceed $10,000,000 may be used for contract support costs associated with new or expanded self-determination contracts, grants, self-governance compacts, or annual funding agreements: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0390–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Clinical services 2,987 3,084 3,187
0002 Preventive health 144 147 151
0003 Urban health 43 43 43
0004 Indian health professions 41 41 41
0005 Tribal management 3 3 3
0006 Direct operations 69 72 73
0007 Self-governance 6 6 6
0008 Contract support costs 398 471 476
0009 Diabetes funds 121 150 150



0799 Total direct obligations 3,812 4,017 4,130
0801 Reimbursable program 1,125 1,132 1,132



0900 Total new obligations 4,937 5,149 5,262

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 434 744 776
1021 Recoveries of prior year unpaid obligations 179



1050 Unobligated balance (total) 613 744 776
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,673 3,872 3,979
1120 Transferred to other accounts [75–0390] –43
1121 Transferred from other accounts [75–0390] 43
1130 Appropriations permanently reduced –7
1141 Approp permanently reduced (Sec 436, HR 2055) –6



1160 Appropriation, discretionary (total) 3,666 3,866 3,979
Appropriations, mandatory:
1200 Appropriation 150 150 150



1260 Appropriations, mandatory (total) 150 150 150
Spending authority from offsetting collections, discretionary:
1700 Collected 1,155 1,165 1,165
1701 Change in uncollected payments, Federal sources 103



1750 Spending auth from offsetting collections, disc (total) 1,258 1,165 1,165
1900 Budget authority (total) 5,074 5,181 5,294
1930 Total budgetary resources available 5,687 5,925 6,070
Memorandum (non-add) entries:
1940 Unobligated balance expiring –6
1941 Unexpired unobligated balance, end of year 744 776 808

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 1,076 866 459
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –233 –331 –331



3020 Obligated balance, start of year (net) 843 535 128
3030 Obligations incurred, unexpired accounts 4,937 5,149 5,262
3031 Obligations incurred, expired accounts 22
3040 Outlays (gross) –4,973 –5,556 –5,482
3050 Change in uncollected pymts, Fed sources, unexpired –103
3051 Change in uncollected pymts, Fed sources, expired 5
3080 Recoveries of prior year unpaid obligations, unexpired –179
3081 Recoveries of prior year unpaid obligations, expired –17
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 866 459 239
3091 Uncollected pymts, Fed sources, end of year –331 –331 –331



3100 Obligated balance, end of year (net) 535 128 –92

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 4,924 5,031 5,144
Outlays, gross:
4010 Outlays from new discretionary authority 4,078 4,335 4,428
4011 Outlays from discretionary balances 839 1,068 898



4020 Outlays, gross (total) 4,917 5,403 5,326
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –366 –368 –368
4033 Non-Federal sources –792 –797 –797



4040 Offsets against gross budget authority and outlays (total) –1,158 –1,165 –1,165
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –103
4052 Offsetting collections credited to expired accounts 3



4060 Additional offsets against budget authority only (total) –100



4070 Budget authority, net (discretionary) 3,666 3,866 3,979
4080 Outlays, net (discretionary) 3,759 4,238 4,161
Mandatory:
4090 Budget authority, gross 150 150 150
Outlays, gross:
4100 Outlays from new mandatory authority 56 144 144
4101 Outlays from mandatory balances 9 12



4110 Outlays, gross (total) 56 153 156
4180 Budget authority, net (total) 3,816 4,016 4,129
4190 Outlays, net (total) 3,815 4,391 4,317

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.653 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2012.

Object Classification (in millions of dollars)


Identification code 75–0390–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 388 390 396
11.3 Other than full-time permanent 21 21 21
11.5 Other personnel compensation 57 58 58
11.7 Military personnel 78 79 82



11.9 Total personnel compensation 544 548 557
12.1 Civilian personnel benefits 136 137 139
12.2 Military personnel benefits 34 34 36
13.0 Benefits for former personnel 10 10 10
21.0 Travel and transportation of persons 12 11 13
21.0 Patient travel 30 30 30
22.0 Transportation of things 7 7 7
23.1 Rental payments to GSA 12 12 13
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 11 11 12
24.0 Printing and reproduction 1
25.1 Advisory and assistance services 13 10 10
25.2 Other services from non-Federal sources 80 102 114
25.3 Other goods and services from Federal sources 62 62 63
25.4 Operation and maintenance of facilities 4 4
25.6 Medical care 342 459 499
25.7 Operation and maintenance of equipment 12 12 12
25.8 Subsistence and support of persons 3 3 3
26.0 Supplies and materials 136 142 146
31.0 Equipment 14 14 14
32.0 Land and structures 1 1
41.0 Grants, subsidies, and contributions 2,351 2,406 2,446
42.0 Insurance claims and indemnities 1 1



99.0 Direct obligations 3,812 4,017 4,130
99.0 Reimbursable obligations 1,125 1,132 1,132



99.9 Total new obligations 4,937 5,149 5,262

Employment Summary


Identification code 75–0390–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 6,982 7,127 7,249
1101 Direct military average strength employment 1,090 1,103 1,112
2001 Reimbursable civilian full-time equivalent employment 5,349 5,356 5,362
2101 Reimbursable military average strength employment 835 828 822

Indian Health Facilities

For construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health and facilities support activities of the Indian Health Service, [$441,052,000] $443,502,000, to remain available until expended: Provided, That notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation or expansion of health facilities for the benefit of an 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 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 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 shall be placed in a Demolition Fund, to remain available until expended, and be used by the Indian Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0391–0–1–551 2011 actual 2012 est. 2013 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

Program and Financing (in millions of dollars)


Identification code 75–0391–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Sanitation and health facilities 154 165 161
0002 Maintenance 54 54 55
0003 Facilities and environmental health 193 199 205
0004 Equipment 23 23 23



0100 Total direct program 424 441 444



0799 Total direct obligations 424 441 444
0801 Reimbursable program 183 183 183



0900 Total new obligations 607 624 627

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 181 215 243
1021 Recoveries of prior year unpaid obligations 25



1050 Unobligated balance (total) 206 215 243
Budget authority:
Appropriations, discretionary:
1100 Appropriation 405 441 444
1130 Appropriations permanently reduced –1
1141 Approp permanently reduced (Sec 436, HR 2055) –1



1160 Appropriation, discretionary (total) 404 440 444
Appropriations, mandatory:
1201 Appropriation (special or trust fund) 8 8 8



1260 Appropriations, mandatory (total) 8 8 8
Spending authority from offsetting collections, discretionary:
1700 Collected 191 191 6
1701 Change in uncollected payments, Federal sources 13 13



1750 Spending auth from offsetting collections, disc (total) 204 204 6
1900 Budget authority (total) 616 652 458
1930 Total budgetary resources available 822 867 701
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 215 243 74

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 550 580 432
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –8 –21 –34



3020 Obligated balance, start of year (net) 542 559 398
3030 Obligations incurred, unexpired accounts 607 624 627
3040 Outlays (gross) –552 –772 –411
3050 Change in uncollected pymts, Fed sources, unexpired –13 –13
3080 Recoveries of prior year unpaid obligations, unexpired –25
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 580 432 648
3091 Uncollected pymts, Fed sources, end of year –21 –34 –34



3100 Obligated balance, end of year (net) 559 398 614

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 608 644 450
Outlays, gross:
4010 Outlays from new discretionary authority 260 336 139
4011 Outlays from discretionary balances 287 428 264



4020 Outlays, gross (total) 547 764 403
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –190 –190 –6
4033 Non-Federal sources –1 –1



4040 Offsets against gross budget authority and outlays (total) –191 –191 –6
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –13 –13



4070 Budget authority, net (discretionary) 404 440 444
4080 Outlays, net (discretionary) 356 573 397
Mandatory:
4090 Budget authority, gross 8 8 8
Outlays, gross:
4100 Outlays from new mandatory authority 3 8 8
4101 Outlays from mandatory balances 2



4110 Outlays, gross (total) 5 8 8
4180 Budget authority, net (total) 412 448 452
4190 Outlays, net (total) 361 581 405

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

Object Classification (in millions of dollars)


Identification code 75–0391–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 47 49 51
11.3 Other than full-time permanent 4 4 4
11.5 Other personnel compensation 3 3 3
11.7 Military personnel 22 23 24



11.9 Total personnel compensation 76 79 82
12.1 Civilian personnel benefits 15 16 16
12.2 Military personnel benefits 8 8 8
21.0 Travel and transportation of persons 3 3 3
22.0 Transportation of things 3 3 3
23.1 Rental payments to GSA 2 2 2
23.3 Communications, utilities, and miscellaneous charges 14 16 16
25.1 Advisory and assistance services 2 2 2
25.2 Other services from non-Federal sources 64 55 55
25.3 Other goods and services from Federal sources 1 1 2
25.4 Operation and maintenance of facilities 6 7 8
25.7 Operation and maintenance of equipment 3 3 4
25.8 Subsistence and support of persons 11 11 11
26.0 Supplies and materials 7 8 8
31.0 Equipment 8 9 9
32.0 Land and structures 23 17 17
41.0 Grants, subsidies, and contributions 178 201 198



99.0 Direct obligations 424 441 444
99.0 Reimbursable obligations 183 183 183



99.9 Total new obligations 607 624 627

Employment Summary


Identification code 75–0391–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 1,036 1,008 1,011
1101 Direct military average strength employment 168 167 169
2001 Reimbursable civilian full-time equivalent employment 25 25 25

ADMINISTRATIVE PROVISIONS

Administrative Provisions—Indian Health Service

Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C. 5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service: Provided, That 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: Provided further, That 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: Provided further, That 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: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That 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: Provided further, That 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: Provided further, That 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, and 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: Provided further, That 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: Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

Centers for Disease Control and Prevention

Federal Funds

CDC-Wide Activities and Program Support

Immunization and Respiratory Diseases

For carrying out titles II, III, VII, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, [$579,375,000] $583,855,000: Provided, That in addition to amounts provided herein, [$12,864,000] $13,765,000 shall be available from amounts available under section 241 of the PHS Act to carry out the National Immunization Surveys.

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention

For carrying out titles II, III, VII, XVII, XXIII, and XXVI of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, [$1,105,995,000] $1,145,678,000: Provided, That Centers for Disease Control and Prevention and State grant recipients may transfer up to ten 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.

Emerging and Zoonotic Infectious Diseases

For carrying out titles II, III, VII, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, [$253,919,000] $279,477,000, 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.

Chronic Disease Prevention and Health Promotion

For carrying out titles II, III, VII, XI, XV, XVII, and XIX of the PHS Act and section 4201 of the Patient Protection and Affordable Care Act, with respect to chronic disease prevention and health promotion, [$760,700,000] $608,019,000: Provided, That, in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out the Prevention Research Centers: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for [not less than] up to 21 States, tribes, or tribal organizations.

Birth Defects, Developmental Disabilities, Disabilities and Health

For carrying out titles II, III, VII, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, [$138,072,000] $18,476,000.

Public Health Scientific Services

For carrying out titles II and III of the PHS Act with respect to health statistics, surveillance, informatics, and workforce development, [$144,795,000] $35,695,000: Provided, That in addition to amounts provided herein, [$247,769,000] $379,374,000 shall be available from amounts available under section 241 of the PHS Act to carry out Public Health Scientific Services.

Environmental Health

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to environmental health, [$105,598,000] $103,672,000.

Injury Prevention and Control

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to injury prevention and control, [$138,480,000] $137,754,000: Provided, That funds appropriated under this heading may be used to fund evaluation, research, and pilot programs for sexual violence prevention programs.

National Institute for Occupational Safety and Health

For carrying out titles II, III, VII, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety and Health Act, with respect to occupational safety and health, [$182,903,000: Provided, That in addition to amounts provided herein, $110,724,000] $249,364,000 shall be available from amounts available under section 241 of the PHS Act.

Energy Employees Occupational Illness Compensation Program

For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain available until expended[, of which $4,500,000 shall be for use by or in support of the Advisory Board on Radiation and Worker Health ("Board'') to carry out its statutory responsibilities, including obtaining audits, technical assistance, and other support from the Board's audit contractor with regard to radiation dose estimation and reconstruction efforts, site profiles, procedures, and review of Special Exposure Cohort petitions and evaluation reports]: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106–554.

Global Health

For carrying out titles II, III, VII and XVII of the PHS Act with respect to global health, [$349,547,000] $362,889,000, of which [$118,023,000] $117,156,000 for international HIV/AIDS shall remain available through September 30, [2013] 2014: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.

Public Health Preparedness and Response

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, [$1,306,906,000] $1,228,360,000, of which [$509,486,000] $439,444,000 shall remain available until expended for the Strategic National Stockpile [under] pursuant to section 319F-2 of the PHS Act.

CDC-Wide Activities and Program Support

For carrying out titles II, III, VII, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support that supplement activities funded under the headings "Immunization and Respiratory Diseases'', "HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention'', "Emerging and Zoonotic Infectious Diseases'', "Chronic Disease Prevention and Health Promotion'', "Birth Defects, Developmental Disabilities, Disabilities and Health'', "Environmental Health'', "Injury Prevention and Control'', "National Institute for Occupational Safety and Health'', "Employees Occupational Illness Compensation Program Act'', "Global Health'', "Public Health Preparedness and Response'', and "Public Health Scientific Services'', and for carrying out section 4001 of the Patient Protection and Affordable Care Act, [$621,445,000] $487,648,000 of which [$30,000,000] $368,529,000 shall be available until September 30, [2013] 2014, for business services[, of which $25,000,000 shall be available until September 30, 2016, for equipment, construction and renovation of facilities, and of which $80,000,000 shall be for the Preventive Health and Health Services Block Grant Program]: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading and in all other accounts of the Centers for Disease Control and Prevention (referred to in this title as "CDC''): Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase, hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC 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 HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through September 30, [2013] 2014: Provided further, That of the funds made available under this heading, up to $1,000 per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: [Provided further, That CDC may establish a Working Capital Fund, with the authorities equivalent to those provided in 42 U.S.C. 231, to improve the provision of supplies and service] Provided further, That the Director may transfer funds between any of the accounts of CDC with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0943–0–1–999 2011 actual 2012 est. 2013 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 CDC-Wide Activities and Program Support –2 –2 –2



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–0943–0–1–999 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Birth Defects, Developmental Disabilities, Disability and Health (BA & Prevention Fund) 136 137 125
0002 Buildings and Facilities 58 25
0003 Business Services Support 361 395 369
0004 Chronic Disease Prevention and Health Promotion 813 756 608
0005 Emerging and Zoonotic Infectious Diseases 252 252 280
0006 Energy Employee Illness Occupational Compensation Program Act (EEOICPA) 57 55 55
0007 Environmental Health 134 105 104
0008 Global Health 365 348 363
0009 Pandemic Influenza Supplemental (H1N1) 18
0010 Healthcare Reform Prevention and Public Health Fund, Other Activities 611 805 796
0011 Health Reform - Chronic Disease Prevention and Health Promotion 7
0012 HIV/AIDS, Viral Hepatitis, STD and TB Prevention 1,075 1,100 1,146
0013 Immunization and Respiratory Diseases 478 576 584
0014 Individual Learning Accounts (ILAs) 7
0015 Injury Prevention and Control 143 138 138
0016 Occupational Safety and Health 230 182
0017 Preventive Health & Health Services Block Grants 80 79
0018 Public Health Leadership & Support 120 119 119
0019 Public Health Preparedness & Response 1,321 1,300 1,228
0020 Public Health Scientific Services 147 144 35



0799 Total direct obligations 6,413 6,516 5,950
0802 Other Reimbursable Programs 622 749 749



0809 Reimbursable program activities, subtotal 622 749 749



0900 Total new obligations 7,035 7,265 6,699

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 283 192 161
1021 Recoveries of prior year unpaid obligations 20 4



1050 Unobligated balance (total) 303 196 161
Budget authority:
Appropriations, discretionary:
1100 Appropriation 5,660 5,668 4,992
1120 Appropriations transferred to other accts [75–0350] –1
1130 Appropriations permanently reduced –11
1143 Approp permanently reduced (Sec 527, HR 2055) –11



1160 Appropriation, discretionary (total) 5,649 5,656 4,992
Appropriations, mandatory:
1200 Appropriation 55 55 55
1201 Appropriation (special or trust fund) 2 2 2
1221 Appropriations transferred from other accts [75–0116] 611 805 903



1260 Appropriations, mandatory (total) 668 862 960
Spending authority from offsetting collections, discretionary:
1700 Collected 310 712 712
1701 Change in uncollected payments, Federal sources 300



1750 Spending auth from offsetting collections, disc (total) 610 712 712
1900 Budget authority (total) 6,927 7,230 6,664
1930 Total budgetary resources available 7,230 7,426 6,825
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3
1941 Unexpired unobligated balance, end of year 192 161 126

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 6,850 6,451 6,487
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –486 –468 –468



3020 Obligated balance, start of year (net) 6,364 5,983 6,019
3030 Obligations incurred, unexpired accounts 7,035 7,265 6,699
3031 Obligations incurred, expired accounts 31
3040 Outlays (gross) –7,277 –7,225 –6,866
3050 Change in uncollected pymts, Fed sources, unexpired –300
3051 Change in uncollected pymts, Fed sources, expired 318
3080 Recoveries of prior year unpaid obligations, unexpired –20 –4
3081 Recoveries of prior year unpaid obligations, expired –168
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 6,451 6,487 6,320
3091 Uncollected pymts, Fed sources, end of year –468 –468 –468



3100 Obligated balance, end of year (net) 5,983 6,019 5,852

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 6,259 6,368 5,704
Outlays, gross:
4010 Outlays from new discretionary authority 2,550 2,453 2,124
4011 Outlays from discretionary balances 4,519 4,441 3,975



4020 Outlays, gross (total) 7,069 6,894 6,099
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –606 –703 –703
4033 Non-Federal sources –13 –9 –9



4040 Offsets against gross budget authority and outlays (total) –619 –712 –712
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –300
4052 Offsetting collections credited to expired accounts 309



4060 Additional offsets against budget authority only (total) 9



4070 Budget authority, net (discretionary) 5,649 5,656 4,992
4080 Outlays, net (discretionary) 6,450 6,182 5,387
Mandatory:
4090 Budget authority, gross 668 862 960
Outlays, gross:
4100 Outlays from new mandatory authority 120 320 353
4101 Outlays from mandatory balances 88 11 414



4110 Outlays, gross (total) 208 331 767
4180 Budget authority, net (total) 6,317 6,518 5,952
4190 Outlays, net (total) 6,658 6,513 6,154

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, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, occupational safety and health, injury prevention and control, environmental health, global health, programs that reduce the occurrence of birth defects and developmental disabilities, and CDC-Wide Activities and Program Support. 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 Services Emergency Fund for pandemic influenza preparedness and response activities.

Object Classification (in millions of dollars)


Identification code 75–0943–0–1–999 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 674 801 723
11.3 Other than full-time permanent 81 100 90
11.5 Other personnel compensation 38 43 38
11.7 Military personnel 62 71 66
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 856 1,016 918
12.1 Civilian personnel benefits 231 273 247
12.2 Military personnel benefits 44 50 47
21.0 Travel and transportation of persons 49 49 40
22.0 Transportation of things 17 16 15
23.1 Rental payments to GSA 10 52 51
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 38 36 33
24.0 Printing and reproduction 5 6 5
25.1 Advisory and assistance services 581 498 439
25.2 Other services from non-Federal sources 237 211 189
25.3 Other goods and services from Federal sources 396 390 364
25.4 Operation and maintenance of facilities 74 50 46
25.5 Research and development contracts 51 68 62
25.6 Medical care 3 29 27
25.7 Operation and maintenance of equipment 33 35 32
25.8 Subsistence and support of persons (Includes 1259) 31 33 30
26.0 Supplies and materials 560 518 518
31.0 Equipment 58 55 55
32.0 Land and structures 41 9 8
41.0 Grants, subsidies, and contributions 3,097 3,121 2,823



99.0 Direct obligations 6,413 6,516 5,950
99.0 Reimbursable obligations 622 749 749



99.9 Total new obligations 7,035 7,265 6,699

Employment Summary


Identification code 75–0943–0–1–999 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 8,432 8,379 8,370
1101 Direct military average strength employment 814 771 771
2001 Reimbursable civilian full-time equivalent employment 1,077 1,082 1,081
2101 Reimbursable military average strength employment 38 81 81

CDC Working Capital Fund

The Consolidated Appropriations Bill, 2012 (P.L. 112–74, Division F) provided authorities equivalent to those provided in 42 U.S.C 231 for CDC to begin creating a Working Capital Fund. The Working Capital Fund will be used by CDC to achieve greater cost efficiencies across the administrative operations of the agency.

Agency for Toxic Substances and Disease Registry

toxic substances and environmental public health

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended; section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA), as amended; and section 3019 of the Solid Waste Disposal Act, as amended, [$76,337,000] $76,300,000, of which up to $1,000 per eligible employee of the Agency for Toxic Substances 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 healthcare 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] 2013, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0944–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Direct program 76 76 76
0002 Direct program - health reform 3



0799 Total direct obligations 79 76 76
0801 Reimbursable program 10 10 10



0900 Total new obligations 89 86 86

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 23 21 21
Budget authority:
Appropriations, discretionary:
1100 Appropriation 77 76 76



1160 Appropriation, discretionary (total) 77 76 76
Spending authority from offsetting collections, discretionary:
1700 Collected 3 3 10
1701 Change in uncollected payments, Federal sources 7 7



1750 Spending auth from offsetting collections, disc (total) 10 10 10
1900 Budget authority (total) 87 86 86
1930 Total budgetary resources available 110 107 107
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 21 21 21

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 43 47 14
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –13 –13 –20



3020 Obligated balance, start of year (net) 30 34 –6
3030 Obligations incurred, unexpired accounts 89 86 86
3040 Outlays (gross) –81 –119 –95
3050 Change in uncollected pymts, Fed sources, unexpired –7 –7
3051 Change in uncollected pymts, Fed sources, expired 7
3081 Recoveries of prior year unpaid obligations, expired –4
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 47 14 5
3091 Uncollected pymts, Fed sources, end of year –13 –20 –20



3100 Obligated balance, end of year (net) 34 –6 –15

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 87 86 86
Outlays, gross:
4010 Outlays from new discretionary authority 55 84 84
4011 Outlays from discretionary balances 26 26 3



4020 Outlays, gross (total) 81 110 87
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –10 –3 –10
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –7 –7
4052 Offsetting collections credited to expired accounts 7



4060 Additional offsets against budget authority only (total) –7



4070 Budget authority, net (discretionary) 77 76 76
4080 Outlays, net (discretionary) 71 107 77
Mandatory:
Outlays, gross:
4101 Outlays from mandatory balances 9 8
4180 Budget authority, net (total) 77 76 76
4190 Outlays, net (total) 71 116 85

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

Object Classification (in millions of dollars)


Identification code 75–0944–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 23 22 22
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 28 28
12.1 Civilian personnel benefits 7 7 7
12.2 Military personnel benefits 2 2 2
25.1 Advisory and assistance services 5 4 4
25.2 Other services from non-Federal sources 7 7 7
25.3 Other goods and services from Federal sources 11 11 11
26.0 Supplies and materials 1 1
31.0 Equipment 1 1
41.0 Grants, subsidies, and contributions 18 15 15



99.0 Direct obligations 79 76 76
99.0 Reimbursable obligations 10 10 10



99.9 Total new obligations 89 86 86

Employment Summary


Identification code 75–0944–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 259 258 258
1101 Direct military average strength employment 39 39 39
2001 Reimbursable civilian full-time equivalent employment 13 13 13

World Trade Center Health Program Fund

Program and Financing (in millions of dollars)


Identification code 75–0946–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Federal Share 71 174 171
0002 NYC 8 19 19



0900 Total new obligations 79 193 190

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (WTC (CDC Direct)) 79 174 171
1200 Appropriation (WTC—NYC DHSS—CDC) 19 19



1260 Appropriations, mandatory (total) 79 193 190
1930 Total budgetary resources available 79 193 190

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 68 131
3030 Obligations incurred, unexpired accounts 79 193 190
3040 Outlays (gross) –11 –130 –161
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 68 131 160



3100 Obligated balance, end of year (net) 68 131 160

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 79 193 190
Outlays, gross:
4100 Outlays from new mandatory authority 11 65 64
4101 Outlays from mandatory balances 65 97



4110 Outlays, gross (total) 11 130 161
4180 Budget authority, net (total) 79 193 190
4190 Outlays, net (total) 11 130 161

HHS along with CDC began implementing provisions of The James Zadroga 9/11 Health and Compensation Act of 2010 (P.L.111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the Program Administrator for the WTC Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The amounts included for FY 2012 and FY 2013 Budget reflect estimated Federal obligations for the WTC Health Program.

Object Classification (in millions of dollars)


Identification code 75–0946–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
25.1 Advisory and assistance services 8 20 19
25.2 Other services from non-Federal sources 33 80 79
25.3 Other goods and services from Federal sources 2 10 10
25.6 Medical care 34 79 78
41.0 Grants, subsidies, and contributions 2 4 4



99.9 Total new obligations 79 193 190

National Institutes of Health

Federal Funds

National Cancer Institute

For carrying out section 301 and title IV of the PHS Act with respect to cancer, [$5,081,788,000] $5,068,864,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2012.)

National Heart, Lung, and Blood Institute

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, [$3,084,851,000] $3,076,067,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Dental and Craniofacial Research

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, [$411,488,000] $408,212,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Diabetes and Digestive and Kidney Diseases

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, [$1,800,447,000] $1,792,107,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Neurological Disorders and Stroke

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, [$1,629,445,000] $1,624,707,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Allergy and Infectious Diseases

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, [$4,499,215,000] $4,495,307,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of General Medical Sciences

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,434,637,000: Provided, That not less than $276,480,000 is provided for the Institutional Development Awards program] $2,378,835,000. (Department of Health and Human Services Appropriations Act, 2012.)

Eunice Kennedy Shriver National Institute of Child Health and Human Development

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, [$1,323,900,000] $1,320,600,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Eye Institute

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$704,043,000] $693,015,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Environmental Health Sciences

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, [$686,869,000] $684,030,000. (Department of Health and Human Services Appropriations Act, 2012.)

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, [$79,054,000] $78,928,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

National Institute on Aging

For carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,105,530,000] $1,102,650,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Arthritis and Musculoskeletal and Skin Diseases

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, [$536,801,000] $535,610,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute on Deafness and Other Communication Disorders

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, [$417,061,000] $417,297,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Nursing Research

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$145,043,000] $144,153,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute on Alcohol Abuse and Alcoholism

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, [$460,389,000] $457,104,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute on Drug Abuse

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,055,362,000] $1,054,001,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Mental Health

For carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,483,068,000] $1,479,204,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Human Genome Research Institute

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$513,844,000] $511,370,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute of Biomedical Imaging and Bioengineering

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, [$338,998,000] $336,896,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Center for Complementary and Alternative Medicine

For carrying out section 301 and title IV of the PHS Act with respect to complementary and alternative medicine, [$128,299,000] $127,930,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Institute on Minority Health and Health Disparities

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, [$276,963,000] $279,389,000. (Department of Health and Human Services Appropriations Act, 2012.)

John E. Fogarty International Center

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), [$69,754,000] $69,758,000. (Department of Health and Human Services Appropriations Act, 2012.)

National Library of Medicine

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$338,278,000] $372,651,000, of which $4,000,000 shall be available until September 30, [2013] 2014, for improvement of information systems: Provided, That in fiscal year [2012] 2013, 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 (referred to in this title as "NIH''): Provided further, That in addition to amounts provided herein, $8,200,000 shall be available from amounts available under section 241 of the PHS Act to carry out the purposes of the National Information Center on Health Services Research and Health Care Technology established under section 478A of the PHS Act and related health services. (Department of Health and Human Services Appropriations Act, 2012.)

National Center for Advancing Translational Sciences

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$576,456,000] $639,033,000: Provided, That up to [$10,000,000] $50,000,000 shall be available to implement section 402C of the PHS Act, relating to the Cures Acceleration Network[: Provided further, That funds appropriated may be used to support the reorganization and activities required to eliminate the National Center for Research Resources: Provided further, That the Director of the NIH shall ensure that, of all funds made available to Institute, Center, and Office of the Director accounts within "Department of Health and Human Services, National Institutes of Health'', at least $487,767,000 is provided to the Clinical and Translational Sciences Awards program]. (Department of Health and Human Services Appropriations Act, 2012.)

Office of the Director

For carrying out the responsibilities of the Office of the Director, NIH, [$1,461,880,000] $1,429,161,000, of which up to $25,000,000 shall be used to carry out section 213 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 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 the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: [Provided further, That $193,880,000 shall be available for continuation of the National Children's Study:] Provided further, That [$545,962,000] $544,930,000 shall be available for the Common Fund established under section 402A(c)(1) of the 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 the Director may direct up to 1 percent of the total made available in this or any other Act to all National Institutes of Health appropriations to activities that the Director may so designate: Provided further, That no such appropriation shall be decreased by more than 1 percent by any such transfers and that the Congress is promptly notified of the transfer. (Department of Health and Human Services Appropriations Act, 2012.)

Buildings and Facilities

For the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, [$125,581,000] $125,308,000, to remain available until [September 30, 2016] expended. (Department of Health and Human Services Appropriations Act, 2012.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9915–0–1–552 2011 actual 2012 est. 2013 est.

0100 Balance, start of year
Receipts:
0220 Cooperative Research and Development Agreements, NIH 17 17 17



0400 Total: Balances and collections 17 17 17
Appropriations:
0500 National Institutes of Health –17 –17 –17



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–9915–0–1–552 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 National Cancer Institute (0849) 5,059 5,071 5,069
0002 National Heart, Lung, and Blood Institute (0872) 3,070 3,078 3,076
0003 National Institute of Dental and Craniofacial Research (0873) 409 411 408
0004 National Institute of Diabetes and Digestive and Kidney Disease (0884) 1,792 1,797 1,792
0005 National Institute of Neurological Disorders and Stroke (0886) 1,622 1,626 1,625
0006 National Institute of Allergy and Infectious Diseases (0885) 4,478 4,489 4,495
0007 National Institute of General Medical Sciences (0851) 2,034 2,429 2,379
0008 National Institute of Child Health and Human Development (0844) 1,318 1,321 1,321
0009 National Eye Institute (0887) 701 703 693
0010 National Institute of Environmental Health Sciences (0862) 763 764 763
0011 National Institute on Aging (0843) 1,100 1,103 1,103
0012 National Institute of Arthritis and Musculoskeletal and Skin Disease (0888) 534 536 536
0013 National Institute on Deafness and Other Communication Disorder (0890) 415 416 417
0014 National Institute of Mental Health (0892) 1,477 1,480 1,479
0015 National Institute on Drug Abuse (0893) 1,050 1,053 1,054
0016 National Institute on Alcohol Abuse and Alcoholism (0894) 458 459 457
0017 National Institute of Nursing Research (0889) 144 145 144
0018 National Human Genome Research Institute (0891) 511 513 511
0019 National Institute of Biomedical Imaging and Bioengineering (0898) 314 338 337
0020 National Center for Research Resources (0848) 1,258
0021 National Center for Complementary and Alternative Medicine (0896) 128 128 128
0022 National Institute on Minority Health and Health Disparities (0897) 210 276 279
0023 John E. Fogarty International Center (0819) 69 70 70
0024 National Library of Medicine (0807) 337 338 373
0025 Office of the Director (0846) 1,167 1,459 1,429
0026 Buildings and facilities (0838) 62 125 125
0027 Cooperative Research and Development Agreements 12 17 17
0028 National Center for Advancing Translational Sciences (0875) 575 639
0031 Type 1 Diabetes 150 150 150



0799 Total direct obligations 30,642 30,870 30,869
0801 Reimbursable program activity 3,190 3,201 3,294
0802 Royalties 88 88 88



0809 Reimbursable program activities, subtotal 3,278 3,289 3,382



0899 Total reimbursable obligations 3,278 3,289 3,382



0900 Total new obligations 33,920 34,159 34,251

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 345 376 375
1020 Adjustment of unobligated bal brought forward, Oct 1 –6
1021 Recoveries of prior year unpaid obligations 46



1050 Unobligated balance (total) 385 376 375
Budget authority:
Appropriations, discretionary:
1100 Appropriation 30,828 30,769 30,702
1120 Transferred to other accounts [72–1028] –297
1120 Appropriations transferred to other accts [75–0350] –9
1121 Transferred from other accounts [75–9912] 1
1130 Appropriations permanently reduced –62
1143 Approp permanently reduced (Sec 527, HR 2055) –58



1160 Appropriation, discretionary (total) 30,470 30,702 30,702
Appropriations, mandatory:
1200 Appropriation 150 150 150
1201 Appropriation (special or trust fund) 17 17 17



1260 Appropriations, mandatory (total) 167 167 167
Spending authority from offsetting collections, discretionary:
1700 Collected 2,734 3,289 3,382
1701 Change in uncollected payments, Federal sources 544



1750 Spending auth from offsetting collections, disc (total) 3,278 3,289 3,382
1900 Budget authority (total) 33,915 34,158 34,251
1930 Total budgetary resources available 34,300 34,534 34,626
Memorandum (non-add) entries:
1940 Unobligated balance expiring –4
1941 Unexpired unobligated balance, end of year 376 375 375

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 39,712 35,622 34,908
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –1,247 –1,151 –1,151
3011 Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1 6



3020 Obligated balance, start of year (net) 38,471 34,471 33,757
3030 Obligations incurred, unexpired accounts 33,920 34,159 34,251
3031 Obligations incurred, expired accounts 857
3040 Outlays (gross) –37,715 –34,873 –33,863
3050 Change in uncollected pymts, Fed sources, unexpired –544
3051 Change in uncollected pymts, Fed sources, expired 634
3080 Recoveries of prior year unpaid obligations, unexpired –46
3081 Recoveries of prior year unpaid obligations, expired –1,106
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 35,622 34,908 35,296
3091 Uncollected pymts, Fed sources, end of year –1,151 –1,151 –1,151



3100 Obligated balance, end of year (net) 34,471 33,757 34,145

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 33,748 33,991 34,084
Outlays, gross:
4010 Outlays from new discretionary authority 10,751 11,150 11,243
4011 Outlays from discretionary balances 26,695 23,556 22,453



4020 Outlays, gross (total) 37,446 34,706 33,696
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –3,246 –3,289 –3,382
4033 Non-Federal sources –99



4040 Offsets against gross budget authority and outlays (total) –3,345 –3,289 –3,382
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –544
4052 Offsetting collections credited to expired accounts 611



4060 Additional offsets against budget authority only (total) 67



4070 Budget authority, net (discretionary) 30,470 30,702 30,702
4080 Outlays, net (discretionary) 34,101 31,417 30,314
Mandatory:
4090 Budget authority, gross 167 167 167
Outlays, gross:
4100 Outlays from new mandatory authority 1 53 53
4101 Outlays from mandatory balances 268 114 114



4110 Outlays, gross (total) 269 167 167
4180 Budget authority, net (total) 30,637 30,869 30,869
4190 Outlays, net (total) 34,370 31,584 30,481

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


2011 20121 2013

Distribution of budget authority by account:
National Cancer Institute 5,059 5,071 5,069
National Heart, Lung, and Blood Institute 3,070 3,078 3,076
National Institute of Dental and Craniofacial Research 409 411 408
National Institute of Diabetes and Digestive and Kidney Diseases 1,942 1,947 1,942
National Institute of Neurological Disorder and Stroke 1,622 1,626 1,625
National Institute of Allergy and Infectious Diseases 4,7762 4,4892 4,495
National Institute of General Medical Sciences 2,034 2,429 2,379
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,318 1,321 1,321
National Eye Institute 701 703 693
National Institute of Environmental Health Sciences 763 764 763
National Institute on Aging 1,100 1,103 1,103
National Institute of Arthritis and Musculoskeletal and Skin Diseases 534 536 536
National Institute on Deafness and Other Communication Disorders 415 416 417
National Institute of Mental Health 1,477 1,480 1,479
National Institute on Drug Abuse 1,050 1,053 1,054
National Institute on Alcohol Abuse and Alcoholism 458 459 457
National Institute of Nursing Research 144 145 144
National Center for Research Resources 1,265 0 0
National Human Genome Research Institute 511 513 511
National Institute of Biomedical Imaging and Bioengineering 314 338 337
National Institute on Minority Health and Health Disparities 210 276 279
National Center for Complementary and Alternative Medicine 119 128 128
National Center for Advancing Translational Sciences 0 575 639
John E. Fogarty International Center 69 70 70
National Library of Medicine 337 338 373
Office of the Director 1,167 1,459 1,429
Buildings and Facilities 50 125 125

ARRA Funds 0 0 0



Subtotal 30,914 30,852 30,852

Cooperative Research and Development Agreements 12 17 17




Total Budget Authority, NIH 30,926 30,869 30,869




1Funding provided in the Consolidated Appropriations Act, 2012, reflects a reorganization of the National Institutes of Health that created the new National Center for Advancing Translational Sciences (NCATS) and abolished the National Center for Research Resources (NCRR). The translational functions of NCRR were moved to NCATS, and the remaining non-translational functions were moved to the National Institute of General Medical Sciences, the National Institute of Biomedical Imaging and Bioengineering, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of the Director.2The Department of Defense and Full-Year Continuing Appropriations Act, 2011, included $297,300,000 in the National Institute of Allergy and Infectious Diseases for transfer to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis. The Consolidated Appropriations Act, 2012, did not include such a transfer.

(in millions of dollars)


2011 2012 2013

Distribution of outlays by account:
National Cancer Institute 5,096 4,704 5,018
National Heart, Lung, and Blood Institute 3,088 3,034 3,045
National Institute of Dental and Craniofacial Research 410 425 415
National Institute of Diabetes and Digestive and Kidney Diseases 1,905 1,893 1,960
National Institute of Neurological Disorders and Stroke 1,580 1,671 1,641
National Institute of Allergy and Infectious Diseases 4,467 4,135 4,526
National Institute of General Medical Sciences 1,985 2,136 2,060
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,274 1,347 1,335
National Eye Institute 693 680 709
National Institute of Environmental Health Sciences 769 770 773
National Institute on Aging 1,099 1,053 1,135
National Institute of Arthritis and Musculoskeletal and Skin Diseases 532 512 540
National Institute on Deafness and Other Communication Disorders 407 422 420
National Institute of Mental Health 1,492 1,452 1,496
National Institute on Drug Abuse 1,069 976 1,054
National Institute on Alcohol Abuse and Alcoholism 457 463 463
National Institute of Nursing Research 145 131 146
National Center for Research Resources 1,217 788 1,268
National Human Genome Research Institute 506 495 520
National Institute of Biomedical Imaging and Bioengineering 309 307 320
National Institute on Minority Health and Health Disparities 211 202 216
National Center for Complementary and Alternative Medicine 131 106 133
National Center for Advancing Translational Sciences 0 92 453
John E. Fogarty International Center 71 68 71
National Library of Medicine 334 315 363
Office of the Director 1,196 1,423 1,193
Buildings and Facilities 115 146 113

ARRA Funds 3,844 1,864 1,095



Subtotal Outlays 34,402 31,610 32,481

Cooperative Research and Development Agreements 17 17 17




Total Outlays, NIH 34,419 31,627 32,498




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

Object Classification (in millions of dollars)


Identification code 75–9915–0–1–552 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 878 885 889
11.3 Other than full-time permanent 477 483 494
11.5 Other personnel compensation 44 43 43
11.7 Military personnel 22 22 23
11.8 Special personal services payments 166 170 169



11.9 Total personnel compensation 1,587 1,603 1,618
12.1 Civilian personnel benefits 403 409 412
12.2 Military personnel benefits 16 16 16
21.0 Travel and transportation of persons 56 55 54
22.0 Transportation of things 5 6 5
23.1 Rental payments to GSA 1 1 1
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 26 27 26
24.0 Printing and reproduction 8 4 7
25.1 Advisory and assistance services 112 117 132
25.2 Other services from non-Federal sources 714 718 725
25.3 Other goods and services from Federal sources 3,054 3,056 3,246
25.4 Operation and maintenance of facilities 126 83 77
25.5 Research and development contracts 2,117 2,157 1,968
25.6 Medical care 18 18 17
25.7 Operation and maintenance of equipment 83 85 82
25.8 Subsistence and support of persons 2
26.0 Supplies and materials 194 204 196
31.0 Equipment 120 125 119
32.0 Land and structures 126 125
41.0 Grants, subsidies, and contributions 21,999 22,059 22,042



99.0 Direct obligations 30,642 30,870 30,869
99.0 Reimbursable obligations 3,278 3,289 3,382



99.9 Total new obligations 33,920 34,159 34,251

Employment Summary


Identification code 75–9915–0–1–552 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 13,292 13,292 13,157
1101 Direct military average strength employment 238 238 238
2001 Reimbursable civilian full-time equivalent employment 4,950 4,950 4,899
2101 Reimbursable military average strength employment 89 89 89

Substance Abuse and Mental Health Services Administration

Federal Funds

Mental Health

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, [$934,853,000] $902,856,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, [$21,039,000] $21,039,000 shall be available under section 241 of the PHS Act 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: Provided further, That section 520E(b)(2) of the PHS Act shall not apply to funds appropriated under this Act for fiscal year [2012: Provided further, That of the amount appropriated under this heading, $45,800,000 shall be for the National Child Traumatic Stress Initiative as described in section 582 of the PHS Act] 2013.

Substance Abuse Treatment

For carrying out titles III, V, and XIX of the PHS Act with respect to substance abuse treatment [and section 1922(a) of the PHS Act with respect to substance abuse prevention], [$2,123,993,000] $1,711,045,000: Provided, That in addition to amounts provided herein, [the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000] $71,724,000 shall be available under section 241 of the PHS Act 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[; and (2) $2,000,000 to evaluate substance abuse treatment programs]: Provided further, That [no funds shall be available for the National All Schedules Prescription Reporting system] section 1922(a)(1) of the PHS Act shall not apply to amounts provided herein.

Substance Abuse Prevention

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$186,361,000] $463,378,000.

Health Surveillance and Program Support

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'' in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, [$109,106,000] $74,229,000: Provided, That in addition to amounts provided herein, [$27,428,000] $71,995,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities: Provided further, That, in addition, fees may be collected for the costs associated with additional publications, data, data tabulations, and data analysis completed under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'': Provided further, That the Administrator may transfer funds between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–1362–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0002 Mental Health Block Grant 420
0003 Substance Abuse Block Grant 1,442
0004 State Prevention Grants 475
0005 Program Management 120
0006 Mental Health 933 903
0007 Substance Abuse Treatment 1,775 1,711
0008 Substance Abuse Prevention 530 464
0009 Health Surveillance and Program Support 109 74
0010 Children's Mental Health 118
0011 PATH Homeless State Grants 65
0012 Protection and Advocacy 36
0013 Innovation and Emerging Issues 680
0014 Public Education and Support 14
0022 Performance and Quality Information Systems 38
0023 Regulatory and Oversight Functions 53



0100 Total, direct program 3,461 3,347 3,152



0799 Total direct obligations 3,461 3,347 3,152
0802 Reimbursable program: PHS Evaluation 256 255 292



0900 Total new obligations 3,717 3,602 3,444

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 88
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,386 3,354 3,152
1120 Appropriations transferred to other accts [75–0350] –1
1130 Appropriations permanently reduced –7
1143 Approp permanently reduced (Sec 527, HR 2055) –6



1160 Appropriation, discretionary (total) 3,379 3,347 3,152
Appropriations, mandatory:
1221 Appropriations transferred from the Prevention and Public Health Fund [75–0116] 88 88 105



1260 Appropriations, mandatory (total) 88 88 105
Spending authority from offsetting collections, discretionary:
1700 Collected 144 255 292
1700 Collected 2
1701 Change in uncollected payments, Federal sources 106



1750 Spending auth from offsetting collections, disc (total) 250 255 294
1900 Budget authority (total) 3,717 3,690 3,551
1930 Total budgetary resources available 3,717 3,690 3,639
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 88 195

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 2,828 2,964 2,877
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –151 –239 –239



3020 Obligated balance, start of year (net) 2,677 2,725 2,638
3030 Obligations incurred, unexpired accounts 3,717 3,602 3,444
3040 Outlays (gross) –3,557 –3,689 –3,699
3050 Change in uncollected pymts, Fed sources, unexpired –106
3051 Change in uncollected pymts, Fed sources, expired 18
3081 Recoveries of prior year unpaid obligations, expired –24
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 2,964 2,877 2,622
3091 Uncollected pymts, Fed sources, end of year –239 –239 –239



3100 Obligated balance, end of year (net) 2,725 2,638 2,383

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,629 3,602 3,446
Outlays, gross:
4010 Outlays from new discretionary authority 1,465 1,594 1,555
4011 Outlays from discretionary balances 2,083 2,042 2,047



4020 Outlays, gross (total) 3,548 3,636 3,602
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –144 –255 –292
4033 Non-Federal sources –2



4040 Offsets against gross budget authority and outlays (total) –144 –255 –294
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –106



4070 Budget authority, net (discretionary) 3,379 3,347 3,152
4080 Outlays, net (discretionary) 3,404 3,381 3,308
Mandatory:
4090 Budget authority, gross 88 88 105
Outlays, gross:
4100 Outlays from new mandatory authority 1 1
4101 Outlays from mandatory balances 9 52 96



4110 Outlays, gross (total) 9 53 97
4180 Budget authority, net (total) 3,467 3,435 3,257
4190 Outlays, net (total) 3,413 3,434 3,405

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. The Consolidated Appropriations Act of 2012 (P.L. 112–74) restructured the appropriation accounts for SAMHSA, which is continued in FY 2013.

Object Classification (in millions of dollars)


Identification code 75–1362–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 47 46 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 54 53 53
12.1 Civilian personnel benefits 12 12 12
12.2 Military personnel benefits 2 2 2
21.0 Travel and transportation of persons 1 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 26 17
25.2 Other services from non-Federal sources 229 201 130
25.3 Other goods and services from Federal sources 87 90 58
25.7 Operation and maintenance of equipment 1 1 1
41.0 Grants, subsidies, and contributions 3,034 2,948 2,865
42.0 Insurance claims and indemnities 1 1 1



99.0 Direct obligations 3,461 3,347 3,152
99.0 Reimbursable obligations 256 255 292



99.9 Total new obligations 3,717 3,602 3,444

Employment Summary


Identification code 75–1362–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 472 496 496
1101 Direct military average strength employment 52 54 54
2001 Reimbursable civilian full-time equivalent employment 19 20 20
2101 Reimbursable military average strength employment 4 4 4

Agency for Healthcare Research and Quality

Federal Funds

Healthcare Research and Quality

For carrying out titles III and IX of the 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, [$369,053,000] $334,357,000 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 [September 30, 2013] expended. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–1700–0–1–552 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0003 Prevention and Public Health Fund 12 12 12
0801 Reimbursable program 17 17 17
0802 Reimbursable program: PHS evaluation 371 369 334



0899 Total reimbursable obligations 388 386 351



0900 Total new obligations 400 398 363

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 6 4 4
Budget authority:
Appropriations, mandatory:
1221 Appropriations transferred from other accts [75–0116] 12 12 12



1260 Appropriations, mandatory (total) 12 12 12
Spending authority from offsetting collections, discretionary:
1700 Collected 159 386 351
1701 Change in uncollected payments, Federal sources 227



1750 Spending auth from offsetting collections, disc (total) 386 386 351
1900 Budget authority (total) 398 398 363
1930 Total budgetary resources available 404 402 367
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 4 4 4

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 1,165 988 324
3010 Uncollected pymts, Fed sources, brought forward, Oct 1 –451 –382 –382



3020 Obligated balance, start of year (net) 714 606 –58
3030 Obligations incurred, unexpired accounts 400 398 363
3031 Obligations incurred, expired accounts 2
3040 Outlays (gross) –566 –1,062 –533
3050 Change in uncollected pymts, Fed sources, unexpired –227
3051 Change in uncollected pymts, Fed sources, expired 296
3081 Recoveries of prior year unpaid obligations, expired –13
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 988 324 154
3091 Uncollected pymts, Fed sources, end of year –382 –382 –382



3100 Obligated balance, end of year (net) 606 –58 –228

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 386 386 351
Outlays, gross:
4010 Outlays from new discretionary authority 126 386 351
4011 Outlays from discretionary balances 435 673 175



4020 Outlays, gross (total) 561 1,059 526
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –451 –768 –388
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –227
4052 Offsetting collections credited to expired accounts 292 382 37



4060 Additional offsets against budget authority only (total) 65 382 37
4080 Outlays, net (discretionary) 110 291 138
Mandatory:
4090 Budget authority, gross 12 12 12
Outlays, gross:
4100 Outlays from new mandatory authority 1
4101 Outlays from mandatory balances 4 3 7



4110 Outlays, gross (total) 5 3 7
4180 Budget authority, net (total) 12 12 12
4190 Outlays, net (total) 115 294 145

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.

Object Classification (in millions of dollars)


Identification code 75–1700–0–1–552 2011 actual 2012 est. 2013 est.

Direct obligations:
25.5 Research and development contracts 8 8 8
41.0 Grants, subsidies, and contributions 4 4 4



99.0 Direct obligations 12 12 12
99.0 Reimbursable obligations 388 386 351



99.9 Total new obligations 400 398 363

Employment Summary


Identification code 75–1700–0–1–552 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 3 3 3
2001 Reimbursable civilian full-time equivalent employment 300 300 300
2101 Reimbursable military average strength employment 10 10 10

Centers for Medicare and Medicaid Services

Federal Funds

Grants to States for Medicaid

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$184,279,110,000] $178,791,197,000, to remain available until expended.

For making, after May 31, [2012] 2013, payments to States under title XIX 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 [2012] 2013 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 [2013, $90,614,082,000] 2014, $106,335,631,000, to remain available until expended.

Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0512–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Medicaid vendor payments 276,980 245,689 263,693
0002 State and local administration 14,083 14,885 14,735
0003 Vaccines for Children 3,953 4,009 4,271
0004 Incurred by providers but not yet reported 117 1,360 1,360



0799 Total direct obligations 295,133 265,943 284,059
0801 Medicare Part B premiums 703 320



0900 Total new obligations 295,836 266,263 284,059

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 17,008 408 14,654
1021 Recoveries of prior year unpaid obligations 20,039 9,465



1050 Unobligated balance (total) 37,047 9,873 14,654
Budget authority:
Appropriations, mandatory:
1200 Appropriation Medicaid 184,279 178,791
1200 Appropriation Medicaid, Indefinite 171,576



1260 Appropriations, mandatory (total) 171,576 184,279 178,791
Advance appropriations, mandatory:
1270 Advance appropriation 86,789 86,445 90,614



1280 Advanced appropriation, mandatory (total) 86,789 86,445 90,614
Spending authority from offsetting collections, mandatory:
1800 Collected 832 320



1850 Spending auth from offsetting collections, mand (total) 832 320
1900 Budget authority (total) 259,197 271,044 269,405
1930 Total budgetary resources available 296,244 280,917 284,059
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 408 14,654

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 28,391 28,392 29,751
3030 Obligations incurred, unexpired accounts 295,836 266,263 284,059
3040 Outlays (gross) –275,796 –255,439 –282,699
3080 Recoveries of prior year unpaid obligations, unexpired –20,039 –9,465
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 28,392 29,751 31,111



3100 Obligated balance, end of year (net) 28,392 29,751 31,111

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 259,197 271,044 269,405
Outlays, gross:
4100 Outlays from new mandatory authority 259,197 237,457 267,961
4101 Outlays from mandatory balances 16,599 17,982 14,738



4110 Outlays, gross (total) 275,796 255,439 282,699
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –703 –320
4123 Non-Federal sources –129



4130 Offsets against gross budget authority and outlays (total) –832 –320



4160 Budget authority, net (mandatory) 258,365 270,724 269,405
4170 Outlays, net (mandatory) 274,964 255,119 282,699
4180 Budget authority, net (total) 258,365 270,724 269,405
4190 Outlays, net (total) 274,964 255,119 282,699

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


2011 actual 2012 est. 2013 est.

Enacted/requested:
Budget Authority 258,365 270,724 269,405
Outlays 274,964 255,119 282,699
Amounts included in the adjusted baseline:
Budget Authority –11 –70
Outlays –11 –70
Legislative proposal, not subject to PAYGO:
Budget Authority –215 –695
Outlays –215 –695
Legislative proposal, subject to PAYGO:
Budget Authority 370 885
Outlays 370 885
Total:
Budget Authority 258,365 270,868 269,525
Outlays 274,964 255,263 282,819

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

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

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

Vaccines for Children (in millions of dollars)


Obligations 2011 2012 2013

Vaccine Purchase 3,663 3,703 3,972
Vaccine Stockpile 138 137 137
Ordering, Distribution, and Operations 108 126 119
Vaccine Management Contract Support 4 2 1

Evaluation Activities 40 41 42



Total Obligations 3,953 4,009 4,271

Object Classification (in millions of dollars)


Identification code 75–0512–0–1–551 2011 actual 2012 est. 2013 est.

41.0 Direct obligations: Grants, subsidies, and contributions 295,133 265,943 284,059
99.0 Reimbursable obligations 703 320



99.9 Total new obligations 295,836 266,263 284,059

Grants to States for Medicaid

(Amounts included in the adjusted baseline)

Program and Financing (in millions of dollars)


Identification code 75–0512–7–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Medicaid vendor payments –11 –70



0900 Total new obligations (object class 41.0) –11 –70

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation –11 –70



1260 Appropriations, mandatory (total) –11 –70
1930 Total budgetary resources available –11 –70

Change in obligated balance:
3030 Obligations incurred, unexpired accounts –11 –70
3040 Outlays (gross) 11 70

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross –11 –70
Outlays, gross:
4100 Outlays from new mandatory authority –11 –70
4180 Budget authority, net (total) –11 –70
4190 Outlays, net (total) –11 –70

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 estimates reflected here.

Grants to States for Medicaid

(Legislative proposal, not subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0512–2–1–551 2011 actual 2012 est. 2013 est.

Budget authority and outlays, net:
Mandatory:
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –215 –695
4180 Budget authority, net (total) –215 –695
4190 Outlays, net (total) –215 –695

This schedule reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individual (QI) program.

Grants to States for Medicaid

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0512–4–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Program Integrity –151
0003 Other Proposals 155 341



0799 Total direct obligations 155 190
0801 Medicare Part B premiums 215 695



0900 Total new obligations 370 885

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation Medicaid 155 190



1260 Appropriations, mandatory (total) 155 190
Spending authority from offsetting collections, mandatory:
1800 Collected 215 695



1850 Spending auth from offsetting collections, mand (total) 215 695
1900 Budget authority (total) 370 885
1930 Total budgetary resources available 370 885

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 370 885
3040 Outlays (gross) –370 –885

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 370 885
Outlays, gross:
4100 Outlays from new mandatory authority 370 885
4180 Budget authority, net (total) 370 885
4190 Outlays, net (total) 370 885

This schedule reflects the Administration's Medicaid proposals.

Object Classification (in millions of dollars)


Identification code 75–0512–4–1–551 2011 actual 2012 est. 2013 est.

41.0 Direct obligations: Grants, subsidies, and contributions 155 190
99.0 Reimbursable obligations 215 695



99.9 Total new obligations 370 885

State Grants and Demonstrations

Program and Financing (in millions of dollars)


Identification code 75–0516–0–1–551 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0010 Ticket to Work grants 75
0011 Emergency health services for undocumented aliens 88 22 18
0012 Medicaid integrity program 77 96 80
0015 Partnerships for long-term care 3
0017 Psychiatric residential treatment demonstration 148
0018 Money follows the person (MFP) demonstration 298 410 403
0019 MFP evaluations and technical support 1 1 1
0023 Grants to improve outreach and enrollment 43 7 34
0024 Application of Prospective Payment System 3
0025 Medicaid emergency psychiatric demonstration 1 23 24
0026 Incentives for prevention of chronic diseases in Medicaid 18 29 22



0799 Total direct obligations 752 591 582
0801 Reimbursable program activity 6



0900 Total new obligations 758 591 582

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 1,206 1,304 1,241
1021 Recoveries of prior year unpaid obligations 47



1050 Unobligated balance (total) 1,253 1,304 1,241
Budget authority:
Appropriations, mandatory:
1200 Appropriation (Ticket to Work) 47
1200 Appropriation (Expansion of long-term care partnerships) 3
1200 Appropriation (Psychiatric residential treatment demonstration) 57
1200 Appropriation (Money follows the person (MFP) demonstration) 449 449 449
1200 Appropriation (MFP research & evaluation) 1 1 1
1200 Appropriation (Medicaid integrity program) 76 78 80
1200 Appropriation (Medicaid Emergency Psychiatric Demo) 75
1200 Appropriation (Incentives for Prevention of Chronic Diseases in Medicaid) 100



1260 Appropriations, mandatory (total) 808 528 530
Spending authority from offsetting collections, mandatory:
1800 Collected 6



1850 Spending auth from offsetting collections, mand (total) 6
1900 Budget authority (total) 814 528 530
1930 Total budgetary resources available 2,067 1,832 1,771
Memorandum (non-add) entries:
1940 Unobligated balance expiring –5
1941 Unexpired unobligated balance, end of year 1,304 1,241 1,189

Change in obligated balance:
Obligated balance, start of year (net):
3000 Unpaid obligations, brought forward, Oct 1 (gross) 738 881 868
3030 Obligations incurred, unexpired accounts 758 591 582
3040 Outlays (gross) –568 –604 –474
3080 Recoveries of prior year unpaid obligations, unexpired –47
Obligated balance, end of year (net):
3090 Unpaid obligations, end of year (gross) 881 868 976



3100 Obligated balance, end of year (net) 881 868 976

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 814 528 530
Outlays, gross:
4100 Outlays from new mandatory authority 57 79 80
4101 Outlays from mandatory balances 511 525 394



4110 Outlays, gross (total) 568 604 474
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –6
4180 Budget authority, net (total) 808 528 530
4190 Outlays, net (total) 562 604 474

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).

The Budget includes an unobligated balance of $125 million for activities authorized by Section 204 of the Ticket to Work and Work Incentives Improvement Act. Thus, pursuant to 31 U.S.C. 1555, any remaining balance (whether obligated or unobligated) will be withdrawn and returned to the Treasury two years after there has been no disbursement made against the appropriation.

Object Classification (in millions of dollars)


Identification code 75–0516–0–1–551 2011 actual 2012 est. 2013 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent - Medicaid Integrity Program 9 9 9
12.1 Civilian personnel benefits - Medicaid Integrity Program 6 6 6
41.0 Grants, subsidies, and contributions - Ticket to Work 75
41.0 Grants, subsidies, and contributions - Emergency services for undocumented aliens 88 22 18
41.0 Grants, subsidies, and contributions - Medicaid Integrity Program 62 81 65
41.0 Grants, subsidies, and contributions - Partnership for long-term care 3
41.0 Grants, subsidies, and contributions - Psychiatric residential treatment demonstration 148
41.0 Grants, subsidies, and contributions - Money follows the person (MFP) demonstration 298 410 403
41.0 Grants, subsidies, and contributions - MFP evaluations and technical support 1 1 1
41.0 Grants, subsidies, and contributions - Grants to improve outreach and enrollment 43 7 34
41.0 Grants, subsidies, and contributions - Application of Prospective Payment System 1 3
41.0 Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration 18 23 24
41.0 Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid 29 22



99.0 Direct obligations 752 591 582
99.0 Reimbursable obligations 6



99.9 Total new obligations 758 591 582

Employment Summary


Identification code 75–0516–0–1–551 2011 actual 2012 est. 2013 est.

1001 Direct civilian full-time equivalent employment 81 100 102

Payments to Health Care Trust Funds

For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, [$230,741,378,000] $251,359,000,000.

In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security Act that were not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2012.)

Program and Financing (in millions of dollars)


Identification code 75–0580–0–1–571 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Federal contribution to match premiums (SMI) 168,849 167,184 189,520
0002 Part D benefits (Rx Drug) 55,929 47,282 60,744
0003 Part D Federal administration (Rx Drug) 373 405 424
0004 General Fund Transfers to HI 489 603 671
0006 Federal Bureau of Investigation (HCFAC) 128 132 135
0007 Federal payments from taxation of OASDI benefits (HI) 15,143 18,443 20,811
0008 Criminal fines (HCFAC) 1,196 1,045 1,127
0009 Civil monetary penalties and damages (HCFAC - DOJ and CMS administration) 18 20 20
0010 Asset Forfeiture 22



0900 Total new obligations 242,147 235,114 273,452

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite, annual) 229,464 230,741 251,359
1200 Appropriation (indefinite, permanent) 15,143 18,443 20,811
1200 Appropriation (HCFAC for FBI) 128 132 135
1200 Appropriation (indefinite for HCFAC) 1,236 1,065 1,147



1260 Appropriations, mandatory (total) 245,971 250,381 273,452
1930 Total budgetary resources available 245,971 250,381 273,452
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3,824 –15,267

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 242,147 235,114 273,452
3031 Obligations incurred, expired accounts 46
3040 Outlays (gross) –242,193 –235,114 –273,452

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 245,971 250,381 273,452
Outlays, gross:
4100 Outlays from new mandatory authority 242,147 235,114 273,452
4101 Outlays from mandatory balances 46



4110 Outlays, gross (total) 242,193 235,114 273,452
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –19
Additional offsets against gross budget authority only:
4142 Offsetting collections credited to expired accounts 19



4160 Budget authority, net (mandatory) 245,971 250,381 273,452
4170 Outlays, net (mandatory) 242,174 235,114 273,452
4180 Budget authority, net (total) 245,971 250,381 273,452
4190 Outlays, net (total) 242,174 235,114 273,452

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


2011 actual 2012 est. 2013 est.

Enacted/requested:
Budget Authority 245,971 250,381 273,452
Outlays 242,174 235,114 273,452
Amounts included in the adjusted baseline:
Budget Authority 4,514
Outlays 4,514
Legislative proposal, not subject to PAYGO:
Budget Authority –4,565
Outlays –4,565
Increased funding for BBEDCA program integrity adjustments:
Outlays 114
Total:
Budget Authority 245,971 250,381 273,401
Outlays 242,174 235,228 273,401

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

Object Classification (in millions of dollars)


Identification code 75–0580–0–1–571 2011 actual 2012 est. 2013 est.

Direct obligations:
41.0 Grants, subsidies, and contributions 241,139 234,106 272,357
42.0 Insurance claims and indemnities 275 262 228
94.0 Financial transfers (Federal admin) 733 746 867



99.9 Total new obligations 242,147 235,114 273,452

Payments to Health Care Trust Funds

(Amounts included in the adjusted baseline)

Program and Financing (in millions of dollars)


Identification code 75–0580–7–1–571 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Federal contribution to match premiums (SMI) 4,514



0900 Total new obligations (object class 41.0) 4,514

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite annuall) 4,514



1260 Appropriations, mandatory (total) 4,514
1930 Total budgetary resources available 4,514

Change in obligated balance:
3030 Obligations incurred, unexpired accounts 4,514
3040 Outlays (gross) –4,514

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 4,514
Outlays, gross:
4100 Outlays from new mandatory authority 4,514
4180 Budget authority, net (total) 4,514
4190 Outlays, net (total) 4,514

Payments to Health Care Trust Funds

(Legislative proposal, not subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0580–2–1–571 2011 actual 2012 est. 2013 est.

Obligations by program activity:
0001 Federal contribution to match premiums (SMI) –15
0002 Part D benefits (Rx Drug) –4,550



0900 Total new obligations (object class 41.0) –4,565

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite, annual) –4,565



1260 Appropriations, mandatory (total) –4,565
1930 Total budgetary resources available –4,565

Change in obligated balance:
3030 Obligations incurred, unexpired accounts –4,565
3040 Outlays (gross) 4,565

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross –4,565
Outlays, gross:
4100 Outlays from new mandatory authority –4,565
4180 Budget authority, net (total) –4,565
4190 Outlays, net (total) –4,565

Quality Improvements Organizations