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; $3,957,738,000: Provided, That, of the amount provided under this heading, $760,000,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this account and remain available until expended; $114,833,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and shall remain available until expended; $534,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain available until expended: Provided further, That, in addition to 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 2014 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, human generic drug, and biosimilar biological product assessments for fiscal year 2014, including any such fees collected prior to fiscal year 2014 but credited for fiscal year 2014, shall be subject to the fiscal year 2014 limitations: Provided further, That the Secretary may, prior to the due date for such fees, accept payment during fiscal year 2014 of user fees specified under this heading and authorized for fiscal year 2015, and that amounts of such fiscal year 2015 fees for which the Secretary accepts payment during fiscal year 2014 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.

In addition, human generic drug user fees authorized by 21 U.S.C. 379j-42, biosimilar biological product fees authorized by 21 U.S.C. 379j-52, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381, priority review user fees authorized by 21 U.S.C. 360n, and food and feed recall and reinspection fees authorized by 21 U.S.C. 379j-31 shall 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, to remain available until expended.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9911–0–1–554 2012 actual 2013 CR 2014 est.

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



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



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–9911–0–1–554 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Foods 866 864 883
0002 Drugs 828 481 466
0003 Devices and radiological products 323 325 321
0004 National Center for Toxicological Research 60 60 59
0005 Other activities 154 163 173
0006 Other rent and rent related activities 106 107 133
0007 Rental payments 160 161 162
0008 Buildings and facilities 9 9 9
0009 CRADAs 2 2 2
0010 Animal Drugs and Feed 138 141
0011 Biologics 213 211



0799 Total direct obligations 2,508 2,523 2,560
0801 Reimbursable program (User fees) 1,086 1,686 1,788
0802 Reimbursable program (Federal sources) 49 49



0899 Total reimbursable obligations 1,086 1,735 1,837



0900 Total new obligations 3,594 4,258 4,397

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 581 854 854
1001 Discretionary unobligated balance brought fwd, Oct 1 581 854
1021 Recoveries of prior year unpaid obligations 1



1050 Unobligated balance (total) 582 854 854
Budget authority:
Appropriations, discretionary:
1100 Appropriation 2,506 2,521 2,558



1160 Appropriation, discretionary (total) 2,506 2,521 2,558
Appropriations, mandatory:
1201 Appropriation (special or trust fund) 2 2 2



1260 Appropriations, mandatory (total) 2 2 2
Spending authority from offsetting collections, discretionary:
1700 Collected 1,275 1,416 1,837
1701 Change in uncollected payments, Federal sources 19
1702 Offsetting collections (previously unavailable) 388 324 333
1725 Spending authority from offsetting collections precluded from obligation (limitation on obligations) –324 –324 –333



1750 Spending auth from offsetting collections, disc (total) 1,358 1,416 1,837
Spending authority from offsetting collections, mandatory:
1800 Collected 319



1850 Spending auth from offsetting collections, mand (total) 319
1900 Budget authority (total) 3,866 4,258 4,397
1930 Total budgetary resources available 4,448 5,112 5,251
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 854 854 854

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 1,459 1,663 1,641
3010 Obligations incurred, unexpired accounts 3,594 4,258 4,397
3011 Obligations incurred, expired accounts 5
3020 Outlays (gross) –3,330 –4,280 –4,354
3040 Recoveries of prior year unpaid obligations, unexpired –1
3041 Recoveries of prior year unpaid obligations, expired –64



3050 Unpaid obligations, end of year 1,663 1,641 1,684
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –46 –44 –44
3070 Change in uncollected pymts, Fed sources, unexpired –19
3071 Change in uncollected pymts, Fed sources, expired 21



3090 Uncollected pymts, Fed sources, end of year –44 –44 –44
Memorandum (non-add) entries:
3100 Obligated balance, start of year 1,413 1,619 1,597
3200 Obligated balance, end of year 1,619 1,597 1,640

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,864 3,937 4,395
Outlays, gross:
4010 Outlays from new discretionary authority 2,420 2,888 3,331
4011 Outlays from discretionary balances 908 1,071 1,021



4020 Outlays, gross (total) 3,328 3,959 4,352
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –49 –49 –49
4033 Non-Federal sources –1,252 –1,367 –1,788



4040 Offsets against gross budget authority and outlays (total) –1,301 –1,416 –1,837
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –19
4052 Offsetting collections credited to expired accounts 26



4060 Additional offsets against budget authority only (total) 7



4070 Budget authority, net (discretionary) 2,570 2,521 2,558
4080 Outlays, net (discretionary) 2,027 2,543 2,515
Mandatory:
4090 Budget authority, gross 2 321 2
Outlays, gross:
4100 Outlays from new mandatory authority 2 321 2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –319
4180 Budget authority, net (total) 2,572 2,523 2,560
4190 Outlays, net (total) 2,029 2,545 2,517

Memorandum (non-add) entries:
5090 Unavailable balance, SOY: Offsetting collections 413 349 349
5091 Unavailable balance, EOY: Offsetting collections 349 349 349

[In millions of dollars]


2012 2013 2014

Distribution of discretionary budget authority by account:
Salaries and expenses 2497 2512 2549
Buildings and facilities 9 9 9
Distribution of discretionary outlays by account:
Salaries and expenses 2018 2534 2506
Buildings and facilities 9 9 9

The Food and Drug Administration (FDA) is responsible for protecting the public health by ensuring the safety, effectiveness, and security of human and veterinary drugs, biological products and medical devices; ensuring the safety of foods, cosmetics, and radiation-emitting products; and regulating tobacco products. FDA also advances public health by helping to speed innovations that make medicines and devices safer and more effective. The agency strives to provide the public with accurate, science-based information necessary to use medical products and foods to maintain and improve their health. FDA also has responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors. Finally, FDA plays a significant role in the Nations counterterrorism efforts. FDA fulfills this responsibility by ensuring the security of the food supply and by fostering the development of medical products to respond to intentional and natural public health threats. 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 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 757 719 787
11.3 Other than full-time permanent 101 97 106
11.5 Other personnel compensation 54 51 56
11.7 Military personnel 60 57 61
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 973 925 1,011
12.1 Civilian personnel benefits 267 254 278
12.2 Military personnel benefits 32 30 32
21.0 Travel and transportation of persons 47 51 49
22.0 Transportation of things 4 5 5
23.1 Rental payments to GSA 161 161 162
23.2 Rental payments to others 3 3 3
23.3 Communications, utilities, and miscellaneous charges 37 40 38
24.0 Printing and reproduction 3 3 3
25.1 Advisory and assistance services 47 50 48
25.2 Other services from non-Federal sources 359 384 340
25.3 Other goods and services from Federal sources 226 242 233
25.4 Operation and maintenance of facilities 57 61 59
25.5 Research and development contracts 33 35 34
25.7 Operation and maintenance of equipment 48 52 50
26.0 Supplies and materials 42 46 44
31.0 Equipment 54 58 56
32.0 Land and structures 4 5 5
41.0 Grants, subsidies, and contributions 110 117 109
42.0 Insurance claims and indemnities 1 1 1



99.0 Direct obligations 2,508 2,523 2,560
99.0 Reimbursable obligations 1,086 1,735 1,837



99.9 Total new obligations 3,594 4,258 4,397

Employment Summary


Identification code 75–9911–0–1–554 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 8,974 10,025 10,316
1101 Direct military average strength employment 690 690 690
2001 Reimbursable civilian full-time equivalent employment 3,514 3,477 3,580
2101 Reimbursable military average strength employment 270 270 270
3001 Allocation account civilian full-time equivalent employment 53 72 74
3101 Allocation account military average strength employment 1 1 1

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall assess a fee with respect to animal drugs and animal generic drugs: Provided, That fees of $23,600,000 with respect to animal drugs shall be credited to this account and remain available until expended; and $7,328,000 with respect to animal generic drugs shall be credited to this account and remain available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for such animal drug user fees and animal generic drug user fees that exceed the respective fiscal year 2014 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from such animal drugs and animal generic drugs assessments for fiscal year 2014, including any such fees collected prior to fiscal year 2014 but credited for fiscal 2014, shall be subject to the fiscal year 2014 limitations: Provided further, That the Secretary may, prior to the due date for such animal drug and animal generic drug user fees, accept payment during fiscal year 2014 of such fees authorized for fiscal year 2015, and that amounts of such fiscal year 2015 fees for which the Secretary accepts payment during fiscal year 2014 shall not be included in amounts provided under this heading.

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

Program and Financing (in millions of dollars)


Identification code 75–9911–2–1–554 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0801 ADUFA 23
0802 AGDUFA 7
0803 Med.Prod.Reinspect 15
0804 Intl.Courier 6
0805 Food Reg.and Inspect 59
0806 Food Import 166
0807 Cosmetics 19
0808 Food Contact 5



0900 Total new obligations 300

Budgetary Resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700 Collected 300



1750 Spending auth from offsetting collections, disc (total) 300
1900 Budget authority (total) 300
1930 Total budgetary resources available 300

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 300
3020 Outlays (gross) –300

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 300
Outlays, gross:
4010 Outlays from new discretionary authority 300
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033 Non-Federal sources –300

The 2014 Budget includes a number of new user fees. Legislation will be proposed to allow FDA to collect fees for food facility registration and inspection as well as for food import to implement the requirements of the FDA Food Safety Modernization Act (FSMA). The additional resources, estimated at $59 million for the food facility registration and inspection program, would enable FDA to target new and improved activities required by FSMA to modernize the food safety system and support improvements in food safety science and risk analysis to prevent food safety outbreaks. The fees collected for the food import program, estimated at $166 million, would support FDA's food safety efforts to modernize the import system. The Budget also reproposes user fees to support activities related to cosmetics and food contact notification activities and user fees to support inspection-related activities at domestic courier facilities and reinspections at medical product facilities.

The FDA transmitted proposed legislation to reauthorize the Animal Drug User Fee Act and the Animal Generic Drug User Fee Act to Congress on February 25, 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 2012 actual 2013 CR 2014 est.

99.9 Total new obligations 300

Employment Summary


Identification code 75–9911–2–1–554 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment
1101 Direct military average strength employment
2001 Reimbursable civilian full-time equivalent employment 612
2101 Reimbursable military average strength employment
3001 Allocation account civilian full-time equivalent employment
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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0801 Reimbursable program 7 8 8

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 2 3 3
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 11 11
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 3 3 3

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 3 3 2
3010 Obligations incurred, unexpired accounts 7 8 8
3020 Outlays (gross) –7 –9 –9



3050 Unpaid obligations, end of year 3 2 1
Memorandum (non-add) entries:
3100 Obligated balance, start of year 3 3 2
3200 Obligated balance, end of year 3 2 1

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 8 8 8
Outlays, gross:
4100 Outlays from new mandatory authority 2 8 8
4101 Outlays from mandatory balances 5 1 1



4110 Outlays, gross (total) 7 9 9
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –8 –8 –8
4190 Outlays, net (total) –1 1 1

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

Object Classification (in millions of dollars)


Identification code 75–4309–0–3–554 2012 actual 2013 CR 2014 est.

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



99.9 Total new obligations 7 8 8

Employment Summary


Identification code 75–4309–0–3–554 2012 actual 2013 CR 2014 est.

2001 Reimbursable civilian full-time equivalent employment 36 37 37

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, $1,566,932,000: 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 $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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

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, $540,804,000: Provided, That sections 747(c)(2) and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply to funds made available under this heading: 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, 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, $824,861,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $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 $10,276,000 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, $2,387,178,000, of which $2,036,898,000 shall remain available to the Secretary through September 30, 2016, for parts A and B of title XXVI of the PHS Act: Provided, That of the funds available for parts A and B of title XXVI of the PHS Act, not less than $943,299,000 shall be for State AIDS Drug Assistance Programs 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, $83,836,000, of which $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: 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 the Secretary based on sales data that shall be submitted by drug manufacturers 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, $122,232,000, of which $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, $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, $10,036,000 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, $327,402,000: 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, $161,794,000: 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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0350–0–1–550 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0010 Health Centers 1,472 1,492 1,472
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 83 84 83
0017 Health Professions 376 383 363
0018 Maternal and Child Health Block Grant 639 649 639
0019 Healthy Start 104 105 104
0020 Poison Control Centers 19 19
0021 EMS for Children 21 21 21
0022 Universal Newborn Hearing Screening 19 19
0023 HIV/AIDS 2,367 2,337 2,387
0024 Organ Transplantation 24 25 26
0025 Bone Marrow Donor Registry 23 23 23
0026 Rural Health Policy Development 10 10 10
0027 Rural Health Outreach Grants 55 56 56
0028 Rural Health Flexibility Grants 41 41 26
0030 Telehealth 11 12 12
0031 Program Management 160 162 162
0032 Family Planning 294 299 327
0033 Loan Repayment/Faculty Fellowship 1 1 1
0035 Health Centers Tort Claim Fund 75 133 95
0036 Heritable Disorders 10 10
0038 Childrens' GME 265 270 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 47 48 47
0046 Cord Blood Stem Cell Bank 12 12 12
0048 Sickle Cell 5 5 5
0049 Drug Pricing Program 4 4 4
0050 Family to Family Health Information Centers ACA 5 5
0067 Prevention Fund 37 57
0073 Health Centers ACA 1,171 1,220 1,246
0074 Health Centers Construction ACA 741 10 7
0075 National Health Service Corps ACA 297 300 305
0076 School Based Health Centers ACA 19 83
0077 GME Payments THC ACA 17 50 73
0079 Rural Health AED 1 3
0080 Pediatric Loan Repayment 5



0300 Total direct programs 8,472 7,938 7,703



0799 Total direct obligations 8,472 7,938 7,703
0801 Reimbursable program 75 71 77
0802 Reimbursable program: PHS evaluation 22 25 25



0899 Total reimbursable obligations 97 96 102



0900 Total new obligations 8,569 8,034 7,805

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 1,061 381 531
1001 Discretionary unobligated balance brought fwd, Oct 1 58 83
1021 Recoveries of prior year unpaid obligations 8



1050 Unobligated balance (total) 1,069 381 531
Budget authority:
Appropriations, discretionary:
1100 Appropriation 6,206 6,232 6,015
1121 Appropriations transferred from other accts [75–9915] 9
1121 Appropriations transferred from other accts [75–0943] 1
1121 Appropriations transferred from other accts [75–1362] 1
1130 Appropriations permanently reduced –12



1160 Appropriation, discretionary (total) 6,205 6,232 6,015
Appropriations, mandatory:
1200 Appropriation 1,550 1,855 2,505
1221 Appropriations transferred from other accts [75–0116] 37 57



1260 Appropriations, mandatory (total) 1,587 1,855 2,562
Spending authority from offsetting collections, discretionary:
1700 Collected 33 81 87
1701 Change in uncollected payments, Federal sources 45



1750 Spending auth from offsetting collections, disc (total) 78 81 87
Spending authority from offsetting collections, mandatory:
1800 Offsetting collections (cash)(HPSL&NSL) 14 16 16



1850 Spending auth from offsetting collections, mand (total) 14 16 16
1900 Budget authority (total) 7,884 8,184 8,680
1930 Total budgetary resources available 8,953 8,565 9,211
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3
1941 Unexpired unobligated balance, end of year 381 531 1,406

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 6,836 6,681 6,186
3010 Obligations incurred, unexpired accounts 8,569 8,034 7,805
3011 Obligations incurred, expired accounts 15
3020 Outlays (gross) –8,638 –8,529 –8,272
3040 Recoveries of prior year unpaid obligations, unexpired –8
3041 Recoveries of prior year unpaid obligations, expired –93



3050 Unpaid obligations, end of year 6,681 6,186 5,719
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –42 –80 –80
3070 Change in uncollected pymts, Fed sources, unexpired –45
3071 Change in uncollected pymts, Fed sources, expired 7



3090 Uncollected pymts, Fed sources, end of year –80 –80 –80
Memorandum (non-add) entries:
3100 Obligated balance, start of year 6,794 6,601 6,106
3200 Obligated balance, end of year 6,601 6,106 5,639

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 6,283 6,313 6,102
Outlays, gross:
4010 Outlays from new discretionary authority 2,515 2,549 2,460
4011 Outlays from discretionary balances 4,277 3,764 3,721



4020 Outlays, gross (total) 6,792 6,313 6,181
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –16 –52 –53
4033 Non-Federal sources –29 –29 –28
4033 Non-Federal sources –6



4040 Offsets against gross budget authority and outlays (total) –45 –81 –87
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –45
4052 Offsetting collections credited to expired accounts 12



4060 Additional offsets against budget authority only (total) –33



4070 Budget authority, net (discretionary) 6,205 6,232 6,015
4080 Outlays, net (discretionary) 6,747 6,232 6,094
Mandatory:
4090 Budget authority, gross 1,601 1,871 2,578
Outlays, gross:
4100 Outlays from new mandatory authority 801 850 855
4101 Outlays from mandatory balances 1,045 1,366 1,236



4110 Outlays, gross (total) 1,846 2,216 2,091
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –14 –16 –16
4180 Budget authority, net (total) 7,792 8,087 8,577
4190 Outlays, net (total) 8,579 8,432 8,169

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


Identification code 75–0350–0–1–550 2012 actual 2013 CR 2014 est.

Guaranteed loan levels supportable by subsidy budget authority:
215001 Health centers: Facilities renovation loan guarantee levels 10 8 4
215002 Health centers: Managed care network development loan guarantee 1 1
215003 Health centers: Managed care plan loan guarantee levels 3 1



215999 Total loan guarantee levels 10 12 6
Guaranteed loan subsidy (in percent):
232001 Health centers: Facilities renovation loan guarantee levels 2.67 2.69 2.81
232002 Health centers: Managed care network development loan guarantee 9.62 9.73 10.10
232003 Health centers: Managed care plan loan guarantee levels 5.76 5.79 5.86



232999 Weighted average subsidy rate 2.67 4.05 4.53

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 2014 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 2011–2012 data reported in the Annual Operating Report.

Health Professions Revolving Loan Programs Federal Capital Contribution


Program Account Balance

HPSL $378,701,815
NSL $171,324,184
PCL $246,664,915

LDS $130,836,447


Total $927,527,361


Object Classification (in millions of dollars)


Identification code 75–0350–0–1–550 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 150 150 151
11.3 Other than full-time permanent 6 6 6
11.5 Other personnel compensation 3 3 4
11.7 Military personnel 20 20 20
11.8 Special personal services payments 1 1



11.9 Total personnel compensation 180 180 181
12.1 Civilian personnel benefits 45 45 44
12.2 Military personnel benefits 11 11 11
21.0 Travel and transportation of persons 3 3 4
23.1 Rental payments to GSA 23 23 23
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 2 2 1
24.0 Printing and reproduction 1
25.1 Advisory and assistance services 13 13 38
25.2 Other services from non-Federal sources 181 176 156
25.3 Other goods and services from Federal sources 202 201 197
25.4 Operation and maintenance of facilities 1 1 1
25.6 Medical care 3 3 3
25.7 Operation and maintenance of equipment 13 13 14
26.0 Supplies and materials 2 2 1
31.0 Equipment 6 6 4
41.0 Grants, subsidies, and contributions 7,718 7,131 6,934
42.0 Insurance claims and indemnities 68 127 89



99.0 Direct obligations 8,472 7,938 7,703
99.0 Reimbursable obligations 97 96 102



99.9 Total new obligations 8,569 8,034 7,805

Employment Summary


Identification code 75–0350–0–1–550 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 1,564 1,556 1,547
1101 Direct military average strength employment 200 200 200
2001 Reimbursable civilian full-time equivalent employment 79 85 85
2101 Reimbursable military average strength employment 8 8 8

Vaccine Injury Compensation

Program and Financing (in millions of dollars)


Identification code 75–0320–0–1–551 2012 actual 2013 CR 2014 est.

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 12 16 16
Budget authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 4



1850 Spending auth from offsetting collections, mand (total) 4
1900 Budget authority (total) 4
1930 Total budgetary resources available 16 16 16
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 16 16 16

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 4
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –4
4190 Outlays, net (total) –4

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 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 2012 actual 2013 CR 2014 est.

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



0900 Total new obligations 2 5 4

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



1050 Unobligated balance (total) 5 6 4
1930 Total budgetary resources available 5 6 4
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 3 1

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 2 1 6
3010 Obligations incurred, unexpired accounts 2 5 4
3020 Outlays (gross) –3



3050 Unpaid obligations, end of year 1 6 10
Memorandum (non-add) entries:
3100 Obligated balance, start of year 2 1 6
3200 Obligated balance, end of year 1 6 10

Budget authority and outlays, net:
Discretionary:
Outlays, gross:
4011 Outlays from discretionary balances 3
4190 Outlays, net (total) 3

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 2012 actual 2013 CR 2014 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 2 3 3
42.0 Insurance claims and indemnities 2 1



99.9 Total new obligations 2 5 4

Employment Summary


Identification code 75–0343–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 4 4 4
1101 Direct military average strength employment 3 3 3

Maternal, Infant, and Early Childhood Home Visiting Programs

Program and Financing (in millions of dollars)


Identification code 75–0321–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0010 Maternal, Infant, and Early Childhood Home Visiting Programs 344 400 406

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 13 13
1012 Unobligated balance transfers between expired and unexpired accounts 7



1050 Unobligated balance (total) 7 13 13
Budget authority:
Appropriations, mandatory:
1200 Appropriation 350 400 400



1260 Appropriations, mandatory (total) 350 400 400
1930 Total budgetary resources available 357 413 413
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 13 13 7

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 313 528 527
3010 Obligations incurred, unexpired accounts 344 400 406
3020 Outlays (gross) –122 –401 –318
3041 Recoveries of prior year unpaid obligations, expired –7



3050 Unpaid obligations, end of year 528 527 615
Memorandum (non-add) entries:
3100 Obligated balance, start of year 313 528 527
3200 Obligated balance, end of year 528 527 615

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 350 400 400
Outlays, gross:
4100 Outlays from new mandatory authority 19 120 120
4101 Outlays from mandatory balances 103 281 198



4110 Outlays, gross (total) 122 401 318
4180 Budget authority, net (total) 350 400 400
4190 Outlays, net (total) 122 401 318

P.L. 111–148 provides resources to Maternal, Infant and Early Childhood Home Visiting Program through 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 2012 actual 2013 CR 2014 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 3 2 2
12.1 Civilian personnel benefits 1 1 1
25.1 Advisory and assistance services 18 15 15
41.0 Grants, subsidies, and contributions 322 382 388



99.9 Total new obligations 344 400 406

Employment Summary


Identification code 75–0321–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 19 21 21
1101 Direct military average strength employment 4 4 4

Health Center Guaranteed Loan Financing Account

Program and Financing (in millions of dollars)


Identification code 75–4442–0–3–551 2012 actual 2013 CR 2014 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 3 3 2
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:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 1
3010 Obligations incurred, unexpired accounts 1 1



3050 Unpaid obligations, end of year 1 2
Memorandum (non-add) entries:
3100 Obligated balance, start of year 1
3200 Obligated balance, end of year 1 2

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4442–0–3–551 2012 actual 2013 CR 2014 est.

Position with respect to appropriations act limitation on commitments:
2121 Limitation available from carry-forward 28 18 6
2143 Uncommitted limitation carried forward –18 –6



2150 Total guaranteed loan commitments 10 12 6
2199 Guaranteed amount of guaranteed loan commitments 8 10 5

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 80 77 77
2231 Disbursements of new guaranteed loans 8 11 5
2251 Repayments and prepayments –10 –10 –10
2263 Adjustments: Terminations for default that result in claim payments –1 –1 –1



2290 Outstanding, end of year 77 77 71

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 70 65 60

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 2011 actual 2012 actual

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


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


4999 Total liabilities and net position 3 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 administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, $2,807,000.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0340–0–1–552 2012 actual 2013 CR 2014 est.

Obligations by program activity:
Credit program obligations:
0707 Reestimates of loan guarantee subsidy 25
0708 Interest on reestimates of loan guarantee subsidy 31
0709 Administrative expenses 3 3



0900 Total new obligations 3 59

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 56



1260 Appropriations, mandatory (total) 56
1900 Budget authority (total) 3 59
1930 Total budgetary resources available 3 59

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 2 1 1
3010 Obligations incurred, unexpired accounts 3 59
3020 Outlays (gross) –3 –59
3041 Recoveries of prior year unpaid obligations, expired –1



3050 Unpaid obligations, end of year 1 1 1
Memorandum (non-add) entries:
3100 Obligated balance, start of year 2 1 1
3200 Obligated balance, end of year 1 1 1

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 56
Outlays, gross:
4100 Outlays from new mandatory authority 56
4180 Budget authority, net (total) 3 59
4190 Outlays, net (total) 3 59

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


Identification code 75–0340–0–1–552 2012 actual 2013 CR 2014 est.

Guaranteed loan upward reestimates:
235001 HEAL Loan guarantee 56



235999 Total upward reestimate budget authority 56
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 2014 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 2012 actual 2013 CR 2014 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 2 2
25.3 Other goods and services from Federal sources 1 1
41.0 Grants, subsidies, and contributions 56



99.9 Total new obligations 3 59

Employment Summary


Identification code 75–0340–0–1–552 2012 actual 2013 CR 2014 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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
Credit program obligations:
0711 Default claim payments on principal 19 13
0742 Downward reestimate paid to receipt account 5
0743 Interest on downward reestimates 7



0900 Total new obligations 31 13

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 69 49 99
1010 Unobligated balance transfer to other accts [91–4300] –99



1050 Unobligated balance (total) 69 49
Financing authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 11 63



1850 Spending auth from offsetting collections, mand (total) 11 63
1930 Total budgetary resources available 80 112
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 49 99

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 31 13
3020 Financing disbursements (gross) –31 –13

Financing authority and disbursements, net:
Mandatory:
4090 Financing authority, gross 11 63
Financing disbursements:
4110 Financing disbursements, gross 31 13
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120 Federal sources-upward estimate and interest –56
4122 Interest on uninvested funds –4 –3
4123 Recoveries of defaulted loans –7 –4



4130 Offsets against gross financing auth and disbursements (total) –11 –63
4170 Financing disbursements, net (mandatory) 20 –50
4190 Financing disbursements, net (total) 20 –50

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4304–0–3–552 2012 actual 2013 CR 2014 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 526 430 402
2251 Repayments and prepayments –77 –15
Adjustments:
2261 Terminations for default that result in loans receivable –18 –9
2263 Terminations for default that result in claim payments –1 –4
2264 Other adjustments, net –402



2290 Outstanding, end of year 430 402

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 430

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 175 184 190
2331 Disbursements for guaranteed loan claims 16 10
2361 Write-offs of loans receivable –7 –4
2364 Other adjustments, net –190



2390 Outstanding, end of year 184 190

Balance Sheet (in millions of dollars)


Identification code 75–4304–0–3–552 2011 actual 2012 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 70 50
Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501 Defaulted guaranteed loans receivable, gross 175 184
1505 Allowance for subsidy cost (-) –126 –126


1599 Net present value of assets related to defaulted guaranteed loans 49 58


1999 Total assets 119 108
LIABILITIES:
2204 Non-Federal liabilities: Liabilities for loan guarantees 119 108


4999 Total liabilities and net position 119 108

Health Education Assistance Loans Liquidating Account

Program and Financing (in millions of dollars)


Identification code 75–4305–0–3–552 2012 actual 2013 CR 2014 est.

Obligations by program activity:
Credit program obligations:
0711 Default claim payments on principal 4 3



0900 Total new obligations (object class 33.0) 4 3

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



1260 Appropriations, mandatory (total) 1 1
Spending authority from offsetting collections, mandatory:
1800 Collected 8 7
1820 Capital transfer of spending authority from offsetting collections to general fund –5 –5



1850 Spending auth from offsetting collections, mand (total) 3 2
1900 Budget authority (total) 4 3
1930 Total budgetary resources available 4 3

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 4 3
3020 Outlays (gross) –4 –3

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 4 3
Outlays, gross:
4100 Outlays from new mandatory authority 4 3
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –8 –7
4180 Budget authority, net (total) –4 –4
4190 Outlays, net (total) –4 –4

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4305–0–3–552 2012 actual 2013 CR 2014 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 83 64 53
2251 Repayments and prepayments –15 –8
Adjustments:
2261 Terminations for default that result in loans receivable –4 –3
2264 Other adjustments, net –53



2290 Outstanding, end of year 64 53

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 64 53

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 362 346 324
2331 Disbursements for guaranteed loan claims 3 3
2351 Repayments of loans receivable –8 –7
2361 Write-offs of loans receivable –21 –18
2364 Other adjustments, net 10 –324



2390 Outstanding, end of year 346 324

Balance Sheet (in millions of dollars)


Identification code 75–4305–0–3–552 2011 actual 2012 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 1 1
1701 Defaulted guaranteed loans, gross 362 346
1703 Allowance for estimated uncollectible loans and interest (-) –238 –238


1799 Value of assets related to loan guarantees 124 108


1999 Total assets 125 109
LIABILITIES:
2104 Federal liabilities: Resources payable to Treasury 119 109
2204 Non-Federal liabilities: Liabilities for loan guarantees 6


2999 Total liabilities 125 109


4999 Total liabilities and net position 125 109

Medical Facilities Guarantee and Loan Fund

Program and Financing (in millions of dollars)


Identification code 75–9931–0–3–551 2012 actual 2013 CR 2014 est.

Budgetary Resources:
Unobligated balance:
1021 Recoveries of prior year unpaid obligations 1
1022 Capital transfer of unobligated balances to general fund –1

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 1
3040 Recoveries of prior year unpaid obligations, unexpired –1
Memorandum (non-add) entries:
3100 Obligated balance, start of year 1

Status of Direct Loans (in millions of dollars)


Identification code 75–9931–0–3–551 2012 actual 2013 CR 2014 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 2011 actual 2012 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 $6,477,000 shall be available from the Trust Fund to the Secretary.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–8175–0–7–551 2012 actual 2013 CR 2014 est.

0100 Balance, start of year 3,115 3,214 3,289
Receipts:
0200 Deposits, Vaccine Injury Compensation Trust Fund 254 262 271
0240 Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund 49 74 121



0299 Total receipts and collections 303 336 392



0400 Total: Balances and collections 3,418 3,550 3,681
Appropriations:
0500 Vaccine Injury Compensation Program Trust Fund –19 –19 –19
0501 Vaccine Injury Compensation Program Trust Fund –185 –242 –242



0599 Total appropriations –204 –261 –261



0799 Balance, end of year 3,214 3,289 3,420

Program and Financing (in millions of dollars)


Identification code 75–8175–0–7–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Compensation: Claims for post - FY 1989 injuries 185 242 242
0103 Claims processing (Claims Court) 5 5 5
0104 Claims processing (HRSA) 6 6 6
0105 Claims processing (Dept. of Justice) 8 8 8



0191 Total, administrative expenses 19 19 19



0799 Total direct obligations 204 261 261
0801 Reimbursable program activity (claims) 1



0900 Total new obligations 205 261 261

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) 185 242 242



1260 Appropriations, mandatory (total) 185 242 242
Spending authority from offsetting collections, mandatory:
1800 Collected 1



1850 Spending auth from offsetting collections, mand (total) 1
1900 Budget authority (total) 205 261 261
1930 Total budgetary resources available 205 261 261

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 19 19
3001 Adjustments to unpaid obligations, brought forward, Oct 1 2
3010 Obligations incurred, unexpired accounts 205 261 261
3020 Outlays (gross) –207 –280 –261



3050 Unpaid obligations, end of year 19
Memorandum (non-add) entries:
3100 Obligated balance, start of year 21 19
3200 Obligated balance, end of year 19

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



4020 Outlays, gross (total) 20 38 19
Mandatory:
4090 Budget authority, gross 186 242 242
Outlays, gross:
4100 Outlays from new mandatory authority 2 242 242
4101 Outlays from mandatory balances 185



4110 Outlays, gross (total) 187 242 242
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –1
4180 Budget authority, net (total) 204 261 261
4190 Outlays, net (total) 206 280 261

Memorandum (non-add) entries:
5000 Total investments, SOY: Federal securities: Par value 3,108 3,194 3,287
5001 Total investments, EOY: Federal securities: Par value 3,194 3,287 3,433

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 2012 actual 2013 CR 2014 est.

Direct obligations:
25.3 Other goods and services from Federal sources 19 19 19
42.0 Insurance claims and indemnities 185 242 242



99.0 Direct obligations 204 261 261
99.0 Reimbursable obligations 1



99.9 Total new obligations 205 261 261

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, $3,505,293,000, 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, $878,575,000 for Purchased/Referred Care, including $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: 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 the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0390–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Clinical services 3,153 3,177 3,189
0002 Preventive health 147 148 152
0003 Urban health 43 43 43
0004 Indian health professions 41 41 41
0005 Tribal management 3 3 3
0006 Direct operations 72 72 72
0007 Self-governance 6 6 6
0008 Contract support costs 471 476
0009 Diabetes funds 187 187 150



0799 Total direct obligations 4,123 4,153 3,656
0801 Reimbursable program 1,100 1,102 1,100



0900 Total new obligations 5,223 5,255 4,756

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 745 560 510
1001 Discretionary unobligated balance brought fwd, Oct 1 700 514
1021 Recoveries of prior year unpaid obligations 118



1050 Unobligated balance (total) 863 560 510
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,872 3,890 3,505
1120 Appropriations transferred to other accts [75–0390] –69
1121 Appropriations transferred from other accts [75–0390] 69
1130 Appropriations permanently reduced –6



1160 Appropriation, discretionary (total) 3,866 3,890 3,505
Appropriations, mandatory:
1200 Appropriation 150 150 150



1260 Appropriations, mandatory (total) 150 150 150
Spending authority from offsetting collections, discretionary:
1700 Collected 1,147 1,165 1,165
1701 Change in uncollected payments, Federal sources –242



1750 Spending auth from offsetting collections, disc (total) 905 1,165 1,165
1900 Budget authority (total) 4,921 5,205 4,820
1930 Total budgetary resources available 5,784 5,765 5,330
Memorandum (non-add) entries:
1940 Unobligated balance expiring –1
1941 Unexpired unobligated balance, end of year 560 510 574

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 866 844 768
3010 Obligations incurred, unexpired accounts 5,223 5,255 4,756
3011 Obligations incurred, expired accounts 30
3020 Outlays (gross) –5,138 –5,331 –5,010
3040 Recoveries of prior year unpaid obligations, unexpired –118
3041 Recoveries of prior year unpaid obligations, expired –19



3050 Unpaid obligations, end of year 844 768 514
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –332 –82 –82
3070 Change in uncollected pymts, Fed sources, unexpired 242
3071 Change in uncollected pymts, Fed sources, expired 8



3090 Uncollected pymts, Fed sources, end of year –82 –82 –82
Memorandum (non-add) entries:
3100 Obligated balance, start of year 534 762 686
3200 Obligated balance, end of year 762 686 432

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 4,771 5,055 4,670
Outlays, gross:
4010 Outlays from new discretionary authority 4,307 4,355 4,039
4011 Outlays from discretionary balances 721 820 815



4020 Outlays, gross (total) 5,028 5,175 4,854
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –324 –368 –368
4033 Non-Federal sources –823 –797 –797



4040 Offsets against gross budget authority and outlays (total) –1,147 –1,165 –1,165
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired 242



4070 Budget authority, net (discretionary) 3,866 3,890 3,505
4080 Outlays, net (discretionary) 3,881 4,010 3,689
Mandatory:
4090 Budget authority, gross 150 150 150
Outlays, gross:
4100 Outlays from new mandatory authority 49 144 144
4101 Outlays from mandatory balances 61 12 12



4110 Outlays, gross (total) 110 156 156
4180 Budget authority, net (total) 4,016 4,040 3,655
4190 Outlays, net (total) 3,991 4,166 3,845

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.403 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2014.

Object Classification (in millions of dollars)


Identification code 75–0390–0–1–551 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 413 413 409
11.3 Other than full-time permanent 21 21 20
11.5 Other personnel compensation 58 58 58
11.7 Military personnel 76 76 75



11.9 Total personnel compensation 568 568 562
12.1 Civilian personnel benefits 148 148 147
12.2 Military personnel benefits 35 35 34
13.0 Benefits for former personnel 9 9 9
21.0 Travel and transportation of persons 8 8 8
21.0 Patient travel 35 35 37
22.0 Transportation of things 7 7 7
23.1 Rental payments to GSA 9 9 9
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 12 12 12
25.1 Advisory and assistance services 9 9 4
25.2 Other services from non-Federal sources 123 125 121
25.3 Other goods and services from Federal sources 48 48 48
25.4 Operation and maintenance of facilities 8 8 8
25.6 Medical care 328 333 343
25.7 Operation and maintenance of equipment 18 18 19
25.8 Subsistence and support of persons 3 3 4
26.0 Supplies and materials 109 111 114
31.0 Equipment 12 12 12
41.0 Grants, subsidies, and contributions 2,633 2,654 2,157



99.0 Direct obligations 4,123 4,153 3,656
99.0 Reimbursable obligations 1,100 1,102 1,100



99.9 Total new obligations 5,223 5,255 4,756

Employment Summary


Identification code 75–0390–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 7,013 7,128 7,128
1101 Direct military average strength employment 1,085 1,103 1,103
2001 Reimbursable civilian full-time equivalent employment 5,272 5,291 5,291
2101 Reimbursable military average strength employment 816 819 819

Indian Health Contract Support Costs

For payments of contract support costs associated with ongoing Indian Self-Determination Act agreements with the Indian Health Service for fiscal or calendar year 2014, not to exceed $477,205,000: Provided, That, notwithstanding any other provision of law, the amount available for contract support costs associated with each ongoing Indian Self-Determination Act agreement with the Indian Health Service for fiscal or calendar year 2014 shall not exceed the amount identified in the Indian Health Service Contract Support Costs table submitted by the Secretary of Health and Human Services to the House and Senate Committees on Appropriations.

In addition, not to exceed $500,000 shall be available for payments for contract support costs associated with new or expanded Indian Self-Determination Act agreements with the Indian Health Service for fiscal or calendar year 2014.

Program and Financing (in millions of dollars)


Identification code 75–3920–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Contract Support Costs 477



0900 Total new obligations (object class 41.0) 477

Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100 Appropriation 477



1160 Appropriation, discretionary (total) 477
1930 Total budgetary resources available 477

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 477
3020 Outlays (gross) –391



3050 Unpaid obligations, end of year 86
Memorandum (non-add) entries:
3200 Obligated balance, end of year 86

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 477
Outlays, gross:
4010 Outlays from new discretionary authority 391
4180 Budget authority, net (total) 477
4190 Outlays, net (total) 391

The Indian Health Service Contract Support Costs (CSC) account supports federal government payments to tribes for certain administrative costs associated with executing tribal self-governance contracts and compacts under the Indian Self Determination and Education Assistance Act (ISDEAA), P.L. 93–638, that are not otherwise funded under the contract or compact. The Bureau of Indian Affairs is also required to pay CSC under ISDEAA. Payments are available for direct and indirect contract support costs. Indirect contract support costs are those incurred for a Tribe's or tribal organization's common services, including, but not limited to, insurance and audits. Direct contract costs include program-specific costs such as unemployment taxes and workers compensation insurance. The account also supports the costs associated with executing or administering new and/or expanded self-determination contracts.

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, $448,139,000 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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0391–0–1–551 2012 actual 2013 CR 2014 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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Sanitation and health facilities 175 176 164
0002 Maintenance 63 63 54
0003 Facilities and environmental health 203 205 207
0004 Equipment 26 26 23



0100 Total direct program 467 470 448



0799 Total direct obligations 467 470 448
0801 Reimbursable program 39 39 39



0900 Total new obligations 506 509 487

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 216 167 115
1001 Discretionary unobligated balance brought fwd, Oct 1 216 167
1021 Recoveries of prior year unpaid obligations 7



1050 Unobligated balance (total) 223 167 115
Budget authority:
Appropriations, discretionary:
1100 Appropriation 441 443 448
1130 Appropriations permanently reduced –1



1160 Appropriation, discretionary (total) 440 443 448
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 18 6 6
1701 Change in uncollected payments, Federal sources –16



1750 Spending auth from offsetting collections, disc (total) 2 6 6
1900 Budget authority (total) 450 457 462
1930 Total budgetary resources available 673 624 577
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 167 115 90

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 578 526 540
3010 Obligations incurred, unexpired accounts 506 509 487
3011 Obligations incurred, expired accounts 1
3020 Outlays (gross) –551 –495 –491
3040 Recoveries of prior year unpaid obligations, unexpired –7
3041 Recoveries of prior year unpaid obligations, expired –1



3050 Unpaid obligations, end of year 526 540 536
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –21 –6 –6
3070 Change in uncollected pymts, Fed sources, unexpired 16
3071 Change in uncollected pymts, Fed sources, expired –1



3090 Uncollected pymts, Fed sources, end of year –6 –6 –6
Memorandum (non-add) entries:
3100 Obligated balance, start of year 557 520 534
3200 Obligated balance, end of year 520 534 530

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 442 449 454
Outlays, gross:
4010 Outlays from new discretionary authority 283 139 141
4011 Outlays from discretionary balances 263 348 342



4020 Outlays, gross (total) 546 487 483
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –18 –6 –6
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired 16



4070 Budget authority, net (discretionary) 440 443 448
4080 Outlays, net (discretionary) 528 481 477
Mandatory:
4090 Budget authority, gross 8 8 8
Outlays, gross:
4100 Outlays from new mandatory authority 2 8 8
4101 Outlays from mandatory balances 3



4110 Outlays, gross (total) 5 8 8
4180 Budget authority, net (total) 448 451 456
4190 Outlays, net (total) 533 489 485

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. An estimated $208.8 million primarily through self determination contracts and compacts, will be administered by tribal governments in 2014.

Object Classification (in millions of dollars)


Identification code 75–0391–0–1–551 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 47 47 47
11.3 Other than full-time permanent 2 2 2
11.5 Other personnel compensation 2 2 2
11.7 Military personnel 23 23 24



11.9 Total personnel compensation 74 74 75
12.1 Civilian personnel benefits 15 15 14
12.2 Military personnel benefits 8 8 8
21.0 Travel and transportation of persons 2 2 2
22.0 Transportation of things 4 4 4
23.1 Rental payments to GSA 1 1 1
23.3 Communications, utilities, and miscellaneous charges 16 16 16
25.1 Advisory and assistance services 2 2 2
25.2 Other services from non-Federal sources 81 82 71
25.3 Other goods and services from Federal sources 4 4 4
25.4 Operation and maintenance of facilities 8 8 6
25.7 Operation and maintenance of equipment 4 4 4
25.8 Subsistence and support of persons 1 1 1
26.0 Supplies and materials 8 8 7
31.0 Equipment 14 14 13
32.0 Land and structures 42 43 41
41.0 Grants, subsidies, and contributions 183 184 179



99.0 Direct obligations 467 470 448
99.0 Reimbursable obligations 39 39 39



99.9 Total new obligations 506 509 487

Employment Summary


Identification code 75–0391–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 1,021 1,021 1,021
1101 Direct military average strength employment 170 170 170
2001 Reimbursable civilian full-time equivalent employment 32 32 32

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.

Centers for Disease Control and Prevention

Federal Funds

CDC-Wide Activities and Program Support

Immunization and Respiratory Diseases

For carrying out titles II, III, 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, $668,696,000: Provided, That in addition to amounts provided herein, $12,864,000 shall be available from amounts available under section 241 of the PHS Act to carry out the National Immunization Surveys.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

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

For carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, $1,173,942,000: Provided, That in addition to the amounts provided herein, $3,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out the evaluation of HIV school health activities.

Emerging and Zoonotic Infectious Diseases

For carrying out titles II, III, 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, $380,664,000, 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, XI, XV, and XVII of the PHS Act and Public Law 111–148 with respect to chronic disease prevention and health promotion, $620,189,000: Provided, That Centers for Disease Control and Prevention and State grant recipients may reallocate up to five percent of grant funds received for diabetes, heart disease and stroke, obesity, and school health activities to address cross-cutting chronic disease issues: 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 reallocate such funds: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for up to 21 States, tribes, or tribal organizations: Provided further, That the Secretary may grant up to ten waivers under section 1503(d) of the PHS Act.

Birth Defects, Developmental Disabilities, Disabilities and Health

For carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, $67,148,000.

Public Health Scientific Services

For carrying out titles II, III, and XVII of the PHS Act and Public Law 111–148 with respect to health statistics, surveillance, health informatics, and workforce development, $144,416,000: Provided, That in addition to amounts provided herein, $324,889,000 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, and XVII of the PHS Act with respect to environmental health, $126,126,000.

Injury Prevention and Control

For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $176,585,000: Provided, that in addition to the amounts provided herein, $5,000,000 shall be available from amounts under section 241 of the PHS Act to carry out the evaluation of Rape Prevention and Education programs authorized by the Violence Against Women Act.

National Institute for Occupational Safety and Health

For carrying out titles II, III, 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, $271,911,000 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: 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, and XVII of the PHS Act with respect to global health, $393,024,000 of which $131,942,000 for international HIV/AIDS shall remain available through September 30, 2015: 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, 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, $1,334,316,000, of which $510,278,000 shall remain available until expended for the Strategic National Stockpile.

CDC-Wide Activities and Program Support

For carrying out titles II, III, and XVII 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, $131,403,000, of which $14,591,000 shall be available until expended for equipment, construction, and renovation of facilities: Provided, That 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") 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, 2015: Provided further, That of the funds made available under this heading and in all other accounts of CDC, up to $1,000 per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: 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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0943–0–1–999 2012 actual 2013 CR 2014 est.

0100 Balance, start of year
Receipts:
0220 Cooperative Research and Development Agreements, Centers for Disease Control 3 2 2



0400 Total: Balances and collections 3 2 2
Appropriations:
0500 CDC-Wide Activities and Program Support –3 –2 –2



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–0943–0–1–999 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Birth Defects, Developmental Disabilities, Disability and Health (BA & Prevention Fund) (0958) 137 138 142
0002 CDC Wide Activities and Program Support (0943) 659 622 173
0004 Chronic Disease Prevention and Health Promotion (0948) 1,167 761 1,036
0005 Emerging and Zoonotic Infectious Diseases (0949) 304 254 432
0006 Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954) 54 55
0007 Environmental Health (0947) 140 106 155
0008 Global Health (0955) 348 350 393
0012 HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950) 1,110 1,107 1,177
0013 Immunization and Respiratory Diseases (0951) 779 593 754
0015 Injury Prevention and Control (0952) 138 139 182
0016 Occupational Safety and Health (0953) 293 294 272
0019 Public Health Preparedness & Response (0956) 1,299 1,308 1,334
0020 Public Health Scientific Services (0959) 462 394 539
0021 Cooperative Research and Development Agreements (CRADA) (5146) 2 2 2



0799 Total direct obligations 6,892 6,068 6,646
0802 Other Reimbursable Programs 273 273 273



0809 Reimbursable program activities, subtotal 273 273 273



0900 Total new obligations 7,165 6,341 6,919

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 193 182
1001 Discretionary unobligated balance brought fwd, Oct 1 96 96
1021 Recoveries of prior year unpaid obligations 7



1050 Unobligated balance (total) 200 182
Budget authority:
Appropriations, discretionary:
1100 Appropriation 5,688 5,692 5,217
1120 Appropriations transferred to other accts [75–0350] –1
1130 Appropriations permanently reduced –31



1160 Appropriation, discretionary (total) 5,656 5,692 5,217
Appropriations, mandatory:
1200 Appropriation 55 55
1201 Appropriation (special or trust fund) 3 2 2
1221 Appropriations transferred from other accts [75–0116] 809 755



1260 Appropriations, mandatory (total) 867 2 812
Spending authority from offsetting collections, discretionary:
1700 Collected 326 465 890
1701 Change in uncollected payments, Federal sources 307



1750 Spending auth from offsetting collections, disc (total) 633 465 890
1900 Budget authority (total) 7,156 6,159 6,919
1930 Total budgetary resources available 7,356 6,341 6,919
Memorandum (non-add) entries:
1940 Unobligated balance expiring –9
1941 Unexpired unobligated balance, end of year 182

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 6,452 6,314 5,830
3010 Obligations incurred, unexpired accounts 7,165 6,341 6,919
3011 Obligations incurred, expired accounts 28
3020 Outlays (gross) –7,243 –6,825 –6,809
3040 Recoveries of prior year unpaid obligations, unexpired –7
3041 Recoveries of prior year unpaid obligations, expired –81



3050 Unpaid obligations, end of year 6,314 5,830 5,940
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –468 –460 –460
3070 Change in uncollected pymts, Fed sources, unexpired –307
3071 Change in uncollected pymts, Fed sources, expired 315



3090 Uncollected pymts, Fed sources, end of year –460 –460 –460
Memorandum (non-add) entries:
3100 Obligated balance, start of year 5,984 5,854 5,370
3200 Obligated balance, end of year 5,854 5,370 5,480

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 6,289 6,157 6,107
Outlays, gross:
4010 Outlays from new discretionary authority 2,497 2,415 2,702
4011 Outlays from discretionary balances 4,183 3,994 3,723



4020 Outlays, gross (total) 6,680 6,409 6,425
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –629 –458 –881
4033 Non-Federal sources –7 –7 –9



4040 Offsets against gross budget authority and outlays (total) –636 –465 –890
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –307
4052 Offsetting collections credited to expired accounts 310



4060 Additional offsets against budget authority only (total) 3



4070 Budget authority, net (discretionary) 5,656 5,692 5,217
4080 Outlays, net (discretionary) 6,044 5,944 5,535
Mandatory:
4090 Budget authority, gross 867 2 812
Outlays, gross:
4100 Outlays from new mandatory authority 207 2 303
4101 Outlays from mandatory balances 356 414 81



4110 Outlays, gross (total) 563 416 384
4180 Budget authority, net (total) 6,523 5,694 6,029
4190 Outlays, net (total) 6,607 6,360 5,919

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 and respiratory diseases, HIV/AIDS, Hepatitis, STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, occupational safety and health, public health and scientific services, 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, and emergency response. The 2012 and 2013 levels in MAX are not comparable with the 2014 Budget levels. The 2014 Budget realigns business support services from the prior fiscal to the program budget lines based on previous consumption data.

Object Classification (in millions of dollars)


Identification code 75–0943–0–1–999 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 696 737 742
11.3 Other than full-time permanent 95 92 92
11.5 Other personnel compensation 31 39 39
11.7 Military personnel 68 67 69
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 891 936 943
12.1 Civilian personnel benefits 247 252 254
12.2 Military personnel benefits 46 48 48
21.0 Travel and transportation of persons 46 41 41
22.0 Transportation of things 20 15 15
23.1 Rental payments to GSA 25 52 52
23.2 Rental payments to others 2 1 1
23.3 Communications, utilities, and miscellaneous charges 51 34 34
24.0 Printing and reproduction 3 5 5
25.1 Advisory and assistance services 634 448 448
25.2 Other services from non-Federal sources 226 193 193
25.3 Other goods and services from Federal sources 386 371 371
25.4 Operation and maintenance of facilities 74 47 47
25.5 Research and development contracts 84 63 63
25.6 Medical care 36 28 28
25.7 Operation and maintenance of equipment 40 33 33
25.8 Subsistence and support of persons (Includes 1259) 41 30 30
26.0 Supplies and materials 646 528 528
31.0 Equipment 94 56 56
32.0 Land and structures 15 8 8
41.0 Grants, subsidies, and contributions 3,285 2,879 3,448



99.0 Direct obligations 6,892 6,068 6,646
99.0 Reimbursable obligations 273 273 273



99.9 Total new obligations 7,165 6,341 6,919

Employment Summary


Identification code 75–0943–0–1–999 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 8,676 8,623 8,623
1101 Direct military average strength employment 805 805 805
2001 Reimbursable civilian full-time equivalent employment 1,018 1,018 1,018
2101 Reimbursable military average strength employment 72 72 72

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; and section 3019 of the Solid Waste Disposal Act, as amended, $76,215,000 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 2014, and existing profiles may be updated as necessary.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0944–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Direct program 79 77 76
0801 Reimbursable program 11 10 10



0900 Total new obligations 90 87 86

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 20 17 17
Budget authority:
Appropriations, discretionary:
1100 Appropriation 76 77 76



1160 Appropriation, discretionary (total) 76 77 76
Spending authority from offsetting collections, discretionary:
1700 Collected 4 10 10
1701 Change in uncollected payments, Federal sources 7



1750 Spending auth from offsetting collections, disc (total) 11 10 10
1900 Budget authority (total) 87 87 86
1930 Total budgetary resources available 107 104 103
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 17 17 17

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 48 52 26
3010 Obligations incurred, unexpired accounts 90 87 86
3020 Outlays (gross) –85 –113 –81
3041 Recoveries of prior year unpaid obligations, expired –1



3050 Unpaid obligations, end of year 52 26 31
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –13 –14 –14
3070 Change in uncollected pymts, Fed sources, unexpired –7
3071 Change in uncollected pymts, Fed sources, expired 6



3090 Uncollected pymts, Fed sources, end of year –14 –14 –14
Memorandum (non-add) entries:
3100 Obligated balance, start of year 35 38 12
3200 Obligated balance, end of year 38 12 17

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 87 87 86
Outlays, gross:
4010 Outlays from new discretionary authority 53 64 63
4011 Outlays from discretionary balances 29 38 15



4020 Outlays, gross (total) 82 102 78
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –9 –10 –10
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –7
4052 Offsetting collections credited to expired accounts 5



4060 Additional offsets against budget authority only (total) –2



4070 Budget authority, net (discretionary) 76 77 76
4080 Outlays, net (discretionary) 73 92 68
Mandatory:
Outlays, gross:
4101 Outlays from mandatory balances 3 11 3
4180 Budget authority, net (total) 76 77 76
4190 Outlays, net (total) 76 103 71

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 2012 actual 2013 CR 2014 est.

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



11.9 Total personnel compensation 27 28 28
12.1 Civilian personnel benefits 7 7 7
12.2 Military personnel benefits 1 2 2
21.0 Travel and transportation of persons 1
25.1 Advisory and assistance services 4 4 4
25.2 Other services from non-Federal sources 7 7 7
25.3 Other goods and services from Federal sources 14 11 11
31.0 Equipment 1 1 1
41.0 Grants, subsidies, and contributions 17 17 15



99.0 Direct obligations 79 77 75
99.0 Reimbursable obligations 11 10 11



99.9 Total new obligations 90 87 86

Employment Summary


Identification code 75–0944–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 249 250 250
1101 Direct military average strength employment 37 35 35
2001 Reimbursable civilian full-time equivalent employment 10 10 10

World Trade Center Health Program Fund

Program and Financing (in millions of dollars)


Identification code 75–0946–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Federal Share 187 231 241
0002 NYC 21 26 26



0900 Total new obligations 208 257 267

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (WTC (CDC Direct)) 187 231 241
1200 Appropriation (WTC—NYC DHSS—CDC) 18 26 26



1260 Appropriations, mandatory (total) 205 257 267
Spending authority from offsetting collections, mandatory:
1800 Collected 3



1850 Spending auth from offsetting collections, mand (total) 3
1900 Budget authority (total) 208 257 267
1930 Total budgetary resources available 208 257 267

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 68 113 137
3010 Obligations incurred, unexpired accounts 208 257 267
3020 Outlays (gross) –146 –233 –226
3041 Recoveries of prior year unpaid obligations, expired –17



3050 Unpaid obligations, end of year 113 137 178
Memorandum (non-add) entries:
3100 Obligated balance, start of year 68 113 137
3200 Obligated balance, end of year 113 137 178

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 208 257 267
Outlays, gross:
4100 Outlays from new mandatory authority 106 129 134
4101 Outlays from mandatory balances 40 104 92



4110 Outlays, gross (total) 146 233 226
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –6
Additional offsets against gross budget authority only:
4142 Offsetting collections credited to expired accounts 3



4160 Budget authority, net (mandatory) 205 257 267
4170 Outlays, net (mandatory) 140 233 226
4180 Budget authority, net (total) 205 257 267
4190 Outlays, net (total) 140 233 226

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 2013 and 2014 Budget reflect estimated Federal obligations for the WTC Health Program.

Object Classification (in millions of dollars)


Identification code 75–0946–0–1–551 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 2 2 2
11.7 Military personnel 1 1 1



11.9 Total personnel compensation 3 3 3
25.1 Advisory and assistance services 3 20 20
25.2 Other services from non-Federal sources 33 33
25.3 Other goods and services from Federal sources 77 4 4
25.6 Medical care 106 177 187
41.0 Grants, subsidies, and contributions 19 20 20



99.9 Total new obligations 208 257 267

Employment Summary


Identification code 75–0946–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 8 8 8
1101 Direct military average strength employment 2 2 2

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, $5,125,951,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer InstituteFrederick Federally Funded Research and Development Center in Frederick, Maryland.

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, $3,098,508,000.

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, $411,515,000.

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, $1,811,786,000.

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, $1,642,619,000.

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, $4,578,813,000.

National Institute of General Medical Sciences

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $2,401,011,000.

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, $1,339,360,000.

National Eye Institute

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $699,216,000.

National Institute of Environment Health Sciences

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $691,348,000.

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $79,411,000.

National Institute on Aging

For carrying out section 301 and title IV of the PHS Act with respect to aging, $1,193,370,000.

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, $540,993,000.

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, $422,936,000.

National Institute of Nursing Research

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, $146,244,000.

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, $463,848,000.

National Institute on Drug Abuse

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $1,071,612,000.

National Institute of Mental Health

For carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,465,782,000.

National Human Genome Research Institute

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, $517,319,000.

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, $338,892,000.

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, $129,041,000.

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, $283,299,000.

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), $72,864,000.

National Library of Medicine

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, $382,252,000, of which $4,000,000 shall be available until September 30, 2015, for improvement of information systems: Provided, That in fiscal year 2014, 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 information services.

National Center for Advancing Translational Sciences

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $665,688,000: Provided, That up to $50,000,000 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.

Office of the Director

For carrying out the responsibilities of the Office of the Director, NIH, $1,473,398,000, of which up to $25,000,000 shall be used to carry out section 211 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 $572,948,000 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.

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, $126,111,000, to remain available until expended.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9915–0–1–552 2012 actual 2013 CR 2014 est.

0100 Balance, start of year
Receipts:
0220 Cooperative Research and Development Agreements, NIH 16 17 17



0400 Total: Balances and collections 16 17 17
Appropriations:
0500 National Institutes of Health –16 –17 –17



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–9915–0–1–552 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 National Cancer Institute (0849) 5,068 5,103 5,126
0002 National Heart, Lung, and Blood Institute (0872) 3,052 3,098 3,099
0003 National Institute of Dental and Craniofacial Research (0873) 410 413 412
0004 National Institute of Diabetes and Digestive and Kidney Disease (0884) 1,795 1,808 1,812
0005 National Institute of Neurological Disorders and Stroke (0886) 1,625 1,636 1,643
0006 National Institute of Allergy and Infectious Diseases (0885) 4,487 4,518 4,579
0007 National Institute of General Medical Sciences (0851) 2,428 2,445 2,401
0008 National Institute of Child Health and Human Development (0844) 1,320 1,329 1,339
0009 National Eye Institute (0887) 702 707 699
0010 National Institute of Environmental Health Sciences (0862) 764 769 771
0011 National Institute on Aging (0843) 1,121 1,110 1,193
0012 National Institute of Arthritis and Musculoskeletal and Skin Disease (0888) 535 539 541
0013 National Institute on Deafness and Other Communication Disorder (0890) 416 419 423
0014 National Institute of Mental Health (0892) 1,479 1,489 1,466
0015 National Institute on Drug Abuse (0893) 1,052 1,060 1,072
0016 National Institute on Alcohol Abuse and Alcoholism (0894) 459 462 464
0017 National Institute of Nursing Research (0889) 145 146 146
0018 National Human Genome Research Institute (0891) 513 516 517
0019 National Institute of Biomedical Imaging and Bioengineering (0898) 338 340 339
0021 National Center for Complementary and Alternative Medicine (0896) 128 129 129
0022 National Institute on Minority Health and Health Disparities (0897) 276 278 283
0023 John E. Fogarty International Center (0819) 70 70 73
0024 National Library of Medicine (0807) 337 340 382
0025 Office of the Director (0846) 1,458 1,468 1,473
0026 Buildings and facilities (0838) 99 126 126
0027 Cooperative Research and Development Agreements 18 17 17
0028 National Center for Advancing Translational Sciences (0875) 575 579 666
0031 Type 1 Diabetes 150 150 150



0799 Total direct obligations 30,820 31,064 31,341
0801 Reimbursable program activity 3,166 3,168 3,377
0802 Royalties 87 88 88



0809 Reimbursable program activities, subtotal 3,253 3,256 3,465



0899 Total reimbursable obligations 3,253 3,256 3,465



0900 Total new obligations 34,073 34,320 34,806

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 374 457 371
1001 Discretionary unobligated balance brought fwd, Oct 1 342 420
1021 Recoveries of prior year unpaid obligations 52



1050 Unobligated balance (total) 426 457 371
Budget authority:
Appropriations, discretionary:
1100 Appropriation 30,769 30,899 31,173
1120 Appropriations transferred to other accts [75–0350] –9
1130 Appropriations permanently reduced –58



1160 Appropriation, discretionary (total) 30,702 30,899 31,173
Appropriations, mandatory:
1200 Appropriation 150 150 150
1201 Appropriation (special or trust fund) 16 17 17



1260 Appropriations, mandatory (total) 166 167 167
Spending authority from offsetting collections, discretionary:
1700 Collected 2,733 3,168 3,377
1701 Change in uncollected payments, Federal sources 530



1750 Spending auth from offsetting collections, disc (total) 3,263 3,168 3,377
1900 Budget authority (total) 34,131 34,234 34,717
1930 Total budgetary resources available 34,557 34,691 35,088
Memorandum (non-add) entries:
1940 Unobligated balance expiring –27
1941 Unexpired unobligated balance, end of year 457 371 282

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 35,624 33,051 32,411
3010 Obligations incurred, unexpired accounts 34,073 34,320 34,806
3011 Obligations incurred, expired accounts 926
3020 Outlays (gross) –36,568 –34,960 –34,713
3040 Recoveries of prior year unpaid obligations, unexpired –52
3041 Recoveries of prior year unpaid obligations, expired –952



3050 Unpaid obligations, end of year 33,051 32,411 32,504
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –1,151 –938 –938
3070 Change in uncollected pymts, Fed sources, unexpired –530
3071 Change in uncollected pymts, Fed sources, expired 743



3090 Uncollected pymts, Fed sources, end of year –938 –938 –938
Memorandum (non-add) entries:
3100 Obligated balance, start of year 34,473 32,113 31,473
3200 Obligated balance, end of year 32,113 31,473 31,566

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 33,965 34,067 34,550
Outlays, gross:
4010 Outlays from new discretionary authority 10,769 11,512 11,794
4011 Outlays from discretionary balances 25,653 23,140 22,750



4020 Outlays, gross (total) 36,422 34,652 34,544
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –3,675 –3,168 –3,377
4033 Non-Federal sources –112



4040 Offsets against gross budget authority and outlays (total) –3,787 –3,168 –3,377
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –530
4052 Offsetting collections credited to expired accounts 1,054



4060 Additional offsets against budget authority only (total) 524



4070 Budget authority, net (discretionary) 30,702 30,899 31,173
4080 Outlays, net (discretionary) 32,635 31,484 31,167
Mandatory:
4090 Budget authority, gross 166 167 167
Outlays, gross:
4100 Outlays from new mandatory authority 10 52 53
4101 Outlays from mandatory balances 136 256 116



4110 Outlays, gross (total) 146 308 169
4180 Budget authority, net (total) 30,868 31,066 31,340
4190 Outlays, net (total) 32,781 31,792 31,336

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


2012 20131 2014

Distribution of budget authority by account:
National Cancer Institute 5,072 5,103 5,126
National Heart, Lung, and Blood Institute 3,079 3,098 3,099
National Institute of Dental and Craniofacial Research 411 413 412
National Institute of Diabetes and Digestive and Kidney Diseases 1,947 1,958 1,962
National Institute of Neurological Disorder and Stroke 1,626 1,636 1,643
National Institute of Allergy and Infectious Diseases 4,491 4,518 4,579
National Institute of General Medical Sciences 2,430 2,445 2,401
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,321 1,329 1,339
National Eye Institute 703 707 699
National Institute of Environmental Health Sciences 764 769 771
National Institute on Aging 1,103 1,110 1,193
National Institute of Arthritis and Musculoskeletal and Skin Diseases 536 539 541
National Institute on Deafness and Other Communication Disorders 416 419 423
National Institute of Mental Health 1,480 1,489 1,466
National Institute on Drug Abuse 1,053 1,060 1,072
National Institute on Alcohol Abuse and Alcoholism 460 462 464
National Institute of Nursing Research 145 146 146
National Center for Research Resources 0 0 0
National Human Genome Research Institute 513 516 517
National Institute of Biomedical Imaging and Bioengineering 338 340 339
National Institute on Minority Health and Health Disparities 276 278 283
National Center for Complementary and Alternative Medicine 128 129 129
National Center for Advancing Translational Sciences 575 579 666
John E. Fogarty International Center 70 70 73
National Library of Medicine 338 340 382
Office of the Director 1,459 1,468 1,473
Buildings and Facilities 125 126 126

ARRA Funds 0 0 0



Subtotal 30,861 31,049 31,323

Cooperative Research and Development Agreements 17 17 17




Total Budget Authority, NIH 30,878 31,066 31,340




1Assumes annualized continuing resolution

(in millions of dollars)


2012 2013 2014

Distribution of outlays by account:
National Cancer Institute 5,154 4,909 5,102
National Heart, Lung, and Blood Institute 3,151 2,925 3,089
National Institute of Dental and Craniofacial Research 403 423 412
National Institute of Diabetes and Digestive and Kidney Diseases 1,927 2,342 1,956
National Institute of Neurological Disorders and Stroke 1,593 1,715 1,636
National Institute of Allergy and Infectious Diseases 4,569 4,340 4,527
National Institute of General Medical Sciences 1,824 2,668 2,427
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,289 1,359 1,331
National Eye Institute 699 707 704
National Institute of Environmental Health Sciences 1,049 490 769
National Institute on Aging 1,101 1,081 1,131
National Institute of Arthritis and Musculoskeletal and Skin Diseases 531 527 539
National Institute on Deafness and Other Communication Disorders 417 420 419
National Institute of Mental Health 1,490 1,435 1,481
National Institute on Drug Abuse 1,090 962 1,061
National Institute on Alcohol Abuse and Alcoholism 467 460 462
National Institute of Nursing Research 145 137 146
National Center for Research Resources 910 406 77
National Human Genome Research Institute 498 537 516
National Institute of Biomedical Imaging and Bioengineering 318 331 339
National Institute on Minority Health and Health Disparities 227 243 274
National Center for Complementary and Alternative Medicine 123 126 129
National Center for Advancing Translational Sciences 98 326 554
John E. Fogarty International Center 65 72 71
National Library of Medicine 341 328 362
Office of the Director 1,341 1,359 1,439
Buildings and Facilities 112 130 90
ARRA Funds 1,880 1,020 277
Management Fund/Service and Supply Fund –46 0 0
Subtotal Outlays 32,769 31,777 31,318

Cooperative Research and Development Agreements 13 16 16




Total Outlays, NIH 32,782 31,792 31,336




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 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 879 933 944
11.3 Other than full-time permanent 475 487 496
11.5 Other personnel compensation 30 32 33
11.7 Military personnel 21 22 22
11.8 Special personal services payments 162 163 166



11.9 Total personnel compensation 1,567 1,637 1,661
12.1 Civilian personnel benefits 411 430 435
12.2 Military personnel benefits 15 16 16
21.0 Travel and transportation of persons 50 49 49
22.0 Transportation of things 5 5 5
23.1 Rental payments to GSA 1 2 2
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 27 27 27
24.0 Printing and reproduction 3 3 3
25.1 Advisory and assistance services 125 115 115
25.2 Other services from non-Federal sources 819 702 725
25.3 Other goods and services from Federal sources 3,171 3,126 3,273
25.4 Operation and maintenance of facilities 45 45 45
25.5 Research and development contracts 1,996 1,984 1,905
25.6 Medical care 20 20 20
25.7 Operation and maintenance of equipment 88 86 86
26.0 Supplies and materials 193 190 189
31.0 Equipment 154 142 144
32.0 Land and structures 126 126
41.0 Grants, subsidies, and contributions 22,130 22,358 22,514



99.0 Direct obligations 30,821 31,064 31,341
99.0 Reimbursable obligations 3,252 3,256 3,465



99.9 Total new obligations 34,073 34,320 34,806

Employment Summary


Identification code 75–9915–0–1–552 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 13,048 13,604 13,607
1101 Direct military average strength employment 201 201 198
2001 Reimbursable civilian full-time equivalent employment 5,137 4,581 4,581
2101 Reimbursable military average strength employment 107 107 107

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, $990,341,000 of which $438,717,000 shall be for carrying out Section 1911 of the PHS Act: 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 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 2014: Provided further, That notwithstanding section 565(b)(1) of the PHS Act, technical assistance may be provided to communities that wish to establish such programs irrespective of whether the communities have a grant under section 561(a): Provided further, That States shall expend at least 3 percent of the amount for carrying out section 1911 of the PHS Act to award competitive subawards that assist providers in building capacity to bill third party insurance or assist individuals to enroll in insurance for which they are eligible: Provided further, That States shall expend at least 5 percent of the amount for carrying out section 1911 of the PHS Act to award competitive subawards that support effective evidence-based mental health prevention and treatment practices: Provided further, That any State receiving 2 percent or more of the total amount distributed for carrying out section 1911 of the PHS Act shall expend the amounts described in the two immediately preceding provisos through competitive subawards.

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, $2,052,926,000 of which $1,748,132,000 shall be for carrying out Section 1921 of the PHS Act: Provided, That in addition to amounts provided herein, $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: Provided further, That States shall expend at least 3 percent of the amount for carrying out section 1921 of the PHS Act to award competitive subawards that assist providers in building capacity to bill third party insurance or assist individuals to enroll in insurance for which they are eligible: Provided further, That any State receiving 1 percent or more of the total amount distributed for carrying out section 1921 of the PHS Act shall expend the amounts described in the immediately preceding proviso through competitive subawards.

Substance Abuse Prevention

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $175,560,000.

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, $129,124,000: Provided, That in addition to amounts provided herein, $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 of 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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–1362–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0006 Mental Health 978 934 990
0007 Substance Abuse Treatment 2,148 2,132 2,053
0008 Substance Abuse Prevention 186 187 176
0009 Health Surveillance and Program Support 126 115 129



0100 Total, direct program 3,438 3,368 3,348



0799 Total direct obligations 3,438 3,368 3,348
0802 Reimbursable program: PHS Evaluation 248 253 257



0900 Total new obligations 3,686 3,621 3,605

Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,354 3,368 3,348
1120 Appropriations transferred to other accts [75–0350] –1
1130 Appropriations permanently reduced –6



1160 Appropriation, discretionary (total) 3,347 3,368 3,348
Appropriations, mandatory:
1221 Appropriations transferred from the Prevention and Public Health Fund [75–0116] 92 58



1260 Appropriations, mandatory (total) 92 58
Spending authority from offsetting collections, discretionary:
1700 Collected 238 253 259
1701 Change in uncollected payments, Federal sources 10



1750 Spending auth from offsetting collections, disc (total) 248 253 259
1900 Budget authority (total) 3,687 3,621 3,665
1930 Total budgetary resources available 3,687 3,621 3,665
Memorandum (non-add) entries:
1940 Unobligated balance expiring –1
1941 Unexpired unobligated balance, end of year 60

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 2,965 3,125 2,899
3010 Obligations incurred, unexpired accounts 3,686 3,621 3,605
3011 Obligations incurred, expired accounts 5
3020 Outlays (gross) –3,487 –3,847 –3,669
3041 Recoveries of prior year unpaid obligations, expired –44



3050 Unpaid obligations, end of year 3,125 2,899 2,835
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –241 –22 –22
3070 Change in uncollected pymts, Fed sources, unexpired –10
3071 Change in uncollected pymts, Fed sources, expired 229



3090 Uncollected pymts, Fed sources, end of year –22 –22 –22
Memorandum (non-add) entries:
3100 Obligated balance, start of year 2,724 3,103 2,877
3200 Obligated balance, end of year 3,103 2,877 2,813

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,595 3,621 3,607
Outlays, gross:
4010 Outlays from new discretionary authority 1,359 1,469 1,468
4011 Outlays from discretionary balances 2,118 2,295 2,150



4020 Outlays, gross (total) 3,477 3,764 3,618
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –471 –253 –257
4033 Non-Federal sources –2



4040 Offsets against gross budget authority and outlays (total) –471 –253 –259
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –10
4052 Offsetting collections credited to expired accounts 233



4060 Additional offsets against budget authority only (total) 223



4070 Budget authority, net (discretionary) 3,347 3,368 3,348
4080 Outlays, net (discretionary) 3,006 3,511 3,359
Mandatory:
4090 Budget authority, gross 92 58
Outlays, gross:
4100 Outlays from new mandatory authority 10
4101 Outlays from mandatory balances 83 51



4110 Outlays, gross (total) 10 83 51
4180 Budget authority, net (total) 3,439 3,368 3,406
4190 Outlays, net (total) 3,016 3,594 3,410

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

Object Classification (in millions of dollars)


Identification code 75–1362–0–1–551 2012 actual 2013 CR 2014 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 46 54 57
11.3 Other than full-time permanent 2 3 4
11.5 Other personnel compensation 1 4 4
11.7 Military personnel 4 4 4



11.9 Total personnel compensation 53 65 69
12.1 Civilian personnel benefits 12 15 16
12.2 Military personnel benefits 2 2 2
21.0 Travel and transportation of persons 2 1 1
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 2 2
25.1 Advisory and assistance services 26 55 49
25.2 Other services from non-Federal sources 201 173 166
25.3 Other goods and services from Federal sources 90 41 32
25.7 Operation and maintenance of equipment 1 1 1
41.0 Grants, subsidies, and contributions 3,039 3,005 3,002
42.0 Insurance claims and indemnities 1



99.0 Direct obligations 3,438 3,368 3,348
99.0 Reimbursable obligations 248 253 257



99.9 Total new obligations 3,686 3,621 3,605

Employment Summary


Identification code 75–1362–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 498 533 552
1101 Direct military average strength employment 44 48 48
2001 Reimbursable civilian full-time equivalent employment 40 43 48
2101 Reimbursable military average strength employment 8 7 7

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, $333,697,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act: Provided, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall remain available until expended.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–1700–0–1–552 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0003 Prevention and Public Health Fund 12
0801 Reimbursable program 15 15 15
0802 Reimbursable program: PHS evaluation 366 371 334



0899 Total reimbursable obligations 381 386 349



0900 Total new obligations 393 386 349

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 4 5 5
1001 Discretionary unobligated balance brought fwd, Oct 1 4 5
Budget authority:
Appropriations, mandatory:
1221 Appropriations transferred from other accts [75–0116] 12



1260 Appropriations, mandatory (total) 12
Spending authority from offsetting collections, discretionary:
1700 Collected 187 386 349
1701 Change in uncollected payments, Federal sources 195



1750 Spending auth from offsetting collections, disc (total) 382 386 349
1900 Budget authority (total) 394 386 349
1930 Total budgetary resources available 398 391 354
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 5 5 5

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 989 726 68
3010 Obligations incurred, unexpired accounts 393 386 349
3020 Outlays (gross) –647 –1,044 –375
3041 Recoveries of prior year unpaid obligations, expired –9



3050 Unpaid obligations, end of year 726 68 42
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –382 –293 –293
3070 Change in uncollected pymts, Fed sources, unexpired –195
3071 Change in uncollected pymts, Fed sources, expired 284



3090 Uncollected pymts, Fed sources, end of year –293 –293 –293
Memorandum (non-add) entries:
3100 Obligated balance, start of year 607 433 –225
3200 Obligated balance, end of year 433 –225 –251

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 382 386 349
Outlays, gross:
4010 Outlays from new discretionary authority 124 386 349
4011 Outlays from discretionary balances 517 651 21



4020 Outlays, gross (total) 641 1,037 370
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –463 –839 –349
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –195
4052 Offsetting collections credited to expired accounts 276 453



4060 Additional offsets against budget authority only (total) 81 453
4080 Outlays, net (discretionary) 178 198 21
Mandatory:
4090 Budget authority, gross 12
Outlays, gross:
4101 Outlays from mandatory balances 6 7 5
4180 Budget authority, net (total) 12
4190 Outlays, net (total) 184 205 26

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 2012 actual 2013 CR 2014 est.

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



99.0 Direct obligations 12
99.0 Reimbursable obligations 381 386 349



99.9 Total new obligations 393 386 349

Employment Summary


Identification code 75–1700–0–1–552 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment
2001 Reimbursable civilian full-time equivalent employment 295 299 294
2101 Reimbursable military average strength employment 9 9 9
3001 Allocation account civilian full-time equivalent employment 4 12 20

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, $177,872,985,000, to remain available until expended.

For making, after May 31, 2014, 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 2014 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 2015, $103,472,323,000, 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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0512–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Medicaid vendor payments 248,004 246,797 283,045
0002 State and local administration 17,216 16,182 16,453
0003 Vaccines for Children 4,000 3,607 4,293
0004 Incurred by providers but not yet reported 1,092 1,959 2,369



0799 Total direct obligations 270,312 268,545 306,160
0801 Medicare Part B premiums 602 645 300



0900 Total new obligations 270,914 269,190 306,460

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 408 21,091 21,951
1021 Recoveries of prior year unpaid obligations 20,186



1050 Unobligated balance (total) 20,594 21,091 21,951
Budget authority:
Appropriations, mandatory:
1200 Appropriation Medicaid 184,279 178,791 177,873



1260 Appropriations, mandatory (total) 184,279 178,791 177,873
Advance appropriations, mandatory:
1270 Advance appropriation 86,445 90,614 106,336



1280 Advanced appropriation, mandatory (total) 86,445 90,614 106,336
Spending authority from offsetting collections, mandatory:
1800 Collected 687 645 300



1850 Spending auth from offsetting collections, mand (total) 687 645 300
1900 Budget authority (total) 271,411 270,050 284,509
1930 Total budgetary resources available 292,005 291,141 306,460
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 21,091 21,951

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 28,392 27,899 29,858
3010 Obligations incurred, unexpired accounts 270,914 269,190 306,460
3020 Outlays (gross) –251,221 –267,231 –304,091
3040 Recoveries of prior year unpaid obligations, unexpired –20,186



3050 Unpaid obligations, end of year 27,899 29,858 32,227
Memorandum (non-add) entries:
3100 Obligated balance, start of year 28,392 27,899 29,858
3200 Obligated balance, end of year 27,899 29,858 32,227

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 271,411 270,050 284,509
Outlays, gross:
4100 Outlays from new mandatory authority 226,477 232,191 267,211
4101 Outlays from mandatory balances 24,744 35,040 36,880



4110 Outlays, gross (total) 251,221 267,231 304,091
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –602 –645 –300
4123 Non-Federal sources –85



4130 Offsets against gross budget authority and outlays (total) –687 –645 –300



4160 Budget authority, net (mandatory) 270,724 269,405 284,209
4170 Outlays, net (mandatory) 250,534 266,586 303,791
4180 Budget authority, net (total) 270,724 269,405 284,209
4190 Outlays, net (total) 250,534 266,586 303,791

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


2012 actual 2013 CR 2014 est.

Enacted/requested:
Budget Authority 270,724 269,405 284,209
Outlays 250,534 266,586 303,791
Legislative proposal, not subject to PAYGO:
Budget Authority –21 –436
Outlays –21 –436
Legislative proposal, subject to PAYGO:
Budget Authority 279
Outlays 279
Total:
Budget Authority 270,724 269,384 284,052
Outlays 250,534 266,565 303,634

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 2012 2013 2014

Vaccine Purchase 3,703 3,335 3,996
Vaccine Stockpile 137 137 137
Ordering, Distribution, and Operations 117 92 117
Vaccine Management Contract Support 2 1 0

Evaluation Activities 41 42 43



Total Obligations 4,000 3,607 4,293

Object Classification (in millions of dollars)


Identification code 75–0512–0–1–551 2012 actual 2013 CR 2014 est.

41.0 Direct obligations: Grants, subsidies, and contributions 270,312 268,545 306,160
99.0 Reimbursable obligations 602 645 300



99.9 Total new obligations 270,914 269,190 306,460

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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Medicaid vendor payments –21 –31



0900 Total new obligations (object class 41.0) –21 –31

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation –21 –31



1260 Appropriations, mandatory (total) –21 –31
1930 Total budgetary resources available –21 –31

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts –21 –31
3020 Outlays (gross) 21 31

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross –21 –31
Outlays, gross:
4100 Outlays from new mandatory authority –21 –31
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –405
4180 Budget authority, net (total) –21 –436
4190 Outlays, net (total) –21 –436

Please see the narratives in the Program Integrity Administrative Expenses (Social Security Administration) and Health Care Fraud and Abuse Control accounts for a description of the program integrity estimates reflected here. This schedule also reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individuals (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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Medicaid Proposals –126
0801 Medicare Part B premiums 405



0900 Total new obligations 279

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation Medicaid –126



1260 Appropriations, mandatory (total) –126
Spending authority from offsetting collections, mandatory:
1800 Collected 405



1850 Spending auth from offsetting collections, mand (total) 405
1900 Budget authority (total) 279
1930 Total budgetary resources available 279

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 279
3020 Outlays (gross) –279

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 279
Outlays, gross:
4100 Outlays from new mandatory authority 279
4180 Budget authority, net (total) 279
4190 Outlays, net (total) 279

This schedule reflects the Administration's Medicaid proposals.

Object Classification (in millions of dollars)


Identification code 75–0512–4–1–551 2012 actual 2013 CR 2014 est.

41.0 Direct obligations: Grants, subsidies, and contributions –126
99.0 Reimbursable obligations 405



99.9 Total new obligations 279

State Grants and Demonstrations

Program and Financing (in millions of dollars)


Identification code 75–0516–0–1–551 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0010 Ticket to Work grants 1
0011 Emergency health services for undocumented aliens 22 16 5
0012 Medicaid integrity program 63 96 86
0018 Money follows the person (MFP) demonstration 296 434 434
0019 MFP evaluations and technical support 1 1 1
0023 Grants to improve outreach and enrollment 3 39 2
0024 Application of Prospective Payment System 1
0025 Medicaid emergency psychiatric demonstration 1 28 26
0026 Incentives for prevention of chronic diseases in Medicaid 28 22 22



0900 Total new obligations 416 636 576

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 1,303 1,459 1,353
1021 Recoveries of prior year unpaid obligations 44



1050 Unobligated balance (total) 1,347 1,459 1,353
Budget authority:
Appropriations, mandatory:
1200 Appropriation (Money follows the person (MFP) demonstration) 449 449 449
1200 Appropriation (MFP research & evaluation) 1 1 1
1200 Appropriation (Medicaid integrity program) 78 80 82



1260 Appropriations, mandatory (total) 528 530 532
1930 Total budgetary resources available 1,875 1,989 1,885
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 1,459 1,353 1,309

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 881 764 612
3010 Obligations incurred, unexpired accounts 416 636 576
3011 Obligations incurred, expired accounts 12
3020 Outlays (gross) –480 –788 –749
3040 Recoveries of prior year unpaid obligations, unexpired –44
3041 Recoveries of prior year unpaid obligations, expired –21



3050 Unpaid obligations, end of year 764 612 439
Memorandum (non-add) entries:
3100 Obligated balance, start of year 881 764 612
3200 Obligated balance, end of year 764 612 439

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 528 530 532
Outlays, gross:
4100 Outlays from new mandatory authority 81 133
4101 Outlays from mandatory balances 480 707 616



4110 Outlays, gross (total) 480 788 749
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –3
Additional offsets against gross budget authority only:
4142 Offsetting collections credited to expired accounts 3



4160 Budget authority, net (mandatory) 528 530 532
4170 Outlays, net (mandatory) 477 788 749
4180 Budget authority, net (total) 528 530 532
4190 Outlays, net (total) 477 788 749

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 $129 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 2012 actual 2013 CR 2014 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 1
41.0 Grants, subsidies, and contributions - Emergency services for undocumented aliens 22 16 5
41.0 Grants, subsidies, and contributions - Medicaid Integrity Program 48 81 71
41.0 Grants, subsidies, and contributions - Money follows the person (MFP) demonstration 296 434 434
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 3 39 2
41.0 Grants, subsidies, and contributions - Application of Prospective Payment System 1
41.0 Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration 1 28 26
41.0 Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid 28 22 22



99.9 Total new obligations 416 636 576

Employment Summary


Identification code 75–0516–0–1–551 2012 actual 2013 CR 2014 est.

1001 Direct civilian full-time equivalent employment 80 97 102

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, $255,185,000,000.

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.

Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

Program and Financing (in millions of dollars)


Identification code 75–0580–0–1–571 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Federal contribution to match premiums (SMI) 165,254 181,351 194,565
0002 Part D benefits (Rx Drug) 44,875 51,245 58,596
0003 Part D Federal administration (Rx Drug) 394 382 373
0004 General Fund Transfers to HI 485 1,104 1,651
0006 Federal Bureau of Investigation (HCFAC) 132 135 138
0007 Federal payments from taxation of OASDI benefits (HI) 18,643 14,387 18,877
0008 Criminal fines (HCFAC) 1,389 1,126 1,141
0009 Civil monetary penalties and damages (HCFAC - DOJ and CMS administration) 18 20 21
0010 Asset Forfeiture 20 23 23



0900 Total new obligations 231,210 249,773 275,385

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 184
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite, annual) 230,741 234,266 255,321
1200 Appropriation (indefinite, permanent) 18,643 14,387 18,877
1200 Appropriation (HCFAC for FBI) 132 135 138
1200 Appropriation (indefinite for HCFAC) 1,428 1,169 1,049



1260 Appropriations, mandatory (total) 250,944 249,957 275,385
1930 Total budgetary resources available 250,944 249,957 275,569
Memorandum (non-add) entries:
1940 Unobligated balance expiring –19,734
1941 Unexpired unobligated balance, end of year 184 184

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 231,210 249,773 275,385
3011 Obligations incurred, expired accounts 171
3020 Outlays (gross) –231,381 –249,773 –275,385

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 250,944 249,957 275,385
Outlays, gross:
4100 Outlays from new mandatory authority 231,210 249,773 275,385
4101 Outlays from mandatory balances 171



4110 Outlays, gross (total) 231,381 249,773 275,385
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –14
Additional offsets against gross budget authority only:
4142 Offsetting collections credited to expired accounts 14



4160 Budget authority, net (mandatory) 250,944 249,957 275,385
4170 Outlays, net (mandatory) 231,367 249,773 275,385
4180 Budget authority, net (total) 250,944 249,957 275,385
4190 Outlays, net (total) 231,367 249,773 275,385

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


2012 actual 2013 CR 2014 est.

Enacted/requested:
Budget Authority 250,944 249,957 275,385
Outlays 231,367 249,773 275,385
Amounts included in the adjusted baseline:
Budget Authority 2,007
Outlays 2,007
Legislative proposal, not subject to PAYGO:
Budget Authority 136
Outlays 127 136
Total:
Budget Authority 250,944 249,957 277,528
Outlays 231,367 249,900 277,528

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 2012 actual 2013 CR 2014 est.

Direct obligations:
41.0 Grants, subsidies, and contributions 230,181 248,413 273,625
42.0 Insurance claims and indemnities 262 228 204
94.0 Financial transfers (Federal admin) 767 1,132 1,556



99.9 Total new obligations 231,210 249,773 275,385

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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 Federal contribution to match premiums (SMI) 2,007



0900 Total new obligations (object class 41.0) 2,007

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite annual) 2,007



1260 Appropriations, mandatory (total) 2,007
1930 Total budgetary resources available 2,007

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 2,007
3020 Outlays (gross) –2,007

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 2,007
Outlays, gross:
4100 Outlays from new mandatory authority 2,007
4180 Budget authority, net (total) 2,007
4190 Outlays, net (total) 2,007

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 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0004 General Fund Transfers to HI 127 136



0900 Total new obligations (object class 41.0) 127 136

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation (definite annual) 136



1260 Appropriations, mandatory (total) 136
1930 Total budgetary resources available 136
Memorandum (non-add) entries:
1940 Unobligated balance expiring 127

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 127 136
3020 Outlays (gross) –127 –136

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 136
Outlays, gross:
4100 Outlays from new mandatory authority 127 136
4180 Budget authority, net (total) 136
4190 Outlays, net (total) 127 136

Quality Improvement Organizations

Program and Financing (in millions of dollars)


Identification code 75–0519–0–1–571 2012 actual 2013 CR 2014 est.

Obligations by program activity:
0001 QIO contracts