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; [$4,346,670,000] $4,430,203,000: Provided, That of the amount provided under this heading, [$760,000,000] $798,000,000 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] $128,282,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain available until expended; [$305,996,000] $312,116,000 shall be derived from human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account and remain available until expended; [$20,716,000] $21,014,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall be credited to this account and remain available until expended; [$23,600,000] $22,464,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account and remain available until expended; [$7,328,000] $6,944,000 shall be derived from animal generic drug user fees authorized by 21 U.S.C. 379j-21, and shall be credited to this account and remain available until expended; [$534,000,000] $566,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain available until expended[; $12,925,000 shall be derived from food and feed recall fees authorized by 21 U.S.C. 379j-31, and shall be credited to this account and remain available until expended; $15,367,000 shall be derived from food reinspection fees authorized by 21 U.S.C. 379j-31, and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified importer program fees authorized by 21 U.S.C. 379j-31 shall be credited to this account and remain available until expended]: Provided further, That in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees, medical device user fees, human generic drug user fees, biosimilar biological product user fees, animal drug user fees, and animal generic drug user fees that exceed the respective fiscal year [2014] 2015 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, biosimilar biological product, animal drug, and animal generic drug assessments for fiscal year [2014] 2015, including any such fees collected prior to fiscal year [2014] 2015 but credited for fiscal year [2014] 2015, shall be subject to the fiscal year [2014] 2015 limitations: Provided further, That the Secretary may accept payment during fiscal year [2014] 2015 of user fees specified under this heading and authorized for fiscal year [2015] 2016, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year [2015] 2016 for which the Secretary accepts payment in fiscal year [2014] 2015 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C. 9701: [Provided further, That of the total amount appropriated: (1) $900,259,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs; (2) $1,289,304,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs; (3) $337,543,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $173,207,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $408,918,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $62,494,000 shall be for the National Center for Toxicological Research; (7) $501,476,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $178,361,000 shall be for Rent and Related activities, of which $61,922,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) not to exceed $219,907,000 shall be for payments to the General Services Administration for rent; and (10) $275,201,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Foods and Veterinary Medicine, the Office of Medical and Tobacco Products, the Office of Global and Regulatory Policy, the Office of Operations, the Office of the Chief Scientist, and central services for these offices:] Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner: [Provided further, That any transfer of funds pursuant to section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd(n)) shall only be from amounts made available under this heading for other activities:] Provided further, That funds may be transferred from one specified activity to another with the prior [approval] notification of the Committees on Appropriations of both Houses of Congress.

In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381, [and] priority review user fees authorized by 21 U.S.C. 360n, food and feed recall fees, food reinspection fees, and voluntary qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C.379j-62, prescription drug wholesale distributer licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), and third-party logistics provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), [may] 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. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2014.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9911–0–1–554 2013 actual 2014 est. 2015 est.

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



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



0799 Balance, end of year 1 1 2

Program and Financing (in millions of dollars)


Identification code 75–9911–0–1–554 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Foods 797 883 903
0002 Drugs 438 466 480
0003 Devices and Radiological Products 296 321 318
0004 National Center for Toxicological Research 55 62 59
0005 Other Activities 160 172 175
0006 Other Rent and Rent Related Activities 118 132 116
0007 Rental Payments 150 162 169
0008 Buildings and Facilities 6 9 9
0009 CRADAs 2 2 2
0010 Animal Drugs and Feed 126 141 145
0011 Biologics 195 211 210
0012 Food and Drug Safety (no-year) 9



0799 Total direct obligations 2,352 2,561 2,586
0801 Reimbursable program (User fees) 1,795 2,456 1,900
0802 Reimbursable program (Federal sources) 40



0899 Total reimbursable obligations 1,835 2,456 1,900



0900 Total new obligations 4,187 5,017 4,486

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 852 670 122
1001 Discretionary unobligated balance brought fwd, Oct 1 1
1021 Recoveries of prior year unpaid obligations 1



1050 Unobligated balance (total) 853 670 122
Budget authority:
Appropriations, discretionary:
1100 Appropriation 2,580 2,561 2,584
1130 Appropriations permanently reduced –194



1160 Appropriation, discretionary (total) 2,386 2,561 2,584
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 1,676 1,827 1,900
1701 Change in uncollected payments, Federal sources 23
1702 Offsetting collections (previously unavailable) 327 333 333
1702 Offsetting collections (previously unavailable) — previously reported as precluded from obligation that will be available for obligation 79
1723 New and/or unobligated balance of spending authority from offsetting collections temporarily reduced –67
1725 Spending authority from offsetting collections precluded from obligation (limitation on obligations) –564 –333 –333



1750 Spending auth from offsetting collections, disc (total) 1,395 1,906 1,900
Spending authority from offsetting collections, mandatory:
1800 Collected 232
1823 New and/or unobligated balance of spending authority from offsetting collections temporarily reduced –11



1850 Spending auth from offsetting collections, mand (total) 221
1900 Budget authority (total) 4,004 4,469 4,486
1930 Total budgetary resources available 4,857 5,139 4,608
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 670 122 122

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 1,663 2,319 2,841
3010 Obligations incurred, unexpired accounts 4,187 5,017 4,486
3011 Obligations incurred, expired accounts 1
3020 Outlays (gross) –3,460 –4,495 –4,776
3040 Recoveries of prior year unpaid obligations, unexpired –1
3041 Recoveries of prior year unpaid obligations, expired –71



3050 Unpaid obligations, end of year 2,319 2,841 2,551
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –44 –51 –51
3070 Change in uncollected pymts, Fed sources, unexpired –23
3071 Change in uncollected pymts, Fed sources, expired 16



3090 Uncollected pymts, Fed sources, end of year –51 –51 –51
Memorandum (non-add) entries:
3100 Obligated balance, start of year 1,619 2,268 2,790
3200 Obligated balance, end of year 2,268 2,790 2,500

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,781 4,467 4,484
Outlays, gross:
4010 Outlays from new discretionary authority 2,516 3,401 3,409
4011 Outlays from discretionary balances 906 1,092 1,365



4020 Outlays, gross (total) 3,422 4,493 4,774
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –33 –1
4033 Non-Federal sources –1,657 –1,826 –1,900



4040 Offsets against gross budget authority and outlays (total) –1,690 –1,827 –1,900
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –23
4052 Offsetting collections credited to expired accounts 14



4060 Additional offsets against budget authority only (total) –9



4070 Budget authority, net (discretionary) 2,082 2,640 2,584
4080 Outlays, net (discretionary) 1,732 2,666 2,874
Mandatory:
4090 Budget authority, gross 223 2 2
Outlays, gross:
4100 Outlays from new mandatory authority 38 2 2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –232
4180 Budget authority, net (total) 2,073 2,642 2,586
4190 Outlays, net (total) 1,538 2,668 2,876

Memorandum (non-add) entries:
5090 Unavailable balance, SOY: Offsetting collections 349 664 585
5091 Unavailable balance, EOY: Offsetting collections 664 585 585

[In millions of dollars]


2013 2014 2015

Distribution of discretionary budget authority by account:
Salaries and expenses 2,380 2,552 2,575
Buildings and facilities 6 9 9
Distribution of discretionary outlays by account:
Salaries and expenses 1,726 2,657 2,865
Buildings and facilities 6 9 9

The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation. FDA also has responsbility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public health and to reduce tobacco use by minors. FDA advances public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by ensuring the security of the food supply and by fostering the development of medical products and countermeasures to respond to deliberate and naturally emerging public health threats. The FY 2015 Budget provides funding to support food and medical product safety, including implementation of the Food Safety Modernization Act and increased oversight of the pharmacy compounding industry, promote development of medical countermeasures, and maintain the integrity of operations and infrastructure.

Object Classification (in millions of dollars)


Identification code 75–9911–0–1–554 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 789 790 793
11.3 Other than full-time permanent 97 106 106
11.5 Other personnel compensation 46 56 56
11.7 Military personnel 62 61 61
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 995 1,014 1,017
12.1 Civilian personnel benefits 276 280 282
12.2 Military personnel benefits 32 32 32
21.0 Travel and transportation of persons 38 38 49
22.0 Transportation of things 3 5 5
23.1 Rental payments to GSA 150 162 169
23.2 Rental payments to others 5 3 3
23.3 Communications, utilities, and miscellaneous charges 38 38 40
24.0 Printing and reproduction 1 3 3
25.1 Advisory and assistance services 49 48 48
25.2 Other services from non-Federal sources 279 340 340
25.3 Other goods and services from Federal sources 143 233 233
25.4 Operation and maintenance of facilities 66 66 66
25.5 Research and development contracts 30 34 34
25.7 Operation and maintenance of equipment 63 50 50
26.0 Supplies and materials 33 44 44
31.0 Equipment 57 56 56
32.0 Land and structures 1 5 5
41.0 Grants, subsidies, and contributions 91 109 109
42.0 Insurance claims and indemnities 1 1 1



99.0 Direct obligations 2,351 2,561 2,586
99.0 Reimbursable obligations 1,836 2,456 1,900



99.9 Total new obligations 4,187 5,017 4,486

Employment Summary


Identification code 75–9911–0–1–554 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 9,113 9,677 9,886
1101 Direct military average strength employment 684 648 648
2001 Reimbursable civilian full-time equivalent employment 3,960 5,117 5,441
2101 Reimbursable military average strength employment 297 343 343
3001 Allocation account civilian full-time equivalent employment 48 48 48
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 user fees with respect to food facility registrations and inspections, food imports, food contact notification activities, 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 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0801 Food Facility Registration and Inspection 60
0802 Food Import 169
0803 International Courier 6
0804 Cosmetics 19
0805 Food Contact Substance Notification 5



0900 Total new obligations 259

Budgetary Resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700 Collected 259



1750 Spending auth from offsetting collections, disc (total) 259
1900 Budget authority (total) 259
1930 Total budgetary resources available 259

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 259
3020 Outlays (gross) –259

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 259
Outlays, gross:
4010 Outlays from new discretionary authority 259
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4033 Non-Federal sources –259

The 2015 Budget includes a number of new user fees. Legislation will be proposed to allow FDA to collect fees for food import and food facility registration and inspection to implement the requirements of the FDA Food Safety Modernization Act (FSMA). The additional resources, estimated at $169 million for the food import program, would support FDA's food safety efforts to modernize the import system. The fees collected for the food facility registration and inspection program, estimated at $60 million, would enable FDA to target new and improved activities required by FSMA to modernize the food safety system and support improvements in safety science and risk analysis to prevent food safety outbreaks. The Budget also reproposes user fees to support activities related to cosmetics and food contact notification activities, and fees to support inspection-related activities at domestic courier facilities.

Object Classification (in millions of dollars)


Identification code 75–9911–2–1–554 2013 actual 2014 est. 2015 est.

99.9 Total new obligations 259

Employment Summary


Identification code 75–9911–2–1–554 2013 actual 2014 est. 2015 est.

2001 Reimbursable civilian full-time equivalent employment 500

Revolving Fund for Certification and Other Services

Program and Financing (in millions of dollars)


Identification code 75–4309–0–3–554 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0801 Reimbursable program 8 8 8

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 3 4 4
Budget authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 9 8 8



1850 Spending auth from offsetting collections, mand (total) 9 8 8
1930 Total budgetary resources available 12 12 12
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 4 4 4

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



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

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 9 8 8
Outlays, gross:
4100 Outlays from new mandatory authority 2 7 8
4101 Outlays from mandatory balances 6 1 1



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

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

Object Classification (in millions of dollars)


Identification code 75–4309–0–3–554 2013 actual 2014 est. 2015 est.

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



99.9 Total new obligations 8 8 8

Employment Summary


Identification code 75–4309–0–3–554 2013 actual 2014 est. 2015 est.

2001 Reimbursable civilian full-time equivalent employment 38 38 38

Health Resources and Services Administration

Federal Funds

Health Resources and Services

Primary Health Care

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,495,276,000] $1,000,040,000: Provided, That no more than [$40,000] $40,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS[Act, including associated administrative expenses and relevant evaluations]: Provided further, That no more than [$94,893,000] $88,983,000 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: Provided further, That [of funds provided for the Health Centers program, as defined by section 330 of the PHS Act, by this Act or any other Act for fiscal year 2014, not less than $110,000,000 shall be obligated in fiscal year 2014 as base grant adjustments and not less than $350,000,000 shall be obligated in fiscal year 2014 to support new access points including approved and unfunded applications from fiscal year 2013, grants to expand medical services, behavioral health, oral health, pharmacy, and vision services, and costs associated with the HHS administration of these grants] funds made available for carrying out section 330 of the PHS Act in this or any prior Act, including section 10503 of Public Law 111–148, may also be used for the construction and improvement of community health centers.

Health Workforce

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$734,236,000] $477,140,000: Provided, That $100,000,000, to remain available until expended, shall be for the National Health Service Corps Program: Provided further, That sections 747(c)(2)[, 751(j)(2),] and 762(k), and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply to funds made available under this heading: Provided further, That [for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary may hereafter waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act: Provided further, That in addition to fees authorized by section 427(b) of the Health Care Quality Improvement Act of 1986, fees shall be collected for the full disclosure of information under such Act sufficient to recover the full costs of operating the National Practitioner Data Bank and shall remain available until expended to carry out that Act: Provided further, That fees collected for the full disclosure of information under the "Health Care Fraud and Abuse Data Collection Program'', authorized by section 1128E(d)(2) of the Social Security Act, shall be sufficient to recover the full costs of operating the program, and shall remain available until expended to carry out that Act: Provided further, That fees collected for the disclosure of information under the information reporting requirement program authorized by section 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the program and shall remain available until expended to carry out that Act:] fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of 1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the programs authorized by such sections and shall remain available until expended for the National Practitioner Data Bank: 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, on April 1, 2015, available amounts appropriated under section 340H(g) of the PHS Act are hereby permanently cancelled, and an equal amount of funding is hereby appropriated to be available until expended to carry out such section: Provided further, That in addition to amounts provided herein, $61,581,000 shall be available from amounts available under section 241 of the PHS Act to carry out section 811 of the PHS Act.

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, [$846,017,000] $846,017,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $77,093,000 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, [$2,293,781,000],$2,297,781,000: of which [$1,970,881,000] $1,970,881,000 shall remain available to the Secretary through September 30, [2016] 2017, for parts A and B of title XXVI of the PHS Act, and of which not less than [$900,313,000] $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That in addition to amounts provided herein, [$25,000,000] $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, and C[, and D] of title XXVI of [the PHS] such 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, [$103,193,000] $103,659,000, of which [$122,000] $122,000 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 of 1969, [the Cardiac Arrest Survival Act of 2000,] and sections 711 and 1820 of the Social Security Act, [$142,335,000] $124,562,000, of which [$40,609,000] $26,200,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program: Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, [$14,942,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and] up to [$1,000,000] $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, [$9,511,000] $9,511,000 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, [$286,479,000] $286,479,000: 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, [$153,061,000] $157,061,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care'', "Health Workforce'', "Maternal and Child Health'', "Ryan White HIV/AIDS Program'', "Health Care Systems'', and "Rural Health'': Provided further, That the Administrator may transfer funds between any of the accounts of HRSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–0350–0–1–550 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0009 Free Clinics Medical Malpractice 1
0010 Health Centers 1,390 1,400 911
0012 National Health Service Corps 100
0013 Hansen's Disease Center 15 15 15
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 78 80 80
0017 Health Professions 357 389 297
0018 Maternal and Child Health Block Grant 605 634 634
0019 Healthy Start 98 101 101
0020 Poison Control Centers 18 19 19
0021 EMS for Children 20 20 20
0022 Universal Newborn Hearing Screening 18 18 18
0023 HIV/AIDS 2,220 2,297 2,298
0024 Organ Transplantation 23 24 24
0025 Bone Marrow Donor Registry 22 22 22
0026 Rural Health Policy Development 9 9 9
0027 Rural Health Outreach Grants 52 57 57
0028 Rural Health Flexibility Grants 38 41 26
0030 Telehealth 11 14 14
0031 Program Management 151 153 157
0032 Family Planning 278 286 286
0033 Loan Repayment/Faculty Fellowship 1 1 1
0035 Health Centers Tort Claim Fund 58 95 89
0036 Heritable Disorders 9 12 12
0038 Childrens' GME 251 265
0041 State Offices of Rural Health 9 10 10
0043 Radiogenic Diseases 2 2 2
0044 Traumatic Brain Injury 9 9 9
0045 Autism and Other Developmental Disorders 45 47 47
0046 Cord Blood Stem Cell Bank 11 11 11
0048 Sickle Cell 4 4 4
0049 Drug Pricing Program 4 10 10
0050 Family to Family Health Information Centers ACA 5 3
0067 Prevention Fund 2
0073 Health Centers ACA 1,491 2,145 3,600
0074 Health Centers Construction ACA 1 28
0075 National Health Service Corps ACA 286 283 310
0076 School Based Health Centers ACA 82 2 2
0077 GME Payments THC ACA 31 73 105
0079 Rural Health AED 2 3



0300 Total direct programs 7,716 8,591 9,309



0799 Total direct obligations 7,716 8,591 9,309
0801 Reimbursable program 48 48 54
0802 Reimbursable program: PHS evaluation 22 25 87



0899 Total reimbursable obligations 70 73 141



0900 Total new obligations 7,786 8,664 9,450

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 382 362 261
1001 Discretionary unobligated balance brought fwd, Oct 1 68
1021 Recoveries of prior year unpaid obligations 32



1050 Unobligated balance (total) 414 362 261
Budget authority:
Appropriations, discretionary:
1100 Appropriation 6,194 6,054 5,293
1100 Appropriation 135
1120 Appropriations transferred to other accts [75–0943] –16
1120 Appropriations transferred to other accts [75–1362] –15
1121 Appropriations transferred from other accts [75–0943] 8
1121 Appropriations transferred from other accts [75–1362] 1
1121 Appropriations transferred from other accts [75–1502] 6
1121 Appropriations transferred from other accts [75–0142] 1
1130 Appropriations permanently reduced –324
1131 Unobligated balance of appropriations permanently reduced –135



1160 Appropriation, discretionary (total) 5,855 6,054 5,293
Appropriations, mandatory:
1200 Appropriation 1,855 2,508 3,910
1221 Appropriations transferred from other accts [75–0116] 2
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –53 –77



1260 Appropriations, mandatory (total) 1,804 2,431 3,910
Spending authority from offsetting collections, discretionary:
1700 Collected 31 62 122
1701 Change in uncollected payments, Federal sources 31
1723 New and/or unobligated balance of spending authority from offsetting collections temporarily reduced –1



1750 Spending auth from offsetting collections, disc (total) 61 62 122
Spending authority from offsetting collections, mandatory:
1800 Offsetting collections (cash)(HPSL&NSL) 16 16 16



1850 Spending auth from offsetting collections, mand (total) 16 16 16
1900 Budget authority (total) 7,736 8,563 9,341
1930 Total budgetary resources available 8,150 8,925 9,602
Memorandum (non-add) entries:
1940 Unobligated balance expiring –2
1941 Unexpired unobligated balance, end of year 362 261 152

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 6,681 6,238 6,334
3010 Obligations incurred, unexpired accounts 7,786 8,664 9,450
3011 Obligations incurred, expired accounts 3
3020 Outlays (gross) –8,136 –8,568 –8,770
3040 Recoveries of prior year unpaid obligations, unexpired –32
3041 Recoveries of prior year unpaid obligations, expired –64



3050 Unpaid obligations, end of year 6,238 6,334 7,014
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –80 –74 –74
3070 Change in uncollected pymts, Fed sources, unexpired –31
3071 Change in uncollected pymts, Fed sources, expired 37



3090 Uncollected pymts, Fed sources, end of year –74 –74 –74
Memorandum (non-add) entries:
3100 Obligated balance, start of year 6,601 6,164 6,260
3200 Obligated balance, end of year 6,164 6,260 6,940

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 5,916 6,116 5,415
Outlays, gross:
4010 Outlays from new discretionary authority 2,201 2,407 2,075
4011 Outlays from discretionary balances 3,820 3,615 3,511



4020 Outlays, gross (total) 6,021 6,022 5,586
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –34 –35 –96
4033 Non-Federal sources –30 –27 –19
4033 Non-Federal sources –7



4040 Offsets against gross budget authority and outlays (total) –64 –62 –122
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –31
4052 Offsetting collections credited to expired accounts 33



4060 Additional offsets against budget authority only (total) 2



4070 Budget authority, net (discretionary) 5,854 6,054 5,293
4080 Outlays, net (discretionary) 5,957 5,960 5,464
Mandatory:
4090 Budget authority, gross 1,820 2,447 3,926
Outlays, gross:
4100 Outlays from new mandatory authority 907 1,166 1,467
4101 Outlays from mandatory balances 1,208 1,380 1,717



4110 Outlays, gross (total) 2,115 2,546 3,184
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –16 –16 –16
4180 Budget authority, net (total) 7,658 8,485 9,203
4190 Outlays, net (total) 8,056 8,490 8,632

Memorandum (non-add) entries:
5090 Unavailable balance, SOY: Offsetting collections 1 1
5091 Unavailable balance, EOY: Offsetting collections 1 1 1

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


2013 actual 2014 est. 2015 est.

Enacted/requested:
Budget Authority 7,658 8,485 9,203
Outlays 8,056 8,490 8,632
Legislative proposal, subject to PAYGO:
Budget Authority 400
Outlays 200
Total:
Budget Authority 7,658 8,485 9,603
Outlays 8,056 8,490 8,832

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


Identification code 75–0350–0–1–550 2013 actual 2014 est. 2015 est.

Guaranteed loan levels supportable by subsidy budget authority:
215001 Health centers: Facilities renovation loan guarantee levels 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 12 6
Guaranteed loan subsidy (in percent):
232001 Health centers: Facilities renovation loan guarantee levels 0.00 2.81 2.67
232002 Health centers: Managed care network development loan guarantee 0.00 10.10 9.68
232003 Health centers: Managed care plan loan guarantee levels 0.00 5.86 5.83



232999 Weighted average subsidy rate 0.00 4.18 4.37

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 2015 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 program's 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 2012–2013 data reported in the Annual Operating Report.

Health Professions Revolving Loan Programs Federal Capital Contribution


Program Account Balance

HPSL 389,796,286
NSL 174,462,796
PCL 258,568,607
LDS 132,944,663

Total 955,772,352


Object Classification (in millions of dollars)


Identification code 75–0350–0–1–550 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 157 166 160
11.3 Other than full-time permanent 6 6 6
11.5 Other personnel compensation 2 2 2
11.7 Military personnel 19 19 19



11.9 Total personnel compensation 184 193 187
12.1 Civilian personnel benefits 47 50 49
12.2 Military personnel benefits 10 10 10
21.0 Travel and transportation of persons 2 2 2
23.1 Rental payments to GSA 21 22 26
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 6 6 6
25.1 Advisory and assistance services 13 13 13
25.2 Other services from non-Federal sources 137 133 127
25.3 Other goods and services from Federal sources 200 196 183
25.4 Operation and maintenance of facilities 1 1 1
25.6 Medical care 3 3 2
25.7 Operation and maintenance of equipment 25 25 23
26.0 Supplies and materials 2 2 2
31.0 Equipment 3 3 3
41.0 Grants, subsidies, and contributions 7,010 7,880 8,623
42.0 Insurance claims and indemnities 51 51 51



99.0 Direct obligations 7,716 8,591 9,309
99.0 Reimbursable obligations 70 73 141



99.9 Total new obligations 7,786 8,664 9,450

Employment Summary


Identification code 75–0350–0–1–550 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 1,578 1,613 1,596
1101 Direct military average strength employment 195 195 195
2001 Reimbursable civilian full-time equivalent employment 62 62 72
2101 Reimbursable military average strength employment 4 4 4

Health Resources and Services

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0350–4–1–550 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0075 National Health Service Corps ACA 400



0300 Total direct programs 400
0803 Reimbursable program: Targeted Support for GME 530



0900 Total new obligations 930

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



1260 Appropriations, mandatory (total) 400
Spending authority from offsetting collections, mandatory:
1800 Collected 530



1850 Spending auth from offsetting collections, mand (total) 530
1900 Budget authority (total) 930
1930 Total budgetary resources available 930

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 930
3020 Outlays (gross) –730



3050 Unpaid obligations, end of year 200
Memorandum (non-add) entries:
3200 Obligated balance, end of year 200

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 930
Outlays, gross:
4100 Outlays from new mandatory authority 730
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –530
4180 Budget authority, net (total) 400
4190 Outlays, net (total) 200

Object Classification (in millions of dollars)


Identification code 75–0350–4–1–550 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 3
11.7 Military personnel 1



11.9 Total personnel compensation 4
12.1 Civilian personnel benefits 1
23.3 Communications, utilities, and miscellaneous charges 2
25.2 Other services from non-Federal sources 5
25.3 Other goods and services from Federal sources 23
25.7 Operation and maintenance of equipment 2
41.0 Grants, subsidies, and contributions 362



99.0 Direct obligations 399
99.0 Reimbursable obligations 531



99.9 Total new obligations 930

Employment Summary


Identification code 75–0350–4–1–550 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 56
1101 Direct military average strength employment 5
2001 Reimbursable civilian full-time equivalent employment
2101 Reimbursable military average strength employment

Vaccine Injury Compensation

Program and Financing (in millions of dollars)


Identification code 75–0320–0–1–551 2013 actual 2014 est. 2015 est.

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 15 19 19
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 19 19 19
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 19 19 19

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 2013 actual 2014 est. 2015 est.

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



0900 Total new obligations 3 4 4

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



1050 Unobligated balance (total) 5 5 4
1930 Total budgetary resources available 5 5 4
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 2 1

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



3050 Unpaid obligations, end of year 2 6 10
Memorandum (non-add) entries:
3100 Obligated balance, start of year 2 2 6
3200 Obligated balance, end of year 2 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 2013 actual 2014 est. 2015 est.

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



99.0 Direct obligations 3 3 3
99.5 Below reporting threshold 1 1



99.9 Total new obligations 3 4 4

Employment Summary


Identification code 75–0343–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 5 5 5
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 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0010 Maternal, Infant, and Early Childhood Home Visiting Programs 378 396

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 14 25
1012 Unobligated balance transfers between expired and unexpired accounts 9



1050 Unobligated balance (total) 23 25
Budget authority:
Appropriations, mandatory:
1200 Appropriation 400 400
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –20 –29



1260 Appropriations, mandatory (total) 380 371
1930 Total budgetary resources available 403 396
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 25

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 528 654 734
3010 Obligations incurred, unexpired accounts 378 396
3020 Outlays (gross) –242 –316 –348
3041 Recoveries of prior year unpaid obligations, expired –10



3050 Unpaid obligations, end of year 654 734 386
Memorandum (non-add) entries:
3100 Obligated balance, start of year 528 654 734
3200 Obligated balance, end of year 654 734 386

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 380 371
Outlays, gross:
4100 Outlays from new mandatory authority 12 15
4101 Outlays from mandatory balances 230 301 348



4110 Outlays, gross (total) 242 316 348
4180 Budget authority, net (total) 380 371
4190 Outlays, net (total) 242 316 348

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


2013 actual 2014 est. 2015 est.

Enacted/requested:
Budget Authority 380 371
Outlays 242 316 348
Legislative proposal, subject to PAYGO:
Budget Authority 500
Outlays 20
Total:
Budget Authority 380 371 500
Outlays 242 316 368

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. The 2015 Budget includes $500 million for the Maternal, Infant and Early Childhood Home Visiting Program to extend and expand evidenced-based home visiting services for at risk communities. These activities are administered by HRSA.

Object Classification (in millions of dollars)


Identification code 75–0321–0–1–551 2013 actual 2014 est. 2015 est.

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



11.9 Total personnel compensation 2 3
12.1 Civilian personnel benefits 1 1
25.1 Advisory and assistance services 19 19
41.0 Grants, subsidies, and contributions 356 373



99.9 Total new obligations 378 396

Employment Summary


Identification code 75–0321–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 19 19
1101 Direct military average strength employment 3 3

Maternal, Infant, and Early Childhood Home Visiting Programs

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0321–4–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0010 Maternal, Infant, and Early Childhood Home Visiting Programs 497

Budgetary Resources:
Unobligated balance:
1012 Unobligated balance transfers between expired and unexpired accounts 25



1050 Unobligated balance (total) 25
Budget authority:
Appropriations, mandatory:
1200 Appropriation 500



1260 Appropriations, mandatory (total) 500
1930 Total budgetary resources available 525
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 28

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 497
3020 Outlays (gross) –20



3050 Unpaid obligations, end of year 477
Memorandum (non-add) entries:
3200 Obligated balance, end of year 477

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 500
Outlays, gross:
4100 Outlays from new mandatory authority 20
4180 Budget authority, net (total) 500
4190 Outlays, net (total) 20

Object Classification (in millions of dollars)


Identification code 75–0321–4–1–551 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 3
11.7 Military personnel 1



11.9 Total personnel compensation 4
12.1 Civilian personnel benefits 1
25.1 Advisory and assistance services 23
41.0 Grants, subsidies, and contributions 469



99.9 Total new obligations 497

Employment Summary


Identification code 75–0321–4–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 19
1101 Direct military average strength employment 3

Health Center Guaranteed Loan Financing Account

Program and Financing (in millions of dollars)


Identification code 75–4442–0–3–551 2013 actual 2014 est. 2015 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 2013 actual 2014 est. 2015 est.

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



2150 Total guaranteed loan commitments 12 6
2199 Guaranteed amount of guaranteed loan commitments 12 6

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 77 77 78
2231 Disbursements of new guaranteed loans 12 6
2251 Repayments and prepayments –10 –10
2263 Adjustments: Terminations for default that result in claim payments –1 –1



2290 Outstanding, end of year 77 78 73

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 77 60 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 2012 actual 2013 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. For administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, $2,687,000.] (Department of Health and Human Services Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–0340–0–1–552 2013 actual 2014 est. 2015 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 2



0900 Total new obligations 59 2

Budgetary Resources:
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3 3
1120 Appropriations transferred to other accts [91–0202] –1



1160 Appropriation, discretionary (total) 3 2
Appropriations, mandatory:
1200 Appropriation 56



1260 Appropriations, mandatory (total) 56
1900 Budget authority (total) 59 2
1930 Total budgetary resources available 59 2

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 1 1 1
3010 Obligations incurred, unexpired accounts 59 2
3020 Outlays (gross) –59 –2



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

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3 2
Outlays, gross:
4010 Outlays from new discretionary authority 3 2
Mandatory:
4090 Budget authority, gross 56
Outlays, gross:
4100 Outlays from new mandatory authority 56
4180 Budget authority, net (total) 59 2
4190 Outlays, net (total) 59 2

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


Identification code 75–0340–0–1–552 2013 actual 2014 est. 2015 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 –43



237999 Total downward reestimate subsidy budget authority –43

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

Pursuant to P.L. 113–76, the Consolidated Appropriations Act, 2014 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 are permanently transferred to the Secretary of Education.

Object Classification (in millions of dollars)


Identification code 75–0340–0–1–552 2013 actual 2014 est. 2015 est.

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



99.9 Total new obligations 59 2

Employment Summary


Identification code 75–0340–0–1–552 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 14 14

Health Education Assistance Loans Financing Account

Program and Financing (in millions of dollars)


Identification code 75–4304–0–3–552 2013 actual 2014 est. 2015 est.

Obligations by program activity:
Credit program obligations:
0711 Default claim payments on principal 10 12
0742 Downward reestimate paid to receipt account 18
0743 Interest on downward reestimates 26



0900 Total new obligations 10 56

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 49 107
1010 Unobligated balance transfer to other accts [91–4300] –54
1023 Unobligated balances applied to repay debt –1



1050 Unobligated balance (total) 48 53
Financing authority:
Spending authority from offsetting collections, mandatory:
1800 Collected 69 3



1850 Spending auth from offsetting collections, mand (total) 69 3
1930 Total budgetary resources available 117 56
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 107

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 10 56
3020 Financing disbursements (gross) –10 –56

Financing authority and disbursements, net:
Mandatory:
4090 Financing authority, gross 69 3
Financing disbursements:
4110 Financing disbursements, gross 10 56
Offsets against gross financing authority and disbursements:
Offsetting collections (collected) from:
4120 Federal sources-upward estimate and interest –56
4122 Interest on uninvested funds –6
4123 Recoveries of defaulted loans –7 –3



4130 Offsets against gross financing auth and disbursements (total) –69 –3
4170 Financing disbursements, net (mandatory) –59 53
4190 Financing disbursements, net (total) –59 53

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4304–0–3–552 2013 actual 2014 est. 2015 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 430 350
2251 Repayments and prepayments –70 –5
Adjustments:
2261 Terminations for default that result in loans receivable –8 –13
2263 Terminations for default that result in claim payments –2 –3
2264 Other adjustments, net –329



2290 Outstanding, end of year 350

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 350

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 184 192
2331 Disbursements for guaranteed loan claims 10 12
2361 Write-offs of loans receivable –2 –3
2364 Other adjustments, net –201



2390 Outstanding, end of year 192

Pursuant to P.L. 113–76, the Consolidated Appropriations Act, 2014 this activity is transferred to the Department of Education.

Balance Sheet (in millions of dollars)


Identification code 75–4304–0–3–552 2012 actual 2013 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 50 108
Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501 Defaulted guaranteed loans receivable, gross 184 192
1505 Allowance for subsidy cost (-) –126 –144


1599 Net present value of assets related to defaulted guaranteed loans 58 48


1999 Total assets 108 156
LIABILITIES:
2204 Non-Federal liabilities: Liabilities for loan guarantees 108 156


4999 Total liabilities and net position 108 156

Health Education Assistance Loans Liquidating Account

Program and Financing (in millions of dollars)


Identification code 75–4305–0–3–552 2013 actual 2014 est. 2015 est.

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



0900 Total new obligations (object class 33.0) 2 2

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



1260 Appropriations, mandatory (total) 1 1
Spending authority from offsetting collections, mandatory:
1800 Collected 9 9
1820 Capital transfer of spending authority from offsetting collections to general fund –8 –8



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

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

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 2 2
Outlays, gross:
4100 Outlays from new mandatory authority 2 2
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –9 –9
4180 Budget authority, net (total) –7 –7
4190 Outlays, net (total) –7 –7

Status of Guaranteed Loans (in millions of dollars)


Identification code 75–4305–0–3–552 2013 actual 2014 est. 2015 est.

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year 64 49
2251 Repayments and prepayments –13 –7
Adjustments:
2261 Terminations for default that result in loans receivable –2 –2
2264 Other adjustments, net –40



2290 Outstanding, end of year 49

Memorandum:
2299 Guaranteed amount of guaranteed loans outstanding, end of year 49

Addendum:
Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310 Outstanding, start of year 346 331
2331 Disbursements for guaranteed loan claims 2 2
2351 Repayments of loans receivable –8 –9
2361 Write-offs of loans receivable –20
2364 Other adjustments, net 11 –324



2390 Outstanding, end of year 331

Pursuant to P.L. 113–76, the Consolidated Appropriations Act, 2014 this activity is transferred to the Department of Education.

Balance Sheet (in millions of dollars)


Identification code 75–4305–0–3–552 2012 actual 2013 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury 1 1
1701 Defaulted guaranteed loans, gross 346 331
1703 Allowance for estimated uncollectible loans and interest (-) –238 –248


1799 Value of assets related to loan guarantees 108 83


1999 Total assets 109 84
LIABILITIES:
2104 Federal liabilities: Resources payable to Treasury 109 82
2204 Non-Federal liabilities: Liabilities for loan guarantees 2


2999 Total liabilities 109 84


4999 Total liabilities and net position 109 84

Medical Facilities Guarantee and Loan Fund

Status of Direct Loans (in millions of dollars)


Identification code 75–9931–0–3–551 2013 actual 2014 est. 2015 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 2012 actual 2013 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 (the "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 [$6,464,000] $7,500,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2014.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–8175–0–7–551 2013 actual 2014 est. 2015 est.

0100 Balance, start of year 3,214 3,244 3,304
Receipts:
0200 Deposits, Vaccine Injury Compensation Trust Fund 204 249 256
0240 Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund 119 115 128



0299 Total receipts and collections 323 364 384



0400 Total: Balances and collections 3,537 3,608 3,688
Appropriations:
0500 Vaccine Injury Compensation Program Trust Fund –18 –19 –21
0501 Vaccine Injury Compensation Program Trust Fund –275 –285 –293



0599 Total appropriations –293 –304 –314



0799 Balance, end of year 3,244 3,304 3,374

Program and Financing (in millions of dollars)


Identification code 75–8175–0–7–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Compensation: Claims for post - FY 1989 injuries 275 285 293
0103 Claims processing (Claims Court) 5 5 5
0104 Claims processing (HRSA) 6 6 8
0105 Claims processing (Dept. of Justice) 8 8 8



0191 Total, administrative expenses 19 19 21



0799 Total direct obligations 294 304 314
0801 Reimbursable program activity (claims) 2



0900 Total new obligations 296 304 314

Budgetary Resources:
Unobligated balance:
1021 Recoveries of prior year unpaid obligations 1



1050 Unobligated balance (total) 1
Budget authority:
Appropriations, discretionary:
1101 Appropriation (special or trust fund) 18 19 21



1160 Appropriation, discretionary (total) 18 19 21
Appropriations, mandatory:
1201 Appropriation (special or trust fund) 275 285 293



1260 Appropriations, mandatory (total) 275 285 293
Spending authority from offsetting collections, mandatory:
1800 Collected 2



1850 Spending auth from offsetting collections, mand (total) 2
1900 Budget authority (total) 295 304 314
1930 Total budgetary resources available 296 304 314

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 19 16
3010 Obligations incurred, unexpired accounts 296 304 314
3020 Outlays (gross) –298 –320 –314
3040 Recoveries of prior year unpaid obligations, unexpired –1



3050 Unpaid obligations, end of year 16
Memorandum (non-add) entries:
3100 Obligated balance, start of year 19 16
3200 Obligated balance, end of year 16

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 18 19 21
Outlays, gross:
4010 Outlays from new discretionary authority 13 19 21
4011 Outlays from discretionary balances 8 16



4020 Outlays, gross (total) 21 35 21
Mandatory:
4090 Budget authority, gross 277 285 293
Outlays, gross:
4100 Outlays from new mandatory authority 277 285 293
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –2
4180 Budget authority, net (total) 293 304 314
4190 Outlays, net (total) 296 320 314

Memorandum (non-add) entries:
5000 Total investments, SOY: Federal securities: Par value 3,194 3,244 3,324
5001 Total investments, EOY: Federal securities: Par value 3,244 3,324 3,415

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 2013 actual 2014 est. 2015 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent 2 2 2
12.1 Civilian personnel benefits 1 1 1
25.3 Other goods and services from Federal sources 3 16 18
42.0 Insurance claims and indemnities 290 285 293



99.9 Total new obligations 296 304 314

Employment Summary


Identification code 75–8175–0–7–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 17 20 23
1101 Direct military average strength employment 2 2 2

Indian Health Service

Federal Funds

Indian Health Services

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education Assistance 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, [$3,982,842,000] $4,172,182,000, 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] $929,041,000 for Purchased/Referred Care, including [$51,500,000] $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. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–0390–0–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Clinical services 3,051 3,099 3,243
0002 Preventive health 143 148 156
0003 Urban health 41 41 41
0004 Indian health professions 32 34 39
0005 Tribal management 2 1 2
0006 Direct operations 68 68 68
0007 Self-governance 6 5 6
0008 Contract support costs 448 587 617
0009 Diabetes funds 147 147



0799 Total direct obligations 3,938 4,130 4,172
0801 Reimbursable program 1,219 1,334 1,364



0900 Total new obligations 5,157 5,464 5,536

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 560 577 408
1001 Discretionary unobligated balance brought fwd, Oct 1 560
1021 Recoveries of prior year unpaid obligations 124



1050 Unobligated balance (total) 684 577 408
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,915 3,983 4,172
1120 Appropriations transferred to other accts [75–0390] –65
1121 Appropriations transferred from other accts [75–0390] 65
1130 Appropriations permanently reduced –202



1160 Appropriation, discretionary (total) 3,713 3,983 4,172
Appropriations, mandatory:
1200 Appropriation 150 150
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –3 –3



1260 Appropriations, mandatory (total) 147 147
Spending authority from offsetting collections, discretionary:
1700 Collected 1,203 1,165 1,165
1701 Change in uncollected payments, Federal sources –10



1750 Spending auth from offsetting collections, disc (total) 1,193 1,165 1,165
1900 Budget authority (total) 5,053 5,295 5,337
1930 Total budgetary resources available 5,737 5,872 5,745
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3
1941 Unexpired unobligated balance, end of year 577 408 209

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 844 833 1,016
3010 Obligations incurred, unexpired accounts 5,157 5,464 5,536
3011 Obligations incurred, expired accounts 24
3020 Outlays (gross) –5,037 –5,281 –5,416
3040 Recoveries of prior year unpaid obligations, unexpired –124
3041 Recoveries of prior year unpaid obligations, expired –31



3050 Unpaid obligations, end of year 833 1,016 1,136
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –82 –68 –68
3070 Change in uncollected pymts, Fed sources, unexpired 10
3071 Change in uncollected pymts, Fed sources, expired 4



3090 Uncollected pymts, Fed sources, end of year –68 –68 –68
Memorandum (non-add) entries:
3100 Obligated balance, start of year 762 765 948
3200 Obligated balance, end of year 765 948 1,068

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 4,906 5,148 5,337
Outlays, gross:
4010 Outlays from new discretionary authority 4,178 4,431 4,586
4011 Outlays from discretionary balances 734 838 830



4020 Outlays, gross (total) 4,912 5,269 5,416
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –263 –368 –368
4033 Non-Federal sources –942 –797 –797



4040 Offsets against gross budget authority and outlays (total) –1,205 –1,165 –1,165
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired 10
4052 Offsetting collections credited to expired accounts 2



4060 Additional offsets against budget authority only (total) 12



4070 Budget authority, net (discretionary) 3,713 3,983 4,172
4080 Outlays, net (discretionary) 3,707 4,104 4,251
Mandatory:
4090 Budget authority, gross 147 147
Outlays, gross:
4100 Outlays from new mandatory authority 48
4101 Outlays from mandatory balances 77 12



4110 Outlays, gross (total) 125 12
4180 Budget authority, net (total) 3,860 4,130 4,172
4190 Outlays, net (total) 3,832 4,116 4,251

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


2013 actual 2014 est. 2015 est.

Enacted/requested:
Budget Authority 3,860 4,130 4,172
Outlays 3,832 4,116 4,251
Legislative proposal, subject to PAYGO:
Budget Authority 150
Outlays 144
Total:
Budget Authority 3,860 4,130 4,322
Outlays 3,832 4,116 4,395

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.248 billion primarily through self-determination contracts and compacts, will be administered by tribal governments in 2015.

Object Classification (in millions of dollars)


Identification code 75–0390–0–1–551 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 397 404 413
11.3 Other than full-time permanent 20 20 21
11.5 Other personnel compensation 50 51 52
11.7 Military personnel 72 74 75



11.9 Total personnel compensation 539 549 561
12.1 Civilian personnel benefits 143 146 149
12.2 Military personnel benefits 32 32 33
13.0 Benefits for former personnel 13 13 13
21.0 Travel and transportation of persons 8 8 8
21.0 Patient travel 32 33 35
22.0 Transportation of things 6 6 6
23.1 Rental payments to GSA 8 8 8
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 11 11 11
25.1 Advisory and assistance services 8 8 8
25.2 Other services from non-Federal sources 90 95 101
25.3 Other goods and services from Federal sources 50 51 52
25.4 Operation and maintenance of facilities 8 9 9
25.6 Medical care 308 452 504
25.7 Operation and maintenance of equipment 13 13 13
25.8 Subsistence and support of persons 3 3 3
26.0 Supplies and materials 98 103 109
31.0 Equipment 7 8 8
41.0 Grants, subsidies, and contributions 2,559 2,580 2,539
42.0 Insurance claims and indemnities 1 1 1



99.0 Direct obligations 3,938 4,130 4,172
99.0 Reimbursable obligations 1,219 1,334 1,364



99.9 Total new obligations 5,157 5,464 5,536

Employment Summary


Identification code 75–0390–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 7,082 7,358 7,474
1101 Direct military average strength employment 1,105 1,138 1,147
2001 Reimbursable civilian full-time equivalent employment 5,173 5,059 5,065
2101 Reimbursable military average strength employment 807 783 777

Indian Health Services

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–0390–4–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0003 Urban health 150



0900 Total new obligations (object class 41.0) 150

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation 150



1260 Appropriations, mandatory (total) 150
1900 Budget authority (total) 150
1930 Total budgetary resources available 150

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 150
3020 Outlays (gross) –144



3050 Unpaid obligations, end of year 6
Memorandum (non-add) entries:
3200 Obligated balance, end of year 6

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 150
Outlays, gross:
4100 Outlays from new mandatory authority 144
4180 Budget authority, net (total) 150
4190 Outlays, net (total) 144

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, $461,995,000 [$451,673,000], 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 may 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 may 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 may be placed in a Demolition Fund, to remain available until expended, and be used by the Indian Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0391–0–1–551 2013 actual 2014 est. 2015 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 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Sanitation and health facilities 164 164 164
0002 Maintenance 54 54 54
0003 Facilities and environmental health 201 211 221
0004 Equipment 20 23 23



0100 Total direct program 439 452 462



0799 Total direct obligations 439 452 462
0801 Reimbursable program 65 65 65



0900 Total new obligations 504 517 527

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 169 156 105
1001 Discretionary unobligated balance brought fwd, Oct 1 169
1021 Recoveries of prior year unpaid obligations 8



1050 Unobligated balance (total) 177 156 105
Budget authority:
Appropriations, discretionary:
1100 Appropriation 442 452 462
1130 Appropriations permanently reduced –23



1160 Appropriation, discretionary (total) 419 452 462
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 56 6 6



1750 Spending auth from offsetting collections, disc (total) 56 6 6
1900 Budget authority (total) 483 466 476
1930 Total budgetary resources available 660 622 581
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 156 105 54

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 525 522 542
3010 Obligations incurred, unexpired accounts 504 517 527
3020 Outlays (gross) –498 –497 –494
3040 Recoveries of prior year unpaid obligations, unexpired –8
3041 Recoveries of prior year unpaid obligations, expired –1



3050 Unpaid obligations, end of year 522 542 575
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –6 –5 –5
3071 Change in uncollected pymts, Fed sources, expired 1



3090 Uncollected pymts, Fed sources, end of year –5 –5 –5
Memorandum (non-add) entries:
3100 Obligated balance, start of year 519 517 537
3200 Obligated balance, end of year 517 537 570

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 475 458 468
Outlays, gross:
4010 Outlays from new discretionary authority 259 142 145
4011 Outlays from discretionary balances 230 347 341



4020 Outlays, gross (total) 489 489 486
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –42 –6 –6
4033 Non-Federal sources –14



4040 Offsets against gross budget authority and outlays (total) –56 –6 –6



4070 Budget authority, net (discretionary) 419 452 462
4080 Outlays, net (discretionary) 433 483 480
Mandatory:
4090 Budget authority, gross 8 8 8
Outlays, gross:
4100 Outlays from new mandatory authority 3 8 8
4101 Outlays from mandatory balances 6



4110 Outlays, gross (total) 9 8 8
4180 Budget authority, net (total) 427 460 470
4190 Outlays, net (total) 442 491 488

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. An estimated $208.7 million primarily through self-determination contracts and compacts, will be administered by tribal governments in 2015.

Object Classification (in millions of dollars)


Identification code 75–0391–0–1–551 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 46 48 51
11.3 Other than full-time permanent 2 2 2
11.5 Other personnel compensation 2 2 2
11.7 Military personnel 24 24 25



11.9 Total personnel compensation 74 76 80
12.1 Civilian personnel benefits 14 15 16
12.2 Military personnel benefits 9 9 9
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 14 16 16
25.1 Advisory and assistance services 3 2 2
25.2 Other services from non-Federal sources 69 71 71
25.3 Other goods and services from Federal sources 2 2 2
25.4 Operation and maintenance of facilities 9 10 10
25.7 Operation and maintenance of equipment 5 6 6
26.0 Supplies and materials 6 7 7
31.0 Equipment 8 9 10
32.0 Land and structures 83 82 82
41.0 Grants, subsidies, and contributions 136 140 144



99.0 Direct obligations 439 452 462
99.0 Reimbursable obligations 65 65 65



99.9 Total new obligations 504 517 527

Employment Summary


Identification code 75–0391–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 1,003 1,049 1,082
1101 Direct military average strength employment 171 171 163
2001 Reimbursable civilian full-time equivalent employment 29 29 29

ADMINISTRATIVE PROVISIONS

Indian Health Service Administrative Provisions

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 notified to 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, [$571,536,000] $607,942,000: 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.

Hiv/Aids, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention

For carrying out titles II, III, XVII, and XXIII[, and XXVI] of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, [$1,072,834,000] $1,124,942,000: 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, [$287,300,000] $393,549,000: Provided, That of the [funds provided for the Advanced Molecular Detection initiative, the CDC Director shall establish and publish a five-year program implementation plan within 90 days of enactment] amounts available to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under federal or state quarantine law, up to $1,000,000 shall remain available until expended.

Chronic Disease Prevention and Health Promotion

For carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health promotion, [$711,650,000] $608,253,000: Provided, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for [not less than] up to 21 States, tribes, or tribal organizations: Provided further, That [of the funds available under this heading, $5,000,000 shall be available to conduct an extension and outreach program to combat obesity in counties with the highest levels of obesity: Provided further, That of the funds provided under this heading, $80,000,000 shall be available for a program consisting of three-year grants of no less than $100,000 per year to non-governmental entities, local public health offices, school districts, local housing authorities, local transportation authorities or Indian tribes to implement evidence-based chronic disease prevention strategies: Provided further, That applicants for grants described in the previous proviso shall determine the population to be served and shall agree to work in collaboration with multi-sector partners] the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available under this heading.

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, [$122,435,000] $61,541,000.

Public Health Scientific Services

For carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics, and workforce development, [$347,179,000] $377,723,000: Provided, That, in addition to amounts provided herein, [$85,691,000] $95,086,000 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, [$147,555,000] $131,811,000.

Injury Prevention and Control

For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, [$142,311,000] $188,699,000: Provided, That, in addition to the amounts provided herein, $5,605,000 shall be available from amounts under section 241 of the PHS Act to carry out the evaluation of Rape Prevention and Education programs.

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, and 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, [$180,300,000: Provided, That in addition to amounts provided herein, $112,000,000] $280,590,000 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, [$383,000,000] $464,301,000, of which [$114,250,000] $128,735,000 for international HIV/AIDS shall remain available through September 30, [2015, and of which $7,500,000 shall remain available through September 30, 2015, to support national public health institutes] 2016: 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, [$1,323,450,000, of which $535,000,000 shall remain available until expended for the Strategic National Stockpile: Provided, That in the event the Director of the CDC activates the Emergency Operations Center, the Director of the CDC may detail CDC staff without reimbursement for up to 30 days to support the work of the CDC Emergency Operations Center, so long as the Director provides a notice to the Committees on Appropriations of the House of Representatives and the Senate within 15 days of the use of this authority and a full report within 30 days after use of this authority which includes the number of staff and funding level broken down by the originating center and number of days detailed: Provided further, That in the previous proviso the annual reimbursement cannot exceed $3,000,000 across CDC: Provided further, That of the funds provided for the Strategic National Stockpile, up to $2,000,000 shall be used to support a comprehensive IOM evaluation of the distribution system] $1,317,375,000: Provided, That, of the amounts available to the Strategic National Stockpile, $542,817,000 shall remain available until expended: Provided further, That the Director of the CDC, or the Administrator of the Agency for Toxic Substances and Disease Registry, may detail staff without reimbursement for up to 180 days, to support an activation of the Emergency Operations Center at the CDC.

Cdc-Wide Activities and Program Support

(including transfer of funds)

For carrying out titles II, III, XVII, and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support that supplement activities funded under the headings "Immunization and Respiratory Diseases'', "HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention'', "Emerging and Zoonotic Infectious Diseases'', "Chronic Disease Prevention and Health Promotion'', "Birth Defects, Developmental Disabilities, Disabilities and Health'', "Environmental Health'', "Injury Prevention and Control'', "National Institute for Occupational Safety and Health'', "Energy Employees Occupational Illness Compensation Program'', "Global Health'', "Public Health Preparedness and Response'', and "Public Health Scientific Services'', [$517,570,000, of which $380,000,000 shall be available until September 30, 2015, for business services and transfer to the Working Capital Fund ,] and for carrying out section 4001 of Public Law 111–148, $123,570,000,of which [$24,000,000] $10,000,000 shall be available until September 30, 2018, for [acquisition of real property,] equipment, construction and renovation of facilities: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading and in all other accounts of the CDC: Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase, hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service, or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through September 30, [2015] 2016: 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 [to facilitate the implementation of the permanent Working Capital Fund ("WCF'') authorized under this heading in division F of Public Law 112–74, on or after enactment of this Act, unobligated balances of amounts appropriated for business services for fiscal year 2013 shall be transferred to the WCF: Provided further, That on or after enactment of this Act, CDC shall transfer amounts available for business services to other CDC appropriations consistent with the benefit each appropriation received from the business services appropriation in fiscal year 2013: Provided further, That once the WCF is implemented in fiscal year 2014, assets purchased in any prior fiscal year with funds appropriated for or reimbursed to business services may be transferred to the WCF and customers billed for depreciation of those assets: Provided further, That CDC shall, consistent with the authorities provided in 42 U.S.C. 231, ensure that the WCF is used only for administrative support services and not for programmatic activities: Provided further, That CDC shall notify the Committees on Appropriations of the House of Representatives and the Senate not later than 15 days prior to any transfers made with funds provided under this heading] the Director may transfer funds between any of the accounts of CDC with notification to the Comittees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–0943–0–1–999 2013 actual 2014 est. 2015 est.

0100 Balance, start of year
Receipts:
0220 Cooperative Research and Development Agreements, Centers for Disease Control 1 2 2



0400 Total: Balances and collections 1 2 2
Appropriations:
0500 CDC-Wide Activities and Program Support –1 –2 –2



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–0943–0–1–999 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Birth Defects, Developmental Disabilities, Disability and Health (0958) 130 132 132
0002 CDC Wide Activities and Program Support (0943) 1,099 299 124
0004 Chronic Disease Prevention and Health Promotion (0948) 739 1,188 1,078
0005 Emerging and Zoonotics Infectious Diseases (0949) 246 393 445
0006 Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954) 50 50 55
0007 Environmental Health (0947) 102 180 169
0008 Global Health (0955) 332 414 465
0012 HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950) 1,045 1,121 1,128
0013 Immunization and Respiratory Diseases (0951) 563 772 735
0015 Injury Prevention and Control (0952) 130 151 189
0016 Occupational Safety and Health (0953) 172 221
0019 Public Health Preparedness and Response (0956) 1,255 1,371 1,317
0020 Public Health Scientific Services (0959) 144 397 431
0021 Cooperative Research and Development Agreements (CRADA) (5146) 1 2 2



0799 Total direct obligations 6,008 6,691 6,270
0802 Reimbursable program activity 588 541 738



0809 Reimbursable program activities, subtotal 588 541 738



0900 Total new obligations 6,596 7,232 7,008

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 182 165 166
1001 Discretionary unobligated balance brought fwd, Oct 1 182
1021 Recoveries of prior year unpaid obligations 46



1050 Unobligated balance (total) 228 165 166
Budget authority:
Appropriations, discretionary:
1100 Appropriation 5,657 5,807 5,400
1120 Appropriations transferred to other accts [75–0350] –8
1121 Appropriations transferred from other accts [75–9915] 59
1121 Appropriations transferred from other accts [75–9912] 2
1121 Appropriations transferred from other accts [75–0140] 2
1121 Appropriations transferred from other accts [75–0142] 5
1121 Appropriations transferred from other accts [75–0350] 16
1130 Appropriations permanently reduced –296



1160 Appropriation, discretionary (total) 5,437 5,807 5,400
Appropriations, mandatory:
1200 Appropriation 55 55 55
1201 Appropriation (special or trust fund) 1 2 2
1221 Appropriations transferred from other accts [75–0116] 463 831 809
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –5 –5



1260 Appropriations, mandatory (total) 514 883 866
Spending authority from offsetting collections, discretionary:
1700 Collected 329 541 736
1701 Change in uncollected payments, Federal sources 260



1750 Spending auth from offsetting collections, disc (total) 589 541 736
Spending authority from offsetting collections, mandatory:
1800 Collected 2 2



1850 Spending auth from offsetting collections, mand (total) 2 2
1900 Budget authority (total) 6,540 7,233 7,004
1930 Total budgetary resources available 6,768 7,398 7,170
Memorandum (non-add) entries:
1940 Unobligated balance expiring –7
1941 Unexpired unobligated balance, end of year 165 166 162

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 6,312 5,779 6,052
3010 Obligations incurred, unexpired accounts 6,596 7,232 7,008
3011 Obligations incurred, expired accounts 32
3020 Outlays (gross) –6,979 –6,959 –6,909
3040 Recoveries of prior year unpaid obligations, unexpired –46
3041 Recoveries of prior year unpaid obligations, expired –136



3050 Unpaid obligations, end of year 5,779 6,052 6,151
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –461 –429 –429
3070 Change in uncollected pymts, Fed sources, unexpired –260
3071 Change in uncollected pymts, Fed sources, expired 292



3090 Uncollected pymts, Fed sources, end of year –429 –429 –429
Memorandum (non-add) entries:
3100 Obligated balance, start of year 5,851 5,350 5,623
3200 Obligated balance, end of year 5,350 5,623 5,722

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 6,026 6,348 6,136
Outlays, gross:
4010 Outlays from new discretionary authority 2,373 2,539 2,470
4011 Outlays from discretionary balances 3,898 3,328 3,531



4020 Outlays, gross (total) 6,271 5,867 6,001
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –603 –532 –727
4033 Non-Federal sources –7 –9 –9



4040 Offsets against gross budget authority and outlays (total) –610 –541 –736
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –260
4052 Offsetting collections credited to expired accounts 281



4060 Additional offsets against budget authority only (total) 21



4070 Budget authority, net (discretionary) 5,437 5,807 5,400
4080 Outlays, net (discretionary) 5,661 5,326 5,265
Mandatory:
4090 Budget authority, gross 514 885 868
Outlays, gross:
4100 Outlays from new mandatory authority 128 329 321
4101 Outlays from mandatory balances 580 763 587



4110 Outlays, gross (total) 708 1,092 908
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –2 –2
4180 Budget authority, net (total) 5,951 6,690 6,266
4190 Outlays, net (total) 6,369 6,416 6,171

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, public health preparedness and emergency response, and CDC-Wide Activities and Program Support. The 2013 levels in MAX are not comparable with 2014 and the 2015 Budget levels. In 2014, CDC implemented a Working Capital Fund, which realigned business support services from the prior fiscal year to the program budget lines based on 2013 consumption data.

Object Classification (in millions of dollars)


Identification code 75–0943–0–1–999 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 700 706 713
11.3 Other than full-time permanent 98 102 102
11.5 Other personnel compensation 25 24 24
11.7 Military personnel 70 65 65
11.8 Special personal services payments 1 1 1



11.9 Total personnel compensation 894 898 905
12.1 Civilian personnel benefits 251 252 254
12.2 Military personnel benefits 48 44 44
13.0 Benefits for former personnel 2 2 2
21.0 Travel and transportation of persons 37 33 40
22.0 Transportation of things 12 10 9
23.1 Rental payments to GSA 35 59 60
23.2 Rental payments to others 1 1 1
23.3 Communications, utilities, and miscellaneous charges 32 34 35
24.0 Printing and reproduction 3 3 3
25.1 Advisory and assistance services 541 796 681
25.2 Other services from non-Federal sources 207 198 135
25.3 Other goods and services from Federal sources 253 293 240
25.4 Operation and maintenance of facilities 67 48 37
25.5 Research and development contracts 37 41 31
25.6 Medical care 5 7 6
25.7 Operation and maintenance of equipment 39 32 25
25.8 Subsistence and support of persons 1 30
26.0 Supplies and materials 561 299 297
31.0 Equipment 53 54 52
32.0 Land and structures 19 11 11
41.0 Grants, subsidies, and contributions 2,911 3,575 3,372



99.0 Direct obligations 6,008 6,691 6,270
99.0 Reimbursable obligations 588 541 738



99.9 Total new obligations 6,596 7,232 7,008

Employment Summary


Identification code 75–0943–0–1–999 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 8,764 8,764 8,764
1101 Direct military average strength employment 800 800 800
2001 Reimbursable civilian full-time equivalent employment 1,159 1,159 1,159
2101 Reimbursable military average strength employment 101 101 101

CDC Working Capital Fund

Program and Financing (in millions of dollars)


Identification code 75–4553–0–4–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0801 Reimbursable program activity 520 517



0900 Total new obligations (object class 25.3) 520 517

Budgetary Resources:
Budget authority:
Spending authority from offsetting collections, discretionary:
1700 Collected 520 517



1750 Spending auth from offsetting collections, disc (total) 520 517
1900 Budget authority (total) 520 517
1930 Total budgetary resources available 520 517

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 520 517
3020 Outlays (gross) –520 –517

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 520 517
Outlays, gross:
4010 Outlays from new discretionary authority 520 517
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –520 –517

Implemented in 2014, CDC's new Working Capital Fund has extended availability and serves as the funding mechanism to finance centralized business services support across CDC. Services rendered under the fund are performed at pre-established rates that are used to cover the full cost of operations and future investments. Contributions are collected for services, thereby creating market-like incentives to maximize efficiency and quality.

Object Classification (in millions of dollars)


Identification code 75–4553–0–4–551 2013 actual 2014 est. 2015 est.

Reimbursable obligations:
25.3 Other goods and services from Federal sources 520 517
99.0 Reimbursable obligations 520 517

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)[; section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA);] and section 3019 of the Solid Waste Disposal Act, $74,691,000, 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)] 104(i) of CERCLA during fiscal year [2014] 2015, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–0944–0–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Direct program 75 75 75
0801 Reimbursable program 4 10 10



0900 Total new obligations 79 85 85

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 17 14 14
Budget authority:
Appropriations, discretionary:
1100 Appropriation 76 75 75
1130 Appropriations permanently reduced –4



1160 Appropriation, discretionary (total) 72 75 75
Appropriations, mandatory:
1200 Appropriation 20



1260 Appropriations, mandatory (total) 20
Spending authority from offsetting collections, discretionary:
1700 Collected 2 10 10
1701 Change in uncollected payments, Federal sources 2



1750 Spending auth from offsetting collections, disc (total) 4 10 10
1900 Budget authority (total) 76 85 105
1930 Total budgetary resources available 93 99 119
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 14 14 34

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 52 42 33
3010 Obligations incurred, unexpired accounts 79 85 85
3020 Outlays (gross) –87 –94 –98
3041 Recoveries of prior year unpaid obligations, expired –2



3050 Unpaid obligations, end of year 42 33 20
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –14 –10 –10
3070 Change in uncollected pymts, Fed sources, unexpired –2
3071 Change in uncollected pymts, Fed sources, expired 6



3090 Uncollected pymts, Fed sources, end of year –10 –10 –10
Memorandum (non-add) entries:
3100 Obligated balance, start of year 38 32 23
3200 Obligated balance, end of year 32 23 10

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 76 85 85
Outlays, gross:
4010 Outlays from new discretionary authority 51 63 63
4011 Outlays from discretionary balances 32 31 21



4020 Outlays, gross (total) 83 94 84
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 –2
4052 Offsetting collections credited to expired accounts 7



4060 Additional offsets against budget authority only (total) 5



4070 Budget authority, net (discretionary) 72 75 75
4080 Outlays, net (discretionary) 74 84 74
Mandatory:
4090 Budget authority, gross 20
Outlays, gross:
4100 Outlays from new mandatory authority 14
4101 Outlays from mandatory balances 4



4110 Outlays, gross (total) 4 14
4180 Budget authority, net (total) 72 75 95
4190 Outlays, net (total) 78 84 88

The Agency for Toxic Substances and Disease Registry (ATSDR) is authorized under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). ATSDR's mission is to use the best science, take responsive action, and provide trustworthy health information to prevent and mitigate harmful exposures to toxic substances and related disease.

Object Classification (in millions of dollars)


Identification code 75–0944–0–1–551 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 22 23 24
11.3 Other than full-time permanent 1 1 1
11.5 Other personnel compensation 1 1 1
11.7 Military personnel 4 4 4



11.9 Total personnel compensation 28 29 30
12.1 Civilian personnel benefits 8 8 8
12.2 Military personnel benefits 1 1 2
23.3 Communications, utilities, and miscellaneous charges 5 5 3
25.1 Advisory and assistance services 3 4 4
25.2 Other services from non-Federal sources 5 5 5
25.3 Other goods and services from Federal sources 7 7 7
25.7 Operation and maintenance of equipment 1 1 1
31.0 Equipment 1 1 1
41.0 Grants, subsidies, and contributions 16 14 14



99.0 Direct obligations 75 75 75
99.0 Reimbursable obligations 4 10 10



99.9 Total new obligations 79 85 85

Employment Summary


Identification code 75–0944–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 240 240 240
1101 Direct military average strength employment 38 38 38
2001 Reimbursable civilian full-time equivalent employment 9 9 9
2101 Reimbursable military average strength employment 1 1 1

World Trade Center Health Program Fund

Program and Financing (in millions of dollars)


Identification code 75–0946–0–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Federal Share 230 268 282
0002 NYC 26 30 31



0900 Total new obligations 256 298 313

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 107
Budget authority:
Appropriations, mandatory:
1200 Appropriation (WTC (CDC Direct)) 234 382 282
1200 Appropriation (WTC—NYC DHSS—CDC) 26 42 31
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –10 –19



1260 Appropriations, mandatory (total) 250 405 313
Spending authority from offsetting collections, mandatory:
1800 Collected 6



1850 Spending auth from offsetting collections, mand (total) 6
1900 Budget authority (total) 256 405 313
1930 Total budgetary resources available 256 405 420
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 107 107

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 114 162 177
3010 Obligations incurred, unexpired accounts 256 298 313
3020 Outlays (gross) –191 –283 –365
3041 Recoveries of prior year unpaid obligations, expired –17



3050 Unpaid obligations, end of year 162 177 125
Memorandum (non-add) entries:
3100 Obligated balance, start of year 114 162 177
3200 Obligated balance, end of year 162 177 125

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 256 405 313
Outlays, gross:
4100 Outlays from new mandatory authority 125 203 157
4101 Outlays from mandatory balances 66 80 208



4110 Outlays, gross (total) 191 283 365
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –21
Additional offsets against gross budget authority only:
4142 Offsetting collections credited to expired accounts 15



4160 Budget authority, net (mandatory) 250 405 313
4170 Outlays, net (mandatory) 170 283 365
4180 Budget authority, net (total) 250 405 313
4190 Outlays, net (total) 170 283 365

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 2014 and 2015 Budget reflect estimated Federal obligations for the WTC Health Program.

Object Classification (in millions of dollars)


Identification code 75–0946–0–1–551 2013 actual 2014 est. 2015 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 18 18 20
25.2 Other services from non-Federal sources 71 82 33
25.3 Other goods and services from Federal sources 10 5 4
25.6 Medical care 134 170 233
41.0 Grants, subsidies, and contributions 20 20 20



99.9 Total new obligations 256 298 313

Employment Summary


Identification code 75–0946–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 18 18 18
1101 Direct military average strength employment 4 4 4

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, [$4,923,238,000] $4,930,715,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$2,988,605,000] $2,987,685,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$398,650,000] $397,131,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$1,744,274,000] $1,743,336,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$1,587,982,000] $1,608,461,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$4,358,841,000] $4,423,357,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Institute of General Medical Sciences

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,364,147,000: Provided, That not less than $273,325,000 is provided for the Institutional Development Awards program] $2,368,877,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$1,282,595,000] $1,283,487,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Eye Institute

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$682,077,000] $675,168,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Institute of Environmental Health Sciences

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, [$665,439,000] $665,080,000. (Department of Health and Human Services Appropriations Act, 2014.)

For necessary expenses [for] of 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 (42 U.S.C. 9660(a)) and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $77,349,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)

National Institute on Aging

For carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,171,038,000] $1,170,880,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$520,053,000] $520,189,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$404,049,000] $403,933,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Institute of Nursing Research

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$140,517,000] $140,452,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$446,025,000] $446,017,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Institute on Drug Abuse

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,025,435,000] $1,023,268,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Institute of Mental Health

For carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,446,172,000] $1,440,076,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Human Genome Research Institute

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$497,813,000] $498,451,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$329,172,000] $328,532,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$124,296,000] $124,509,000. (Department of Health and Human Services Appropriations Act, 2014.)

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, [$268,322,000] $267,953,000. (Department of Health and Human Services Appropriations Act, 2014.)

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), [$67,577,000] $67,776,000. (Department of Health and Human Services Appropriations Act, 2014.)

National Library of Medicine

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$327,723,000, of which] $372,851,000: Provided, That, of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, [2015 , for improvement of information systems] 2016: Provided further, That, in fiscal year [2014] 2015, 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. (Department of Health and Human Services Appropriations Act, 2014.)

National Center for Advancing Translational Sciences

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$633,267,000] $657,471,000: Provided, That up to [$9,835,000] $29,810,000 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network[: Provided further, That at least $474,746,000 is provided to the Clinical and Translational Sciences Awards program]. (Department of Health and Human Services Appropriations Act, 2014.)

Office of the Director

For carrying out the responsibilities of the Office of the Director, NIH, [$1,400,134,000] $1,451,786,000, of which up to [$25,000,000] $30,000,000 shall be used to carry out section [213] 212 of this Act: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That 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 $165,000,000 shall be for the National Children's Study ("NCS''), except that not later than July 15, [2014] 2015, the Director shall estimate the amount needed for the NCS during fiscal year [2014] 2015, and any funds in excess of the estimated need shall be transferred to and merged with the accounts for the various Institutes and Centers in proportion to their shares of total NIH appropriations made by this Act: Provided further, That [$533,039,000] $583,039,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That the Director may direct up to 1 percent of the total made available in this or any other Act to all National Institutes of Health appropriations to activities that the Director may so designate: Provided further, That no such appropriation shall be decreased by more than 1 percent by any such transfers and that the Congress is promptly notified of the transfer. (Department of Health and Human Services Appropriations Act, 2014.)

Buildings and Facilities

For the study of, construction or demolition of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, [$128,663,000] $128,663,000, to remain available until [September 30, 2018, of which up to $7,000,000 may be used for demolition] expended. (Department of Health and Human Services Appropriations Act, 2014.)

Special and Trust Fund Receipts (in millions of dollars)


Identification code 75–9915–0–1–552 2013 actual 2014 est. 2015 est.

0100 Balance, start of year
Receipts:
0220 Cooperative Research and Development Agreements, NIH 18 17 17



0400 Total: Balances and collections 18 17 17
Appropriations:
0500 National Institutes of Health –18 –17 –17



0799 Balance, end of year

Program and Financing (in millions of dollars)


Identification code 75–9915–0–1–552 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 National Cancer Institute (0849) 4,789 4,929 4,931
0002 National Heart, Lung, and Blood Institute (0872) 2,904 2,987 2,988
0003 National Institute of Dental and Craniofacial Research (0873) 387 398 397
0004 National Institute of Diabetes and Digestive and Kidney Disease (0884) 1,695 1,744 1,743
0005 National Institute of Neurological Disorders and Stroke (0886) 1,534 1,588 1,608
0006 National Institute of Allergy and Infectious Diseases (0885) 4,235 4,399 4,423
0007 National Institute of General Medical Sciences (0851) 2,293 2,365 2,369
0008 National Institute of Child Health and Human Development (0844) 1,246 1,283 1,283
0009 National Eye Institute (0887) 657 675 675
0010 National Institute of Environmental Health Sciences (0862) 721 742 742
0011 National Institute on Aging (0843) 1,041 1,171 1,171
0012 National Institute of Arthritis and Musculoskeletal and Skin Disease (0888) 505 520 520
0013 National Institute on Deafness and Other Communication Disorder (0890) 393 404 404
0014 National Institute of Mental Health (0892) 1,396 1,419 1,440
0015 National Institute on Drug Abuse (0893) 993 1,017 1,023
0016 National Institute on Alcohol Abuse and Alcoholism (0894) 433 446 446
0017 National Institute of Nursing Research (0889) 137 141 141
0018 National Human Genome Research Institute (0891) 484 498 498
0019 National Institute of Biomedical Imaging and Bioengineering (0898) 319 327 329
0021 National Center for Complementary and Alternative Medicine (0896) 121 124 125
0022 National Institute on Minority Health and Health Disparities (0897) 261 268 268
0023 John E. Fogarty International Center (0819) 66 68 68
0024 National Library of Medicine (0807) 317 328 373
0025 Office of the Director (0846) 1,412 1,400 1,452
0026 Buildings and facilities (0838) 167 129 129
0027 Cooperative Research and Development Agreements 21 17 17
0028 National Center for Advancing Translational Sciences (0875) 543 633 657
0031 Type 1 Diabetes 142 139



0799 Total direct obligations 29,212 30,159 30,220
0801 Reimbursable - Other 3,151 3,192 3,201
0802 Royalties 92 179 179



0809 Reimbursable program activities, subtotal 3,243 3,371 3,380



0899 Total reimbursable obligations 3,243 3,371 3,380



0900 Total new obligations 32,455 33,530 33,600

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 458 739 564
1001 Discretionary unobligated balance brought fwd, Oct 1 253 702
1021 Recoveries of prior year unpaid obligations 59 4



1050 Unobligated balance (total) 517 743 564
Budget authority:
Appropriations, discretionary:
1100 Appropriation 30,780 30,003 30,203
1120 Appropriations transferred to other accts [75–0943] –59
1120 Appropriations transferred to other accts [75–0511] –114
1121 Appropriations transferred from other accts [75–0140] 149
1130 Appropriations permanently reduced –1,607



1160 Appropriation, discretionary (total) 29,149 30,003 30,203
Appropriations, mandatory:
1200 Appropriation 150 150
1201 Appropriation (special or trust fund) 18 17 17
1230 Appropriations and/or unobligated balance of appropriations permanently reduced –8 –11



1260 Appropriations, mandatory (total) 160 156 17
Spending authority from offsetting collections, discretionary:
1700 Collected 2,609 3,192 3,201
1701 Change in uncollected payments, Federal sources 762



1750 Spending auth from offsetting collections, disc (total) 3,371 3,192 3,201
1900 Budget authority (total) 32,680 33,351 33,421
1930 Total budgetary resources available 33,197 34,094 33,985
Memorandum (non-add) entries:
1940 Unobligated balance expiring –3
1941 Unexpired unobligated balance, end of year 739 564 385

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 33,050 31,107 30,317
3010 Obligations incurred, unexpired accounts 32,455 33,530 33,600
3011 Obligations incurred, expired accounts 203
3020 Outlays (gross) –34,173 –34,316 –32,870
3040 Recoveries of prior year unpaid obligations, unexpired –59 –4
3041 Recoveries of prior year unpaid obligations, expired –369



3050 Unpaid obligations, end of year 31,107 30,317 31,047
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –938 –1,253 –1,253
3070 Change in uncollected pymts, Fed sources, unexpired –762
3071 Change in uncollected pymts, Fed sources, expired 447



3090 Uncollected pymts, Fed sources, end of year –1,253 –1,253 –1,253
Memorandum (non-add) entries:
3100 Obligated balance, start of year 32,112 29,854 29,064
3200 Obligated balance, end of year 29,854 29,064 29,794

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 32,520 33,195 33,404
Outlays, gross:
4010 Outlays from new discretionary authority 10,579 11,293 11,356
4011 Outlays from discretionary balances 23,438 22,905 21,384



4020 Outlays, gross (total) 34,017 34,198 32,740
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –3,080 –3,192 –3,201
4033 Non-Federal sources –117



4040 Offsets against gross budget authority and outlays (total) –3,197 –3,192 –3,201
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –762
4052 Offsetting collections credited to expired accounts 588



4060 Additional offsets against budget authority only (total) –174



4070 Budget authority, net (discretionary) 29,149 30,003 30,203
4080 Outlays, net (discretionary) 30,820 31,006 29,539
Mandatory:
4090 Budget authority, gross 160 156 17
Outlays, gross:
4100 Outlays from new mandatory authority 7 49 17
4101 Outlays from mandatory balances 149 69 113



4110 Outlays, gross (total) 156 118 130
4180 Budget authority, net (total) 29,309 30,159 30,220
4190 Outlays, net (total) 30,976 31,124 29,669

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


2013 actual 2014 est. 2015 est.

Enacted/requested:
Budget Authority 29,309 30,159 30,220
Outlays 30,976 31,124 29,669
Legislative proposal, subject to PAYGO:
Budget Authority 150
Outlays 36
Total:
Budget Authority 29,309 30,159 30,370
Outlays 30,976 31,124 29,705

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


2013 2014 2015

Distribution of budget authority by account:
National Cancer Institute 4,789 4,929 4,931
National Heart, Lung, and Blood Institute 2,904 2,987 2,988
National Institute of Dental and Craniofacial Research 387 398 397
National Institute of Diabetes and Digestive and Kidney Diseases 1,695 1,744 1,743
National Institute of Neurological Disorder and Stroke 1,534 1,588 1,608
National Institute of Allergy and Infectious Diseases 4,235 4,399 4,423
National Institute of General Medical Sciences 2,293 2,365 2,369
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,246 1,283 1,283
National Eye Institute 657 675 675
National Institute of Environmental Health Sciences 721 742 742
National Institute on Aging 1,041 1,171 1,171
National Institute of Arthritis and Musculoskeletal and Skin Diseases 505 520 520
National Institute on Deafness and Other Communication Disorders 393 404 404
National Institute of Mental Health 1,396 1,419 1,440
National Institute on Drug Abuse 993 1,017 1,023
National Institute on Alcohol Abuse and Alcoholism 433 446 446
National Institute of Nursing Research 137 141 141
National Center for Research Resources 0 0 0
National Human Genome Research Institute 484 498 498
National Institute of Biomedical Imaging and Bioengineering 319 327 329
National Institute on Minority Health and Health Disparities 261 268 268
National Center for Complementary and Alternative Medicine 121 124 125
National Center for Advancing Translational Sciences 543 633 657
John E. Fogarty International Center 66 68 68
National Library of Medicine 317 328 373
Office of the Director 1,412 1,400 1,452
Buildings and Facilities 167 129 129



Subtotal 29,049 30,003 30,203
Cooperative Research and Development Agreements 21 17 17



Total Budget Authority, NIH 29,070 30,020 30,220





2013 2014 2015

Distribution of outlays by account:
National Cancer Institute 4,867 5,075 4,832
National Heart, Lung, and Blood Institute 3,021 2,945 2,926
National Institute of Dental and Craniofacial Research 401 430 390
National Institute of Diabetes and Digestive and Kidney Diseases 1,908 2,067 1,710
National Institute of Neurological Disorders and Stroke 1,593 1,735 1,560
National Institute of Allergy and Infectious Diseases 4,514 4,250 4,314
National Institute of General Medical Sciences 2,574 2,583 2,315
Eunice Kennedy Shriver National Institute of Child Health and Human Development 1,298 1,388 1,257
National Eye Institute 707 693 661
National Institute of Environmental Health Sciences 507 718 728
National Institute on Aging 1,074 1,115 1,127
National Institute of Arthritis and Musculoskeletal and Skin Diseases 517 540 509
National Institute on Deafness and Other Communication Disorders 407 421 396
National Institute of Mental Health 1,476 1,419 1,399
National Institute on Drug Abuse 1,071 936 999
National Institute on Alcohol Abuse and Alcoholism 469 448 437
National Institute of Nursing Research 143 138 138
National Center for Research Resources 125 83 28
National Human Genome Research Institute 470 567 488
National Institute of Biomedical Imaging and Bioengineering 330 338 320
National Institute on Minority Health and Health Disparities 248 262 260
National Center for Complementary and Alternative Medicine 125 128 122
National Center for Advancing Translational Sciences 476 564 578
John E. Fogarty International Center 67 73 66
National Library of Medicine 318 336 345
Office of the Director 1,324 1,504 1,387
Buildings and Facilities 95 83 91
ARRA Funds 935 273 273
Management Fund/Service and Supply Fund –103
Subtotal Outlays
Cooperative Research and Development Agreements 18 16 16



Total Outlays, NIH 30,975 31,125 29,670




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 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 905 921 931
11.3 Other than full-time permanent 463 468 473
11.5 Other personnel compensation 18 19 19
11.7 Military personnel 21 21 22
11.8 Special personal services payments 160 160 162



11.9 Total personnel compensation 1,567 1,589 1,607
12.1 Civilian personnel benefits 422 430 445
12.2 Military personnel benefits 15 15 15
21.0 Travel and transportation of persons 43 45 45
22.0 Transportation of things 5 5 5
23.1 Rental payments to GSA 2 2 2
23.2 Rental payments to others 1 1
23.3 Communications, utilities, and miscellaneous charges 28 29 29
24.0 Printing and reproduction 1 1 1
25.1 Advisory and assistance services 112 114 115
25.2 Other services from non-Federal sources 732 791 760
25.3 Other goods and services from Federal sources 2,872 2,985 3,032
25.4 Operation and maintenance of facilities 210 174 174
25.5 Research and development contracts 2,072 2,201 2,180
25.6 Medical care 21 22 22
25.7 Operation and maintenance of equipment 106 108 109
26.0 Supplies and materials 178 185 184
31.0 Equipment 131 136 135
41.0 Grants, subsidies, and contributions 20,695 21,326 21,359



99.0 Direct obligations 29,212 30,159 30,220
99.0 Reimbursable obligations 3,243 3,371 3,380



99.9 Total new obligations 32,455 33,530 33,600

Employment Summary


Identification code 75–9915–0–1–552 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 13,255 13,240 13,240
1101 Direct military average strength employment 200 200 200
2001 Reimbursable civilian full-time equivalent employment 4,675 4,690 4,690
2101 Reimbursable military average strength employment 100 100 100

National Institutes of Health

(Legislative proposal, subject to PAYGO)

Program and Financing (in millions of dollars)


Identification code 75–9915–4–1–552 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Direct program activity 150



0900 Total new obligations (object class 41.0) 150

Budgetary Resources:
Budget authority:
Appropriations, mandatory:
1200 Appropriation 150



1260 Appropriations, mandatory (total) 150
1900 Budget authority (total) 150
1930 Total budgetary resources available 150

Change in obligated balance:
Unpaid obligations:
3010 Obligations incurred, unexpired accounts 150
3020 Outlays (gross) –36



3050 Unpaid obligations, end of year 114
Memorandum (non-add) entries:
3200 Obligated balance, end of year 114

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 150
Outlays, gross:
4100 Outlays from new mandatory authority 36
4180 Budget authority, net (total) 150
4190 Outlays, net (total) 36

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, [$1,055,347,000] $992,792,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, [$21,039,000] $26,039,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for mental health activities and 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] 2015: Provided further, That [of the amount appropriated under this heading, $46,000,000 shall be for the National Child Traumatic Stress Initiative as described in section 582 of the PHS Act] notwithstanding section 565(b)(1) of the PHS Act, technical assistance may be provided to a public entity to establish or operate a system of comprehensive community mental health services to children with a serious emotional disturbance, without regard to whether the public entity receives a grant under section 561(a) of such Act: Provided further, That States shall expend at least 5 percent of the amount each receives for carrying out section 1911 of the PHS Act to support evidence-based [programs that] mental health prevention and treatment practices to address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act.

Substance Abuse Treatment

For carrying out titles III[,] and V[, and XIX] of the PHS Act with respect to substance abuse treatment and [section 1922(a) of the PHS Act] title XIX of such Act with respect to substance abuse treatment and prevention, [$2,052,661,000] $2,008,056,000: Provided, That in addition to amounts provided herein, [the following amounts] $109,200,000 shall be available under section 241 of the PHS Act[: (1) $79,200,000] to supplement funds otherwise available for substance abuse treatment activities and to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data, data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX[; and (2) $2,000,000 to evaluate substance abuse treatment programs]: Provided further, That none of the funds provided for section 1921 of the PHS Act shall be subject to section 241 of such Act.

Substance Abuse Prevention

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$175,631,000] $169,092,000: Provided, That in addition to amounts provided herein, $16,468,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for substance abuse prevention activities.

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, [$151,296,000] $127,729,000: Provided, That in addition to amounts provided herein, [$30,428,000] $58,995,000 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 amounts made available in this Act for carrying out section 501(m) of the PHS Act shall remain available through September 30, 2016: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'': Provided further, That the Administrator may transfer funds between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–1362–0–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0006 Mental Health 894 1,055 999
0007 Substance Abuse Treatment 2,033 2,052 2,002
0008 Substance Abuse Prevention 176 176 169
0009 Health Surveillance and Program Support 121 152 128



0100 Total, direct program 3,224 3,435 3,298



0799 Total direct obligations 3,224 3,435 3,298
0802 Reimbursables 280 249 328



0900 Total new obligations 3,504 3,684 3,626

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 1 63
1001 Discretionary unobligated balance brought fwd, Oct 1 1
Budget authority:
Appropriations, discretionary:
1100 Appropriation 3,349 3,435 3,298
1120 Appropriations transferred to other accts [75–0350] –1
1121 Appropriations transferred from other accts [75–0350] 15
1121 Appropriations transferred from other accts [75–1536] 21
1121 Appropriations transferred from other accts [75–1515] 2
1130 Appropriations permanently reduced –175



1160 Appropriation, discretionary (total) 3,211 3,435 3,298
Appropriations, mandatory:
1221 Appropriations transferred from the Prevention and Public Health Fund [75–0116] 15 62 58



1260 Appropriations, mandatory (total) 15 62 58
Spending authority from offsetting collections, discretionary:
1700 Collected 145 249 330
1701 Change in uncollected payments, Federal sources 135



1750 Spending auth from offsetting collections, disc (total) 280 249 330
1900 Budget authority (total) 3,506 3,746 3,686
1930 Total budgetary resources available 3,506 3,747 3,749
Memorandum (non-add) entries:
1940 Unobligated balance expiring –1
1941 Unexpired unobligated balance, end of year 1 63 123

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 3,125 3,219 2,953
3010 Obligations incurred, unexpired accounts 3,504 3,684 3,626
3011 Obligations incurred, expired accounts 10
3020 Outlays (gross) –3,378 –3,950 –3,739
3041 Recoveries of prior year unpaid obligations, expired –42



3050 Unpaid obligations, end of year 3,219 2,953 2,840
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –22 –143 –143
3070 Change in uncollected pymts, Fed sources, unexpired –135
3071 Change in uncollected pymts, Fed sources, expired 14



3090 Uncollected pymts, Fed sources, end of year –143 –143 –143
Memorandum (non-add) entries:
3100 Obligated balance, start of year 3,103 3,076 2,810
3200 Obligated balance, end of year 3,076 2,810 2,697

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 3,491 3,684 3,628
Outlays, gross:
4010 Outlays from new discretionary authority 1,176 1,554 1,583
4011 Outlays from discretionary balances 2,167 2,289 2,100



4020 Outlays, gross (total) 3,343 3,843 3,683
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –153 –249 –328
4033 Non-Federal sources –2



4040 Offsets against gross budget authority and outlays (total) –153 –249 –330
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –135
4052 Offsetting collections credited to expired accounts 8



4060 Additional offsets against budget authority only (total) –127



4070 Budget authority, net (discretionary) 3,211 3,435 3,298
4080 Outlays, net (discretionary) 3,190 3,594 3,353
Mandatory:
4090 Budget authority, gross 15 62 58
Outlays, gross:
4100 Outlays from new mandatory authority 4 24 22
4101 Outlays from mandatory balances 31 83 34



4110 Outlays, gross (total) 35 107 56
4180 Budget authority, net (total) 3,226 3,497 3,356
4190 Outlays, net (total) 3,225 3,701 3,409

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 2013 actual 2014 est. 2015 est.

Direct obligations:
Personnel compensation:
11.1 Full-time permanent 48 51 51
11.3 Other than full-time permanent 4 4 4
11.5 Other personnel compensation 1 1
11.7 Military personnel 3 3 3



11.9 Total personnel compensation 55 59 59
12.1 Civilian personnel benefits 15 16 16
12.2 Military personnel benefits 2 2 2
21.0 Travel and transportation of persons 1 1 1
23.1 Rental payments to GSA 6 6 10
23.3 Communications, utilities, and miscellaneous charges 1 1
24.0 Printing and reproduction 1 1 1
25.1 Advisory and assistance services 54 48 50
25.2 Other services from non-Federal sources 163 204 192
25.3 Other goods and services from Federal sources 33 63 70
25.4 Operation and maintenance of facilities 2 1 1
25.5 Research and development contracts 4 4
41.0 Grants, subsidies, and contributions 2,892 3,029 2,891



99.0 Direct obligations 3,224 3,435 3,298
99.0 Reimbursable obligations 280 249 328



99.9 Total new obligations 3,504 3,684 3,626

Employment Summary


Identification code 75–1362–0–1–551 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment 492 520 509
1101 Direct military average strength employment 34 35 37
2001 Reimbursable civilian full-time equivalent employment 66 85 93
2101 Reimbursable military average strength employment 16 15 16

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, [$364,008,000] $334,099,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act: Provided, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this appropriation and shall remain available until [September 30, 2015] expended. (Department of Health and Human Services Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–1700–0–1–552 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0003 Prevention and Public Health Fund 6 7
0801 Reimbursable program 15 15 15
0802 Reimbursable program: PHS evaluation 366 364 334



0899 Total reimbursable obligations 381 379 349



0900 Total new obligations 387 386 349

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 4 21 21
1001 Discretionary unobligated balance brought fwd, Oct 1 4 21
Budget authority:
Appropriations, mandatory:
1221 Appropriations transferred from other accts [75–0116] 6 7



1260 Appropriations, mandatory (total) 6 7
Spending authority from offsetting collections, discretionary:
1700 Collected 121 379 349
1701 Change in uncollected payments, Federal sources 256



1750 Spending auth from offsetting collections, disc (total) 377 379 349
Spending authority from offsetting collections, mandatory:
1800 Collected 21



1850 Spending auth from offsetting collections, mand (total) 21
1900 Budget authority (total) 404 386 349
1930 Total budgetary resources available 408 407 370
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 21 21 21

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 725 487 151
3010 Obligations incurred, unexpired accounts 387 386 349
3011 Obligations incurred, expired accounts 4
3020 Outlays (gross) –613 –722 –462
3041 Recoveries of prior year unpaid obligations, expired –16



3050 Unpaid obligations, end of year 487 151 38
Uncollected payments:
3060 Uncollected pymts, Fed sources, brought forward, Oct 1 –293 –387 –387
3070 Change in uncollected pymts, Fed sources, unexpired –256
3071 Change in uncollected pymts, Fed sources, expired 162



3090 Uncollected pymts, Fed sources, end of year –387 –387 –387
Memorandum (non-add) entries:
3100 Obligated balance, start of year 432 100 –236
3200 Obligated balance, end of year 100 –236 –349

Budget authority and outlays, net:
Discretionary:
4000 Budget authority, gross 377 379 349
Outlays, gross:
4010 Outlays from new discretionary authority 126 379 349
4011 Outlays from discretionary balances 477 331 100



4020 Outlays, gross (total) 603 710 449
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4030 Federal sources –273 –379 –349
Additional offsets against gross budget authority only:
4050 Change in uncollected pymts, Fed sources, unexpired –256
4052 Offsetting collections credited to expired accounts 152



4060 Additional offsets against budget authority only (total) –104
4080 Outlays, net (discretionary) 330 331 100
Mandatory:
4090 Budget authority, gross 27 7
Outlays, gross:
4101 Outlays from mandatory balances 10 12 13
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4123 Non-Federal sources –21
4180 Budget authority, net (total) 6 7
4190 Outlays, net (total) 319 343 113

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 2013 actual 2014 est. 2015 est.

Direct obligations:
25.5 Research and development contracts 2 7
41.0 Grants, subsidies, and contributions 4



99.0 Direct obligations 6 7
99.0 Reimbursable obligations 381 379 349



99.9 Total new obligations 387 386 349

Employment Summary


Identification code 75–1700–0–1–552 2013 actual 2014 est. 2015 est.

1001 Direct civilian full-time equivalent employment
2001 Reimbursable civilian full-time equivalent employment 296 297 297
2101 Reimbursable military average strength employment 9 9 9
3001 Allocation account civilian full-time equivalent employment 6 20 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] $234,608,916,000, to remain available until expended.

For making, after May 31, [2014] 2015, 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] 2015 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] 2016, [$103,472,323,000] $113,272,140,000, to remain available until expended.

Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2014.)

Program and Financing (in millions of dollars)


Identification code 75–0512–0–1–551 2013 actual 2014 est. 2015 est.

Obligations by program activity:
0001 Medicaid vendor payments 265,069 290,533 315,239
0002 State and local administration 17,767 18,556 18,766
0003 Vaccines for Children 3,607 3,562 4,077



0799 Total direct obligations 286,443 312,651 338,082
0801 Medicare Part B premiums 477 390
0802 Medicare Part D 6



0899 Total reimbursable obligations 477 390 6



0900 Total new obligations 286,920 313,041 338,088

Budgetary Resources:
Unobligated balance:
1000 Unobligated balance brought forward, Oct 1 21,091 2,283 1
1021 Recoveries of prior year unpaid obligations 18,143



1050 Unobligated balance (total) 39,234 2,283 1
Budget authority:
Appropriations, mandatory:
1200 Appropriation Medicaid 158,827 204,033 234,609



1260 Appropriations, mandatory (total) 158,827 204,033 234,609
Advance appropriations, mandatory:
1270 Advance appropriation 90,614 106,336 103,472



1280 Advanced appropriation, mandatory (total) 90,614 106,336 103,472
Spending authority from offsetting collections, mandatory:
1800 Collected 528 390 6



1850 Spending auth from offsetting collections, mand (total) 528 390 6
1900 Budget authority (total) 249,969 310,759 338,087
1930 Total budgetary resources available 289,203 313,042 338,088
Memorandum (non-add) entries:
1941 Unexpired unobligated balance, end of year 2,283 1

Change in obligated balance:
Unpaid obligations:
3000 Unpaid obligations, brought forward, Oct 1 27,899 30,756 34,967
3010 Obligations incurred, unexpired accounts 286,920 313,041 338,088
3020 Outlays (gross) –265,920 –308,830 –331,446
3040 Recoveries of prior year unpaid obligations, unexpired –18,143



3050 Unpaid obligations, end of year 30,756 34,967 41,609
Memorandum (non-add) entries:
3100 Obligated balance, start of year 27,899 30,756 34,967
3200 Obligated balance, end of year 30,756 34,967 41,609

Budget authority and outlays, net:
Mandatory:
4090 Budget authority, gross 249,969 310,759 338,087
Outlays, gross:
4100 Outlays from new mandatory authority 230,914 279,612 331,446
4101 Outlays from mandatory balances 35,006 29,218



4110 Outlays, gross (total) 265,920 308,830 331,446
Offsets against gross budget authority and outlays:
Offsetting collections (collected) from:
4120 Federal sources –477 –390 –6
4123 Non-Federal sources –51



4130 Offsets against gross budget authority and outlays (total) –528 –390 –6



4160 Budget authority, net (mandatory) 249,441 310,369 338,081
4170 Outlays, net (mandatory) 265,392 308,440 331,440
4180 Budget authority, net (total) 249,441 310,369 338,081
4190 Outlays, net (total) 265,392 308,440 331,440

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


2013 actual 2014 est. 2015 est.

Enacted/requested:
Budget Authority 249,441 310,369 338,081
Outlays 265,392 308,440 331,440
Amounts included in the adjusted baseline:
Budget Authority 7
Outlays 7
Legislative proposal, not subject to PAYGO:
Budget Authority –365 –636
Outlays –365 –636
Legislative proposal, subject to PAYGO:
Budget Authority 540 5,151
Outlays 540 5,151
Total:
Budget Authority 249,441 310,544 342,603
Outlays 265,392 308,615 335,962

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 2013 2014 2015

Vaccine Purchase 3,335 3,273 3,776
Vaccine Stockpile 137 135 138
Ordering, Distribution, and Operations 94 111 119
Vaccine Management Contract Support 1 0 0
Evaluation Activities 42 43 44



Total Obligations 3,609 3,562 4,077

Object Classification