Full text of Budget of the United States Government - Appendix : Fiscal Year 2009 : Department of Health and Human Services

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
In addition, export certification user fees authorized by 21 U.S.C.
381 may be credited to this account, to remain available until expended.

FOOD AND DRUG ADMINISTRATION
Federal Funds

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SALARIES

AND

BUILDINGS

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; ø$2,247,961,000¿ $2,332,425,000: Provided,
That of the amount provided under this heading, ø$459,412,000¿
$511,108,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h and 379h–1 and shall be credited to this
account and remain available until expended, and shall not include
any fees pursuant to 21 U.S.C. 379h(a)(2) and (a)(3) assessed for
fiscal year ø2009¿ 2010 but collected in fiscal year ø2008¿ 2009;
ø$48,431,000¿ $52,547,000 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 expendedø; and $13,696,000 shall
be derived from animal drug user fees authorized by 21 U.S.C. 379j,
and shall be credited to this account and remain available until
expended¿: Provided further, That fees derived from prescription
drugø,¿and medical deviceø, and animal drug¿ assessments for fiscal
year 2009 received during fiscal year ø2008¿ 2009, including any
such fees assessed prior to øthe current¿ fiscal year 2009 but credited
øduring the current¿ for fiscal year 2009, shall be subject to the
fiscal year ø2008 limitation¿ 2009 limitationsø: 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) $513,461,000 shall
be for the Center for Food Safety and Applied Nutrition and related
field activities in the Office of Regulatory Affairs; (2) $682,759,000
shall be for the Center for Drug Evaluation and Research and related
field activities in the Office of Regulatory Affairs, of which no less
than $41,900,000 shall be available for the Office of Generic Drugs;
(3) $236,985,000 shall be for the Center for Biologics Evaluation
and Research and for related field activities in the Office of Regulatory Affairs; (4) $109,244,000 shall be for the Center for Veterinary
Medicine and for related field activities in the Office of Regulatory
Affairs; (5) $267,284,000 shall be for the Center for Devices and
Radiological Health and for related field activities in the Office of
Regulatory Affairs; (6) $44,316,000 shall be for the National Center
for Toxicological Research; (7) not to exceed $99,922,000 shall be
for Rent and Related activities, of which $38,808,000 is for White
Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (8) not to exceed $160,094,000 shall
be for payments to the General Services Administration for rent;
and (9) $133,896,000 shall be for other activities, including the Office
of the Commissioner; the Office of Scientific and Medical Programs;
the Office of Policy, Planning and Preparedness; the Office of International and Special Programs; the Office of Operations; and central
services for these offices: Provided further, That of the amounts made
available under this heading, $28,000,000 for the Center for Food
Safety and Applied Nutrition and related field activities in the Office
of Regulatory Affairs shall be available from July 1, 2008, to September 30, 2009, for implementation of a comprehensive food safety
performance plan: Provided further, That none of the funds made
available under this heading shall be used to transfer funds under
section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
379dd): Provided further, That funds may be transferred from one
specified activity to another with the prior approval of the Committees on Appropriations of both Houses of Congress¿.
In addition, mammography user fees authorized by 42 U.S.C. 263b
may be credited to this account, to remain available until expended.
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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,
ø$2,450,000¿ $2,433,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2008.)
Special and Trust Fund Receipts (in millions of dollars)
Identification code 75–9911–0–1–554

01.00

2007 actual

2008 est.

2009 est.

Balance, start of year .................................................... ................... ...................

Balance, start of year .................................................... ................... ...................
Receipts:
02.00 User Fees, FDA—legislative proposal subject to
PAYGO ........................................................................ ................... ...................
02.01 User Fees, FDA—legislative proposal subject to
PAYGO ........................................................................ ................... ...................
02.20 Cooperative Research and Development Agreements,
FDA ............................................................................
4
4

01.99

02.99

23
4
4

Total receipts and collections ...................................

Total: Balances and collections ....................................
Appropriations:
05.00 Salaries and Expenses ...................................................

¥4

¥3

05.99

¥4

¥3

Balance, end of year ..................................................... ...................

04.00

07.99

Total appropriations ..................................................

Program and Financing (in millions of dollars)
Identification code 75–9911–0–1–554

2007 actual

Obligations by program activity:
00.01 Foods ..............................................................................
00.02 Drugs ..............................................................................
00.03 Devices and radiological products ................................
00.04 National Center for Toxicological Research ...................
00.05 Other activities ..............................................................
00.06 Other rent and rent related activities ...........................
00.07 Rental payments ............................................................
00.08 Buildings and facilities .................................................
00.09 CRADAs ..........................................................................
09.01 Reimbursable program ..................................................
10.00

Total new obligations ................................................

21.40
22.00
22.10

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................
Resources available from recoveries of prior year obligations .......................................................................

2008 est.

2009 est.

457
556
231
42
92
68
127
10
3
424

510
605
238
44
97
89
131
6
3
543

543
620
242
46
99
89
131
2
3
585

2,010

2,266

2,360

117
2,026

134
2,292

160
2,357

1 ................... ...................

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

2,144
¥2,010

2,426
¥2,266

2,517
¥2,360

24.40

Unobligated balance carried forward, end of year

134

160

157

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
1,574
40.33
Appropriation permanently reduced (P.L. 110–161) ...................

1,732
1,771
¥12 ...................

43.00

1,574

1,720

1,771

250

876

583

58.00
58.10
58.26
Sfmt 3643

Appropriation (total discretionary) ........................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................
Change in uncollected customer payments from
Federal sources (unexpired) .............................
Offsetting collections (previously unavailable) ....
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HHS

12 ................... ...................
212
26
333

423

424

FOOD AND DRUG ADMINISTRATION—Continued
Federal Funds—Continued

BUILDINGS

AND

THE BUDGET FOR FISCAL YEAR 2009

FACILITIES—Continued

Program and Financing (in millions of dollars)—Continued
Identification code 75–9911–0–1–554

58.45

2007 actual

Portion precluded from obligation (limitation on
obligations) .......................................................

58.90

60.20

Spending authority from offsetting collections
(total discretionary) ..........................................
Mandatory:
Appropriation (special fund) .....................................

70.00

Total new budget authority (gross) ..........................

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Recoveries of prior year obligations ..............................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.40
73.45
74.00

2008 est.

2009 est.

¥26

¥333

448

569

583

2,026

2,292

2,357

415
593
586
2,010
2,266
2,360
¥1,836
¥2,273
¥2,314
¥10 ................... ...................
¥1 ................... ...................

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

¥12 ................... ...................

Object Classification (in millions of dollars)

27 ................... ...................
Identification code 75–9911–0–1–554

74.40

86.90
86.93
86.97
86.98

Obligated balance, end of year ................................

593

586

632

Outlays (gross), detail:
Outlays from new discretionary authority .....................
1,495
1,855
1,905
Outlays from discretionary balances .............................
339
415
406
Outlays from new mandatory authority ......................... ...................
3
3
Outlays from mandatory balances ................................
2 ................... ...................

87.00

Total outlays (gross) .................................................

1,836

2,273

2,314

¥47

¥62

¥65

¥223

¥814

¥518

88.90

88.95
88.96

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

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

¥270

¥876

¥583

11.1
11.3
11.5
11.7
11.9
12.1
12.2
21.0
22.0
23.1
23.2
23.3

595
79
32
46

637
85
34
49

702
177
23
21
4
127
2

752
190
25
24
4
131
2

805
203
27
23
4
132
2

42
3
74
106

41
3
72
103

25.4
25.5
25.7
26.0
31.0
32.0
41.0
42.0

106
48
28
34
26
47
9
30
2

119
54
31
38
29
53
10
34
2

116
52
30
37
28
52
10
33
2

1,416
1,397

1,774
1,731

212

333

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

1,586
424

1,723
543

1,775
585

333

99.9

Total new obligations ................................................

2,010

2,266

2,360

Employment Summary
2007

2008 1

2009
Identification code 75–9911–0–1–554

1,569
5

1,407
6

1,769
2

1,557
7

1389
5

1722
6

budget authority in 2008 is adjusted for collections precluded from obligation.

Summary of Budget Authority and Outlays
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555
74
30
43

37
3
66
94

24.0
25.1
25.2
25.3

[In millions of dollars]

1 Net

2009 est.

1,764
1,566

94.01

Distribution of budget authority by account:
Salaries and expenses ............................................................
Buildings and facilities ..........................................................
Distribution of outlays by account:
Salaries and expenses ............................................................
Buildings and facilities ..........................................................

2008 est.

Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Travel and transportation of persons .......................
Transportation of things ...........................................
Rental payments to GSA ...........................................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................
Printing and reproduction .........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of facilities ..................
Research and development contracts .......................
Operation and maintenance of equipment ...............
Supplies and materials .............................................
Equipment .................................................................
Land and structures ..................................................
Grants, subsidies, and contributions ........................
Insurance claims and indemnities ...........................

¥12 ................... ...................
20 ................... ...................

2007 actual

Direct:
1001 Civilian full-time equivalent employment
1101 Military full-time equivalent employment
Reimbursable:
2001 Civilian full-time equivalent employment
2101 Military full-time equivalent employment
Allocation account:
3001 Civilian full-time equivalent employment

2008 est.

2009 est.

.....................
.....................

7,151
554

7,292
565

7,585
549

.....................
.....................

1,765
137

2,001
156

2,122
166

.....................

(in millions of dollars)
2007 actual

2008 est.

Total:
Budget Authority .....................................................................
Outlays ....................................................................................
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1,566
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SALARIES

2009 est.

Enacted/requested:
Budget Authority .....................................................................
1,764
1,416
1,774
Outlays ....................................................................................
1,566
1,397
1,731
Legislative proposal, not subject to PAYGO:
Budget Authority ..................................................................... .................... .................... ....................
Outlays .................................................................................... .................... .................... ....................

1,416
1,397

1,774
1,731

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AND

EXPENSES

(Legislative proposal, not subject to PAYGO)
Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for animal drug review activities: Provided,
That such fees, in an amount not to exceed $13,698,000, shall be
credited as an offsetting collection to this account and remain available until expended for the purpose of animal drug review activities:
Provided further, That fees derived from animal drug review assessments for FY 2009 received during fiscal year 2009, including fees
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HHS

HEALTH RESOURCES AND SERVICES ADMINISTRATION
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
assessed prior to fiscal year 2009 but credited for fiscal year 2009,
shall be subject to fiscal year 2009 limitations.
In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for animal generic drug review
activities: Provided, That such fees, in an amount not to exceed
$4,831,000, shall be credited as an offsetting collection to this account,
to remain available until expended for animal generic drug review
activities.
In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for generic drug review activities:
Provided, That such fees, in an amount not to exceed $16,628,000,
shall be credited as an offsetting collection to this account, to remain
available until expended for generic drug review activities.
Program and Financing (in millions of dollars)
Identification code 75–9911–2–1–554

2007 actual

2008 est.

2009 est.

Obligations by program activity:
09.01 Reimbursable program—ADUFA .................................... ................... ...................
09.02 Reimbursable program—Generic Drug ......................... ................... ...................
09.03 Reimbursable program—Generic Animal Drug ............. ................... ...................

14
17
5

10.00

Total new obligations ................................................ ................... ...................

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................ ................... ...................
Total new obligations .................................................... ................... ...................

36
¥36

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

Change in obligated balances:
Total new obligations .................................................... ................... ...................
Total outlays (gross) ...................................................... ................... ...................

36
¥36

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

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

¥36

73.10
73.20

88.45

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................ ................... ................... ...................
Outlays ........................................................................... ................... ................... ...................

The FY 2009 Budget includes a number of new and current
user fees. Legislation will be proposed to allow FDA to collect
fees to support generic animal drug review activities. The
additional resources, estimated at $5 million in 2009, would
enable FDA to reduce review times and respond to the number of generic animal drug applications. The Budget reproposes user fees to support activities related to generic human
drug reviews, re-inspections of FDA-regulated facilities, and
the issuance of export certificates for food and animal feeds.
The Budget includes $14 million in animal drug user fees.
Authorizing language for these fees will be proposed to reauthorize the collection and spending of the fees subject to appropriations language.
The Budget also proposes a new authority to approve follow-on protein products.

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2007 actual

FOR

2008 est.

Reimbursable obligations .......................................... ................... ...................

99.9

Total new obligations ................................................ ................... ...................

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2007 actual

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2007 actual

2008 est.

2009 est.

10.00

Total new obligations ................................................

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

2
7

2
8

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

9
¥7

10
¥8

24.40

Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Mandatory:
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

72.40
73.10
73.20

2
7
¥6

3
7
¥7

3
8
¥8

86.97

Outlays (gross), detail:
Outlays from new mandatory authority .........................

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

¥7

¥8

89.00
90.00

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

11.1
12.1
23.1
25.2
26.0
31.0

2007 actual

2008 est.

2009 est.

Reimbursable obligations:
Personnel compensation: Full-time permanent .............
3
3
4
Civilian personnel benefits ............................................
1
1
1
Rental payments to GSA ................................................
1
1
1
Other services ................................................................ ...................
1
1
Supplies and materials .................................................
1
1
1
Equipment ......................................................................
1 ................... ...................

99.9

Total new obligations ................................................

Employment Summary
Identification code 75–4309–0–3–554

2007 actual

2008 est.

2009 est.

HEALTH RESOURCES AND SERVICES
ADMINISTRATION
Federal Funds

2008 est.

Reimbursable:
Civilian full-time equivalent employment ..................... ................... ...................
Military full-time equivalent employment ..................... ................... ...................

VerDate Aug 31 2005

OTHER SERVICES

Obligations by program activity:
09.01 Reimbursable program ..................................................

Employment Summary

2001
2101

AND

Identification code 75–4309–0–3–554

2009 est.

99.0

Identification code 75–9911–2–1–554

CERTIFICATION

Program and Financing (in millions of dollars)

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

Object Classification (in millions of dollars)
Identification code 75–9911–2–1–554

REVOLVING FUND

425

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HEALTH RESOURCES

2009 est.

112
6
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AND

SERVICES

For carrying out titles II, III, IV, VII, VIII, X, XII, øXIX,¿ and
XXVI of the Public Health Service Act, section 427(a) of the Federal
Coal Mine Health and Safety Act, title V and sections 1128E, and
711ø, and 1820¿ of the Social Security Act, the Health Care Quality
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HHS

426

HEALTH RESOURCES AND SERVICES ADMINISTRATION—Continued
Federal Funds—Continued

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HEALTH RESOURCES

AND

THE BUDGET FOR FISCAL YEAR 2009

SERVICES—Continued

Improvement Act of 1986, as amended, the Native Hawaiian Health
Care Act of 1988, as amended, øthe Cardiac Arrest Survival Act
of 2000, and¿ section 712 of the American Jobs Creation Act of
2004, and the Stem Cell Therapeutic and Research Act of 2005,
ø$6,978,099,000, of which $309,889,000 shall be available for construction and renovation (including equipment) of health care and
other facilities and other health-related activities specified in the
explanatory statement described in section 4 (in the matter preceding
division A of this consolidated Act), and of which $38,538,000 from
general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the Medicare rural hospital flexibility grants program under such section¿ $5,864,511,000:
Provided, That of the funds made available under this heading,
ø$160,000¿ $100,000 shall be available until expended for facilities
renovations at the Gillis W. Long Hansen’s Disease Center: øProvided
further, That $40,000,000 of the funding provided for community
health centers shall be for base grant adjustments for existing health
centers:¿ Provided further, That in addition to fees authorized by
section 427(b) of the Health Care Quality Improvement Act of 1986,
fees shall be collected for the full disclosure of information under
the Act sufficient to recover the full costs of operating the National
Practitioner Data Bank, and shall remain available until expended
to carry out that Act: Provided further, That fees collected for the
full disclosure of information under the ‘‘Health Care Fraud and
Abuse Data Collection Program’’, authorized by section 1128E(d)(2)
of the Social Security Act, shall be sufficient to recover the full
costs of operating the program, and shall remain available until expended to carry out that Act: Provided further, That no more than
$40,000 is available until expended for carrying out the provisions
of 42 U.S.C. 233(o) including associated administrative expenses and
relevant evaluations: Provided further, That no more than
$44,055,000 is 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 pertaining to administrative
claims made under such law: Provided further, That $26,000,000 of
funding provided for health centers shall be used for high-need areas,
notwithstanding section 330(r)(2)(B) of the PHS Act: Provided further,
That of the funds made available under this heading, ø$305,315,000¿
$299,981,000 shall be for the program under title X of the Public
Health Service Act to provide for voluntary family planning projects:
Provided further, That amounts provided to said projects under such
title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be
expended for any activity (including the publication or distribution
of literature) that in any way tends to promote public support or
opposition to any legislative proposal or candidate for public office:
Provided further, That of the funds available under this heading,
ø$1,854,800,000¿ $1,828,911,000 shall remain available to the Secretary of Health and Human Services through September 30, ø2010¿
2011, for parts A and B of title XXVI of the Public Health Service
Act: øProvided further, That within the amounts provided for part
A of title XXVI of the Public Health Service Act, funds shall be
made available to qualifying jurisdictions, within 45 days of enactment, for increasing supplemental grants for fiscal year 2008 to metropolitan areas that received grant funding in fiscal year 2007 under
subparts I and II of part A of title XXVI of the Public Health Service
Act to ensure that an area’s total funding under part A for fiscal
year 2007, together with the amount of this additional funding, is
not less than 86.6 percent of the amount of such area’s total funding
under part A for fiscal year 2006: Provided further, That, notwithstanding section 2603(c)(1) of the Public Health Service Act, the additional funding to areas under the immediately preceding proviso,
which may be used for costs incurred during fiscal year 2007, shall
be available to the area for obligation from the date of the award
through the end of the grant year for the award:¿ Provided further,
That ø$808,500,000¿ $814,546,000 shall be for State AIDS Drug Assistance Programs authorized by section 2616 of the Public Health
Service Act: Provided further, That in addition to amounts provided
herein, $25,000,000 shall be available from amounts available under
section 241 of the Public Health Service Act to carry out parts A,
B, C, and D of title XXVI of the Public Health Service Act to fund
section 2691 Special Projects of National Significance: øProvided further, That, notwithstanding section 502(a)(1) and 502(b)(1) of the
Social Security Act, not to exceed $100,937,000 is available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and $10,586,000 is available
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for projects described in paragraphs (A) through (F) of section
501(a)(3) of such Act: Provided further, That of the funds provided,
$39,283,000 shall be provided to the Denali Commission as a direct
lump payment pursuant to Public Law 106–113: Provided further,
That of the funds provided, $25,000,000 shall be provided for the
Delta Health Initiative as authorized in section 219 of this Act and
associated administrative expenses: Provided further, That notwithstanding section 747(e)(2) of the PHS Act, not less than $5,000,000
shall be for general dentistry programs, not less than $5,000,000
shall be for pediatric dentistry programs and not less than
$24,614,000 shall be for family medicine programs:¿ Provided further,
That of the funds available under this heading, ø$9,000,000¿
$11,966,000 shall be provided for the National Cord Blood Inventory
øpursuant to¿ as authorized in the Stem Cell Therapeutic and Research Act of 2005. (Department of Health and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–0350–0–1–550

2007 actual

2008 est.

Obligations by program activity:
Health centers ................................................................
1,943
2,022
National Health Service Corps .......................................
40
40
National Health Service Corps recruitment ...................
85
84
Hansen’s Disease Center ...............................................
16
16
Payment to Hawaii for the treatment of Hansen’s
disease ......................................................................
2
2
00.15 Black lung clinics ..........................................................
6
6
00.16 Nursing education loan repayment and scholarships
31
31
00.17 Health professions .........................................................
302
319
00.18 Maternal and child health block grant .........................
693
666
00.19 Healthy start ..................................................................
101
100
00.20 Poison control centers ...................................................
23
27
00.21 EMS for children ............................................................
20
19
00.22 Universal newborn hearing screening ...........................
10
12
00.23 HIV/AIDS .........................................................................
2,112
2,142
00.24 Organ transplantation ...................................................
23
23
00.25 Bone marrow donor registry ..........................................
25
23
00.26 Rural health policy development ...................................
9
9
00.27 Rural health outreach grants ........................................
39
48
00.28 Rural health flexibility grants .......................................
63
38
00.29 Denali Commission ........................................................
40
39
00.30 Telehealth .......................................................................
7
7
00.31 Program management ...................................................
144
141
00.32 Family planning .............................................................
283
300
00.33 Loan Repayment/Faculty Fellowship ..............................
1
1
00.34 Public Health Improvement (Facilities & Other
Projects) .....................................................................
2
304
00.35 Health Centers Loan Subsidy ........................................
1 ...................
00.36 Health centers tort claim fund ......................................
42
62
00.39 Childrens’ GME ..............................................................
297
302
00.41 Delta Health Initiative ................................................... ...................
24
00.42 State offices of rural health ..........................................
8
8
00.45 Rural and community access to emergency devices
1
1
00.46 Radiogenic diseases ......................................................
2
2
00.47 Traumatic brain injury ...................................................
9
9
00.48 Autism and Other Developmental Disorders ................. ...................
36
00.50 Cord blood stem cell bank ............................................
26
9
00.54 Sickle cell .......................................................................
2
3
00.56 Family to family health information centers .................
3
4
00.57 Parklawn Replacement Contract ................................... ................... ...................
00.10
00.11
00.12
00.13
00.14

2009 est.

2,048
26
95
16
2
6
43
66
666
100
10
...................
...................
2,143
23
22
9
...................
...................
...................
7
141
300
...................
...................
...................
73
...................
...................
8
...................
2
...................
36
12
2
5
36

03.00
09.01
09.02

Total direct programs ................................................
Reimbursable program ..................................................
Reimbursable program: PHS evaluation ........................

6,411
126
25

6,879
128
25

5,897
128
25

10.00

Total new obligations ................................................

6,562

7,032

6,050

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

109
6,547

91
7,013

72
6,018

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

6,656
7,104
6,090
¥6,562
¥7,032
¥6,050
¥3 ................... ...................
91

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
6,886
6,978
5,865
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥122 ...................
40.36
Unobligated balance permanently reduced .............. ................... ...................
¥5
41.00
Transferred to other accounts ...................................
¥495 ................... ...................
Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

HEALTH RESOURCES AND SERVICES ADMINISTRATION—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
43.00
58.00
58.00
58.10
58.35
58.90

60.00
69.00
70.00

Appropriation (total discretionary) ........................
6,391
6,856
5,860
Spending authority from offsetting collections:
Offsetting collections (cash) ................................
90
128
128
Offsetting collections (HPSL/NSL Recall) ............. ...................
15
100
Change in uncollected customer payments from
Federal sources (unexpired) .............................
38 ................... ...................
Offsetting collections permanently reduced (¥) ...................
¥15
¥100
Spending authority from offsetting collections
(total discretionary) ..........................................
Mandatory:
Appropriation .............................................................
Spending authority from offsetting collections: Offsetting collections (cash)(HPSL&NSL) ..................
Total new budget authority (gross) ..........................

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.40
74.00

128

6,547

7,013

6,018

5,349
5,127
5,676
6,562
7,032
6,050
¥6,689
¥6,483
¥6,592
¥102 ................... ...................
¥38 ................... ...................
45 ................... ...................

74.40

Obligated balance, end of year ................................

5,127

5,676

5,134

86.90
86.93
86.97

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................
Outlays from new mandatory authority .........................

2,628
4,033
28

2,734
3,720
29

2,355
4,207
30

87.00

Total outlays (gross) .................................................

6,689

6,483

6,592

¥111
¥48

¥105
¥63

¥105
¥148

88.90

¥159

¥168

¥253

Object Classification (in millions of dollars)
Identification code 75–0350–0–1–550

11.1
11.3
11.5
11.7

2007 actual

11.9
12.1
12.2
13.0
21.0
23.1
23.2
23.3

88.95
88.96

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥38 ................... ...................
44 ................... ...................

6,394
6,530

6,845
6,315

Guaranteed loan levels supportable by subsidy budget
authority:
215001 Health centers: Facilities renovation loan guarantee
levels .........................................................................
215999 Total loan guarantee levels ...........................................
Guaranteed loan subsidy (in percent):
232001 Health centers: Facilities renovation loan guarantee
levels .........................................................................

cprice-sewell on PROD1PC71 with BUDGET PAG

232999 Weighted average subsidy rate .....................................
Guaranteed loan subsidy budget authority:
233001 Health centers: Facilities renovation loan guarantee
levels .........................................................................

2008 est.

143
27
13
4
3
4
2

145
27
13
4
2
7
2

25.4
25.6
25.7
26.0
31.0
33.0
41.0
42.0

200
2
3
2
2
2
5
5,797
38

204
1
3
2
1
1
8
6,245
53

143
1
2
2
2
1
9
5,305
61

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

6,411
151

6,879
153

5,897
153

99.9

Total new obligations ................................................

6,562

7,032

6,050

Employment Summary
2007 actual

Direct:
Civilian full-time equivalent employment
Military full-time equivalent employment
Reimbursable:
2001 Civilian full-time equivalent employment
2101 Military full-time equivalent employment
1001
1101

2008 est.

2009 est.

.....................
.....................

1,170
238

1,235
229

1,209
229

.....................
.....................

96
254

56
8

58
8

VACCINE INJURY COMPENSATION
Program and Financing (in millions of dollars)
2007 actual

2008 est.

2009 est.

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

5
7
7
2 ................... ...................

23.90

Total budgetary resources available for obligation

8 ...................

24.40

Unobligated balance carried forward, end of year

3.42

3.41

0.00

3.42

3.41

0.00

1 ................... ...................

¥1 ...................

Activities displayed here support categorical health resources and services grants, treatment and care for those
living with HIV/AIDS, and the medical malpractice claims
funds, which pay malpractice claims filed against employees
of federally-supported health centers.
Jkt 214754

129
26
11
3
3
9
2

8 ...................

237999 Total downward reestimate subsidy budget authority ...................

16:43 Jan 24, 2008

112
3
5
25

233999 Total subsidy budget authority ......................................
1 ................... ...................
Guaranteed loan downward reestimates:
237001 Health centers: Facilities renovation loan guarantee
levels ......................................................................... ...................
¥1 ...................

VerDate Aug 31 2005

111
3
5
24

2
1
41
127

5,765
6,339

2009 est.

101
4
3
21

3
1
49
112

Identification code 75–0320–0–1–551
2007 actual

2009 est.

5
1
46
125

24.0
25.1
25.2
25.3

Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in
millions of dollars)
Identification code 75–0350–0–1–550

2008 est.

Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Benefits for former personnel ...................................
Travel and transportation of persons .......................
Rental payments to GSA ...........................................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................
Printing and reproduction .........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of facilities ..................
Medical care ..............................................................
Operation and maintenance of equipment ...............
Supplies and materials .............................................
Equipment .................................................................
Investments and loans ..............................................
Grants, subsidies, and contributions ........................
Insurance claims and indemnities ...........................

Identification code 75–0350–0–1–550

427

PO 00000

Frm 00005

Fmt 3616

New budget authority (gross), detail:
Mandatory:
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

2 ................... ...................

73.20

Change in obligated balances:
Total outlays (gross) ...................................................... ................... ................... ...................

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

87.00

Total outlays (gross) ................................................. ................... ................... ...................

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

89.00

¥2 ................... ...................
2 ................... ...................

¥2 ................... ...................

Net budget authority and outlays:
Budget authority ............................................................ ................... ................... ...................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

428

HEALTH RESOURCES AND SERVICES ADMINISTRATION—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

VACCINE INJURY COMPENSATION—Continued
2210
2231
2251
2263

Program and Financing (in millions of dollars)—Continued
Identification code 75–0320–0–1–551

90.00

2007 actual

Outlays ...........................................................................

2008 est.

2009 est.

¥2 ................... ...................

The Vaccine Injury Compensation Program was established
pursuant to Public Law 99–660 and Public Law 100–203,
and serves as a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims
associated with vaccine related injury or death occurring before October 1, 1988 are financed from the General Fund
and are reflected in this account. Given sufficient carry-over
funds from prior years’ appropriations to pay for the balance
of the pre–1988 claims yet to be adjudicated, no appropriation
is requested in 2009 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.
f

HEALTH CENTER GUARANTEED LOAN FINANCING ACCOUNT

Cumulative balance of guaranteed loans outstanding:
Outstanding, start of year .............................................
38
63
59
Disbursements of new guaranteed loans ......................
28 ................... ...................
Repayments and prepayments ......................................
¥3
¥3
¥3
Adjustments: Terminations for default that result in
claim payments ......................................................... ...................
¥1 ...................

2290

Outstanding, end of year ..........................................

2299

Memorandum:
Guaranteed amount of guaranteed loans outstanding,
end of year ................................................................

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

Program and Financing (in millions of dollars)
Identification code 75–4442–0–3–551

2007 actual

2008 est.

Identification code 75–4442–0–3–551

2009 est.

00.01
08.02

Obligations by program activity:
Default claims ............................................................... ...................
Downward reestimates paid to receipt accounts .......... ...................

1 ...................
1 ...................

10.00

Total new obligations ................................................ ...................

2 ...................

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year
22.00 New financing authority (gross) ....................................
23.90
23.95
24.40

3
4
2
1 ................... ...................

Total budgetary resources available for obligation
4
Total new obligations .................................................... ...................
Unobligated balance carried forward, end of year

New financing authority (gross), detail:
Mandatory:
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

73.10

Change in obligated balances:
Total new obligations .................................................... ...................

87.00

Outlays (gross), detail:
Total financing disbursements (gross) ..................... ................... ................... ...................

Offsets:
Against gross financing authority and financing disbursements:
88.40
Offsetting collections (cash) from: Non-Federal
sources ..................................................................

89.00
90.00

¥1 ................... ...................

cprice-sewell on PROD1PC71 with BUDGET PAG

2007 actual

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

2999

Total liabilities .............................................................................

4999

Total liabilities and net position ...............................................

HEALTH EDUCATION ASSISTANCE LOANS PROGRAM ACCOUNT
Such sums as may be necessary to carry out the purpose of the
program, as authorized by title VII of the Public Health Service
Act, as amended. For administrative expenses to carry out the guaranteed loan program, including section 709 of the Public Health Service Act, ø$2,898,000¿ $2,906,000. (Department of Health and Human
Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–0340–0–1–552

2008 est.

2009 est.

28
8 ...................
23 ................... ...................
PO 00000

Frm 00006

Fmt 3616

2007 actual

Obligations by program activity:
Reestimates of Subsidy ................................................. ...................
Interest on reestimates of loan guarantee ................... ...................
Administrative expenses ................................................
2

10.00

Total new obligations ................................................

22.00
23.95
23.98

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Position with respect to appropriations act limitation
on commitments:
2111 Limitation on guaranteed loans made by private lenders .............................................................................. ................... ................... ...................
2121 Limitation available from carry-forward .......................
98
70
62
2142 Uncommitted loan guarantee limitation ....................... ................... ................... ...................
2143 Uncommitted limitation carried forward .......................
¥70
¥62
¥62
Total guaranteed loan commitments ........................
Guaranteed amount of guaranteed loan commitments

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

00.07
00.08
00.09

Status of Guaranteed Loans (in millions of dollars)

2150
2199

1999

2 ...................

Net financing authority and financing disbursements:
Financing authority ........................................................ ................... ................... ...................
Financing disbursements ...............................................
¥1 ................... ...................

Identification code 75–4442–0–3–551

1 ................... ...................

2007 actual

4
2
¥2 ...................

2006 actual

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

2008 est.

2009 est.

20 ...................
5 ...................
3
3
28

3
28
3
¥2
¥28
¥3
¥1 ................... ...................

Unobligated balance carried forward, end of year ................... ................... ...................

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
3
Mandatory:
60.00
Appropriation ............................................................. ...................

25 ...................

70.00

Total new budget authority (gross) ..........................

72.40
73.10
73.20

2
2
¥2

2
28
¥28

2
3
¥3

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

HEALTH RESOURCES AND SERVICES ADMINISTRATION—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
74.40

86.90
86.93
86.97
87.00

Obligated balance, end of year ................................

Outlays (gross), detail:
Outlays from new discretionary authority .....................
1
3
3
Outlays from discretionary balances .............................
1 ................... ...................
Outlays from new mandatory authority ......................... ...................
25 ...................
Total outlays (gross) .................................................

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

3
2

28
28

3
3

Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in
millions of dollars)
Identification code 75–0340–0–1–552

2007 actual

2008 est.

2009 est.

Total budgetary resources available for obligation
Total new obligations ....................................................

156
¥49

141
¥60

89
¥16

24.40

Unobligated balance carried forward, end of year

107

New financing authority (gross), detail:
Mandatory:
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

73.10
73.20

Change in obligated balances:
Total new obligations ....................................................
Total financing disbursements (gross) .........................

49
¥49

60
¥60

16
¥16

87.00

Outlays (gross), detail:
Total financing disbursements (gross) .....................

235999 Total upward reestimate budget authority .................... ...................
Guaranteed loan downward reestimates:
237001 HEAL Loan guarantee ....................................................
¥34

¥44 ...................

237999 Total downward reestimate subsidy budget authority

¥34

¥44 ...................

88.90

Administrative expense data:
Budget authority ............................................................
Outlays from new authority ...........................................

3
2

3510
3590

25 ...................
25 ...................

3
3

The Health Education Assistance Loan (HEAL) program
guarantees loans from private lenders to health professions
students to help pay for the costs of their training. As required by the Federal Credit Reform Act of 1990, this account
records, for the HEAL program, the subsidy costs associated
with HEAL loan guarantees committed in 1992 and beyond
(including modifications of HEAL loan guarantees that resulted from obligations or commitments in any year), as well
as administrative expenses of the program. The administrative expenses are estimated on a cash basis.

Identification code 75–0340–0–1–552

2007 actual

2008 est.

2009 est.

Direct obligations:
11.1 Personnel compensation: Full-time permanent .............
1
25.3 Other purchases of goods and services from Government accounts ...........................................................
1
41.0 Grants, subsidies, and contributions ............................ ...................

2
2
25 ...................

99.9

Total new obligations ................................................

Employment Summary
Identification code 75–0340–0–1–552

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

2008 est.

2009 est.

HEALTH EDUCATION ASSISTANCE LOANS FINANCING ACCOUNT
Program and Financing (in millions of dollars)
Identification code 75–4304–0–3–552

2007 actual

Obligations by program activity:
00.01 Default Claims ...............................................................
08.02 Payment of downward reestimate to receipt account
08.04 Payment of interest on downward reestimate to receipt account .............................................................

2008 est.

2009 est.

15
20

16
16
20 ...................

24 ...................

08.91

Subtotal (reestimates) ...............................................

44 ...................

10.00

Total new obligations ................................................

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year
22.00 New financing authority (gross) ....................................
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

143
13
PO 00000

89.00
90.00

Total, offsetting collections (cash) .......................

107
34

81
8

Frm 00007

Fmt 3616

¥25 ...................
¥5
¥4
¥4
¥4

¥13

¥34

¥8

Status of Guaranteed Loans (in millions of dollars)
Identification code 75–4304–0–3–552

2007 actual

2008 est.

2009 est.

Total guaranteed loan commitments ........................ ................... ................... ...................

Cumulative balance of guaranteed loans outstanding:
Outstanding, start of year .............................................
Repayments and prepayments ......................................
Adjustments:
2261
Terminations for default that result in loans receivable .......................................................................
2263
Terminations for default that result in claim payments ....................................................................
2210
2251

Object Classification (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

23.90
23.95

Offsets:
Against gross financing authority and financing disbursements:
Offsetting collections (cash) from:
88.00
Federal sources ..................................................... ...................
88.25
Interest on uninvested funds ...............................
¥6
88.40
Recoveries of defaulted loans ..............................
¥7

Guaranteed loan upward reestimates:
235001 HEAL Loan guarantee .................................................... ...................

429

1,156
¥183

958
¥101

841
¥97

¥13

¥14

¥2

2290

Outstanding, end of year ..........................................

958

841

728

2299

Memorandum:
Guaranteed amount of guaranteed loans outstanding,
end of year ................................................................

958

841

728

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

640
15
¥7

648
16
¥4

660
16
¥4

2390

648

660

672

Outstanding, end of year ......................................

This account records all cash flows to and from the Government resulting from HEAL loan guarantees committed between 1992 and 2004. No new loan guarantees will be issued
after 2004.
Balance Sheet (in millions of dollars)
Identification code 75–4304–0–3–552

2006 actual

ASSETS:
1101 Federal assets: Fund balances with Treasury ..........................
Net value of assets related to post–1991 acquired defaulted
guaranteed loans receivable:
1501 Defaulted guaranteed loans receivable, gross ..........................
1505 Allowance for subsidy cost (–) ..................................................
1599

Net present value of assets related to defaulted guaranteed
loans .........................................................................................

Sfmt 3633

E:\BUDGET\HHS.XXX

HHS

2007 actual

144

107

640
–568

648
–591

430

HEALTH RESOURCES AND SERVICES ADMINISTRATION—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

HEALTH EDUCATION ASSISTANCE LOANS FINANCING ACCOUNT—
Continued

2290

Outstanding, end of year ..........................................

173

156

138

Balance Sheet (in millions of dollars)—Continued

2299

Memorandum:
Guaranteed amount of guaranteed loans outstanding,
end of year ................................................................

173

156

138

99
3
¥14

88
3
¥10

81
3
¥10

Identification code 75–4304–0–3–552

1901

2006 actual

2007 actual

Other Federal assets: Other, upward reestimate ......................

....................

Total assets ..................................................................................
LIABILITIES:
Non-Federal liabilities:
2204 Liabilities for loan guarantees ...................................................
2207 Other, downward reestimate .......................................................

216

189

182
34

145
44

2999

Total liabilities .............................................................................

216

189

4999

Total liabilities and net position ...............................................

216

189

1999

2390

Outstanding, end of year ......................................

Note.—Includes carryover commitments from prior years.
Note.—The adjustment to loans receivable represents interest, which had not previously
been reflected in cumulative outstanding balances.

This account records all cash flows to and from the Government resulting from HEAL loan guarantees committed prior
to 1992.

HEALTH EDUCATION ASSISTANCE LOANS LIQUIDATING ACCOUNT
Program and Financing (in millions of dollars)
Identification code 75–4305–0–3–552

2007 actual

2008 est.

Balance Sheet (in millions of dollars)

2009 est.

00.02

Obligations by program activity:
Defaulted loans ..............................................................

10.00

Total new obligations (object class 42.0) ................

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year ...................
3 ...................
New budget authority (gross) ........................................
3
3
3
Resources available from recoveries of prior year obligations .......................................................................
3 ................... ...................
22.40 Capital transfer to general fund ................................... ...................
¥3 ...................
21.40
22.00
22.10

23.90
23.95
24.40

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................
Spending authority from offsetting collections:
69.00
Offsetting collections (cash) ................................
69.27
Capital transfer to general fund ..........................
69.90

cprice-sewell on PROD1PC71 with BUDGET PAG

70.00

6
¥3

3
¥3

3 ................... ...................

14
¥12

10
¥8

Spending authority from offsetting collections
(total mandatory) .............................................

Total new budget authority (gross) ..........................

72.40
73.10
73.20
73.45

74.40

Obligated balance, end of year ................................

86.97

Outlays (gross), detail:
Outlays from new mandatory authority .........................

4
1
1
3
3
3
¥3
¥3
¥3
¥3 ................... ...................

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

¥14

¥10

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥11
¥11

¥7
¥7

89.00
90.00

2007 actual

Cumulative balance of guaranteed loans outstanding:
2210 Outstanding, start of year .............................................
2251 Repayments and prepayments ......................................
2261 Adjustments: Terminations for default that result in
loans receivable ........................................................
VerDate Aug 31 2005

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2006 actual

2008 est.

2009 est.

216
¥40

173
¥14

156
¥15

¥3

Frm 00008

Fmt 3616

PO 00000

2007 actual

1101
1701
1703

ASSETS:
Federal assets: Fund balances with Treasury ..........................
Defaulted guaranteed loans, gross ............................................
Allowance for estimated uncollectible loans and interest (–)

4
99
–4

1
88
–1

1704

Defaulted guaranteed loans and interest receivable, net .......

1799

Value of assets related to loan guarantees ............................

Total assets ..................................................................................
LIABILITIES:
2104 Federal liabilities: Resources payable to Treasury ...................

2999

Total liabilities .............................................................................

4999

Total liabilities and net position ...............................................

1999

MEDICAL FACILITIES GUARANTEE

AND

LOAN FUND

Program and Financing (in millions of dollars)
Identification code 75–9931–0–3–551

2007 actual

2008 est.

2009 est.

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

74.40

89.00
90.00

Obligated balance, end of year ................................

Status of Direct Loans (in millions of dollars)
Identification code 75–9931–0–3–551

Status of Guaranteed Loans (in millions of dollars)
Identification code 75–4305–0–3–552

Identification code 75–4305–0–3–552

2007 actual

2008 est.

2009 est.

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

1290

Outstanding, end of year ..........................................

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.
Sfmt 3616

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HHS

INDIAN HEALTH SERVICES
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Balance Sheet (in millions of dollars)
Identification code 75–9931–0–3–551

2006 actual

2007 actual

ASSETS:
1206 Non-Federal assets: Receivables, net ........................................
1601 Direct loans, gross ......................................................................

12
7

11
7

1999

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

2999

Total liabilities .............................................................................

4999

Total liabilities and net position ...............................................

431

73.10
73.20

Total new obligations ....................................................
Total outlays (gross) ......................................................

112
¥103

135
¥135

273
¥273

74.40

Obligated balance, end of year ................................

86.90
86.97

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from new mandatory authority .........................

14
89

16
119

16
257

87.00

Total outlays (gross) .................................................

103

135

273

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

¥1 ................... ...................

Trust Funds

89.00
90.00

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND
For payments from the Vaccine Injury Compensation Program
Trust Fund, such sums as may be necessary for claims associated
with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI
of the Public Health Service Act, to remain available until expended:
Provided, That for necessary administrative expenses, not to exceed
ø$5,500,000¿ $4,528,000 shall be available from the Trust Fund to
the Secretary of Health and Human Services. (Department of Health
and Human Services Appropriations Act, 2008.)
Special and Trust Fund Receipts (in millions of dollars)
Identification code 20–8175–0–7–551

2007 actual

01.99

Balance, start of year ....................................................
Receipts:
02.00 Interest and Profits on Investments, Vaccine Injury
Compensation Trust Fund .........................................
02.60 Deposits, Vaccine Injury Compensation Trust Fund ......
02.99

2008 est.

2009 est.

2,371

2,610

2,806

109
241

113
218

117
219

Memorandum (non-add) entries:
Total investments, start of year: Federal securities:
Par value ...................................................................
92.02 Total investments, end of year: Federal securities:
Par value ...................................................................

111
102

135
135

273
273

2,380

2,625

2,490

2,625

2,490

2,344

92.01

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 vaccinerelated 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)

Total receipts and collections ...................................

350

331

336

Total: Balances and collections ....................................
Appropriations:
05.00 Vaccine Injury Compensation Program Trust Fund .......
05.01 Vaccine Injury Compensation Program Trust Fund .......

2,721

2,941

3,142

¥14
¥97

¥16
¥119

¥16
¥257

04.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

05.99

Total appropriations ..................................................

¥111

¥135

¥273

07.99

Balance, end of year .....................................................

2,610

2,806

2,869

Identification code 20–8175–0–7–551

2007 actual

Direct obligations:
25.2 Other services ................................................................
25.3 Other purchases of goods and services from Government accounts ...........................................................
42.0 Insurance claims and indemnities ................................
99.9

Total new obligations ................................................

2008 est.

2009 est.

10
98

11
119

11
257

112

135

273

INDIAN HEALTH SERVICES
Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 20–8175–0–7–551

2007 actual

Federal Funds
2008 est.

INDIAN HEALTH SERVICES

2009 est.

00.01
01.03
01.04
01.05

Obligations by program activity:
Compensation: Claims for post—FY 1989 injuries ......
Claims processing (Claims Court) ................................
Claims processing (HRSA) .............................................
Claims processing (Dept. of Justice) ............................

98
4
4
6

119
4
5
7

257
4
5
7

01.91

Total, administrative expenses .................................

10.00

Total new obligations ................................................

112

135

273

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

1
112

1
135

1
273

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

113
¥112

136
¥135

274
¥273

24.40

Unobligated balance carried forward, end of year

119

257

New budget authority (gross), detail:
Discretionary:
40.26
Appropriation (trust fund) .........................................
Mandatory:
60.26
Appropriation (Vaccine Injury Trust fund) ................
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

1 ................... ...................

70.00

Total new budget authority (gross) ..........................

112

135

273

72.40

Change in obligated balances:
Obligated balance, start of year ...................................

Frm 00009

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For expenses necessary to carry out the Act of August 5, 1954
(68 Stat. 674), the Indian Self-Determination Act, the Indian Health
Care Improvement Act, and titles II and III of the Public Health
Service Act with respect to the Indian Health Service,
ø$3,018,624,000¿ $2,971,533,000, 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 ø$588,515,000¿ $588,161,000 for contract medical
care, including ø$27,000,000¿ $25,000,000 for the Indian Catastrophic
Health Emergency Fund, shall remain available until expended: øProvided further, That no less than $35,094,000 is provided for maintaining operations of the urban Indian health program:¿ Provided further,
That of the funds provided, up to ø$32,000,000¿ $18,000,000 shall
remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health Care Improvement Act: øProvided further, That $14,000,000 is provided for a methamphetamine and suicide prevention and treatment initiative, of
which up to $5,000,000 may be used for mental health, suicide prevention, and behavioral issues associated with methamphetamine use:
Provided further, That notwithstanding any other provision of law,
these funds shall be allocated outside all other distribution methods
and formulas at the discretion of the Director of the Indian Health
Sfmt 3616

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HHS

432

INDIAN HEALTH SERVICES—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

60.00

Mandatory:
Appropriation .............................................................

150

70.00

Total new budget authority (gross) ..........................

3,946

4,084

INDIAN HEALTH SERVICES—Continued
Service and shall remain available until expended:¿ Provided further,
That funds provided in this Act may be used for one-year contracts
and grants which are to be performed in two fiscal years, so long
as the total obligation is recorded in the year for which 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 (exclusive of planning, design, or construction of new facilities): Provided further, That funding contained herein, and in any earlier appropriations Acts for scholarship programs
under the Indian Health Care Improvement Act (25 U.S.C. 1613)
shall remain available until expended: Provided further, That
amounts received by tribes and tribal organizations under title IV
of the Indian Health Care Improvement Act shall be reported and
accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That, notwithstanding any
other provision of law, of the amounts provided herein, not to exceed
ø$271,636,000¿ $271,636,000 shall be for payments to tribes and
tribal organizations for contract or grant support costs associated
with contracts, grants, self-governance compacts, or annual funding
agreements between the Indian Health Service and a tribe or tribal
organization pursuant to the Indian Self-Determination Act of 1975,
as amended, prior to or during fiscal year ø2008¿ 2009, of which
not to exceed $5,000,000 may be used for contract support costs
associated with new or expanded self-determination contracts, grants,
self-governance compacts, or annual funding agreements: Provided
further, That the Bureau of Indian Affairs may collect from the Indian Health Service and 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 funds available for 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, 2008.)
Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–0390–0–1–551

2007 actual

2008 est.

2009 est.

00.01
00.02
00.03
00.04
00.05
00.06
00.07
00.08
00.09
09.01

Obligations by program activity:
Clinical services .............................................................
Preventive health ...........................................................
Urban health ..................................................................
Indian health professions ..............................................
Tribal management ........................................................
Direct operations ............................................................
Self-governance .............................................................
Contract support costs ..................................................
Diabetes funds ...............................................................
Reimbursable program ..................................................

2,268
123
34
32
2
64
6
270
166
962

2,434
2,476
128
131
35 ...................
36
22
2
2
64
63
6
6
267
272
150
150
962
962

10.00

Total new obligations ................................................

3,927

4,084

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

182
3,946

182
4,084

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

4,128
4,266
4,266
¥3,927
¥4,084
¥4,084
¥19 ................... ...................
182

182

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
2,826
3,019
2,972
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥47 ...................
41.00
Transferred to other accounts ...................................
¥7 ................... ...................
43.00
58.00
58.10
58.90

Appropriation (total discretionary) ........................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................
Change in uncollected customer payments from
Federal sources (unexpired) .............................
Spending authority from offsetting collections
(total discretionary) ..........................................

VerDate Aug 31 2005

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Jkt 214754

2,819

2,972

966

962

11 ................... ...................
977
PO 00000

962

Frm 00010

Fmt 3616

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.40
74.00

610
663
442
3,927
4,084
4,084
¥3,866
¥4,305
¥4,204
¥1 ................... ...................
¥11 ................... ...................
4 ................... ...................

74.40

Obligated balance, end of year ................................

663

442

322

86.90
86.93
86.97
86.98

3,419
297
132
18

3,637
518
135
15

3,637
416
135
16

87.00

Total outlays (gross) .................................................

3,866

4,305

4,204

¥461
¥506

¥456
¥506

88.90

¥967

¥962

88.95
88.96

89.00
90.00

Total, offsetting collections (cash) .......................
Against gross budget authority only:
Change in uncollected customer payments from
Federal sources (unexpired) ..................................
Portion of offsetting collections (cash) credited to
expired accounts ...................................................
Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥11 ................... ...................
1 ................... ...................

2,969
2,899

3,122
3,343

3,122
3,242

The Indian Health Services account provides medical care,
public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $1,805 million, primarily through self determination
contracts and compacts, will be administered by tribal governments in 2009.
Object Classification (in millions of dollars)
Identification code 75–0390–0–1–551

11.1
11.3
11.5
11.7

2007 actual

11.9
12.1
12.2
13.0
21.0
21.0
22.0
23.1
23.2
23.3

2008 est.

2009 est.

345
25
39
76

359
25
40
79

368
26
42
83

485
113
36
8
13
21
8
8
2

503
116
37
8
13
23
9
8
2

519
120
39
8
12
24
9
8
2

16
2
1
84

16
2
2
86

16
1
2
95

25.4
25.6
25.7
25.8
26.0
31.0
41.0

Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Benefits for former personnel ...................................
Travel and transportation of persons .......................
Patient travel .............................................................
Transportation of things ...........................................
Rental payments to GSA ...........................................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................
Printing and reproduction .........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of facilities ..................
Medical care ..............................................................
Operation and maintenance of equipment ...............
Subsistence and support of persons ........................
Supplies and materials .............................................
Equipment .................................................................
Grants, subsidies, and contributions ........................

61
6
243
5
2
97
12
1,742

61
3
267
5
2
98
13
1,848

66
3
270
5
2
99
14
1,808

99.0

Direct obligations ..................................................

2,965

3,122

24.0
25.1
25.2
25.3

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

INDIAN HEALTH SERVICES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
99.0

Reimbursable obligations ..............................................

962

99.9

Total new obligations ................................................

3,927

4,084

Employment Summary
Identification code 75–0390–0–1–551

2007 actual

2008 est.

2009 est.

.....................
.....................

7,099
1,141

7,119
1,153

7,158
1,145

.....................
.....................

4,748
764

4,750
762

4,744
768

10.00

Total new obligations ................................................

374

384

362

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

250
371

247
384

247
362

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

621
¥374

631
¥384

609
¥362

24.40

Unobligated balance carried forward, end of year

247

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
354
381
353
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥6 ...................
42.00 Transferred from other accounts ...................................
7 ................... ...................
43.00

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,
ø$380,583,000¿ $353,329,000, to remain available until expended:
Provided, That notwithstanding any other provision of law, funds
appropriated for the planning, design, construction or renovation of
health facilities for the benefit of øan¿ a federally-recognized Indian
tribe or tribes may be used to purchase land for sites to construct,
improve, or enlarge health or related facilities: Provided further, That
not to exceed $500,000 shall be used by the Indian Health Service
to purchase TRANSAM equipment from the Department of Defense
for distribution to the Indian Health Service and tribal facilities:
Provided further, That none of the funds appropriated to the Indian
Health Service may be used for sanitation facilities construction for
new homes funded with grants by the housing programs of the United
States Department of Housing and Urban Development: Provided
further, That not to exceed $1,000,000 from this account and the
‘‘Indian Health Services’’ account shall be used by the Indian Health
Service to obtain ambulances for the Indian Health Service and tribal
facilities in conjunction with an existing interagency agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed $500,000 shall be placed
in a Demolition Fund, available until expended, to be used by the
Indian Health Service for demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2008.)

2007 actual

2008 est.

58.00
58.10
58.90

60.20

Spending authority from offsetting collections
(total discretionary) ..........................................
Mandatory:
Appropriation (special fund) .....................................

70.00

Total new budget authority (gross) ..........................

72.40
73.10
73.20
74.00

361

375

353

1 ................... ...................
2

371

384

362

237
374
¥375

235
384
¥336

283
362
¥401

¥1 ................... ...................

74.40

Obligated balance, end of year ................................

235

283

244

86.90
86.93
86.97

116
251
8

114
214
8

107
286
8

87.00

Total outlays (gross) .................................................

375

336

401

¥1

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥1 ................... ...................

369
374

383
335

361
400

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

Special and Trust Fund Receipts (in millions of dollars)
Identification code 75–0391–0–1–551

433

2009 est.

01.99

Balance, start of year .................................................... ................... ................... ...................
Receipts:
02.20 Rent and Charges for Quarters, Indian Health Service
8
8
8
02.99

Total receipts and collections ...................................

04.00

Total: Balances and collections ....................................
Appropriations:
05.00 Indian Health Facilities .................................................

cprice-sewell on PROD1PC71 with BUDGET PAG

07.99

¥8

Balance, end of year ..................................................... ................... ................... ...................

Program and Financing (in millions of dollars)
Identification code 75–0391–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Sanitation and health facilities ....................................
00.02 Maintenance ...................................................................
00.03 Facilities and environmental health ..............................
00.04 Equipment ......................................................................

129
52
165
19

131
53
170
21

110
53
169
21

01.00
09.01

365
9

375
9

353
9

Frm 00011

Fmt 3616

Total direct program .................................................
Reimbursable program ..................................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

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Object Classification (in millions of dollars)
Identification code 75–0391–0–1–551

11.1
11.3
11.5
11.7

2007 actual

11.9
12.1
12.2
21.0
22.0
23.3
25.1
25.2
25.3
25.4
25.7
Sfmt 3643

2008 est.

2009 est.

39
6
1
20

40
6
1
21

41
6
1
21

Total personnel compensation ..............................
66
Civilian personnel benefits .......................................
12
Military personnel benefits ........................................
8
Travel and transportation of persons .......................
3
Transportation of things ...........................................
2
Communications, utilities, and miscellaneous
charges .................................................................
15
Advisory and assistance services .............................
30
Other services ............................................................
88
Other purchases of goods and services from Government accounts .................................................
3
Operation and maintenance of facilities .................. ...................
Operation and maintenance of equipment ...............
2

68
12
8
3
3

69
12
8
3
3

17
20
99

18
10
93

1
3
2

1
2
2

E:\BUDGET\HHS.XXX

HHS

434

INDIAN HEALTH SERVICES—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

INDIAN HEALTH FACILITIES—Continued
Object Classification (in millions of dollars)—Continued
Identification code 75–0391–0–1–551

2007 actual

2008 est.

2009 est.

26.0
31.0
32.0
41.0
42.0

Supplies and materials .............................................
Equipment .................................................................
Land and structures ..................................................
Grants, subsidies, and contributions ........................
Insurance claims and indemnities ...........................

6
13
16
99
2

7
12
7
112
1

7
10
5
109
1

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

365
9

375
9

353
9

99.9

Total new obligations ................................................

374

384

362

Employment Summary
Identification code 75–0391–0–1–551

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................
1101 Military full-time equivalent employment .....................
Reimbursable:
2001 Civilian full-time equivalent employment .....................

2008 est.

2009 est.

978
236

974
238

quest has been included in an appropriations Act and enacted into
law.
With respect to functions transferred by the Indian Health Service
to tribes or tribal organizations, the Indian Health Service is authorized to provide goods and services to those entities, on a reimbursable
basis, including payment in advance with subsequent adjustment.
The reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination
Act, may be credited to the same or subsequent appropriation account
that provided the funding, with such amounts to remain available
until expended.
Reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including
direct, administrative, and overhead associated with the provision
of goods, services, or technical assistance.
The appropriation structure for the Indian Health Service may
not be altered without advance notification to the House and Senate
Committees on Appropriations. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2008.)
f

CENTERS FOR DISEASE CONTROL AND
PREVENTION

Federal Funds
DISEASE CONTROL, RESEARCH,

cprice-sewell on PROD1PC71 with BUDGET PAG

ADMINISTRATIVE PROVISIONS, INDIAN HEALTH SERVICE
Appropriations in this Act to the Indian Health Service shall be
available for services as authorized by 5 U.S.C. 3109 but 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; and for uniforms or allowances
therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of
attendance at meetings which are concerned with the functions or
activities for which the appropriation is made or which will contribute
to improved conduct, supervision, or management of those functions
or activities.
In accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care
at all tribally administered or Indian Health Service facilities, subject
to charges, and the proceeds along with funds recovered under the
Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be
credited to the account of the facility providing the service and shall
be available without fiscal year limitation. Notwithstanding any other
law or regulation, funds transferred from the Department of Housing
and Urban Development to the Indian Health Service shall be administered under Public Law 86–121 (the Indian Sanitation Facilities
Act) and Public Law 93–638, as amended.
Funds appropriated to the Indian Health Service in this Act, except
those used for administrative and program direction purposes, shall
not be subject to limitations directed at curtailing Federal travel
and transportation.
øNone of the funds made available to the Indian Health Service
in this Act shall be used for any assessments or charges by the
Department of Health and Human Services unless identified in the
budget justification and provided in this Act, or approved by the
House and Senate Committees on Appropriations through the reprogramming process.¿
Notwithstanding any other provision of law, funds previously or
herein made available to a tribe or tribal organization through a
contract, grant, or agreement authorized by title I or title V of the
Indian Self-Determination and Education Assistance Act of 1975 (25
U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance agreement under
title V of such Act and thereafter shall remain available to the tribe
or tribal organization without fiscal year limitation.
None of the funds made available to the Indian Health Service
in this Act shall be used to implement the final rule published in
the Federal Register on September 16, 1987, by the Department
of Health and Human Services, relating to the eligibility for the
health care services of the Indian Health Service until the Indian
Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such reVerDate Aug 31 2005

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Frm 00012

Fmt 3616

AND

TRAINING

To carry out titles II, III, VII, XI, XV, XVII, XIX, XXI, and XXVI
of the Public Health Service Act (‘‘PHS Act’’), sections 101, 102, 103,
201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and
Health Act of 1977, section 13 of the Mine Improvement and New
Emergency Response Act of 2006, sections 20, 21, and 22 of the
Occupational Safety and Health Act of 1970, title IV of the Immigration and Nationality Act, section 501 of the Refugee Education Assistance Act of 1980, and for expenses necessary to support activities
related to countering potential biological, disease, nuclear, radiological, and chemical threats to civilian populations; including purchase and insurance of official motor vehicles in foreign countries;
and purchase, hire, maintenance, and operation of aircraft,
ø$6,156,541,000, of which $56,000,000 shall remain available until
expended for equipment, construction and renovation of facilities¿
$5,618,009,000; of which ø$568,803,000¿ $570,307,000 shall remain
available until expended for the Strategic National Stockpile; øof
which $27,215,000 shall be available for public health improvement
activities specified in the explanatory statement described in section
4 (in the matter preceding division A of this consolidated Act);¿ of
which ø$121,541,000¿ $118,727,000 for international HIV/AIDS shall
remain available until September 30, ø2009¿ 2010; of which, of the
funds made available under this heading for domestic HIV/AIDS,
$30,000,000 shall remain available until expended for section 2625
of the PHS Act; and of which ø$109,000,000¿ $25,000,000 shall be
available until expended to provide screening and treatment for first
response emergency services personnelø, residents, students, and others¿ related to the September 11, 2001 terrorist attacks on the World
Trade Centerø: Provided, That of this amount, $56,500,000 is designated as described in section 5 (in the matter preceding division
A of this consolidated Act)¿. In addition, such sums as may be derived
from authorized user fees, which shall be credited to this account:
Provided, That in addition to amounts provided herein, the following
amounts shall be available from amounts available under section
241 of the Public Health Service Act: (1) $12,794,000 to carry out
the National Immunization Surveys; (2) ø$113,636,000¿ $124,701,000
to carry out the National Center for Health Statistics surveys; (3)
$24,751,000 to carry out information systems standards development
and architecture and applications-based research used at local public
health levels; (4) ø$48,523,000¿ $1,933,000 for Health Marketing;
(5) $31,000,000 to carry out Public Health Research; and (6)
ø$94,969,000¿ $87,480,000 to carry out research activities within the
National Occupational Research Agenda: Provided further, That none
of the funds made available for injury prevention and control at
the Centers for Disease Control and Prevention may be used, in
whole or in part, to advocate or promote gun control: øProvided
further, That up to $31,800,000 shall be made available until expended for Individual Learning Accounts for full-time equivalent employees of the Centers for Disease Control and Prevention:¿ Provided
further, That the Director may redirect the total amount made available under authority of Public Law 101–502, section 3, dated NovemSfmt 3616

E:\BUDGET\HHS.XXX

HHS

CENTERS FOR DISEASE CONTROL AND PREVENTION—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
ber 3, 1990, to activities the Director may so designate: Provided
further, That the Committees on Appropriations of the House of Representatives and the Senate are to be notified promptly of any such
transfer: Provided further, That not to exceed ø$18,929,000¿
$18,521,000 may be available for making grants under section 1509
of the Public Health Service Act to not less than 15 States, tribes,
or tribal organizations: øProvided further, That notwithstanding any
other provision of law, the Centers for Disease Control and Prevention shall award a single contract or related contracts for development
and construction of the next building or facility designated in the
Buildings and Facilities Master Plan that collectively include the
full scope of the project: Provided further, That the solicitation and
contract shall contain the clause ‘‘availability of funds’’ found at 48
CFR 52.232–18:¿ Provided further, That of the funds appropriated,
$10,000 is for official reception and representation expenses when
specifically approved by the Director of the Centers for Disease Control and Preventionø: Provided further, That employees of the Centers
for Disease Control and Prevention or the Public Health Service,
both civilian and Commissioned Officers, detailed to States, municipalities, or other organizations under authority of section 214 of the
Public Health Service Act, or in overseas assignments, shall be treated as non-Federal employees for reporting purposes only and shall
not be included within any personnel ceiling applicable to the Agency,
Service, or the Department of Health and Human Services during
the period of detail or assignment: Provided further, That out of
funds made available under this heading for domestic HIV/AIDS testing, up to $30,000,000 shall be for States eligible under section 2625
of the Public Health Service Act as of December 31, 2007 and shall
be distributed by May 31, 2008 based on standard criteria relating
to a State’s epidemiological profile, and of which not more than
$1,000,000 may be made available to any one State, and any amounts
that have not been obligated by May 31, 2008 shall be used to
make grants authorized by other provisions of the Public Health
Service Act to States and local public health departments for HIV
prevention activities¿.
In addition, for necessary expenses to administer the Energy Employees Occupational Illness Compensation 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 of Division B, Title I of Public Law 106–
554. (Department of Health and Human Services Appropriations Act,
2008.)
Special and Trust Fund Receipts (in millions of dollars)
Identification code 75–0943–0–1–550

2007 actual

2008 est.

2009 est.

01.99

Balance, start of year .................................................... ................... ................... ...................
Receipts:
02.20 Cooperative Research and Development Agreements,
Centers for Disease Control ......................................
3
3
3
04.00

Total: Balances and collections ....................................
Appropriations:
05.00 Disease Control, Research, and Training ......................
07.99

¥3

Balance, end of year ..................................................... ................... ................... ...................

10.00

Total new obligations ................................................

21.40
22.00
22.10

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

43.00

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Obligations by program activity:
00.01 Infectious diseases ........................................................
00.02 Health promotion ...........................................................
00.03 Health information and service .....................................
00.04 Environmental health and injury ...................................
00.05 Occupational safety and health ....................................
00.06 Global health .................................................................
00.08 Public health improvement and leadership ..................
00.09 Prev. health and health services block grant ...............
00.10 Buildings and facilities .................................................
00.11 Business services support .............................................
00.12 Terrorism ........................................................................
00.14 World Trade Center Registry ..........................................
Reimbursable program:
09.01
Health statistics ........................................................
09.02
Other reimbursable program .....................................
09.03
Public health research ..............................................
09.09

Subtotal, reimbursable programs .........................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

1,753
946
133
282
173
308
206
99
291
370
1,414
49

2008 est.

2009 est.

1,792
1,857
961
932
111
133
289
271
179
214
371
302
225
182
97 ...................
127
51
365
338
1,497
1,419
108
25

33
419
31

33
551
31

33
571
31

483

615

635

Frm 00013

Fmt 3616

PO 00000

58.00
58.10
58.90

60.00
60.20

6,737

6,359

466
6,459

418
6,737

418
6,360

4 ................... ...................
6,929
7,155
6,778
¥6,507
¥6,737
¥6,359
¥4 ................... ...................
418

418

419

5,971

6,050

5,618

255

684

230 ................... ...................

Spending authority from offsetting collections
(total discretionary) ..........................................
485
684
Mandatory:
Appropriation ............................................................. ................... ...................
Appropriation (special fund) .....................................
3
3

684
55
3

62.50

Appropriation (total mandatory) ...........................

70.00

Total new budget authority (gross) ..........................

6,459

6,737

6,360

4,693
5,164
4,776
6,507
6,737
6,359
¥6,052
¥7,125
¥6,684
¥73 ................... ...................
¥4 ................... ...................
¥230 ................... ...................
323 ................... ...................

74.40

Obligated balance, end of year ................................

5,164

4,776

4,451

86.90
86.93
86.97

2,369
3,680
3

3,044
4,078
3

2,875
3,785
24

87.00

Total outlays (gross) .................................................

6,052

7,125

6,684

¥133
¥439

¥682
¥2

88.90

¥572

¥684

88.95
2007 actual

6,507

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
5,901
6,157
5,618
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥107 ...................
40.36
Unobligated balance permanently reduced ..............
¥30 ................... ...................
42.00 Transferred from other accounts ...................................
100 ................... ...................

Program and Financing (in millions of dollars)
Identification code 75–0943–0–1–550

435

88.96

89.00
90.00

¥230 ................... ...................
317 ................... ...................

5,974
5,480

6,053
6,441

5,676
6,000

The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve
the health, safety, and protection of all Americans. These
activities include immunization, HIV prevention, chronic disease prevention and health promotion, infectious disease control, occupational safety and health, injury prevention and
control, environmental health, and programs that reduce the
occurrence of birth defects and developmental disabilities.
CDC also supports bioterrorism, emergency response, and
pandemic influenza preparedness activities.
Sfmt 3616

E:\BUDGET\HHS.XXX

HHS

436

CENTERS FOR DISEASE CONTROL AND PREVENTION—Continued
Federal Funds—Continued

DISEASE CONTROL, RESEARCH,

AND

THE BUDGET FOR FISCAL YEAR 2009

TRAINING—Continued

Program and Financing (in millions of dollars)

Object Classification (in millions of dollars)
Identification code 75–0943–0–1–550

11.1
11.3
11.5
11.7
11.8
11.9
12.1
12.2
21.0
22.0
23.1
23.2
23.3
24.0
25.1
25.2
25.3
25.4
25.5
25.6
25.7
25.8
26.0
31.0
32.0
41.0

2007 actual

Identification code 75–0944–0–1–551
2008 est.

2009 est.

2008 est.

2009 est.

75
5

74
6

73
6

477
52
25
56
1

531
57
28
62
1

541
61
26
65
1

10.00

Total new obligations ................................................

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

1
80

1
79

Total personnel compensation ..............................
611
Civilian personnel benefits .......................................
151
Military personnel benefits ........................................
35
Travel and transportation of persons .......................
44
Transportation of things ...........................................
10
Rental payments to GSA ...........................................
54
Rental payments to others ........................................
4
Communications, utilities, and miscellaneous
charges .................................................................
40
Printing and reproduction .........................................
9
Advisory and assistance services .............................
382
Other services ............................................................
199
Other purchases of goods and services from Government accounts .................................................
414
Operation and maintenance of facilities ..................
95
Research and development contracts .......................
97
Medical care ..............................................................
1
Operation and maintenance of equipment ...............
30
Subsistence and support of persons ........................ ...................
Supplies and materials .............................................
486
Equipment .................................................................
66
Land and structures ..................................................
271
Grants, subsidies, and contributions ........................
3,025

679
168
39
44
22
71
1

694
174
42
39
19
63
1

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

81
¥80

80
¥79

24.40

Unobligated balance carried forward, end of year

22
9
394
222

20
8
352
196

359
80
131
20
22
4
549
73
179
3,034

321
72
119
17
20
3
431
65
150
2,918

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

6,024
483

6,122
615

5,724
635

99.9

Total new obligations ................................................

6,507

6,737

6,359

Employment Summary
Identification code 75–0943–0–1–550

2007 actual

2008 est.

AGENCY

FOR

.....................
.....................

6,586
762

6,899
763

6,837
763

.....................
.....................

855
70

TOXIC SUBSTANCES

AND

DISEASE REGISTRY

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)ø,¿and 111(c)(4)ø, and 111(c)(14)¿ of the Comprehensive
Environmental Response, Compensation, and Liability Act of 1980
(CERCLA), as amended; section 118(f) of the Superfund Amendments
and Reauthorization Act of 1986 (SARA), as amended; and section
3019 of the Solid Waste Disposal Act, as amended, ø$75,212,000,
of which up to $1,500,000, to remain available until expended, is
for Individual Learning Accounts for full-time equivalent employees
of the Agency for Toxic Substances and Disease Registry¿
$72,882,000: Provided, That notwithstanding any other provision of
law, in lieu of performing a health assessment under section 104(i)(6)
of CERCLA, the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without
limitation, biomedical testing, clinical evaluations, medical monitoring, and referral to accredited health care providers: Provided further, That in performing any such health assessment or health study,
evaluation, or activity, the Administrator of ATSDR shall not be
bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided
further, That none of the funds appropriated under this heading shall
be available for ATSDR to issue in excess of 40 toxicological profiles
pursuant to section 104(i) of CERCLA during fiscal year 2009, and
existing profiles may be updated as necessary. (Department of the
Interior, Environment, and Related Agencies Appropriations Act,
2008.)
VerDate Aug 31 2005

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Jkt 214754

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Frm 00014

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
75
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
43.00

Fmt 3616

58.00
58.10

75
73
¥1 ...................

3 ................... ...................

58.90

Spending authority from offsetting collections
(total discretionary) ..........................................

70.00

Total new budget authority (gross) ..........................

39
80
¥77

41
80
¥80

47
79
¥80

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
74.00

¥3 ................... ...................
2

74.40

Obligated balance, end of year ................................

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

45
32

51
29

87.00

Total outlays (gross) .................................................

¥4

¥6

2009 est.

cprice-sewell on PROD1PC71 with BUDGET PAG

2007 actual

Obligations by program activity:
00.01 Direct program ...............................................................
09.01 Reimbursable program ..................................................

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

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥3 ................... ...................
2 ................... ...................

75
73

74
74

73
74

The Agency for Toxic Substances and Disease Registry
(ATSDR) is authorized under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980
(CERCLA). ATSDR assesses health hazards at specific hazardous waste sites helping to prevent or reduce exposure and
illnesses that result, and increasing knowledge and understanding of the health effects that may result from exposure
to hazardous substances.
Object Classification (in millions of dollars)
Identification code 75–0944–0–1–551

11.1
11.3
11.5
11.7

2007 actual

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

19
1
1
3

2008 est.

18
1
1
3

2009 est.

18
1
1
3

NATIONAL INSTITUTES OF HEALTH
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
11.9
12.1
12.2
21.0
23.3

24
6
2
1

23
5
2
1

12
4
6

10
4
9

10
4
8

25.5
31.0
41.0

2
1
1
16

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

75
5

74
6

73
6

25.1
25.2
25.3

99.9

Total new obligations ................................................

Employment Summary
Identification code 75–0944–0–1–551

2007 actual

2008 est.

NATIONAL INSTITUTE

AND

CRANIOFACIAL RESEARCH

DIABETES AND DIGESTIVE
DISEASES

AND

KIDNEY

For carrying out section 301 and title IV of the Public Health
Service Act with respect to diabetes and digestive and kidney disease,
ø$1,736,199,000¿ $1,708,487,000. (Department of Health and Human
Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

NEUROLOGICAL DISORDERS

AND

STROKE

For carrying out section 301 and title IV of the Public Health
Service Act with respect to neurological disorders and stroke,
ø$1,571,353,000¿ $1,545,397,000. (Department of Health and Human
Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

2009 est.

DENTAL

For carrying out section 301 and title IV of the Public Health
Service Act with respect to dental disease, ø$396,632,000¿
$390,535,000. (Department of Health and Human Services Appropriations Act, 2008.)

ALLERGY

AND

INFECTIOUS DISEASES

(INCLUDING TRANSFER OF FUNDS)

Direct:
Civilian full-time equivalent employment .....................
Military full-time equivalent employment .....................
Reimbursable:
2001 Civilian full-time equivalent employment .....................
1001
1101

274
13

278
13

273
13

Trust Funds
TOXIC SUBSTANCES AND ENVIRONMENTAL PUBLIC HEALTH, AGENCY
FOR TOXIC SUBSTANCES AND DISEASE REGISTRY
Program and Financing (in millions of dollars)
Identification code 75–8252–0–7–551

2007 actual

2008 est.

For carrying out section 301 and title IV of the Public Health
Service Act with respect to allergy and infectious diseases,
ø$4,641,746,000¿ $4,568,778,000: Provided, That $300,000,000 may
be made available to International Assistance Programs ‘‘Global Fund
to Fight HIV/AIDS, Malaria, and Tuberculosis’’, to remain available
until expendedø: Provided further, That such sums obligated in fiscal
years 2003 through 2007 for extramural facilities construction
projects are to remain available until expended for disbursement,
with prior notification of such projects to the Committees on Appropriations of the House of Representatives and the Senate¿. (Department of Health and Human Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

2009 est.

GENERAL MEDICAL SCIENCES

24.41

Budgetary resources available for obligation:
Special and trust fund receipts returned to Schedule
N ................................................................................ ................... ................... ...................

For carrying out section 301 and title IV of the Public Health
Service Act with respect to general medical sciences, ø$1,970,228,000¿
$1,937,690,000. (Department of Health and Human Services Appropriations Act, 2008.)

72.40
73.40
74.10

Change in obligated balances:
Obligated balance, start of year ...................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (expired) ................................................

øNATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT¿ EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD
HEALTH AND HUMAN DEVELOPMENT

74.40

89.00
90.00

2
2
2
¥1 ................... ...................
1 ................... ...................

Obligated balance, end of year ................................

The Agency for Toxic Substances and Disease Registry
(ATSDR) received appropriations solely from the Hazardous
Substance Superfund trust fund until 2004, when ATSDR
received an appropriation from the general fund, depending
on any available balances from the trust fund. The Budget
proposes that ATSDR’s appropriation come only from the general fund in 2009, without regard to any available balances
in the trust fund.
f

NATIONAL INSTITUTES OF HEALTH
Federal Funds
NATIONAL CANCER INSTITUTE
cprice-sewell on PROD1PC71 with BUDGET PAG

NATIONAL INSTITUTE

437

For carrying out section 301 and title IV of the Public Health
Service Act with respect to cancer, ø$4,890,525,000¿ $4,809,819,000,
of which up to $8,000,000 may be used for facilities repairs and
improvements at the NCI-Frederick Federally Funded Research and
Development Center in Frederick, Maryland. (Department of Health
and Human Services Appropriations Act, 2008.)
NATIONAL HEART, LUNG,

AND

16:43 Jan 24, 2008

Jkt 214754

NATIONAL EYE INSTITUTE
For carrying out section 301 and title IV of the Public Health
Service Act with respect to eye diseases and visual disorders,
ø$678,978,000¿ $667,764,000. (Department of Health and Human
Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

PO 00000

Frm 00015

Fmt 3616

ENVIRONMENTAL HEALTH SCIENCES

For carrying out sections 301 øand 311¿ and title IV of the Public
Health Service Act with respect to environmental health sciences,
ø$653,673,000¿ $642,875,000. (Department of the Health and Human
Services Appropriations Act, 2008.)
For necessary expenses for the National Institute of Environmental
Health Sciences in carrying out activities set forth in section 311(a)
of the Comprehensive Environmental Response, Compensation, and
Liability Act of 1980, as amended, and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, ø$78,775,000¿
$77,546,000. (Department of the Interior, Environment, and Related
Agencies Appropriations Act, 2008.)
NATIONAL INSTITUTE

AGING

For carrying out section 301 and title IV of the Public Health
Service Act with respect to aging, ø$1,065,881,000¿ $1,048,278,000.
(Department of Health and Human Services Appropriations Act,
2008.)
NATIONAL INSTITUTE

BLOOD INSTITUTE

For carrying out section 301 and title IV of the Public Health
Service Act with respect to cardiovascular, lung, and blood diseases,
and blood and blood products, ø$2,974,900,000¿ $2,924,942,000. (Department of Health and Human Services Appropriations Act, 2008.)
VerDate Aug 31 2005

For carrying out section 301 and title IV of the Public Health
Service Act with respect to child health and human development,
ø$1,277,017,000¿ $1,255,920,000. (Department of Health and Human
Services Appropriations Act, 2008.)

ARTHRITIS AND MUSCULOSKELETAL
SKIN DISEASES

AND

For carrying out section 301 and title IV of the Public Health
Service Act with respect to arthritis and musculoskeletal and skin
diseases, ø$517,629,000¿ $509,080,000. (Department of Health and
Human Services Appropriations Act, 2008.)
Sfmt 3616

E:\BUDGET\HHS.XXX

HHS

438

NATIONAL INSTITUTES OF HEALTH—Continued
Federal Funds—Continued

NATIONAL INSTITUTE

THE BUDGET FOR FISCAL YEAR 2009

DEAFNESS AND OTHER COMMUNICATION
DISORDERS

For carrying out section 301 and title IV of the Public Health
Service Act with respect to deafness and other communication disorders, ø$401,146,000¿ $395,047,000. (Department of Health and
Human Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

NURSING RESEARCH

For carrying out section 301 and title IV of the Public Health
Service Act with respect to nursing research, ø$139,920,000¿
$137,609,000. (Department of Health and Human Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

ALCOHOL ABUSE

AND

ALCOHOLISM

For carrying out section 301 and title IV of the Public Health
Service Act with respect to alcohol abuse and alcoholism,
ø$444,016,000¿ $436,681,000. (Department of Health and Human
Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

DRUG ABUSE

For carrying out section 301 and title IV of the Public Health
Service Act with respect to drug abuse, ø$1,018,493,000¿
$1,001,672,000. (Department of Health and Human Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

MENTAL HEALTH

For carrying out section 301 and title IV of the Public Health
Service Act with respect to mental health, ø$1,429,466,000¿
$1,406,841,000. (Department of Health and Human Services Appropriations Act, 2008.)
NATIONAL HUMAN GENOME RESEARCH INSTITUTE
For carrying out section 301 and title IV of the Public Health
Service Act with respect to human genome research, ø$495,434,000¿
$487,878,000. (Department of Health and Human Services Appropriations Act, 2008.)
NATIONAL INSTITUTE

BIOMEDICAL IMAGING

AND

BIOENGINEERING

For carrying out section 301 and title IV of the Public Health
Service Act with respect to biomedical imaging and bioengineering
research, ø$303,955,000¿ $300,254,000. (Department of Health and
Human Services Appropriations Act, 2008.)
NATIONAL CENTER

FOR

COMPLEMENTARY
MEDICINE

AND

ALTERNATIVE

For carrying out section 301 and title IV of the Public Health
Service Act with respect to complementary and alternative medicine,
ø$123,739,000¿ $121,695,000. (Department of Health and Human
Services Appropriations Act, 2008.)
NATIONAL CENTER

MINORITY HEALTH

AND

HEALTH DISPARITIES

For carrying out section 301 and title IV of the Public Health
Service Act with respect to minority health and health disparities
research, ø$203,117,000¿ $199,762,000. (Department of Health and
Human Services Appropriations Act, 2008.)
JOHN E. FOGARTY INTERNATIONAL CENTER

cprice-sewell on PROD1PC71 with BUDGET PAG

For carrying out the activities of the John E. Fogarty International
Center (described in subpart 2 of part E of title IV of the Public
Health Service Act), ø$67,741,000¿ $66,623,000. (Department of
Health and Human Services Appropriations Act, 2008.)
NATIONAL LIBRARY

MEDICINE

For carrying out section 301 and title IV of the Public Health
Service Act with respect to health information communications,
ø$326,669,000¿ $323,046,000, of which $4,000,000 shall be available
until expended for improvement of information systems: Provided,
That in fiscal year ø2008¿ 2009, the National Library of Medicine
may enter into personal services contracts for the provision of services
in facilities owned, operated, or constructed under the jurisdiction
of the National Institutes of Health: Provided further, That in addition to amounts provided herein, $8,200,000 shall be available from
amounts available under section 241 of the Public Health Service
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

PO 00000

Frm 00016

OFFICE

OF THE

DIRECTOR

For carrying out the responsibilities of the Office of the Director,
National Institutes of Health, ø$1,128,819,000¿ $1,056,797,000, of
which up to $25,000,000 shall be used to carry out section ø215¿
214 of this Act: Provided, That funding shall be available for the
purchase of not to exceed 29 passenger motor vehicles for replacement
only: Provided further, That the National Institutes of Health is authorized to collect third party payments for the cost of clinical services
that are incurred in National Institutes of Health research facilities
and that such payments shall be credited to the National Institutes
of Health Management Fund: Provided further, That all funds credited to such Fund shall remain available for one fiscal year after
the fiscal year in which they are deposited: øProvided further, That
$112,872,000 shall be available for continuation of the National Children’s Study:¿ Provided further, That ø$504,420,000¿ $533,877,000
shall be available for the Common Fund established under section
402A(c)(1) of the Public Health Service 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 National Institutes of Healthø: Provided further, That the Office
of AIDS Research within the Office of the Director of the National
Institutes of Health may spend up to $4,000,000 to make grants
for construction or renovation of facilities as provided for in section
2354(a)(5)(B) of the Public Health Service Act¿. (Department of Health
and Human Services Appropriations Act, 2008.)
BUILDINGS

AND

FACILITIES

For the study of, construction of, renovation of, and acquisition
of equipment for, facilities of or used by the National Institutes of
Health, including the acquisition of real property, ø$121,081,000¿
$125,581,000, to remain available until expended. (Department of
Health and Human Services Appropriations Act, 2008.)
Special and Trust Fund Receipts (in millions of dollars)
Identification code 75–9915–0–1–552

2007 actual

2008 est.

2009 est.

01.99

RESEARCH RESOURCES

For carrying out section 301 and title IV of the Public Health
Service Act with respect to research resources and general research
support grants, ø$1,169,884,000¿ $1,160,473,000. (Department of
Health and Human Services Appropriations Act, 2008.)
NATIONAL CENTER

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 Public Health Service Act and related
health services. (Department of Health and Human Services Appropriations Act, 2008.)

Fmt 3616

Balance, start of year .................................................... ................... ................... ...................
Receipts:
02.20 Cooperative Research and Development Agreements,
NIH .............................................................................
22
22
22
04.00

Total: Balances and collections ....................................
Appropriations:
05.00 National Institutes of Health .........................................
07.99

¥22

Balance, end of year ..................................................... ................... ................... ...................

Program and Financing (in millions of dollars)
Identification code 75–9915–0–1–552

2007 actual

Obligations by program activity:
00.01 National Cancer Institute ..............................................
00.02 National Heart, Lung, and Blood Institute ....................
00.03 National Institute of Dental and Craniofacial Research
00.04 National Institute of Diabetes and Digestive and Kidney Disease ...............................................................
00.05 National Institute of Neurological Disorders and Stroke
00.06 National Institute of Allergy and Infectious Diseases
00.07 National Institute of General Medical Sciences ............
00.08 National Institute of Child Health and Human Development .......................................................................
00.09 National Eye Institute ....................................................
00.10 National Institute of Environmental Health Sciences
00.11 National Institute on Aging ...........................................
00.12 National Institute of Arthritis and Musculoskeletal and
Skin Disease ..............................................................
00.13 National Institute on Deafness and Other Communication Disorder ..............................................................
00.14 National Institute of Mental Health ..............................
00.15 National Institute on Drug Abuse ..................................
00.16 Natinal Institute on Alcohol Abuse and Alcoholism
00.17 National Institute of Nursing Research .........................
00.18 National Human Genome Research Institute ................
00.19 National Institute of Biomedical Imaging and Bioengineering ................................................................
Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

2008 est.

2009 est.

4,793
2,922
389

4,805
2,923
390

4,810
2,925
390

1,853
1,533
4,264
1,933

1,856
1,544
4,561
1,936

1,858
1,545
4,569
1,938

1,253
666
726
1,045

1,255
667
720
1,047

1,256
668
720
1,048

507

509

393
1,402
1,002
435
137
508

394
1,405
1,001
436
137
486

395
1,407
1,002
437
138
488

296

299

300

NATIONAL INSTITUTES OF HEALTH—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
00.20
00.21

00.23
00.24
00.25
00.26
00.27
00.28
09.00

National Center for Research Resources .......................
National Center for Complementary and Alternative
Medicine ....................................................................
National Center on Minority Health and Health Disparities ......................................................................
John E. Fogarty International Center .............................
National Library of Medicine .........................................
Office of the Director .....................................................
Buildings and facilities .................................................
Cooperative Research and Development Agreements
Royalties .........................................................................
Reimbursable program ..................................................

10.00

Total new obligations ................................................

31,897

32,423

32,514

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

378
31,925

404
32,422

403
32,514

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

00.22

1,132

1,149

1,160

121

122

32,303
32,826
32,917
¥31,897
¥32,423
¥32,514
¥2 ................... ...................
404

403

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
29,078
29,827
29,307
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥521 ...................
41.00 Transferred to other accounts .......................................
¥198 ................... ...................
42.00 Transferred from other accounts ................................... ...................
1 ...................
43.00
58.00
58.10
58.90

29,307

2,229

2,943

3,035

644 ................... ...................

60.00
60.20
62.50

Appropriation (total mandatory) ...........................

172

70.00

Total new budget authority (gross) ..........................

31,925

32,422

32,514

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
74.40

cprice-sewell on PROD1PC71 with BUDGET PAG

28,880

72.40
73.10
73.20
73.40
74.00

Obligated balance, end of year ................................

2,873

2,943

3,035

150
22

29,575
30,186
30,911
31,897
32,423
32,514
¥30,849
¥31,698
¥32,411
¥279 ................... ...................
¥644 ................... ...................
486 ................... ...................
30,186

30,911

31,014

86.90
86.93
86.97
86.98

9,831
20,855
40
123

10,381
21,151
41
125

10,419
21,821
41
130

87.00

Total outlays (gross) .................................................

30,849

31,698

32,411

¥2,621
¥2,943
¥3,035
¥90 ................... ...................

88.90

¥2,711

88.95
88.96

16:43 Jan 24, 2008

Jkt 214754

DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT
[Dollars in millions]
2007

199
200
200
66
67
67
321
321
323
1,047
1,109
1,056
89
119
126
19
22
22
76 ................... ...................
2,770
2,943
3,035

¥2,943

¥3,035

¥644 ................... ...................
482 ................... ...................

29,052
28,138
PO 00000

29,479
28,755

29,479
29,376

Frm 00017

Fmt 3616

439

Distribution of budget authority by account:
National Cancer Institute .......................................................
National Heart, Lung, and Blood Institute .............................
National Institute of Dental and Craniofacial Research .......
National Institute of Diabetes and Digestive and Kidney
Diseases .............................................................................
National Institute of Neurological Disorder and Stroke .........
National Institute of Allergy and Infectious Diseases ...........
National Institute of General Medical Sciences .....................
Eunice Kennedy Shriver National Institute of Child Health
and Human Development ...................................................
National Eye Institute .............................................................
National Institute of Environmental Health Sciences ............
National Institute on Aging ....................................................
National Institute of Arthritis and Musculoskeletal and Skin
Diseases .............................................................................
National Institute on Deafness and Other Communication
Disorders .............................................................................
National Institute of Nursing Research ..................................
National Institute on Alcohol Abuse and Alcoholism .............
National Institute on Drug Abuse ...........................................
National Institute of Mental Health .......................................
National Center for Research Resources ................................
National Human Genome Research Institute .........................
National Institute of Biomedical Imaging and Bioengineering .........................................................................
National Center for Complementary and Alternative Medicine .....................................................................................
National Center for Minority Health and Health Disparities
John E. Fogarty International Center ......................................
National Library of Medicine ..................................................
Office of the Director ..............................................................
Buildings and facilities ..........................................................

2008

2009

4,793
2,922
389

4,805
2,923
390

4,810
2,925
390

1,853
1,533
4,264
1,933

1,856
1,544
4,561
1,936

1,858
1,545
4,569
1,938

1,253
666
726
1,045

1,255
667
720
1,047

1,256
668
720
1,048

507

509

393
137
435
1,002
1,402
1,132
508

394
137
436
1,001
1,405
1,149
486

395
138
437
1,002
1,407
1,160
488

296

299

300

121
199
66
321
1,047
89

122
200
66
321
1,109
119

122
200
67
323
1,056
126

Subtotal ..........................................................................
Cooperative Research and Development Agreements ............

29,032
19

29,457
22

Total Budget Authority, NIH ...........................................

29,051

29,479

[Dollars in millions]
2007

Distribution of outlays by account:
National Cancer Institute .......................................................
National Heart, Lung, and Blood Institute .............................
National Institute of Dental and Craniofacial Research .......
National Institute of Diabetes and Digestive and Kidney
Diseases .............................................................................
National Institute of Neurological Disorders and Stroke .......
National Institute of Allergy and Infectious Diseases ...........
National Institute of General Medical Sciences .....................
Eunice Kennedy Shriver National Institute of Child Health
and Human Development ...................................................
National Eye Institute .............................................................
National Institute of Environmental Health Sciences ............
National Institute on Aging ....................................................
National Institute of Arthritis and Musculoskeletal and Skin
Diseases .............................................................................
National Institute on Deafness and Other Communication
Disorders .............................................................................
National Institute of Nursing Research ..................................
National Institute on Alcohol Abuse and Alcoholism .............
National Institute on Drug Abuse ...........................................
National Institute of Mental Health .......................................
National Center for Research Resources ................................
National Human Genome Research Institute .........................
National Institute of Biomedical Imaging and Bioengineering .........................................................................
National Center for Complementary and Alternative Medicine .....................................................................................
National Center for Minority Health and Health Disparities
John E. Fogarty International Center ......................................
National Library of Medicine ..................................................
Office of the Director ..............................................................
Buildings and Facilities ..........................................................
Service and Supply Fund/Management Fund .........................

2008

2009

4,634
2,843
386

4,782
2,861
372

4,758
2,924
390

1,783
1,533
4,292
1,904

1,786
1,482
4,234
1,888

1,857
1,544
4,504
1,937

1,237
640
700
1,014

1,270
675
714
1,055

1,257
668
720
1,049

498

505

509

380
136
423
961
1,374
1,141
457

382
135
439
1,005
1,345
1,046
541

395
138
437
991
1,406
1,147
488

294

296

299

118
193
66
307
696
175
–67

118
190
67
329
1,048
170
0

122
200
67
322
1,063
164
0

Subtotal Outlays ............................................................
Cooperative Research and Development Agreements ............

28,118
20

28,735
20

29,356
20

Total Outlays, NIH ..........................................................

28,138

28,755

29,376

This program funds biomedical research and research training. These accounts will continue to be appropriated sepaSfmt 3616

E:\BUDGET\HHS.XXX

HHS

440

NATIONAL INSTITUTES OF HEALTH—Continued
Federal Funds—Continued

BUILDINGS

AND

THE BUDGET FOR FISCAL YEAR 2009

FACILITIES—Continued

rately, 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

11.1
11.3
11.5
11.7
11.8
11.9
12.1
12.2
21.0
22.0
23.2
23.3

2007 actual

2008 est.

2009 est.

853
242
48
25
173

901
257
38
26
177

942
269
40
28
182

1,341
310
17
56
6
1

1,399
327
18
56
6
1

1,461
342
19
54
6
1

29
12
133
522

29
12
125
506

29
11
124
495

25.4
25.5
25.6
25.7
26.0
31.0
41.0

Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Travel and transportation of persons .......................
Transportation of things ...........................................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................
Printing and reproduction .........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of facilities ..................
Research and development contracts .......................
Medical care ..............................................................
Operation and maintenance of equipment ...............
Supplies and materials .............................................
Equipment .................................................................
Grants, subsidies, and contributions ........................

2,621
213
2,175
21
85
220
160
21,207

2,680
245
2,442
20
85
209
147
21,173

2,693
251
2,361
20
84
205
145
21,178

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

29,129
2,768

29,480
2,943

29,479
3,035

24.0
25.1
25.2
25.3

99.9

Total new obligations ................................................

31,897

32,423

32,514

Employment Summary
Identification code 75–9915–0–1–552

2007 actual

2008 est.

2009 est.

cprice-sewell on PROD1PC71 with BUDGET PAG

400
1,699
79
114
60
34

263

299

155

193

194

158

396

326

3,234
122
146

3,025
133
143

10.00

Total new obligations ................................................

3,463

3,502

3,301

22.00
23.95
23.98

3,467
3,502
3,301
¥3,463
¥3,502
¥3,301
¥4 ................... ...................

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
3,206
40.33
Appropriation permanently reduced (P.L. 110–161) ...................

3,292
3,025
¥58 ...................

3,206

3,234

3,025

216

268

276

5,054
134

58.00
58.10

58.90

Fmt 3616

400
1,680
75
102
53
35

395

5,026
134

Frm 00018

407
1,679
77
104
54
34

3,206
121
136

4,843
120

PO 00000

2009 est.

Total, direct program ................................................
Reimbursable program: PHS Evaluation .......................
Reimbursable program ..................................................

.....................
.....................

Jkt 214754

2008 est.

01.00
09.02
09.49

43.00

For carrying out titles V and XIX of the Public Health Service
Act (‘‘PHS Act’’) with respect to substance abuse and mental health
services, and the Protection and Advocacy for Individuals with Mental
Illness Act, øand section 301 of the PHS Act with respect to program
management, $3,291,543,000, of which $19,120,000 shall be available
for the projects and in the amounts specified in the explanatory
statement described in section 4 (in the matter preceding division
A of this consolidated Act)¿ $3,024,967,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated
for carrying out section 520A are available for carrying out section
1971 of the PHS Act: Provided further, That $18,869,000 shall be
available for such purposes under section 1921 of the PHS Act for
supplemental performance awards for grant recipients that have demonstrated superior performance as determined by the Secretary: Provided further, That in addition to amounts provided herein, the following amounts shall be available under section 241 of the PHS
Act: (1) ø$79,200,000¿ $79,200,000 to carry out subpart II of part
B of title XIX of the PHS Act to fund section 1935(b) technical
assistance, national data, data collection and evaluation activities,
16:43 Jan 24, 2008

Obligations by program activity:
Mental health block grant .............................................
Substance abuse block grant ........................................
Program management ...................................................
Children’s mental health ...............................................
PATH homeless State grants .........................................
Protection and advocacy ................................................
Mental health programs of regional and national significance ....................................................................
00.18 Prevention programs of regional and national significance .........................................................................
00.19 Treatment programs of regional and national significance .........................................................................

11,857
204

MENTAL HEALTH SERVICES

2007 actual

00.02
00.03
00.05
00.10
00.11
00.12
00.13

11,769
204

Federal Funds

VerDate Aug 31 2005

Identification code 75–1362–0–1–551

11,756
273

SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION
AND

Program and Financing (in millions of dollars)

.....................
.....................

SUBSTANCE ABUSE

and further that the total available under this Act for section 1935(b)
activities shall not exceed 5 percent of the amounts appropriated
for subpart II of part B of title XIX; (2) ø$21,413,000¿ $21,039,000
to carry out subpart I of part B of title XIX of the PHS Act to
fund section 1920(b) technical assistance, national data, data collection and evaluation activities, and further that the total available
under this Act for section 1920(b) activities shall not exceed 5 percent
of the amounts appropriated for subpart I of part B of title XIX;
(3) ø$17,750,000¿ $21,750,000 to carry out national surveys on drug
abuse; and (4) ø$4,300,000¿ $11,192,000 to collect and analyze data
and evaluate substance abuse treatment programsø: Provided further,
That section 520E(b)(2) of the Public Health Service Act shall not
apply to funds appropriated under this Act for fiscal year 2008¿.
(Department of Health and Human Services Appropriations Act,
2008.)

70.00

45 ................... ...................

Spending authority from offsetting collections
(total discretionary) ..........................................

261

268

276

Total new budget authority (gross) ..........................

3,467

3,502

3,301

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.40
74.00

2,588
2,588
2,559
3,463
3,502
3,301
¥3,397
¥3,531
¥3,422
¥31 ................... ...................
¥45 ................... ...................
10 ................... ...................

74.40

Obligated balance, end of year ................................

2,588

2,559

2,438

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

1,409
1,988

1,561
1,970

1,486
1,936

87.00

Total outlays (gross) .................................................

3,397

3,531

3,422

¥218

¥268

¥276

E:\BUDGET\HHS.XXX

HHS

¥45 ................... ...................

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
88.96

Portion of offsetting collections (cash) credited to
expired accounts ...................................................

Program and Financing (in millions of dollars)
2 ................... ...................
Identification code 75–1700–0–1–552

3,206
3,179

3,234
3,263

3,025
3,146

This program provides Federal support to strengthen the
capacity of the Nation’s health care delivery system to provide
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 address the needs of individuals with substance
abuse disorders and/or mental illness and to identify and
respond to the community risk factors that contribute to these
illnesses.
Object Classification (in millions of dollars)
Identification code 75–1362–0–1–551

11.1
11.3
11.5
11.7
11.9
12.1
12.2
21.0
23.1
23.3

2007 actual

2008 est.

2009 est.

39
3
1
2

40
3
1
3

41
3
1
4

45
10
1
2
6

47
11
2
1
6

49
11
2
1
6

1
4
10
143

1
4
11
148

1
2
9
90

25.4
26.0
41.0
42.0

154
9
1
2,818
2

160
9
1
2,832
1

98
5
1
2,749
1

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

3,206
257

3,234
268

3,025
276

99.9

Total new obligations ................................................

3,463

3,502

3,301

Employment Summary
Identification code 75–1362–0–1–551

2007 actual

2008 est.

441
31

447
31

441
31

.....................
.....................

36
20

cprice-sewell on PROD1PC71 with BUDGET PAG

HEALTHCARE RESEARCH

AND

27
326

10.00

Total new obligations ................................................

346

362

353

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

17
339

10
362

10
353

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

356
¥346

372
¥362

363
¥353

24.40

Unobligated balance carried forward, end of year

362

353

New budget authority (gross), detail:
Discretionary:
Spending authority from offsetting collections:
58.00
Offsetting collections (cash) ................................
58.10
Change in uncollected customer payments from
Federal sources (unexpired) .............................
Spending authority from offsetting collections
(total discretionary) ..........................................

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.40
74.00

74.40

86.90
86.93

Obligated balance, end of year ................................

87.00

Total outlays (gross) .................................................

89.00
90.00

For carrying out titles III and IX of the Public Health Service
Act, øand¿ part A of title XI of the Social Security Act, and section
1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, amounts received from Freedom of Information
Act fees, reimbursable and interagency agreements, and the sale of
data shall be credited to this appropriation and shall remain available
until expended: Provided, That the amount made available pursuant
to section 937(c) of the Public Health Service Act shall not exceed
ø$334,564,000¿ $325,664,000.
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309 ................... ...................
339

362

353

45
¥88 ...................
346
362
353
¥323
¥274
¥353
¥7 ................... ...................
¥309 ................... ...................
160 ................... ...................
¥88 ................... ...................

Outlays (gross), detail:
Outlays from new discretionary authority .....................
323
Outlays from discretionary balances ............................. ...................

362
353
¥88 ...................

323

274

353

¥187

¥362

¥353

¥309 ................... ...................
157 ................... ...................

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

QUALITY

2009 est.

27
335

AGENCY FOR HEALTHCARE RESEARCH AND
QUALITY
Federal Funds

2008 est.

27
319

2009 est.

.....................
.....................

2007 actual

Obligations by program activity:
09.01 Reimbursable program ..................................................
09.02 Reimbursable program: PHS evaluation ........................

58.90

24.0
25.1
25.2
25.3

441

2007 actual

2008 est.

2009 est.

99.0

Reimbursable obligations ..........................................

346

362

353

99.9

Total new obligations ................................................

346

362

353

Employment Summary
Identification code 75–1700–0–1–552

2001
2101

2007 actual

Reimbursable:
Civilian full-time equivalent employment .....................
Military full-time equivalent employment .....................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

281
14

2008 est.

285
14

2009 est.

286
14

442

CENTERS FOR MEDICARE AND MEDICAID SERVICES
Federal Funds

THE BUDGET FOR FISCAL YEAR 2009
Summary of Budget Authority and Outlays

CENTERS FOR MEDICARE AND MEDICAID
SERVICES

(in millions of dollars)
2007 actual

Federal Funds
GRANTS

STATES

FOR

MEDICAID

For carrying out, except as otherwise provided, titles XI and XIX
of the Social Security Act, ø$141,628,056,000¿ $149,335,031,000, to
remain available until expended.
For making, after May 31, ø2008¿ 2009, payments to States under
title XIX of the Social Security Act for the last quarter of fiscal
year ø2008¿ 2009 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 ø2009, $67,292,669,000¿ 2010,
$71,700,038,000, to remain available until expended.
Payment under title XIX may be made for any quarter with respect
to a State plan or plan amendment in effect during such quarter,
if submitted in or prior to such quarter and approved in that or
any subsequent quarter. (Department of Health and Human Services
Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–0512–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Medicaid vendor payments ............................................
00.02 State and local administration .....................................
00.03 Vaccines for Children ....................................................
00.04 Incurred by providers but not yet reported ...................
09.01 Medicare Part B premiums ............................................
09.02 Vaccines for Children collections ..................................

189,318
190,926
204,468
11,086
10,125
10,303
2,736
2,702
2,766
1,614
3,000
3,232
359
300 ...................
1 ................... ...................

10.00

Total new obligations (object class 41.0) ................

205,114

207,053

220,769

21.40
22.00
22.10

26,586
168,615

4,008
207,186

4,141
216,628

Enacted/requested:
Budget Authority .....................................................................
Outlays ....................................................................................
Legislative proposal, not subject to PAYGO:
Budget Authority .....................................................................
Outlays ....................................................................................
Legislative proposal, subject to PAYGO:
Budget Authority .....................................................................
Outlays ....................................................................................
Total:
Budget Authority .....................................................................
Outlays ....................................................................................

Total budgetary resources available for obligation
Total new obligations ....................................................

209,122
¥205,114

24.40

Unobligated balance carried forward, end of year

4,008

211,194
¥207,053

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................
65.00
Advance appropriation ..............................................
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

105,471
62,784

70.00

Total new budget authority (gross) ..........................

168,615

72.40
73.10
73.20
73.45

74.40

Obligated balance, end of year ................................

20,236

23,236

26,468

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

168,615
22,369

200,045
4,008

213,396
4,141

87.00

Total outlays (gross) .................................................

190,984

204,053

217,537

360

141,628
65,258

149,335
67,293

300 ...................
207,186

168,255
190,624

206,886
203,753

216,628
217,537

....................
....................

–105
–105

–270
–270

....................
....................

140
140

–1,605
–1,605

168,255
190,624

206,921
203,788

214,753
215,662

Vaccines for Children
(in millions)
Obligations

2007

2008

2009

Vaccine Purchase ........................................................................
Vaccine Stockpile ........................................................................
Operations ...................................................................................
Evaluation Activities ....................................................................

2477
145
78
36

2369
221
75
37

2451
215
62
38

Total Obligations .....................................................................

2736

2702

2766

GRANTS

STATES

FOR

MEDICAID

(Legislative proposal, not subject to PAYGO)

220,769
¥220,769

4,141 ...................

2009 est.

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.

13,921 ................... ...................

23.90
23.95

2008 est.

Program and Financing (in millions of dollars)
Identification code 75–0512–2–1–551

2007 actual

2008 est.

2009 est.

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

¥105

¥270

Net budget authority and outlays:
Budget authority ............................................................ ...................
Outlays ........................................................................... ...................

¥105
¥105

¥270
¥270

89.00
90.00

216,628

20,027
20,236
23,236
205,114
207,053
220,769
¥190,984 ¥204,053 ¥217,537
¥13,921 ................... ...................

This schedule reflects the Administration’s Medicaid proposals.
GRANTS

STATES

FOR

MEDICAID

(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 75–0512–4–1–551

Obligations by program activity:
Administrative Services Reforms ...................................
Reimbursement Reforms ................................................
Pharmacy Reforms .........................................................
Program Integrity Reforms .............................................
Long Term Care Reforms ...............................................
Managed Care Reforms .................................................
Statutory modifications ..................................................
Other Proposals ..............................................................
Medicare Part B premiums ............................................

2007 actual

2008 est.

2009 est.

...................
...................
...................
...................
...................
...................
...................
...................
...................

...................
...................
...................
...................
...................
...................
35
...................
105

¥1,230
¥770
¥195
¥127
¥100
¥100
485
162
270

¥359
¥300 ...................
¥1 ................... ...................

00.01
00.02
00.03
00.04
00.05
00.06
00.07
00.08
09.01

88.90

Total, offsetting collections (cash) .......................

¥360

10.00

Total new obligations (object class 41.0) ................ ...................

140

¥1,605

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

168,255
190,624

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................ ...................
Total new obligations .................................................... ...................

140
¥140

¥1,605
1,605

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¥300 ...................

206,886
203,753

216,628
217,537

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HHS

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ...................
69.00
Spending authority from offsetting collections: Offsetting collections (cash) ..................................... ...................

70.00

Total new budget authority (gross) .......................... ...................

¥1,875

Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Recoveries of prior year obligations ..............................

105

270

74.40

Obligated balance, end of year ................................

686

616

535

140

¥1,605
86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

8
1,267

348
581

278
581

87.00

Total outlays (gross) .................................................

1,275

929

859

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

698
1,275

764
929

527
859

140
¥140

¥1,605
1,605

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ...................

140

¥1,605

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

¥1,275
¥929
¥859
¥22 ................... ...................
¥320
¥1 ...................

73.20
73.40
73.45

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

86.97

443

140
140

¥1,605
¥1,605

Summary of Budget Authority and Outlays

This schedule reflects the Administration’s Medicaid proposals.

(in millions of dollars)
2007 actual

STATE GRANTS

AND

DEMONSTRATIONS

Program and Financing (in millions of dollars)
Identification code 75–0516–0–1–551

2007 actual

Obligations by program activity:
00.01 Ticket to work—grants ..................................................
00.02 High risk pools—grants ................................................
00.03 Emergency health services for undocumented aliens
00.04 Background checks pilot program .................................
00.08 Medicaid integrity program ...........................................
00.10 Funding for PACE outliers .............................................
00.11 Drug surveys & reports ..................................................
00.12 Partnerships for long term care ....................................
00.13 Grants to establish alternate non-emergency services
00.14 Psychiatric residential treatment demonstration ..........
00.15 Money follows the person (MFP) demonstration ...........
00.16 MFP evaluations & technical support ...........................
00.17 Medicaid transformation grants ....................................
00.19 Katrina relief ..................................................................
09.11 Reimbursable program-Katrina/Rita hurricane support

2008 est.

Total new obligations ................................................

Total:
Budget Authority .....................................................................
Outlays ....................................................................................

652
934

cprice-sewell on PROD1PC71 with BUDGET PAG

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

860

320

759
764

1 ...................

22 ................... ...................

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

1,675
¥899
¥17

24.40

Unobligated balance carried forward, end of year

759

1,524
1,164
¥860
¥778
¥27 ...................
637

386

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation (Ticket to Work) ..................................
43
44
45
60.00
Appropriation (Emergency health services for undocumented aliens) ..............................................
250
250 ...................
60.00
Appropriation (Katrina relief) .................................... ................... ................... ...................
60.00
Appropriation (Federal upper payment Limit for
multiple source drugs) .........................................
5
5
5
60.00
Appropriation (Expansion of long term care partnerships) ....................................................................
3
3
3
60.00
Appropriation (Psychiatric residential treatment
demonstration) ......................................................
22
37
49
60.00
Appropriation (Money follows the person (MFP)
demonstration) ......................................................
248
299
349
60.00
Appropriation (MFP evaluation) .................................
2
1
1
60.00
Appropriation (Medicaid transformation grants) ......
75
75 ...................
60.00
Appropriation (Medicaid integrity program) ..............
50
50
75
62.50

Appropriation (total mandatory) ...........................

698

764

527

Change in obligated balances:
72.40 Obligated balance, start of year ...................................
73.10 Total new obligations ....................................................

1,404
899

686
860

616
778

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764
929

Object Classification (in millions of dollars)

778

637
527

698
1,275

State Grants and Demonstrations provides funding for
grant programs established under several legislative authorities, including the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L.
108–173), and the Deficit Reduction Act of 2005 (P.L. 109–
171).

11.1
635
698

527
859

2009 est.

73
42
46
2 ................... ...................
220
225
250
...................
1 ...................
51
50
75
...................
5
3
...................
3
3
3
3
3
...................
50 ...................
21
37
49
45
348
348
1
2
1
75
75 ...................
371
19 ...................
37 ................... ...................
899

2009 est.

125
75

Identification code 75–0516–0–1–551

10.00

2008 est.

Enacted/requested:
Budget Authority .....................................................................
698
764
Outlays ....................................................................................
1,275
929
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................

12.1
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0
41.0

2007 actual

Direct obligations:
Personnel compensation: Full-time permanent—
Medicaid Integrity Program ..................................
Civilian personnel benefits—Medicaid Integrity Program ......................................................................
Grants, subsidies, and contributions—Ticket to
Work ......................................................................
Grants, subsidies, and contributions—High-Risk
Pools ......................................................................
Grants, subsidies, and contributions—Fed’l
Reimb.—Emer Svcs, Undoc. Aliens .....................
Grants, subsidies, and contributions—Background
Checks ...................................................................
Grants, subsidies, and contributions—Medicaid Integrity Program .....................................................
Grants, subsidies, and contributions—Funding for
PACE Outliers ........................................................
Grants, subsidies, and contributions—Drug Surveys
& Reports ..............................................................
Grants, subsidies, and contributions—Partnership
for Long Term Care ...............................................
Grants, subsidies, and contributions—Alternate
Non-Emergency Network Providers .......................
Grants, subsidies, and contributions—Psychiatric
Residential Treatment Demonstration ..................
Grants, subsidies, and contributions—Money follows the Person (MFP) Demonstration .................
Grants, subsidies, and contributions—MFP Evaluations & Technical Support ....................................
Grants, subsidies, and contributions—Medicaid
Transformation Grants ..........................................
Grants, subsidies, and contributions—Katrina Relief .........................................................................

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

99.9

Total new obligations ................................................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

2008 est.

2009 est.

2 ................... ...................
220
...................

225

250

1 ...................

...................

50 ...................

348

75 ...................

371

19 ...................

862
860
778
37 ................... ...................
899

860

778

444

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

STATE GRANTS

AND

THE BUDGET FOR FISCAL YEAR 2009

DEMONSTRATIONS—Continued

Balance Sheet (in millions of dollars)

Employment Summary
Identification code 75–0516–0–1–551

Identification code 75–4438–0–3–551
2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

STATE GRANTS

AND

2008 est.

2009 est.

100

DEMONSTRATIONS

(Legislative proposal, subject to PAYGO)

2006 actual

ASSETS:
Net value of assets related to post–1991 direct loans receivable:
1401 Direct loans receivable, gross ....................................................
1402 Interest receivable ........................................................................
1405 Allowance for subsidy cost (–) ..................................................

2007 actual

140
7
–147

1499

Net present value of assets related to direct loans ..............

....................

1999

Total assets ..................................................................................

....................

Program and Financing (in millions of dollars)
f
Identification code 75–0516–4–1–551

2007 actual

2008 est.

2009 est.

00.01
00.02

Obligations by program activity:
High risk pools ............................................................... ................... ...................
Outreach grants ............................................................. ................... ...................

75
50

10.00

Total new obligations ................................................ ................... ...................

125

22.00
23.95

125
¥125

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation—High risk pools ................................ ................... ...................
60.00
Appropriation—Outreach grants ............................... ................... ...................

75
50

62.50

Appropriation (total mandatory) ........................... ................... ...................

PAYMENTS

HEALTH CARE TRUST FUNDS

For payment to the Federal Hospital Insurance and the Federal
Supplementary Medical Insurance Trust Funds, as provided under
section s 217(g), 1844 and 1860D–16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965,
section 278(d) of Public Law 97–248, and for administrative expenses
incurred pursuant to section 201(g) of the Social Security Act,
ø$188,445,000,000¿ $195,308,000,000.
In addition, for making matching payments under section 1844,
and benefit payments under section 1860D–16 of the Social Security
Act, not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations
Act, 2008.)
Program and Financing (in millions of dollars)

125

Identification code 75–0580–0–1–571

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

125
¥75

74.40

Obligated balance, end of year ................................ ................... ...................

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................ ................... ...................
Outlays ........................................................................... ................... ...................

125
75

This schedule reflects the Administration’s State Grants
and Demonstrations proposals.
Object Classification (in millions of dollars)
Identification code 75–0516–4–1–551

2007 actual

2008 est.

2009 est.

Direct obligations:
41.0 Grants, subsidies, and contributions—High Risk Pools ................... ...................
41.0 Grants, subsidies, and contributions—Outreach
Grants ........................................................................ ................... ...................
99.9

Total new obligations ................................................ ................... ...................

75
50
125

2007 actual

2008 est.

Obligations by program activity:
00.01 Supplementary medical insurance (SMI) .......................
137,822
144,399
00.02 Part D Benefits (Rx Drug) .............................................
40,333
36,024
00.03 Part D Federal Administration (Rx Drug) ......................
615
608
00.04 Hospital insurance for uninsured (HI) ...........................
239
269
00.05 Federal uninsured payment (HI) ....................................
229
237
00.06 General Fund portion of administrative costs (HI) .......
175
192
00.07 General fund portion of HCFAC ..................................... ................... ...................
00.08 Quinquennial Adjustment .............................................. ................... ...................
00.10 Federal payments from taxation of OASDI benefits
(HI) .............................................................................
10,593
12,453
00.11 Criminal fines (HCFAC) ..................................................
201
200
00.12 Civil monetary penalties and damages—DOJ admin.
(HCFAC) .....................................................................
7
10
00.13 FBI (HCFAC) ...................................................................
118
121
194,513

2009 est.

147,716
44,999
547
351
263
206
198
1,028
14,072
200
10
125

10.00

Total new obligations ................................................

190,332

209,715

22.00
23.95
23.98

199,309
¥190,332
¥8,977

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation (definite, annual) ................................
60.00
Appropriation (permanent) ........................................
60.00
Appropriation (HCFAC for FBI) ..................................

188,390
10,801
118

188,445
12,663
121

195,308
14,282
125

62.50

Appropriation (total mandatory) ...........................

199,309

201,229

209,715

73.10
73.20
73.40

Change in obligated balances:
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................

190,332
194,513
209,715
¥190,743 ¥194,513 ¥209,715
411 ................... ...................

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

190,332
194,513
209,715
411 ................... ...................

87.00

Total outlays (gross) .................................................

190,743

194,513

209,715

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

199,309
190,743

201,229
194,513

209,715
209,715

201,229
209,715
¥194,513 ¥209,715
¥6,716 ...................

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HEALTH CARE INFRASTRUCTURE IMPROVEMENT PROGRAM, DIRECT
LOAN FINANCING ACCOUNT
Status of Direct Loans (in millions of dollars)
Identification code 75–4438–0–3–551

1210
1231
1264
1290

2007 actual

2008 est.

2009 est.

Cumulative balance of direct loans outstanding:
Outstanding, start of year .............................................
140
140
140
Disbursements: Direct loan disbursements ................... ................... ................... ...................
Write-offs for default: Loan forgiveness ....................... ................... ................... ...................
Outstanding, end of year ..........................................

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HHS

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PROGRAM MANAGEMENT

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

2008 est.

Enacted/requested:
Budget Authority .....................................................................
199,309
201,229
Outlays ....................................................................................
190,743
194,513
Legislative proposal, not subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................
Total:
Budget Authority .....................................................................
Outlays ....................................................................................

199,309
190,743

201,229
194,513

2009 est.

209,715
209,715
–1,804
–1,804

207,911
207,911

Payments are made to the Federal Hospital Insurance and
Federal Supplementary Medical Insurance trust funds from
the general fund of the Treasury to finance Medicare’s medical and drug benefits for beneficiaries and certain other
qualified individuals. In addition, 2009 includes funds to pay
the Federal Hospital Insurance Trust Fund for the quinquennial adjustments for FICA tax equivalents related to military
service deemed wage credits.
Object Classification (in millions of dollars)
Identification code 75–0580–0–1–571

2007 actual

2008 est.

2009 est.

Direct obligations:
41.0 Grants, subsidies, and contributions ............................
42.0 Insurance claims and indemnities ................................
94.0 Financial transfers (Federal admin) ..............................

189,074
468
790

193,207
506
800

208,357
614
744

99.0

Direct obligations ......................................................

190,332

194,513

209,715

99.9

Total new obligations ................................................

190,332

194,513

209,715

PAYMENTS

HEALTH CARE TRUST FUNDS

(Legislative proposal, not subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 75–0580–2–1–571

00.01
00.02

2007 actual

2008 est.

Obligations by program activity:
Supplementary medical insurance (SMI) ....................... ................... ...................
Part D Benefits (Rx Drug) ............................................. ................... ...................

For carrying out, except as otherwise provided, titles XI, XVIII,
XIX, and XXI of the Social Security Act, titles XIII and XXVII of
the Public Health Service Act, and the Clinical Laboratory Improvement Amendments of 1988, not to exceed ø$3,207,690,000¿
$3,307,344,000, to be transferred from the Federal Hospital Insurance
and the Federal Supplementary Medical Insurance Trust Funds, as
authorized by section 201(g) of the Social Security Act; together with
all funds collected in accordance with section 353 of the Public Health
Service Act and section 1857(e)(2) of the Social Security Act, funds
retained by the Secretary pursuant to section 302 of the Tax Relief
and Health Care Act of 2006; and such sums as may be collected
from authorized user fees and the sale of data, which shall be credited
to this account and remain available until expended: Provided, That
all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the Public Health Service Act
shall be credited to and available for carrying out the purposes of
this appropriation: Provided further, That ø$45,000,000¿ $35,700,000,
to remain available until September 30, ø2009¿ 2010, is for contract
costs for the Healthcare Integrated General Ledger Accounting System: Provided further, That ø$193,000,000¿ $108,900,000, to remain
available until September 30, ø2009¿ 2010, is for CMS Medicare
contracting reform activities: Provided further, That funds appropriated under this heading are available for the Healthy Start, Grow
Smart program under which the Centers for Medicare and Medicaid
Services may, directly or through grants, contracts, or cooperative
agreements, produce and distribute informational materials including,
but not limited to, pamphlets and brochures on infant and toddler
health care to expectant parents enrolled in the Medicaid program
and to parents and guardians enrolled in such program with infants
and children: Provided further, That the Secretary of Health and
Human Services is directed to collect fees in fiscal year ø2008¿ 2009
from Medicare Advantage organizations pursuant to section 1857(e)(2)
of the Social Security Act and from eligible organizations with risksharing contracts under section 1876 of that Act pursuant to section
1876(k)(4)(D) of that Actø:¿ øProvided further, That $5,007,000 shall
be available for the projects and in the amounts specified in the
explanatory statement described in section 4 (in the matter preceding
division A of this consolidated Act)¿. (Department of Health and
Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

2009 est.

Identification code 75–0511–0–1–550

¥1,454
¥350

10.00

Total new obligations (object class 41.0) ................ ................... ...................

¥1,804

22.00
23.95

¥1,804
1,804

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation (Subsidy for HI & SMI benefits, General Fund federal admin) ..................................... ................... ...................
¥1,454
60.00
Appropriation (Part D Drug Benefits) ....................... ................... ...................
¥350
60.00
Appropriation (HCFAC for FBI) .................................. ................... ................... ...................

cprice-sewell on PROD1PC71 with BUDGET PAG

445

00.01
00.02
00.03
00.04
00.05
00.06

2007 actual

Obligations by program activity:
Direct program:
Medicare operations ..................................................
2,175
Federal administration ..............................................
642
State survey and certification ...................................
258
Research, demonstrations, and evaluation projects
63
Revitalization plan ....................................................
22
High-Risk Pools ......................................................... ...................

01.00
09.01
09.03
09.04
09.06

Total direct program .................................................
CLIA ................................................................................
Other reimbursements ...................................................
Coordination of benefits ................................................
MA/PDP ...........................................................................

3,160
44
89
32
58

2008 est.

2009 est.

2,377
2,340
631
643
281
293
32
31
5 ...................
49 ...................
3,375
43
4
32
62

3,307
43
4
66
65

09.09

Total reimbursable program ......................................

223

141

178

62.50

Appropriation (total mandatory) ........................... ................... ...................

¥1,804

10.00

Total new obligations ................................................

3,383

3,516

3,485

73.10
73.20

¥1,804
1,804

21.40
22.00
22.10

116
3,469

207
3,408

99
3,485

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

¥1,804

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

89.00
90.00

23.90
23.95
23.98

¥1,804
¥1,804

24.40

Unobligated balance carried forward, end of year

The Budget includes a package of reforms that encourage
competition and efficiency, promote high quality care, rationalize payments, improve program integrity, enhance fiscal
sustainability, and strengthen responsibility for health care
choices.
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12 ................... ...................
3,597
3,615
3,584
¥3,383
¥3,516
¥3,485
¥7 ................... ...................
207

New budget authority (gross), detail:
Discretionary:
Spending authority from offsetting collections:
58.00
Offsetting collections (cash) ................................
2,256
3,152
3,307
58.00
Offsetting collections (cash) ................................ ...................
141
178
58.10
Change in uncollected customer payments from
Federal sources (unexpired) .............................
1,114 ................... ...................
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HHS

446

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009
11.3
11.5
11.7

PROGRAM MANAGEMENT—Continued
Program and Financing (in millions of dollars)—Continued
Identification code 75–0511–0–1–550

58.90

60.00
69.00
69.10
69.90
70.00

2007 actual

2008 est.

2009 est.

Spending authority from offsetting collections
(total discretionary) ..........................................
3,370
3,293
3,485
Mandatory:
Appropriation ............................................................. ...................
60 ...................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................ ...................
55 ...................
Change in uncollected customer payments from
Federal sources (unexpired) .............................
99 ................... ...................
Spending authority from offsetting collections
(total mandatory) .............................................

Total new budget authority (gross) ..........................

3,469

74.40

Obligated balance, end of year ................................

86.90
86.93
86.97
86.98

87.00

Total outlays (gross) .................................................

55 ...................
3,408

3,485

¥94
¥179
¥71
3,383
3,516
3,485
¥3,062
¥3,408
¥3,485
¥41 ................... ...................
¥12 ................... ...................
¥1,213 ................... ...................
860 ................... ...................
¥179

¥71

3,062

3,408

3,485

¥3,307
¥178

88.90

¥3,057

¥3,348

¥3,485

89.00
90.00

24.0
25.1
25.2
25.3
25.4
25.5
25.6
25.7
26.0
31.0
32.0
41.0

13
6
8

14
6
8

411
419
94
99
4
4
8
7
................... ...................
26
27
2
2
2
3
................... ...................
112
112
3
...................
...................
2,638
...................
1
...................
10
64

3
...................
...................
2,613
...................
1
...................
10
7

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

3,160
223

3,375
141

3,307
178

99.9

Total new obligations ................................................

3,383

3,516

3,485

Employment Summary
2007 actual

2008 est.

2009 est.

4,256
83

4,131
91

4,057
91

109

PROGRAM MANAGEMENT
¥3,207
¥141

88.96

17
6
7

Total personnel compensation ..............................
396
Civilian personnel benefits .......................................
96
Military personnel benefits ........................................
4
Travel and transportation of persons .......................
8
Transportation of things ...........................................
1
Rental payments to GSA ...........................................
34
Communications, utilities, and miscellaneous
charges .................................................................
54
Printing and reproduction .........................................
32
Advisory and assistance services .............................
35
Other services ............................................................
833
Other purchases of goods and services from Government accounts .................................................
79
Operation and maintenance of facilities ..................
9
Research and development contracts .......................
46
Medical care ..............................................................
1,140
Operation and maintenance of equipment ...............
340
Supplies and materials .............................................
2
Equipment .................................................................
3
Land and structures .................................................. ...................
Grants, subsidies, and contributions ........................
48

Identification code 75–0511–0–1–550

2,279
3,293
3,485
752 ................... ...................
1
115 ...................
30 ................... ...................

¥2,919
¥138

88.95

11.9
12.1
12.2
21.0
22.0
23.1
23.3

¥71

Offsets:
Against gross budget authority and outlays:
Offsetting collections (cash) from:
88.00
Federal sources .....................................................
88.40
Non-Federal sources .............................................
Total, offsetting collections (cash) .......................
Against gross budget authority only:
Change in uncollected customer payments from
Federal sources (unexpired) ..................................
Portion of offsetting collections (cash) credited to
expired accounts ...................................................

Other than full-time permanent ...........................
Other personnel compensation .............................
Military personnel .................................................

(Legislative proposal, not subject to PAYGO)

¥1,213 ................... ...................
801 ................... ...................

60 ...................
60 ...................

In addition, the Secretary may, contingent upon the enactment of
authorizing legislation, charge a fee for conducting revisit surveys
on health care facilities cited for deficiencies during initial certification, recertification, or substantiated complaint surveys; Provided,
That such fees, in an amount not to exceed $35,000,000, shall be
credited to this account as offsetting collections to remain available
until expended for the purpose of conducting such revisit surveys;
Provided further, That amounts transferred to this account from the
Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds for fiscal year 2009 shall be reduced by the
amount credited to this account under this paragraph.
Program and Financing (in millions of dollars)

Summary of Budget Authority and Outlays

Identification code 75–0511–2–1–550

(in millions of dollars)
2007 actual

2008 est.

2009 est.

Enacted/requested:
Budget Authority ..................................................................... ....................
60 ....................
Outlays ....................................................................................
5
60 ....................
Legislative proposal, not subject to PAYGO:
Budget Authority ..................................................................... .................... .................... ....................
Outlays .................................................................................... .................... .................... ....................

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Total:
Budget Authority ..................................................................... ....................
Outlays ....................................................................................
5

Object Classification (in millions of dollars)
Identification code 75–0511–0–1–550

11.1

2007 actual

Direct obligations:
Personnel compensation:
Full-time permanent .............................................

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2008 est.

2009 est.

¥35

01.00
09.03

Total direct program ................................................. ................... ...................
Revisit Fees .................................................................... ................... ...................

¥35
35

09.09

Total reimbursable program ...................................... ................... ...................

10.00

Total new obligations ................................................ ................... ................... ...................

73.10

Change in obligated balances:
Total new obligations .................................................... ................... ................... ...................

60 ....................
60 ....................

Program management activities include funding for research, Medicare operations, survey and certification, Clinical
Laboratory Improvement Amendments (CLIA), Medicare Advantage, and administrative costs.

2007 actual

Obligations by program activity:
Direct program:
00.03
State survey and certification ................................... ................... ...................

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

35
¥35

88.90

Total, offsetting collections (cash) ....................... ................... ................... ...................

89.00
90.00

2009 est.

384

391

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HHS

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

The Budget includes $35 million in user fees to finance
survey and certification activities. Centers for Medicare &
Medicaid Services (CMS) would charge revisit user fees to
health care facilities cited for deficiencies during initial certification, recertification, or substantiated complaint surveys.
Proposed appropriations language provides authority to collect
and spend these fees. The amount appropriated from the Federal Hospital Insurance (HI) and Federal Supplementary
Medical Insurance (SMI) trust funds would be reduced on
a dollar-for-dollar basis with fees collected.

able to use Title XXI funds for obtaining health benefit coverage for uninsured children through a SCHIP program, a
SCHIP Medicaid expansion program, or a combination of
both.
STATE CHILDREN’S HEALTH INSURANCE FUND
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 75–0515–4–1–551

2007 actual

2008 est.

2009 est.

00.01

Obligations by program activity:
SCHIP Reauthorization ................................................... ................... ...................

1,500

10.00

Total new obligations (object class 41.0) ................ ................... ...................

1,500

22.00
23.95

1,500
¥1,500

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ................... ...................

1,500

73.10
73.20

1,500
¥2,105

74.40

Obligated balance, end of year ................................ ................... ...................

¥605

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................
Outlays from mandatory balances ................................ ................... ...................

1,500
605

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation, BBA ....................................................
5,000
5,000
5,000
60.00
Appropriation, BBRA for territories ...........................
40
40
40
60.00
Appropriation, PL 110–28 .........................................
650 ................... ...................
60.00
Appropriation—SCHIP Extension of 2007 ................. ...................
1,600
275

87.00

Total outlays (gross) ................................................. ................... ...................

2,105

89.00
90.00

1,500
2,105

62.50

Appropriation (total mandatory) ...........................

72.40
73.10
73.20
73.40

This schedule reflects the Administration’s SCHIP reauthorization proposal.

74.40

Obligated balance, end of year ................................

4,437

3,477

2,695

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

2,552
3,448

4,199
3,401

3,406
2,691

87.00

Total outlays (gross) .................................................

6,000

7,600

6,097

STATE CHILDREN’S HEALTH INSURANCE FUND
Program and Financing (in millions of dollars)
Identification code 75–0515–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Grants to States and U.S. territories ............................
5,941
00.02 SCHIP Extension Act of 2007 ........................................ ...................

5,040
1,600

5,040
275

10.00

6,640

5,315

34
6,640

141
5,315

21.40
22.00
22.30
23.90
23.95
24.40

Total new obligations (object class 41.0) ................

5,941

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year ...................
New budget authority (gross) ........................................
5,690
Expired unobligated balance transfer to unexpired account ..........................................................................
285
Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance carried forward, end of year

5,975
¥5,941
34

5,690

107 ...................
6,781
¥6,640
141

6,640

5,456
¥5,315
141

5,315

5,690
6,000

6,640
7,600

5,315
6,097

2007 actual

2008 est.

1,500
2,105

Total:
Budget Authority .....................................................................
Outlays ....................................................................................

6,815
8,202

5,690
6,000

6,640
7,600

5,315
6,097

The Balanced Budget Act of 1997 established the State
Children’s Health Insurance Program (SCHIP) under Title
XXI of the Social Security Act. Title XXI provides Federal
matching funds to States to enable them to extend coverage
to uninsured children from low-income families. States are
Jkt 214754

Program and Financing (in millions of dollars)

PO 00000

Frm 00025

2007 actual

2008 est.

2009 est.

Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year ...................
22.00 New budget authority (gross) ........................................
24

24
35

59
48

23.90

Total budgetary resources available for obligation

107

24.40

Unobligated balance carried forward, end of year

107

New budget authority (gross), detail:
Mandatory:
69.10
Spending authority from offsetting collections:
Change in uncollected customer payments from
Federal sources (unexpired) ..................................

2009 est.

Enacted/requested:
Budget Authority .....................................................................
5,690
6,640
Outlays ....................................................................................
6,000
7,600
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................

16:43 Jan 24, 2008

MEDICARE ADVANTAGE STABILIZATION FUND

Identification code 75–0520–0–1–571

(in millions of dollars)

VerDate Aug 31 2005

4,908
4,437
3,477
5,941
6,640
5,315
¥6,000
¥7,600
¥6,097
¥412 ................... ...................

Summary of Budget Authority and Outlays

cprice-sewell on PROD1PC71 with BUDGET PAG

447

Fmt 3616

Change in obligated balances:
Obligated balance, start of year ................................... ...................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
¥24

¥24

¥59

¥35

¥48

Obligated balance, end of year ................................

¥24

¥59

¥107

Offsets:
Against gross budget authority only:
88.95
Change in uncollected customer payments from
Federal sources (unexpired) ..................................

¥24

¥35

¥48

72.40
74.00
74.40

89.00
90.00

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

448

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

MEDICARE ADVANTAGE STABILIZATION FUND—Continued

Program and Financing (in millions of dollars)

The Medicare Advantage (MA) Regional Stabilization Fund
finances incentives, both to have MA regional plans offered
in each MA region and to retain MA plans in certain regions
with below national average MA market penetration. The
Medicare, Medicaid, and SCHIP Extension Act of 2007
amended this fund.
f

Trust Funds

01.00

Balance, start of year ....................................................

281,754

2008 est.

290,036

293,657

Balance, start of year ....................................................
281,754
290,036
Receipts:
02.00 FHI Trust Fund, Federal Employer Contributions (FICA)
2,826
2,931
02.01 FHI Trust Fund, Postal Service Employer Contributions
(FICA) .........................................................................
712
767
02.02 FHI Trust Fund, Interest Received by Trust Funds
16,112
16,507
02.03 FHI Trust Fund, Interest Received by Trust Funds—
legislative proposal not subject to PAYGO ............... ................... ...................
02.04 FHI Trust Fund, Taxation on OASDI Benefits .................
10,593
12,453
02.05 FHI Trust Fund, Payment from the General Fund for
Health Care Fraud and Abuse Control Account ........
118
121
02.06 FHI Trust Fund, Transfers from General Fund (criminal
Fines) .........................................................................
201
200
02.07 FHI Trust Fund, Transfers from General Fund (civil
Monetary Penalties) ...................................................
13
20
02.08 FHI Trust Fund, Interest Payments by Railroad Retirement Board ................................................................
29
30
02.09 FHI Trust Fund, Payments from the General Fund
(uninsured and Program Management) ....................
644
699
02.10 FHI Trust Fund, Payments for Pre–1957 Military Service (Quinquennial Adjustment) ................................. ................... ...................
02.20 FHI Trust Fund, Other Proprietary Receipts from the
Public .........................................................................
4
2
02.21 FHI Trust Fund, Basic Premium, Medicare Advantage
75
100
02.22 FHI Trust Fund, Medicare Refunds ................................
4,674
4,850
02.23 FHI Trust Fund, Premiums Collected for Uninsured
Individuals not Otherwise Eligible ............................
2,761
2,942
02.60 FHI Trust Fund, Transfers from General Fund (FICA
Taxes) ........................................................................
171,022
180,323
02.61 FHI Trust Fund, Transfers from General Fund (FICA
Taxes)—legislative proposal subject to PAYGO ....... ................... ...................
02.62 FHI Trust Fund, Receipts from Railroad Retirement
Board .........................................................................
455
474
02.63 FHI Trust Fund, Transfers from General Fund (SECA
Taxes) ........................................................................
13,431
14,656
02.64 FHI Trust Fund, Civil Penalties and Damages ..............
211
275

293,657

01.99

02.99

Total receipts and collections ...................................

04.00

cprice-sewell on PROD1PC71 with BUDGET PAG

2009 est.

Total: Balances and collections ....................................
Appropriations:
05.00 Federal Hospital Insurance Trust Fund .........................
05.01 Federal Hospital Insurance Trust Fund .........................
05.02 Federal Hospital Insurance Trust Fund .........................
05.03 Federal Hospital Insurance Trust Fund .........................
05.04 Federal Hospital Insurance Trust Fund .........................
05.05 Federal Hospital Insurance Trust Fund .........................
05.06 Federal Hospital Insurance Trust Fund—legislative
proposal not subject to PAYGO .................................
05.07 Federal Hospital Insurance Trust Fund—legislative
proposal not subject to PAYGO .................................
05.08 Federal Hospital Insurance Trust Fund—legislative
proposal not subject to PAYGO .................................
05.09 Federal Hospital Insurance Trust Fund—legislative
proposal subject to PAYGO .......................................
05.10 Federal Hospital Insurance Trust Fund—legislative
proposal subject to PAYGO .......................................
05.11 Health Care Fraud and Abuse Control Account ............
05.12 Health Care Fraud and Abuse Control Account ............
05.99
06.10
06.11
07.95

Total appropriations ..................................................
Federal Hospital Insurance Trust Fund .........................
Health Care Fraud and Abuse Control Account ............
Rounding adjustment ....................................................

07.99

Balance, end of year .....................................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

223,881
505,635

237,350
527,386

799
15,973
114
14,072
125

226,122
18
1,968
344

242,234
25
2,052
427

10.00

206,186

228,452

244,738

206,170

228,452

244,738

Total new obligations ................................................

23.90
23.95
23.98
24.41

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................
Special and trust fund receipts returned to Schedule
N ................................................................................

168 ................... ...................
¥131 ................... ...................
206,207
228,452
244,738
¥206,186 ¥228,452 ¥244,738
¥22 ................... ...................
22 ................... ...................

New budget authority (gross), detail:
Discretionary:
40.26
Appropriation (trust fund) .........................................
1,691
40.34
Appropriation temporarily reduced (P.L. 110–161) ...................

1,839
1,897
¥31 ...................

43.00

1,808

Appropriation (total discretionary) ........................
Mandatory:
Appropriation (trust fund) .........................................
Appropriation (previously unavailable) .....................
Portion precluded from balances ..............................
Transferred to other accounts .......................................

1,691
221,079
8,484
¥16,600
¥8,484

1,897

60.26
60.28
60.45
61.00

62.50

Appropriation (total mandatory) ...........................

204,479

226,644

242,841

70.00

Total new budget authority (gross) ..........................

206,170

228,452

244,738

2
115
5,000

72.40
73.10
73.20
73.45

3,179

74.40

Obligated balance, end of year ................................

20,485

20,506

20,620

86.90
86.93
86.97
86.98

1,330
243
185,249
19,752

1,486
321
206,297
20,327

1,569
331
221,496
21,228

87.00

Total outlays (gross) .................................................

206,574

228,431

244,624

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

206,170
206,574

228,452
228,431

244,738
244,624

302,186

319,377

314,041

319,377

314,041

319,495

200

1,019
1,028

190,154
¥5,644
488
14,718
275
244,673
538,330

................... ...................

¥35

................... ...................

5,491

................... ...................
................... ...................
¥1,112
¥1,132

5,419
¥198
¥1,156

¥215,635 ¥233,729 ¥235,147
22 ................... ...................
17 ................... ...................
¥3 ................... ...................

PO 00000

2009 est.

3,007

131 ................... ...................
¥1,691
¥1,839
¥1,897
...................
31 ...................
¥221,079 ¥234,389 ¥246,962
¥8,484
¥4,145 ...................
16,600
7,745
4,121

290,036

2008 est.

204,193
13
1,848
132

22.00
22.10

Special and Trust Fund Receipts (in millions of dollars)
2007 actual

2007 actual

Obligations by program activity:
00.01 Benefit payments, HI .....................................................
00.02 Stabilization fund ..........................................................
00.03 Administration, HI ..........................................................
00.04 Quality improvement organizations, HI .........................

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Resources available from recoveries of prior year obligations .......................................................................
23.33 Adjustment for changes in allocation ...........................

FEDERAL HOSPITAL INSURANCE TRUST FUND

Identification code 20–8005–0–7–571

293,657

303,183

Frm 00026

Fmt 3616

234,389
246,962
4,145 ...................
¥7,745
¥4,121
¥4,145 ...................

21,041
20,485
20,506
206,186
228,452
244,738
¥206,574 ¥228,431 ¥244,624
¥168 ................... ...................

92.01

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

E:\BUDGET\HHS.XXX

HHS

206,170
206,574

2008 est.

2009 est.

228,452
228,431

244,738
244,624

.................... ....................
.................... ....................

–35
–35

.................... ....................
.................... ....................

–10,910
–10,910

206,170
206,574

228,452
228,431

233,793
233,679

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

The Hospital Insurance (HI) program funds the costs of
hospital and related care for individuals age 65 or older and
for eligible disabled people.
The status of the trust fund is as follows:
Status of Funds (in millions of dollars)
Identification code 20–8005–0–7–571

2007 actual

Unexpended balance, start of year:
Balance, start of year ....................................................
Adjustments:
0191
Adjustments ...............................................................
0100

0199

Total balance, start of year ......................................
Cash income during the year:
Current law:
Receipts:
1200
FHI Trust Fund, Federal Employer Contributions
(FICA) ................................................................
1201
FHI Trust Fund, Postal Service Employer Contributions (FICA) ...............................................
1202
FHI Trust Fund, Interest Received by Trust Funds
1204
FHI Trust Fund, Taxation on OASDI Benefits ........
1205
FHI Trust Fund, Payment from the General Fund
for Health Care Fraud and Abuse Control
Account .............................................................
1206
FHI Trust Fund, Transfers from General Fund
(criminal Fines) ................................................
1207
FHI Trust Fund, Transfers from General Fund
(civil Monetary Penalties) .................................
1208
FHI Trust Fund, Interest Payments by Railroad
Retirement Board .............................................
1209
FHI Trust Fund, Payments from the General Fund
(uninsured and Program Management) ...........
1210
FHI Trust Fund, Payments for Pre–1957 Military
Service (Quinquennial Adjustment) ..................
Offsetting receipts (proprietary):
1220
FHI Trust Fund, Other Proprietary Receipts from
the Public .........................................................
1221
FHI Trust Fund, Basic Premium, Medicare Advantage .............................................................
1222
FHI Trust Fund, Medicare Refunds .......................
1223
FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible .........
Offsetting governmental receipts:
1260
FHI Trust Fund, Transfers from General Fund
(FICA Taxes) ......................................................
1262
FHI Trust Fund, Receipts from Railroad Retirement Board .......................................................
1263
FHI Trust Fund, Transfers from General Fund
(SECA Taxes) ....................................................
1264
FHI Trust Fund, Civil Penalties and Damages
Offsetting collections:
1280
Health Care Fraud and Abuse Control Account
1299
Income under present law ........................................
Proposed legislation:
Receipts:
2203
FHI Trust Fund, Interest Received by Trust Funds
Offsetting governmental receipts:
2261
FHI Trust Fund, Transfers from General Fund
(FICA Taxes) ......................................................
2299
Income under proposed legislation ...........................

303,131

2008 est.

2009 est.

310,964

Object Classification (in millions of dollars)
Identification code 20–8005–0–7–571

303,138

310,964

2007 actual

2008 est.

2009 est.

Direct obligations:
41.0 Payment for Quality Improvement Organization (QIO)
activities ....................................................................
42.0 Insurance claims and indemnities (benefits) ...............
94.0 Financial transfers .........................................................

132
204,193
1,861

344
226,140
1,968

427
242,259
2,052

99.0

Direct obligations ......................................................

206,186

228,452

244,738

99.9

Total new obligations ................................................

206,186

228,452

244,738

7 ................... ...................

FEDERAL HOSPITAL INSURANCE TRUST FUND

314,602

(Legislative proposal, not subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 20–8005–2–7–571

2007 actual

2008 est.

2009 est.

2,826

2,931

3,007

712
16,112
10,593

767
16,507
12,453

799
15,973
14,072

00.03

Obligations by program activity:
Administration ................................................................ ................... ...................

¥35

10.00

Total new obligations (object class 94.0) ................ ................... ...................

¥35

118

121

125

201

200

22.00
23.95

¥35
35

644

699

1,019

New budget authority (gross), detail:
Discretionary:
40.26
Appropriation (trust fund) ......................................... ................... ...................
Mandatory:
60.26
Appropriation (trust fund) ......................................... ................... ...................
60.45
Portion precluded from obligation ............................ ................... ...................

................... ...................

1,028

62.50

¥35
35
¥35

Appropriation (total mandatory) ........................... ................... ................... ...................

70.00

Total new budget authority (gross) .......................... ................... ...................

¥35

115
5,000

73.10
73.20

¥35
35

2,942

3,179

74.40

171,022

180,323

190,154

455

474

488

13,431
211

14,656
275

3
223,884

75
4,674

100
4,850

2,761

Obligated balance, end of year ................................ ................... ................... ...................

86.90

Outlays (gross), detail:
Outlays from new discretionary authority ..................... ................... ...................

¥35

14,718
275

89.00
90.00

¥35
¥35

10
237,360

10
250,213

92.01

................... ...................

114

................... ...................
................... ...................

¥5,644
¥5,530

Total cash income .....................................................
223,884
237,360
Cash outgo during year:
Current law:
4500
Federal Hospital Insurance Trust Fund ..................... ¥206,574 ¥228,431
4501
Health Care Fraud and Abuse Control Account ........
¥1,000
¥1,146
4599
Outgo under current law (¥) .................................. ¥207,574 ¥229,577
Proposed legislation:
5500
Federal Hospital Insurance Trust Fund ..................... ................... ...................
5501
Federal Hospital Insurance Trust Fund ..................... ................... ...................
5599
Outgo under proposed legislation (¥) .................... ................... ...................

244,683

3299

cprice-sewell on PROD1PC71 with BUDGET PAG

314,602

449

6599
7645

Total cash outgo (¥) ...............................................
Federal Hospital Insurance Trust Fund .........................

¥207,574
¥8,484

Memorandum (non-add) entries:
Total investments, start of year: Federal securities:
Par value ................................................................... ................... ................... ...................
92.02 Total investments, end of year: Federal securities:
Par value ................................................................... ................... ...................
35

The Budget proposes a user fee to cover the costs associated
with follow-up visits to health care facilities found to be out
of compliance with Medicare standards.
FEDERAL HOSPITAL INSURANCE TRUST FUND
(Legislative proposal, subject to PAYGO)

¥244,624
¥1,364
¥245,988
35
10,910
10,945

¥229,577 ¥235,043
¥4,145 ...................

Total adjustments ..........................................................
¥8,484
¥4,145 ...................
Unexpended balance, end of year:
8700 Uninvested balance (net), end of year ..........................
¥8,413
561
¥707
8701 Federal Hospital Insurance Trust Fund .........................
319,377
314,041
319,495
8701 Federal Hospital Insurance Trust Fund ......................... ................... ...................
35
8701 Federal Hospital Insurance Trust Fund ......................... ................... ...................
5,419

Program and Financing (in millions of dollars)
Identification code 20–8005–4–7–571

Total balance, end of year ........................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

310,964
PO 00000

314,602

324,242

Frm 00027

Fmt 3616

2008 est.

2009 est.

00.01

Obligations by program activity:
Benefit payments, HI ..................................................... ................... ...................

¥10,910

10.00

Total new obligations (object class 42.0) ................ ................... ...................

¥10,910

22.00
23.95

¥10,910
10,910

¥5,491
¥5,419

7699

8799

2007 actual

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

450

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009
23.98
24.41

FEDERAL HOSPITAL INSURANCE TRUST FUND—Continued
Program and Financing (in millions of dollars)—Continued
Identification code 20–8005–4–7–571

62.50

2007 actual

2008 est.

2009 est.

Appropriation (total mandatory) ........................... ................... ...................

¥10,910

¥10,910
10,910

Unobligated balance expiring or withdrawn .................
Special and trust fund receipts returned to Schedule
N ................................................................................

89.00
90.00

¥10,910

¥10,910
¥10,910

72.40
73.10
73.20
73.40
73.45

AND

86.90
86.97
86.98

In addition to amounts otherwise available for program integrity
and program management, $198,000,000, to be transferred from the
Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section
201(g) of the Social Security Act, of which $147,038,000 is for the
Medicare Integrity Program at the Centers for Medicare and Medicaid
Services to conduct oversight of activities for Medicare Advantage
and the Medicare Prescription Drug Program authorized in title XVIII
of the Social Security Act, including activities listed in section 1893(b)
of such Act (42 U.S.C. 1395ddd(b)); of which $18,967,000 is for the
Department of Health and Human Services Office of Inspector General; of which $13,028,000 is for the Medicaid and SCHIP program
integrity activities; and of which $18,967,000 is for the Department
of Justice: Provided, That the report required section 1817(k)(5) of
the Social Security Act for FY 2009 shall include measures of the
operational efficiency and impact on fraud, waste and abuse in the
Medicare, Medicaid and SCHIP programs for the funds provided by
this appropriation.
Program and Financing (in millions of dollars)
Identification code 75–8393–0–7–571

2007 actual

cprice-sewell on PROD1PC71 with BUDGET PAG

Obligations by program activity:
00.01 Medicare integrity program ...........................................
00.02 FBI fraud and abuse control .........................................
00.03 Other fraud and abuse control ......................................

2009 est.

756
121
259

768
125
263

00.91
01.01
01.02
01.03

Subtotal, mandatory ..................................................
1,112
1,136
MIP—discretionary ........................................................ ................... ...................
FBI—discretionary ......................................................... ................... ...................
Other discretionary ......................................................... ................... ...................

1,156
147
9
42

01.91
09.01

Subtotal, discretionary .............................................. ................... ...................
Reimbursable (OIG) ........................................................
6
3

198
10

10.00

Total new obligations ................................................

744
118
250

2008 est.

1,118

Budgetary resources available for obligation:
New budget authority (gross) ........................................
1,115
Resources available from recoveries of prior year obligations ....................................................................... ...................
22.30 Expired unobligated balance transfer to unexpired account ..........................................................................
6
22.00
22.10

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

1,121
¥1,118
PO 00000

1,139

1,364

1,142

1,364

4 ...................
3

1,149
¥1,139

1,374
¥1,364

Frm 00028

Fmt 3616

¥10

17 ................... ...................

1,115

1,142

198
1,156
10
1,364

Change in obligated balances:
Obligated balance, start of year ...................................
343
447
436
Total new obligations ....................................................
1,118
1,139
1,364
Total outlays (gross) ......................................................
¥1,000
¥1,146
¥1,364
Adjustments in expired accounts (net) .........................
¥14 ................... ...................
Recoveries of prior year obligations .............................. ...................
¥4 ...................
Obligated balance, end of year ................................

447

436

Outlays (gross), detail:
Outlays from new discretionary authority ..................... ................... ...................
198
Outlays from new mandatory authority .........................
798
1,142
1,166
Outlays from mandatory balances ................................
202
4 ...................

87.00

Total outlays (gross) .................................................

1,000

1,146

1,364

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

¥3

¥10

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

1,112
997

1,132
1,136

1,354
1,354

89.00
90.00

ABUSE CONTROL ACCOUNT

Total new budget authority (gross) ..........................

74.40

HEALTH CARE FRAUD

¥10

New budget authority (gross), detail:
Discretionary:
40.26
Appropriation (trust fund) ......................................... ................... ...................
Mandatory:
60.26
Appropriation (trust fund) .........................................
1,112
1,132
69.00
Spending authority from offsetting collections: Offsetting collections (cash) .....................................
3
10
70.00

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

¥3

P.L. 104–191 established the Health Care Fraud and Abuse
Control (HCFAC) account within the Federal hospital insurance trust fund and appropriated funds, to be available without further appropriation, from the trust fund to the HCFAC
account for specified health care fraud and abuse control activities of the Department of Health and Human Services
(HHS), the Department of Justice, and other agencies.
This schedule reflects the estimated distribution of the account for 2008 and 2009. As required by statute, actual 2008
and 2009 agency distributions will be determined by the Secretary of HHS and the Attorney General consistent with the
Administration’s priorities.
2007 actual

2008 actual

Department of Justice, DOJ .........................................................
Office of the Inspector General, HHS ..........................................
Other specific HHS fraud and abuse projects ............................

52
166
32

54
173
32

2009 est.

54
175
34

Total ...............................................................................

250

259

263

The 2009 Budget includes the following structural changes
to the Health Care Fraud and Abuse Control Account: (1)
splitting the current funding provided jointly to the Department of Health and Human Services and the Department
of Justice into separate funding streams; (2) eliminating the
annual negotiations process between the two Departments;
and (3) requiring the Federal Bureau of Investigations and
the Medicare Integrity Program to contribute to the annual
HCFAC report.
The 2009 Budget also includes a discretionary request for
efforts to safeguard Medicaid, Medicare Advantage, and the
Medicare prescription drug benefit, and will supplement the
mandatory funds made available by P.L. 104–191.
It is important that these cost increases and new enforcement investments be fully funded. The Administration is proposing to fund them as contingent appropriations. To ensure
full funding of the new enforcement investments, the Administration proposes to employ a budget enforcement mechanism
that allows for an adjustment by the Budget Committees
to the section 302(a) allocation to the Appropriations CommitSfmt 3616

E:\BUDGET\HHS.XXX

HHS

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

tees found in the concurrent resolution on the budget. In
addition, the Administration will also seek to establish statutory spending limits, as defined by section 251 of the Balanced
Budget and Emergency Deficit Control Act of 1985, and to
adjust them for this purpose. These adjustments would only
be permissible if the use of these funds was clearly restricted
to the specified purpose. The maximum allowable adjustment
to the 302(a) allocation and/or the statutory spending limit
would be $198 million for 2009 (see chapter 15 in Analytical
Perspectives).
The HCFAC entities will develop a comprehensive plan for
Medicare, Medicaid and SCHIP program integrity activities.
The plan will indicate how program integrity appropriations
from all sources (DRA, HIPAA and the discretionary cap adjustment) will be allocated to address program integrity priorities. These priorities include the fraud, waste, and abuse
vulnerabilities of these programs, and efforts to address responsibilities under the Improper Payments Improvement Act.

2007 actual

2008 est.

2009 est.

25.6
94.0

Direct obligations:
Personnel compensation: Full-time permanent (CMS
100 FTEs) ..............................................................
Civilian personnel benefits (CMS) ............................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................
Other services (CMS) .................................................
Other purchases of goods and services from Government accounts (HHS) .......................................
Other purchases of goods and services from Government accounts (DoJ) ........................................
Other purchases of goods and services from Government accounts (HHS/OIG) ................................
Other purchases of goods and services from Government accounts (HHS/AoA) ................................
Other purchases of goods and services from Government accounts (HHS/OGC) ...............................
Medical care (CMS) ...................................................
Financial transfers ....................................................

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

1,112
6

1,136
3

1,354
10

99.9

Total new obligations ................................................

1,118

1,139

1,364

11.1
12.1
23.2
23.3
25.2
25.3
25.3
25.3
25.3
25.3

8
2
1

10
2
1

1
10

1
23

166

174

194

5
744
118

6
756
121

5
915
134

Employment Summary
Identification code 75–8393–0–7–571

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

2008 est.

100

FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND
Special and Trust Fund Receipts (in millions of dollars)
2007 actual

01.00

Balance, start of year ....................................................
Adjustments:
01.91 Adjustments ...................................................................

10,660

2008 est.

23,644

2009 est.

¥13 ................... ...................

cprice-sewell on PROD1PC71 with BUDGET PAG

Balance, start of year ....................................................
10,647
23,644
37,916
Receipts:
02.00 Federal Contributions, FSMI Fund .................................
137,822
144,399
147,716
02.01 Federal Contributions, FSMI Fund—legislative proposal not subject to PAYGO ...................................... ................... ...................
¥1,454
02.02 Interest Received by Trust Fund, FSMI Fund ................
1,970
3,602
3,225
02.03 Interest Received by Trust Fund, FSMI Fund—legislative proposal not subject to PAYGO .......................... ................... ...................
8
02.04 Interest, Medicare Prescription Drug Account, FSMI
16
12
14
02.05 Federal Contributions, Transitional Assistance Account, FSMI ................................................................
10 ................... ...................
02.06 Federal Contribution for Admin. Contribution for
Admin. Costs, Prescription Drug Account, FSMI .......
1,017
608
547
02.07 Federal Contributions for Benefits, Prescription Drug
Account, SMI ..............................................................
40,333
36,024
44,999
16:43 Jan 24, 2008

Jkt 214754

PO 00000

02.22

02.23
02.24
02.25
02.26
02.27
02.28
02.29
02.99

Frm 00029

................... ...................

¥350

1
12

1
3

1,628

2,148

2,631

................... ...................

300

6,977
67
3,416
38,552

6,911
88
3,600
41,759

7,208
101
3,750
43,523

................... ...................
7,190
7,364

¥248
7,549

................... ...................

¥65

Total receipts and collections ...................................

239,011

246,519

259,458

Total: Balances and collections ....................................
Appropriations:
05.00 Federal Supplementary Medical Insurance Trust Fund
05.01 Federal Supplementary Medical Insurance Trust Fund
05.02 Federal Supplementary Medical Insurance Trust Fund
05.03 Federal Supplementary Medical Insurance Trust Fund
05.04 Federal Supplementary Medical Insurance Trust Fund
05.05 Federal Supplementary Medical Insurance Trust Fund
05.06 Federal Supplementary Medical Insurance Trust
Fund—legislative proposal not subject to PAYGO
05.07 Federal Supplementary Medical Insurance Trust
Fund—legislative proposal subject to PAYGO .........
05.08 Federal Supplementary Medical Insurance Trust
Fund—legislative proposal subject to PAYGO .........
05.09 Transitional Drug Assistance, Federal Supplementary
Medical Insurance Trust Fund ..................................
05.10 Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund ..................................
05.11 Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund ..................................
05.12 Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund ..................................
05.13 Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund—legislative proposal
subject to PAYGO ......................................................
Adjustments:
05.91
Adjustments ...............................................................

249,658

270,163

297,374

05.99
06.10

Total appropriations ..................................................
Federal Supplementary Medical Insurance Trust Fund

07.99

Balance, end of year .....................................................

448 ................... ...................
¥2,662
¥2,607
¥2,820
...................
46 ...................
¥185,396 ¥198,280 ¥203,156
4,504
10,195
8,668
8,484
4,145 ...................
¥105

¥270

................... ...................

1,767

................... ...................

¥277

...................

7 ................... ...................
¥514
...................
¥50,446

¥556

¥545

10 ...................
¥45,095

¥54,816

................... ...................

¥476 ................... ...................
¥226,051 ¥232,247 ¥251,399
37 ................... ...................
23,644

37,916

45,975

Program and Financing (in millions of dollars)
Identification code 20–8004–0–7–571

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Benefit payments, SMI ...................................................
00.02 Transfer to Medicaid for payment of SMI premiums
00.03 Stabilization fund ..........................................................
00.04 Administration, SMI .......................................................
00.05 Quality Improvement Organizations, SMI ......................

180,374
359
12
2,775
34

187,835
194,351
100 ...................
17
23
2,608
2,827
86
107

10.00

183,554

190,646

197,308

183,554

190,646

197,308

Total new obligations ................................................

37,916

01.99

VerDate Aug 31 2005

02.20
02.21

2009 est.

Identification code 20–8004–0–7–571

02.09

Federal Contributions for Benefits, Prescription Drug
Account, SMI—legislative proposal not subject to
PAYGO ........................................................................
Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund ....................
Other Proprietary Receipts from the Public, FSMI Fund
Premiums Collected for Medicare Prescription Drug
Account, FSMI ............................................................
Premiums Collected for Medicare Prescription Drug
Account, FSMI—legislative proposal subject to
PAYGO ........................................................................
Payments from States, Medicare Prescription Drug
Account, FSMI ............................................................
Basic Premium, Medicare Advantage, FSMI Trust Fund
Medicare Refunds, SMI ..................................................
Premiums Collected for the Aged, FSMI Fund ..............
Premiums Collected for the Aged, FSMI Fund—legislative proposal subject to PAYGO .............................
Premiums Collected for the Disabled, FSMI Fund ........
Premiums Collected for the Disabled, FSMI Fund—
legislative proposal subject to PAYGO ......................

04.00

Object Classification (in millions of dollars)
Identification code 75–8393–0–7–571

02.08

451

Fmt 3616

23.90
23.95
23.98
24.41

40.26
40.34

485 ................... ...................
¥448 ................... ...................
183,591
190,646
197,308
¥183,554 ¥190,646 ¥197,308
¥37 ................... ...................
37 ................... ...................

New budget authority (gross), detail:
Discretionary:
Appropriation (trust fund) .........................................
2,662
Appropriation temporarily reduced (P.L. 110–161) ...................

43.00
Sfmt 3643

Appropriation (total discretionary) ........................
E:\BUDGET\HHS.XXX

HHS

2,662

2,607
2,820
¥46 ...................
2,561

2,820

452

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009
1205

FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND—
Continued

1206

Program and Financing (in millions of dollars)—Continued
1207
Identification code 20–8004–0–7–571

2007 actual

2008 est.

2009 est.

1209
60.26
60.45
60.45
62.00

Mandatory:
Appropriation (trust fund) .........................................
Portion precluded from obligation ............................
Portion precluded from obligation ............................
Transferred from other accounts ...................................

185,396
¥4,504
¥8,484
8,484

62.50

Appropriation (total mandatory) ...........................

180,892

188,085

194,488

1223

70.00

Total new budget authority (gross) ..........................

183,554

190,646

197,308

1224

198,280
203,156
¥10,195
¥8,668
¥4,145 ...................
4,145 ...................

19,495
19,525
19,504
183,554
190,646
197,308
¥183,039 ¥190,667 ¥197,256
¥485 ................... ...................

1221

1225
1226
1228
1299

74.40

Obligated balance, end of year ................................

19,525

19,504

19,556

86.90
86.93
86.97
86.98

1,734
294
162,849
18,162

2,085
455
169,975
18,152

2,230
579
175,385
19,062

2222
2227
2229
2299

87.00

Total outlays (gross) .................................................

183,039

190,667

197,256

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

183,554
183,039

190,646
190,667

197,308
197,256

33,061

39,248

48,750

39,248

48,750

56,300

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

2008 est.

2009 est.

3299

Total cash income .....................................................
Cash outgo during year:
Current law:
4500
Federal Supplementary Medical Insurance Trust
Fund ......................................................................
4501
Transitional Drug Assistance, Federal Supplementary Medical Insurance Trust Fund ................
4502
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund .........................
4599
Outgo under current law (¥) ..................................
Proposed legislation:
5500
Federal Supplementary Medical Insurance Trust
Fund ......................................................................
5501
Federal Supplementary Medical Insurance Trust
Fund ......................................................................
5502
Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund .........................
5599
Outgo under proposed legislation (¥) ....................

190,646
190,667

197,308
197,256

....................
....................

105
105

270
270

6599
7645

.................... ....................
.................... ....................

–1,490
–1,490

7699

183,554
183,039

190,751
190,772

196,088
196,036

Status of Funds (in millions of dollars)
Identification code 20–8004–0–7–571

2201
2203
2208

183,554
183,039

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

cprice-sewell on PROD1PC71 with BUDGET PAG

1220

2007 actual

2008 est.

2009 est.

Federal Contributions, Transitional Assistance
Account, FSMI ...................................................
Federal Contribution for Admin. Contribution for
Admin. Costs, Prescription Drug Account,
FSMI ..................................................................
Federal Contributions for Benefits, Prescription
Drug Account, SMI ............................................
Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund ...........
Offsetting receipts (proprietary):
Other Proprietary Receipts from the Public, FSMI
Fund ..................................................................
Premiums Collected for Medicare Prescription
Drug Account, FSMI ..........................................
Payments from States, Medicare Prescription
Drug Account, FSMI ..........................................
Basic Premium, Medicare Advantage, FSMI Trust
Fund ..................................................................
Medicare Refunds, SMI .........................................
Premiums Collected for the Aged, FSMI Fund
Premiums Collected for the Disabled, FSMI Fund
Income under present law ........................................
Proposed legislation:
Receipts:
Federal Contributions, FSMI Fund ........................
Interest Received by Trust Fund, FSMI Fund .......
Federal Contributions for Benefits, Prescription
Drug Account, SMI ............................................
Offsetting receipts (proprietary receipts):
Premiums Collected for Medicare Prescription
Drug Account, FSMI ..........................................
Premiums Collected for the Aged, FSMI Fund
Premiums Collected for the Disabled, FSMI Fund
Income under proposed legislation ...........................

10 ................... ...................

1,017

608

547

40,333

36,024

44,999

1,628

2,148

2,631

6,977

6,911

7,208

67
3,416
38,552
7,190
239,011

88
3,600
41,759
7,364
246,519

101
3,750
43,523
7,549
261,267

................... ...................
................... ...................

¥1,454
8

................... ...................

¥350

...................
...................
...................
...................

300
¥248
¥65
¥1,809

239,011

246,519

259,458

¥183,039

¥190,667

¥197,256

¥20

¥31 ...................

¥50,126
¥233,185

¥45,737
¥236,435

¥55,360
¥252,616

...................

¥105

¥270

................... ...................

1,490

................... ...................
...................
¥105

50
1,270

Total cash outgo (¥) ...............................................
Federal Supplementary Medical Insurance Trust Fund

¥233,185
8,484

¥236,540 ¥251,346
4,145 ...................

Total adjustments ..........................................................
Unexpended balance, end of year:
8700 Uninvested balance (net), end of year ..........................
8701 Federal Supplementary Medical Insurance Trust Fund

8,484

4,145 ...................

8,326
39,248

12,948
48,750

13,510
56,300

8799

47,574

61,698

69,810

Total balance, end of year ........................................

Object Classification (in millions of dollars)
Identification code 20–8004–0–7–571

2007 actual

2008 est.

2009 est.

Direct obligations:
Payment for Quality Improvement Organization (QIO)
activity .......................................................................
42.0 Insurance claims and indemnities ................................
94.0 Financial transfers .........................................................

45
180,374
3,135

86
187,952
2,608

107
194,374
2,827

99.0

Direct obligations ......................................................

183,554

190,646

197,308

99.9

Total new obligations ................................................

183,554

190,646

197,308

41.0

Unexpended balance, start of year:
0100 Balance, start of year ....................................................

33,264

47,574

61,698

FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND

0199

33,264

47,574

61,698

(Legislative proposal, not subject to PAYGO)

Total balance, start of year ......................................
Cash income during the year:
Current law:
Receipts:
1200
Federal Contributions, FSMI Fund ........................
1202
Interest Received by Trust Fund, FSMI Fund .......
1204
Interest, Medicare Prescription Drug Account,
FSMI ..................................................................
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

Program and Financing (in millions of dollars)
137,822
1,970

144,399
3,602

147,716
3,225

Frm 00030

Fmt 3616

PO 00000

Identification code 20–8004–2–7–571

2007 actual

Obligations by program activity:
00.02 Transfer to Medicaid for payment of SMI premiums ...................
Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

2008 est.

105

2009 est.

270

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
10.00

Total new obligations (object class 42.0) ................ ...................

105

270

22.00
23.95

105
¥105

270
¥270

Total budgetary resources available for obligation ................... ................... ...................

New budget authority (gross), detail:
Mandatory:
60.26
Appropriation (trust fund) .........................................

¥7 ................... ...................

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ................... ................... ...................
60.45
Portion precluded from obligation ............................ ...................
105
270

72.40
73.20
73.45

Change in obligated balances:
Obligated balance, start of year ...................................
Total outlays (gross) ......................................................
Recoveries of prior year obligations ..............................

58
31 ...................
¥20
¥31 ...................
¥7 ................... ...................

62.50

Appropriation (total mandatory) ........................... ...................

105

270

74.40

Obligated balance, end of year ................................

31 ................... ...................

73.10
73.20

Change in obligated balances:
Total new obligations .................................................... ...................
Total outlays (gross) ...................................................... ...................

105
¥105

270
¥270

86.93
86.98

Outlays (gross), detail:
Outlays from discretionary balances .............................
Outlays from mandatory balances ................................

10
31 ...................
10 ................... ...................

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ...................

87.00

Total outlays (gross) .................................................

86.97

105

270
89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

105
105

270
270

The Budget includes a Medicaid proposal to extend the
subsidy of Medicare cost sharing for certain qualified individuals that are reimbursed by Medicare.
FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 20–8004–4–7–571

2007 actual

31 ...................

¥7 ................... ...................
20
31 ...................

Authorized under the Medicare Modernization Act as section 1860 D–31 of the Social Security Act, the Medicare Transitional Drug Assistance program provided low-income beneficiaries with $600 per year in 2004 and 2005 to help them
pay for their prescription drugs and covered the cost of enrollment fees. Some benefits remained available in early 2006,
until beneficiaries had the opportunity to enroll in the voluntary Medicare prescription drug benefits.
f

2008 est.

2009 est.

00.01

Obligations by program activity:
Benefit payments, SMI ................................................... ................... ...................

¥1,490

MEDICARE PRESCRIPTION DRUG ACCOUNT, FEDERAL SUPPLEMENTARY
INSURANCE TRUST FUND

10.00

Total new obligations (object class 42.0) ................ ................... ...................

¥1,490

Program and Financing (in millions of dollars)

22.00
23.95

¥1,490
1,490

Identification code 75–8308–0–7–571

New budget authority (gross), detail:
Mandatory:
60.26
Appropriation (trust fund) ......................................... ................... ...................
¥1,767
60.45
Portion precluded from obligation ............................ ................... ...................
277
60.45
Portion precluded from obligation ............................ ................... ................... ...................
62.50

73.10
73.20

Appropriation (total mandatory) ........................... ................... ...................
Change in obligated balances:
Total new obligations .................................................... ................... ...................
Total outlays (gross) ...................................................... ................... ...................

¥1,490
1,490

¥1,490

¥1,490
¥1,490

The budget includes a package of reforms that encourage
competition and efficiency, promote high quality care, rationalize payments, improve program integrity, enhance fiscal
sustainability, and strengthen responsibility for health care
choices.
f

TRANSITIONAL DRUG ASSISTANCE, FEDERAL SUPPLEMENTARY
MEDICAL INSURANCE TRUST FUND
Program and Financing (in millions of dollars)
Identification code 75–8307–0–7–571

2007 actual

Budgetary resources available for obligation:
22.00 New budget authority (gross) ........................................
22.10 Resources available from recoveries of prior year obligations .......................................................................
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

2008 est.

2009 est.

¥7 ................... ...................
7 ................... ...................
PO 00000

Frm 00031

Fmt 3616

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Prescription Drug Benefits .............................................
00.02 Administrative Costs ......................................................

50,976
516

45,087
555

54,815
546

10.00

Total new obligations ................................................

51,492

45,642

55,361

22.00
22.10

50,960

45,641

55,361

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

¥1,490

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

89.00
90.00

cprice-sewell on PROD1PC71 with BUDGET PAG

23.90

453

532 ................... ...................
51,492
¥51,492

New budget authority (gross), detail:
Discretionary:
40.26
Appropriation (trust fund) .........................................
514
40.34
Appropriation temporarily reduced (P.L. 110–161) ...................
43.00

45,641
¥45,642

55,361
¥55,361

556
545
¥10 ...................

514

546

545

60.26

Appropriation (total discretionary) ........................
Mandatory:
Appropriation (trust fund) .........................................

50,446

45,095

54,816

70.00

Total new budget authority (gross) ..........................

50,960

45,641

55,361

72.40
73.10
73.20
73.40
73.45

74.40

Obligated balance, end of year ................................

86.90
86.93
86.97
86.98

87.00

89.00

3,064
4,374
4,279
51,492
45,642
55,361
¥50,126
¥45,737
¥55,360
476 ................... ...................
¥532 ................... ...................
4,279

4,280

490
453
531
191
49,104
45,093
1 ...................

437
105
54,816
2

Total outlays (gross) .................................................

50,126

45,737

55,360

Net budget authority and outlays:
Budget authority ............................................................

50,960

45,641

55,361

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

4,374

454

CENTERS FOR MEDICARE AND MEDICAID SERVICES—Continued
Trust Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

ADMINISTRATION FOR CHILDREN AND
FAMILIES

MEDICARE PRESCRIPTION DRUG ACCOUNT, FEDERAL SUPPLEMENTARY
INSURANCE TRUST FUND—Continued

Federal Funds

Program and Financing (in millions of dollars)—Continued

TEMPORARY ASSISTANCE
Identification code 75–8308–0–7–571

90.00

2007 actual

Outlays ...........................................................................

2008 est.

50,126

45,737

FOR

NEEDY FAMILIES

2009 est.

Program and Financing (in millions of dollars)

55,360

Identification code 75–1552–0–1–609

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

2008 est.

Enacted/requested:
Budget Authority .....................................................................
50,960
45,641
Outlays ....................................................................................
50,126
45,737
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................
Total:
Budget Authority .....................................................................
Outlays ....................................................................................

50,960
50,126

45,641
45,737

2009 est.

55,361
55,360
–50
–50

55,311
55,310

Since January 2006, Medicare beneficiaries have had the
opportunity to enroll in a comprehensive voluntary prescription drug benefit.
Object Classification (in millions of dollars)
Identification code 75–8308–0–7–571

2007 actual

2008 est.

2009 est.

Direct obligations:
25.2 Other services ................................................................
41.0 Grants, subsidies, and contributions ............................

516
50,976

555
45,087

546
54,815

99.9

51,492

45,642

55,361

Total new obligations ................................................

MEDICARE PRESCRIPTION DRUG ACCOUNT, FEDERAL
SUPPLEMENTARY INSURANCE TRUST FUND
(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
Identification code 75–8308–4–7–571

2007 actual

2008 est.

¥50

10.00

¥50

cprice-sewell on PROD1PC71 with BUDGET PAG

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

¥50
50

New budget authority (gross), detail:
Mandatory:
60.26
Appropriation (trust fund) ......................................... ................... ...................

¥50

73.10
73.20

¥50
50

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

¥50

89.00
90.00

¥50
¥50

2009 est.

Obligations by program activity:
State family assistance grant .......................................
Territories—family assistance grants ...........................
Supplemental grants for population increases .............
Tribal work programs .....................................................
Healthy marriage and responsible fatherhood grants

16,480
77
319
8
150

16,504
16,483
78
78
319 ...................
8
8
150
150

10.00

Total new obligations ................................................

17,034

17,059

16,719

22.00
23.95
23.98

17,059
17,059
¥17,034
¥17,059
¥25 ...................

16,739
¥16,719
¥20

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................

17,059

16,739

72.40
73.10
73.20
73.40

74.40

Obligated balance, end of year ................................

6,566

6,595

6,465

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

12,717
4,159

12,624
4,406

12,371
4,478

87.00

Total outlays (gross) .................................................

16,876

17,030

16,849

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

17,059
16,876

17,059
17,030

16,739
16,849

6,414
6,566
6,595
17,034
17,059
16,719
¥16,876
¥17,030
¥16,849
¥6 ................... ...................

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

Total new obligations (object class 41.0) ................ ................... ...................

2008 est.

00.01
00.02
00.04
00.06
00.09

2009 est.

Obligations by program activity:
00.01 Prescription Drug Benefits ............................................. ................... ...................

2007 actual

2008 est.

2009 est.

Enacted/requested:
Budget Authority .....................................................................
17,059
17,059
Outlays ....................................................................................
16,876
17,030
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................
Total:
Budget Authority .....................................................................
Outlays ....................................................................................

17,059
16,876

17,059
17,030

16,739
16,849
319
236

17,058
17,085

This Budget provides funding for activities authorized by
the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit
Reduction Act of 2005 (P.L. 109–171), including the Temporary Assistance for Needy Families block grant, which provides funding to States to promote work, personal responsibility and self-sufficiency, and the healthy marriage and fatherhood grant program.
Object Classification (in millions of dollars)

The Budget proposes changes to strengthen the financing
of the Medicare prescription drug benefit.
f

ALLOCATIONS RECEIVED

FROM

OTHER ACCOUNTS

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

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Identification code 75–1552–0–1–609

11.1
12.1
21.0
23.1
25.1
25.3

2007 actual

Direct obligations:
Personnel compensation: Full-time permanent .............
Civilian personnel benefits ............................................
Travel and transportation of persons ............................
Rental payments to GSA ................................................
Advisory and assistance services ..................................
Other purchases of goods and services from Government accounts ...........................................................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

2008 est.

2009 est.

2
1
1
1
26

2
1
1
1
21

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
41.0
99.9

Grants, subsidies, and contributions ............................

17,000

Total new obligations ................................................

17,030

17,034

17,059

16,690

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

TEMPORARY ASSISTANCE

FOR

2008 est.

86.98

Outlays (gross), detail:
Outlays from mandatory balances ................................

89.00
90.00

NEEDY FAMILIES

271

The Budget proposes to allow States participating in the
child welfare program the option to access the TANF contingency fund if they experience increases in their foster care
caseload.
f

Program and Financing (in millions of dollars)
2007 actual

231

2009 est.

(Legislative proposal, subject to PAYGO)

Identification code 75–1552–4–1–609

16,719

Employment Summary
Identification code 75–1552–0–1–609

455

PAYMENTS
2008 est.

2009 est.

00.01

Obligations by program activity:
Supplemental Grants for Population Increases ............. ................... ...................

319

10.00

Total new obligations (object class 41.0) ................ ................... ...................

319

22.00
23.95

319
¥319

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ................... ...................

319

73.10
73.20

319
¥236

74.40

Obligated balance, end of year ................................ ................... ...................

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

236

89.00
90.00

319
236

STATES FOR CHILD SUPPORT ENFORCEMENT
FAMILY SUPPORT PROGRAMS

AND

For making payments to States or other non-Federal entities under
titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and
the Act of July 5, 1960 (24 U.S.C. chapter 9), ø$2,949,713,000¿
$2,759,078,000, to remain available until expended; and for such purposes for the first quarter of fiscal year ø2009¿ 2010, $1,000,000,000,
to remain available until expended.
For making payments to each State for carrying out the program
of Aid to Families with Dependent Children under title IV-A of the
Social Security Act before the effective date of the program of Temporary Assistance for Needy Families (TANF) with respect to such
State, such sums as may be necessary: Provided, That the sum of
the amounts available to a State with respect to expenditures under
such title IV-A in fiscal year 1997 under this appropriation and
under such title IV-A as amended by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 shall not exceed
the limitations under section 116(b) of such Act.
For making, after May 31 of the current fiscal year, payments
to States or other non-Federal entities under titles I, IV-D, X, XI,
XIV, and XVI of the Social Security Act and the Act of July 5,
1960 (24 U.S.C. chapter 9), for the last 3 months of the current
fiscal year for unanticipated costs, incurred for the current fiscal
year, such sums as may be necessary. (Department of Health and
Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

The Budget proposes to extend supplemental grants for population increases. It also proposes to eliminate the separate
two-parent family work participation rate and to require twoparent families to meet the 50 percent work rate to which
single parent families adhere.
f

CONTINGENCY FUND
Program and Financing (in millions of dollars)
Identification code 75–1522–0–1–609

2007 actual

258

273

10.00

258

273

1,793

1,748

1,490

Total new obligations (object class 41.0) ................

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
Resources available from recoveries of prior year obligations .......................................................................
22.30 Expired unobligated balance transfer to unexpired account ..........................................................................

00.91
01.02
01.03

Subtotal, child support enforcement ........................
Payments to territories ..................................................
Repatriation ...................................................................

4,399
33
1

4,204
35
1

3,823
35
1

01.91
09.01

Subtotal, other payments ..........................................
Offset obligations (CSE grants to States) ....................

34
7

36
7

10.00

Total new obligations ................................................

4,440

4,247

3,866

21.40
22.00
22.10

8
4,406

142 ...................
4,005
3,766

10 ................... ...................

24.40

Unobligated balance carried forward, end of year

1,807
¥59

1,748
¥258

1,490
¥273

24.40

Unobligated balance carried forward, end of year

1,748

1,490

1,217

72.40
73.10
73.20
73.40
73.45

74.40

Obligated balance, end of year ................................
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3,315
498
10

Total budgetary resources available for obligation
Total new obligations ....................................................

16:43 Jan 24, 2008

45
34
61
59
258
273
¥56
¥231
¥271
¥10 ................... ...................
¥4 ................... ...................

PO 00000

2009 est.

3,711
483
10

23.90
23.95

2008 est.

3,918
471
10

4 ................... ...................

23.90
23.95

VerDate Aug 31 2005

2007 actual

Obligations by program activity:
00.01 State child support administrative costs ......................
00.02 Child support incentive payments .................................
00.03 Access and visitation grants .........................................

2009 est.

Obligations by program activity:
00.01 Contingency fund ...........................................................

21.40
22.10

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2008 est.

Identification code 75–1501–0–1–609

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168

100

4,582
¥4,440

4,247
¥4,247

3,866
¥3,866

142 ................... ...................

3,199
1,200

2,998
1,000

2,759
1,000

70.00

Total new budget authority (gross) ..........................

4,406

4,005

3,766

72.40
73.10
73.20

799
4,440
¥4,245

826
4,247
¥4,284

689
3,866
¥3,960

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

456

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

PAYMENTS

THE BUDGET FOR FISCAL YEAR 2009

TO STATES FOR CHILD SUPPORT ENFORCEMENT AND
FAMILY SUPPORT PROGRAMS—Continued

Program and Financing (in millions of dollars)—Continued
Identification code 75–1501–0–1–609

2007 actual

2008 est.

2009 est.

73.45

Recoveries of prior year obligations ..............................

¥168

¥100

74.40

Obligated balance, end of year ................................

826

689

495

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

3,652
593

3,373
911

3,383
577

87.00

Total outlays (gross) .................................................

4,245

4,284

3,960

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

¥7

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

4,399
4,238

3,998
4,277

3,759
3,953

89.00
90.00

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

2008 est.

Enacted/requested:
Budget Authority .....................................................................
4,399
3,998
Outlays ....................................................................................
4,238
4,277
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................
Total:
Budget Authority .....................................................................
Outlays ....................................................................................

4,399
4,238

3,998
4,277

2009 est.

STATES FOR CHILD SUPPORT ENFORCEMENT
FAMILY SUPPORT PROGRAMS

7
7

3,766
3,960

AND

(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–1501–4–1–609

2007 actual

2008 est.

LOW-INCOME HOME ENERGY ASSISTANCE
For making payments under section ø2604(a)–(d)¿ 2602(b) of the
Low-Income Home Energy Assistance Act of 1981 (42 U.S.C.
ø8623(a)–(d)¿ 8621(b) ), ø$2,015,206,000¿ $1,700,000,000.
For making payments under section ø2604(e)¿ 2602(e) of the LowIncome Home Energy Assistance Act of 1981 (42 U.S.C. ø8623(e)¿
8621(e) ), ø$596,379,000¿ $300,000,000, to remain available until expended: Provided, that these funds are for the unanticipated home
energy assistance needs of one or more states, as authorized by section
2604(e) of the Act, and notwithstanding the designation requirement
of section 2602(e) of such Actø: Provided, That of the amount provided
by this paragraph, $250,000,000 is designated as described in section
5 (in the matter preceding division A of this consolidated Act)¿. (Department of Health and Human Services Appropriations Act, 2008.)

3,759
3,953

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

forcement services are available in international child support
cases. Additionally, this request includes several proposals
from previous President’s Budgets aimed at increasing child
support collections, improving States’ efforts to collect medical
support on behalf of children, increasing resources to support
and facilitate non-custodial parents’ access to and visitation
of their children, providing Tribal child support programs
with access to the same waivers and enforcement tools that
States have, and increasing the annual spending limit on
the Repatriation program.

2009 est.

Program and Financing (in millions of dollars)
Identification code 75–1502–0–1–609

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Direct program activity ..................................................

2,161

2,570

2,000

10.00

Total new obligations (object class 41.0) ................

2,161

2,570

2,000

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

20
2,161

20
2,570

20
2,000

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

2,181
¥2,161

2,590
¥2,570

2,020
¥2,000

24.40

Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation—Block ................................................
1,980
40.00
Appropriation—Contingency Fund ............................
181
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
40.33
Appropriation permanently reduced (P.L. 110–161) ...................

2,015
1,700
596
300
¥35 ...................
¥6 ...................
2,570

Obligations by program activity:
00.01 State child support administrative costs ...................... ................... ...................
00.03 Access and visitation grants ......................................... ................... ...................

5
2

43.00

Appropriation (total discretionary) ........................

10.00

Total new obligations (object class 41.0) ................ ................... ...................

7
¥7

72.40
73.10
73.20
73.40

74.40

Obligated balance, end of year ................................

724

772

636

2,161

2,000

1,069
724
772
2,161
2,570
2,000
¥2,498
¥2,522
¥2,136
¥8 ................... ...................

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ................... ...................

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

1,530
968

1,902
620

1,480
656

7
¥7

87.00

Total outlays (gross) .................................................

2,498

2,522

2,136

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

2,161
2,498

2,570
2,522

2,000
2,136

89.00
90.00

7
7

This request includes a new legislative proposal that will
make technical changes to ensure that all child support enVerDate Aug 31 2005

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This program makes grants to States and Indian Tribes
to aid low-income households with high energy costs through
payments to eligible households, energy suppliers, and weatherization providers. Obligation estimates for the contingency
fund are based on average historical obligation rates.
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HHS

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
REFUGEE

AND

25.3

ENTRANT ASSISTANCE

For necessary expenses for refugee and entrant assistance activities
øand for costs associated with the care and placement of unaccompanied alien children¿ authorized by øtitle IV¿ section 414 of the
Immigration and Nationality Act and section 501 of the Refugee
Education Assistance Act of 1980, for carrying out section 462 of
the Homeland Security Act of 2002, for costs associated with the
care and placement of unaccompanied alien children, and for carrying
out the Torture Victims Relief Act of 1998, ø$667,288,000¿
$628,044,000, of which up to ø$9,988,000¿ $9,814,000 shall be available to carry out the Trafficking Victims Protection Act of 2000,
as amended: Provided, That funds appropriated under this heading
pursuant to section 414(a) of the Immigration and Nationality Act
and section 462 of the Homeland Security Act of 2002 for fiscal
year ø2008¿ 2009 shall be available for the costs of assistance provided and other activities to remain available through September
30, ø2010¿ 2011 (6 U.S.C. 279; 8 U.S.C. 1522, note, 1524; 22 U.S.C.
2152 note, 7101 et seq ). (Department of Health and Human Services
Appropriations Act, 2008.)

41.0

Other purchases of goods and services from Government accounts ...........................................................
Grants, subsidies, and contributions ............................

8
535

10
621

13
628

99.9

Total new obligations ................................................

566

658

668

Employment Summary
Identification code 75–1503–0–1–609

2007 actual

2008 est.

2009 est.

PROMOTING SAFE

AND

STABLE FAMILIES

For carrying out section 436 of the Social Security Act,
$345,000,000 and section 437, ø$64,437,000¿ $63,311,000. (Department of Health and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

2008 est.

2009 est.

Identification code 75–1512–0–1–506

2007 actual

2008 est.

2009 est.

00.01
00.02
00.03

Obligations by program activity:
Refugee and entrant assistance ...................................
Assistance for treatment of torture victims ..................
Unaccompanied alien children ......................................

461
10
95

529
10
119

530
10
128

Obligations by program activity:
00.01 Grants to States and Tribes ..........................................
00.02 Research, training and technical assistance ...............
00.03 State court improvement activities ...............................

10.00

Total new obligations ................................................

566

658

668

10.00

Total new obligations ................................................

454

428

21.40
22.00
22.10

17
588

42
656

40
628

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

454
¥454

428
¥428

3 ................... ...................

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

608
¥566

24.40

Unobligated balance carried forward, end of year

698
¥658

668
¥668

40 ...................

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
588
40.33
Appropriation permanently reduced (P.L. 110–161) ...................

668
628
¥12 ...................

43.00

Appropriation (total discretionary) ........................

72.40
73.10
73.20
73.40
73.45

74.40

Obligated balance, end of year ................................

549

610

649

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

217
292

262
335

251
378

87.00

Total outlays (gross) .................................................

509

597

629

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2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

Program and Financing (in millions of dollars)
Identification code 75–1503–0–1–609

457

588

656

628

506
549
610
566
658
668
¥509
¥597
¥629
¥11 ................... ...................
¥3 ................... ...................

588
509

656
597

628
629

States are subsidized for administering the refugee assistance program. Funds also are provided to assist in the rehabilitation of victims of torture, trafficking victims, and the
care and placement of unaccompanied alien children.

Identification code 75–1503–0–1–609

11.1
23.1
25.1
25.2

2007 actual

Direct obligations:
Personnel compensation: Full-time permanent .............
Rental payments to GSA ................................................
Advisory and assistance services ..................................
Other services ................................................................

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1
18
2
PO 00000

2008 est.

2009 est.

3
1
21
2

Frm 00035

Fmt 3616

386
9
33

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
89
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
43.00

64
63
¥1 ...................

60.00

Appropriation (total discretionary) ........................
Mandatory:
Appropriation .............................................................

365

70.00

Total new budget authority (gross) ..........................

454

428

72.40
73.10
73.20
73.40

74.40

Obligated balance, end of year ................................

444

424

430

86.90
86.93
86.97
86.98

31
58
110
260

6
80
128
234

6
54
128
234

87.00

Total outlays (gross) .................................................

459

448

422

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

454
459

428
448

428
422

452
444
424
454
428
428
¥459
¥448
¥422
¥3 ................... ...................

This program provides funds for a broad range of child
welfare services, including family preservation and family
support services.
Object Classification (in millions of dollars)
Identification code 75–1512–0–1–506

Object Classification (in millions of dollars)

412
9
33

2007 actual

2008 est.

2009 est.

Direct obligations:
25.1 Advisory and assistance services ..................................
25.3 Other purchases of goods and services from Government accounts ...........................................................
41.0 Grants, subsidies, and contributions ............................

2 ................... ...................
443
425
425

99.9

454

Sfmt 3643

Total new obligations ................................................
E:\BUDGET\HHS.XXX

HHS

428

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

458

CHILD CARE ENTITLEMENT

THE BUDGET FOR FISCAL YEAR 2009

STATES

Program and Financing (in millions of dollars)

Program and Financing (in millions of dollars)
Identification code 75–1550–0–1–609

2007 actual

Obligations by program activity:
00.01 Mandatory child care .....................................................
00.02 Matching child care .......................................................
00.03 Training and technical assistance ................................
00.04 Child care tribal grants .................................................
10.00

Total new obligations ................................................

22.00
22.30

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Expired unobligated balance transfer to unexpired account ..........................................................................

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

74.40

Obligated balance, end of year ................................

2008 est.

1,178
1,677
7
58

1,178
1,674
7
58

2009 est.

1,178
1,674
7
58

2,920

2,917

3 ................... ...................
2,920
¥2,920

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................

72.40
73.10
73.20
73.40

Identification code 75–1515–0–1–609

2,917
¥2,917

2,917

2,917
¥2,917

2,917

728
650
589
2,920
2,917
2,917
¥2,994
¥2,978
¥2,966
¥4 ................... ...................
650

589

2,339
655

2,389
589

2,389
577

87.00

Total outlays (gross) .................................................

2,994

2,978

2,966

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

2,917
2,994

2,917
2,978

2,917
2,966

This account provides child care funding for welfare recipients and low-income working families and was established
by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the
Deficit Reduction Act of 2005 (P.L. 109–171).
Object Classification (in millions of dollars)
2007 actual

2008 est.

2009 est.

Direct obligations:
Advisory and assistance services ..................................
Grants, subsidies, and contributions ............................

7
2,913

7
2,910

99.9

Total new obligations ................................................

2,920

2,917

cprice-sewell on PROD1PC71 with BUDGET PAG

STATES

FOR THE
BLOCK

CHILD CARE
GRANT

AND

DEVELOPMENT

For carrying out the Child Care and Development Block Grant
Act of 1990ø, $2,098,746,000¿ (42 U.S.C. 9858 et seq.), $2,062,081,000
shall be used to supplement, not supplant State general revenue
funds for child care assistance for low-income families: Provided, That
ø$18,777,370¿ $18,449,329 shall be available for child care resource
and referral and school-aged child care activities, of which ø$982,080¿
$964,923 shall be øfor the Child Care Aware toll-free hotline¿ available to the Secretary for discretionary activities to support comprehensive consumer education or parental choice: Provided further, That,
in addition to the amounts required to be reserved by the States
under section 658G, ø$267,785,718¿ $263,107,502 shall be reserved
by the States for activities authorized under section 658G, of which
ø$98,208,000¿ $96,492,306 shall be for activities that improve the
quality of infant and toddler care: Provided further, That
ø$9,821,000¿ $9,649,000 shall be for use by the Secretary for child
care research, demonstration, and evaluation activities. (Department
of Health and Human Services Appropriations Act, 2008.)
VerDate Aug 31 2005

16:43 Jan 24, 2008

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2009 est.

2,052
10

10.00

Total new obligations ................................................

2,062

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

2,062
¥2,062

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
2,062
40.33
Appropriation permanently reduced (P.L. 110–161) ...................

2,099
2,062
¥37 ...................

43.00

Appropriation (total discretionary) ........................

2,062

72.40
73.10
73.20
73.40

74.40

Obligated balance, end of year ................................

498

559

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

1,629
506

1,588
413

1,588
474

87.00

Total outlays (gross) .................................................

2,135

2,001

2,062

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

2,062
2,135

2,062
2,001

2,062
2,062

2,062

575
498
559
2,062
2,062
2,062
¥2,135
¥2,001
¥2,062
¥4 ................... ...................

This appropriation helps low-income families pay for child
care and related services and supports grants to States for
activities to improve child care quality.
Object Classification (in millions of dollars)
Identification code 75–1515–0–1–609

2007 actual

2008 est.

2009 est.

Direct obligations:
Advisory and assistance services ..................................
Other purchases of goods and services from Government accounts ...........................................................
41.0 Grants, subsidies, and contributions ............................

1
2,052

99.9

2,062

25.1
25.3

Total new obligations ................................................
f

25.1
41.0

PAYMENTS

2008 est.

540

Outlays (gross), detail:
86.97 Outlays from new mandatory authority .........................
86.98 Outlays from mandatory balances ................................

Identification code 75–1550–0–1–609

2007 actual

Obligations by program activity:
00.01 Block grant payments to States ....................................
00.04 Research and evaluation fund ......................................

PO 00000

Frm 00036

Fmt 3616

SOCIAL SERVICES BLOCK GRANT
For making grants to States pursuant to section 2002 of the Social
Security Act (42 U.S.C. 1397a), ø$1,700,000,000¿ $1,200,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2)
of such Act, the applicable percent specified under such subparagraph
for a State to carry out State programs pursuant to title XX of
such Act shall be 10 percent: Provided further, That notwithstanding
section 2003(c) of such Act, the amount specified for allocation under
such section for fiscal year 2009 shall be $1,200,000,000. (Department
of Health and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–1534–0–1–506

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Direct program activity ..................................................

1,713

1,700

1,200

10.00

Total new obligations (object class 41.0) ................

1,713

1,700

1,200

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

17
1,700

4
1,700

4
1,200

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

1,717
¥1,713

1,704
¥1,700

1,204
¥1,200

Sfmt 3643

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HHS

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
24.40

Unobligated balance carried forward, end of year

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation ............................................................. ................... ...................
Mandatory:
60.00
Appropriation .............................................................
1,700
1,700

¥500
1,700

70.00

Total new budget authority (gross) ..........................

1,700

1,200

72.40
73.10
73.20

832
1,713
¥1,956

589
1,700
¥1,936

353
1,200
¥1,302

74.40

Obligated balance, end of year ................................

589

353

251

Outlays (gross), detail:
Outlays from new discretionary authority ..................... ................... ...................
Outlays from new mandatory authority .........................
1,448
1,445
Outlays from mandatory balances ................................
508
491

¥425
1,445
282

86.90
86.97
86.98
87.00

Total outlays (gross) .................................................

1,956

1,936

1,302

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

1,700
1,956

1,700
1,936

1,200
1,302

cprice-sewell on PROD1PC71 with BUDGET PAG

CHILDREN

AND

FAMILIES SERVICES PROGRAMS

For carrying out, except as otherwise provided, the Runaway and
Homeless Youth Act, the Developmental Disabilities Assistance and
Bill of Rights Act, the Head Start Act, the Child Abuse Prevention
and Treatment Act, sections 310 and 316 of the Family Violence
Prevention and Services Act, the Native American Programs Act of
1974, title II of the Child Abuse Prevention and Treatment and
Adoption Reform Act of 1978 (adoption opportunities), sections 330F
and 330G of the Public Health Service Act, the Abandoned Infants
Assistance Act of 1988, sections 261 and 291 of the Help America
Vote Act of 2002, part B–1 ø(1)¿ of title IV and sections 413, 1110,
and 1115 of the Social Security Act; for making payments under
øthe Community Services Block Grant Act,¿ sections 439(i), 473B,
and 477(i) of the Social Security Act, and the Assets for Independence
Act, and for necessary administrative expenses to carry out øsuch¿
said Acts and titles I, IV, V, X, XI, XIV, XVI, and XX of the Social
Security Act, the Act of July 5, 1960 (24 U.S.C. chapter 9), the
Low-Income Home Energy Assistance Act of 1981, title IV of the
Immigration and Nationality Act, section 501 of the Refugee Education Assistance Act of 1980, øand section 505 of the Family Support
Act of 1988, $9,129,990,000¿ $8,493,210,000, of which ø$4,400,000¿
$19,674,000, to remain available until September 30, ø2009¿ 2010,
shall be for grants to States for adoption incentive payments, as
authorized by section 473A of the Social Security Act and may be
made for adoptions completed before September 30, ø2008¿ 2009:
Provided, That ø$7,000,270,000¿ $7,026,571,000 shall be for making
payments under the Head Start Act, of which $1,388,800,000 shall
become available October 1, ø2008¿ 2009, and shall remain available
through September 30, ø2009: Provided further, That $705,451,000
shall be for making payments under the Community Services Block
Grant Act: Provided further, That not less than $8,000,000 shall
be for section 680(3)(B) of the Community Services Block Grant Act¿
2010: Provided further, That in addition to amounts provided herein,
ø$6,000,000¿ $5,762,000 shall be available from amounts available
under section 241 of the Public Health Service Act to carry out
the provisions of section 1110 of the Social Security Act: øProvided
further, That to the extent Community Services Block Grant funds
are distributed as grant funds by a State to an eligible entity as
provided under the Act, and have not been expended by such entity,
they shall remain with such entity for carryover into the next fiscal
year for expenditure by such entity consistent with program purposes:
Provided further, That the Secretary of Health and Human Services
shall establish procedures regarding the disposition of intangible
property which permits grant funds, or intangible assets acquired
with funds authorized under section 680 of the Community Services
Block Grant Act to become the sole property of such grantees after
a period of not more than 12 years after the end of the grant for
purposes and uses consistent with the original grant: Provided further, That funds appropriated for section 680(a)(2) of the Community
VerDate Aug 31 2005

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Fmt 3616

459

Services Block Grant Act shall be available for financing construction
and rehabilitation and loans or investments in private business enterprises owned by community development corporations:¿ Provided further, That ø$53,625,000¿ $75,000,000 is for a compassion capital fund
to provide grants to charitable organizations to emulate model social
service programs and to encourage research on the best practices
of social service organizations: Provided further, That ø$17,720,000¿
$17,410,000 shall be for activities authorized by the Help America
Vote Act of 2002, of which ø$12,370,000¿ $12,154,000 shall be for
payments to States to promote access for voters with disabilities,
and of which ø$5,350,000¿ $5,256,000 shall be for payments to States
for protection and advocacy systems for voters with disabilities: Provided further, That ø$110,836,000¿ $136,664,000 shall be for making
competitive grants to provide abstinence education (as defined by
section 510(b)(2) of the Social Security Act) to adolescents, and for
Federal costs of administering the grant: Provided further, That
grants under the immediately preceding proviso shall be made only
to public and private entities which agree that, with respect to an
adolescent to whom the entities provide abstinence education under
such grant, the entities will not provide to that adolescent any other
education regarding sexual conduct, except that, in the case of an
entity expressly required by law to provide health information or
services the adolescent shall not be precluded from seeking health
information or services from the entity in a different setting than
the setting in which abstinence education was provided: Provided
further, That within amounts provided herein for abstinence education for adolescents, up to ø$10,000,000¿ $10,000,000 may be available for a national abstinence education campaign: Provided further,
That in addition to amounts provided herein for abstinence education
for adolescents, ø$4,500,000¿ $4,410,000 shall be available from
amounts available under section 241 of the Public Health Service
Act to carry out evaluations (including longitudinal evaluations) of
adolescent pregnancy prevention approaches: Provided further, That
$10,000,000 shall be for a human services case management system
for Federally-declared disasters, to include funding for local and State
planning grants, for comprehensive national case management contracts, and for Federal costs of administering the system, to remain
available through September 30, 2010; Provided further, That up to
$2,000,000 shall be for improving the Public Assistance Reporting
Information System, including grants to States to support data collection for a study of the system’s effectivenessø: Provided further, That
$17,301,000 shall be available for the projects and in the amounts
specified in the explanatory statement described in section 4 (in the
matter preceding division A of this consolidated Act)¿.
(42 U.S.C. 254c–6, 254 c–7, 604 note, 670 note, 673b, 2991 et seq.,
5101 et seq., 5111 et seq., 5751 et seq., 9834 et seq., 10409, 10416,
15001 et seq., 15421, 15461; 24 U.S.C. ch. 9) (Department of Health
and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–1536–0–1–506

2007 actual

Obligations by program activity:
01.01 Head start ......................................................................
01.03 Runaway and homeless youth (basic centers) .............
01.04 Transitional living ..........................................................
01.06 Education grants to reduce sexual abuse of runaway
youth ..........................................................................
01.07 Abstinence education (mandatory) ................................
01.08 Mentoring children of prisoners ....................................
01.09 Child abuse state grants ..............................................
01.10 Child abuse discretionary activities ..............................
01.11 Community-based child abuse prevention ....................
01.12 Child welfare services ...................................................
01.13 Child welfare training ....................................................
01.14 Adoption opportunities ...................................................
01.15 Abandoned infants assistance ......................................
01.16 Adoption incentives ........................................................
01.17 Independent living training vouchers ............................
01.18 Children’s health act programs ....................................
01.19 State councils on developmental disabilities ...............
01.20 Protection and advocacy ................................................
01.21 Projects of national significance ...................................
01.22 University centers for excellence ...................................
01.23 Voting access for individuals with disabilities .............
01.24 Native american programs ............................................
01.25 Social services and income maintenance research ......
01.26 Compassion capital fund ..............................................
01.28 Federal administration ...................................................
01.29 Center for faith-based and community initiatives .......
01.30 Abstinence education (discretionary) ............................
Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

6,888
48
40
15
39
49
27
26
42
287
7
27
12
7
46
13
72
39
11
33
16
44
6
64
187
1
113

2008 est.

6,878
53
43

2009 est.

7,027
53
43

17
17
38 ...................
49
50
27
26
37
37
42
42
282
282
7
7
26
26
12
12
4
20
45
45
12
12
72
72
39
39
14
14
37
37
17
17
46
46
15 ...................
53
75
185
196
1
1
109
137

460

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

CHILDREN

AND

THE BUDGET FOR FISCAL YEAR 2009

FAMILIES SERVICES PROGRAMS—Continued

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

Program and Financing (in millions of dollars)—Continued
Identification code 75–1536–0–1–506

2007 actual

2008 est.

2009 est.

01.31

Disaster Human Services Case Management ............... ................... ...................

01.91
03.01
03.03
03.04
03.06
03.08
03.09

Subtotal .....................................................................
Community services block grant ...................................
Rural communtiy facilities ............................................
Community services discretionary (JOLI & CED) ...........
Assets for independence ................................................
Domestic violence hotline ..............................................
Family violence prevention and services .......................

8,159
630
7
33
24
3
125

03.91

Subtotal .....................................................................

822

849

150

04.00
09.01

Total, direct program ................................................
Reimbursable program ..................................................

8,981
11

9,009
17

8,493
17

10.00

Total new obligations ................................................

8,992

9,026

8,510

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

9
9,006

8
9,025

7
8,510

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

58.00
58.10
58.90

Appropriation (total discretionary) ........................
Advance appropriation ..............................................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................
Change in uncollected customer payments from
Federal sources (unexpired) .............................

16 ................... ...................

Total new budget authority (gross) ..........................

9,006

Obligated balance, end of year ................................

7,741
7,104
¥160 ...................
7,104
1,389

70.00

74.40

7,581
1,389

60.00

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................

7,550
1,389

Spending authority from offsetting collections
(total discretionary) ..........................................
Mandatory:
Appropriation .............................................................

72.40
73.10
73.20
73.40
74.00

8,160
8,343
654 ...................
8 ...................
37 ...................
24
24
3
3
123
123

9,015
9,033
8,517
¥8,992
¥9,026
¥8,510
¥15 ................... ...................

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
7,550
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
43.00
55.00

38 ...................
9,025

8,510

4,850
4,879
4,988
8,992
9,026
8,510
¥8,882
¥8,917
¥8,675
¥74 ................... ...................
¥16 ................... ...................
9 ................... ...................
4,879

4,988

4,823

Total:
Budget Authority .....................................................................
Outlays ....................................................................................

4,813
4,028
17
24

4,775
4,493
4,108
4,160
14 ...................
20
22

87.00

8,882

8,917

cprice-sewell on PROD1PC71 with BUDGET PAG

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

¥11

¥17

Identification code 75–1536–0–1–506

11.1
11.3
11.5

2007 actual

11.9
12.1
21.0
23.1
23.2
23.3
24.0
25.1
25.2
25.3
25.4
25.5
26.0
41.0

12
5

50
25

9,020
8,905

8,543
8,683

2008 est.

2009 est.

97
5
3

106
6
3

109
6
3

Total personnel compensation ..............................
105
Civilian personnel benefits .......................................
23
Travel and transportation of persons .......................
4
Rental payments to GSA ...........................................
10
Rental payments to others ........................................ ...................
Communications, utilities, and miscellaneous
charges .................................................................
4
Printing and reproduction .........................................
2
Advisory and assistance services .............................
213
Other services ............................................................
3
Other purchases of goods and services from Government accounts .................................................
69
Operation and maintenance of facilities ..................
2
Research and development contracts ....................... ...................
Supplies and materials .............................................
2
Grants, subsidies, and contributions ........................
8,546

115
25
4
16
1

118
25
4
14
1

5
1
214
6

7
2
208
6

47
2
1
1
8,571

54
3
1
1
8,049

Direct obligations ..................................................
Reimbursable obligations ..............................................

8,983
9

9,009
17

8,493
17

99.9

Total new obligations ................................................

8,992

9,026

8,510

Employment Summary
Identification code 75–1536–0–1–506

1001
1101

2007 actual

Direct:
Civilian full-time equivalent employment .....................
Military full-time equivalent employment .....................
AND

2008 est.

1,109
1

1,167
4

2009 est.

1,165
4

FAMILIES SERVICES PROGRAMS

(Legislative proposal, subject to PAYGO)
Program and Financing (in millions of dollars)
2007 actual

2008 est.

2009 est.

8,675
Obligations by program activity:
01.07 Abstinence education ..................................................... ...................

04.00

Total, direct program ................................................ ...................

10.00

Total new obligations (object class 41.0) ................ ...................

22.00
23.95

12
¥12

50
¥50

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ...................

¥17

10 ................... ...................

PO 00000

8,493
8,658

99.0
99.0

¥16 ................... ...................

8,989
8,871

9,008
8,900

Object Classification (in millions of dollars)

Identification code 75–1536–4–1–506

Total outlays (gross) .................................................

8,989
8,871

2009 est.

The 2009 Budget proposes to eliminate the Community
Services Block Grant, Community Economic Development,
Rural Community Facilities and Job Opportunities for LowIncome Individuals programs as a result of poor performance
and/or duplication with other Federal programs that can
achieve greater results and better focus on communities most
in need.

CHILDREN

Outlays (gross), detail:
86.90 Outlays from new discretionary authority .....................
86.93 Outlays from discretionary balances .............................
86.97 Outlays from new mandatory authority .........................
86.98 Outlays from mandatory balances ................................

2008 est.

Enacted/requested:
Budget Authority .....................................................................
8,989
Outlays ....................................................................................
8,871
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... ....................
Outlays .................................................................................... ....................

9,008
8,900

8,493
8,658

Frm 00038

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Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

72.40
73.10
73.20
74.40

Change in obligated balances:
Obligated balance, start of year ................................... ................... ...................
Total new obligations .................................................... ...................
12
Total outlays (gross) ...................................................... ...................
¥5
Obligated balance, end of year ................................ ...................

88.90
7
50
¥25
32

Outlays (gross), detail:
86.97 Outlays from new mandatory authority ......................... ...................
5
86.98 Outlays from mandatory balances ................................ ................... ...................

20
5

87.00

Total outlays (gross) ................................................. ...................

89.00
90.00

12
5

50
25

This legislative proposal provides for an extension of the
Title V abstinence education program, which provides grants
to States to implement abstinence-only education programs.
f

CHILDREN’S RESEARCH

AND

TECHNICAL ASSISTANCE

Program and Financing (in millions of dollars)
Identification code 75–1553–0–1–609

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Training and technical assistance ................................
00.02 Federal parent locator service .......................................
00.03 Child welfare study ........................................................
00.04 Welfare research ............................................................
09.01 Reimbursable program ..................................................

12
25
6
15
22

15
25
6
15
28

12
25
6
15
30

10.00

Total new obligations ................................................

21.40
22.00
22.10

2
80

3 ...................
86
88

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

24.40

Unobligated balance carried forward, end of year

88.95

89.00
90.00

¥7

461

¥28

¥30

¥15 ................... ...................

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

58
70

58
58

58
61

This account provides funding for research and technical
assistance activities established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.
104–193), as amended by the Deficit Reduction Act of 2005
(P.L. 109–171).
Object Classification (in millions of dollars)
Identification code 75–1553–0–1–609

2007 actual

2008 est.

2009 est.

25.7
41.0

Direct obligations:
Personnel compensation: Full-time permanent ........
Civilian personnel benefits .......................................
Travel and transportation of persons .......................
Rental payments to GSA ...........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of equipment ...............
Grants, subsidies, and contributions ........................

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

58
22

61
28

58
30

99.9

Total new obligations ................................................

11.1
12.1
21.0
23.1
25.1
25.2
25.3

7
1
1
3
22
11

7
1
1
3
24
11

7
1
1
3
21
11

7
4
2

7
4
3

Employment Summary

1 ................... ...................
83
¥80

89
¥89

Identification code 75–1553–0–1–609

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

88
¥88

2008 est.

2009 est.

3 ................... ...................

DISABLED VOTER SERVICES
New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................
Spending authority from offsetting collections:
69.00
Offsetting collections (cash) ................................
69.10
Change in uncollected customer payments from
Federal sources (unexpired) .............................
69.90
70.00

Identification code 75–1533–0–1–808

2007 actual

15 ................... ...................

Change in obligated balances:
72.40 Obligated balance, start of year ...................................
73.20 Total outlays (gross) ......................................................

Spending authority from offsetting collections
(total mandatory) .............................................

74.40

Total new budget authority (gross) ..........................

Change in obligated balances:
72.40 Obligated balance, start of year ...................................
73.10 Total new obligations ....................................................
73.20 Total outlays (gross) ......................................................
73.45 Recoveries of prior year obligations ..............................
74.00 Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................

cprice-sewell on PROD1PC71 with BUDGET PAG

Program and Financing (in millions of dollars)
58

64
52
55
80
89
88
¥77
¥86
¥91
¥1 ................... ...................

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

56
21

47
39

51
40

87.00

Total outlays (gross) .................................................

¥6
¥1

¥23
¥5

¥25
¥5

Frm 00039

Fmt 3616

Jkt 214754

7
¥3

4
¥2

2
¥1

Obligated balance, end of year ................................

86.93

Outlays (gross), detail:
Outlays from discretionary balances .............................

89.00
90.00

1 ................... ...................

Obligated balance, end of year ................................

16:43 Jan 24, 2008

2009 est.

¥15 ................... ...................

74.40

VerDate Aug 31 2005

2008 est.

PO 00000

PAYMENTS

STATES

FOR

FOSTER CARE

AND

ADOPTION ASSISTANCE

For making payments to States or other non-Federal entities under
title IV-E of the Social Security Act, ø$5,067,000,000¿ $5,096,000,000.
For making payments to States or other non-Federal entities under
title IV-E of the Act, for the first quarter of fiscal year ø2009,
$1,776,000,000¿ 2010, $1,800,000,000.
For making, after May 31 of the current fiscal year, payments
to States or other non-Federal entities under section 474 of title
IV-E, for the last 3 months of the current fiscal year for unanticipated
costs, incurred for the current fiscal year, such sums as may be
necessary. (Department of Health and Human Services Appropriations
Act, 2008.)
Sfmt 3616

E:\BUDGET\HHS.XXX

HHS

ADMINISTRATION FOR CHILDREN AND FAMILIES—Continued
Federal Funds—Continued

462

PAYMENTS

STATES FOR FOSTER CARE
ASSISTANCE—Continued

THE BUDGET FOR FISCAL YEAR 2009
AND

1001

ADOPTION

PAYMENTS

Program and Financing (in millions of dollars)
Identification code 75–1545–0–1–609

2007 actual

Obligations by program activity:
00.01 Foster care .....................................................................
00.02 Independent living .........................................................
00.04 Adoption assistance .......................................................
10.00

Total new obligations ................................................

22.00
23.95
23.98

2008 est.

STATES

FOR FOSTER
ASSISTANCE

CARE

AND

ADOPTION

(Legislative proposal, subject to PAYGO)

2009 est.

Program and Financing (in millions of dollars)
4,688
140
1,942

4,581
140
2,156

6,770

6,877

4,449
140
2,283

Identification code 75–1545–4–1–609

6,872

Obligations by program activity:
00.01 Foster care ..................................................................... ................... ...................
00.04 Adoption assistance ....................................................... ................... ...................

14
3

10.00

Total new obligations (object class 41.0) ................ ................... ...................

22.00
23.95

17
¥17

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation ............................................................. ................... ...................

73.10
73.20

17
¥14

74.40

Obligated balance, end of year ................................ ................... ...................

86.97

Outlays (gross), detail:
Outlays from new mandatory authority ......................... ................... ...................

89.00
90.00

17
14

6,855
6,877
6,872
¥6,770
¥6,877
¥6,872
¥86 ................... ...................

5,125
1,730

5,067
1,810

5,096
1,776

70.00

6,855

6,877

6,872

Total new budget authority (gross) ..........................

Civilian full-time equivalent employment .....................

917
1,031
1,238
6,770
6,877
6,872
¥6,563
¥6,670
¥6,872
¥93 ................... ...................

Obligated balance, end of year ................................

1,031

1,238

Outlays (gross), detail:
86.97 Outlays from new mandatory authority .........................
86.98 Outlays from mandatory balances ................................

5,907
656

5,864
806

5,872
1,000

87.00

Total outlays (gross) .................................................

6,563

6,670

6,872

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

6,855
6,563

6,877
6,670

6,872
6,872

Summary of Budget Authority and Outlays
(in millions of dollars)
2007 actual

2008 est.

Enacted/requested:
Budget Authority .....................................................................
6,855
6,877
Outlays ....................................................................................
6,563
6,670
Legislative proposal, subject to PAYGO:
Budget Authority ..................................................................... .................... ....................
Outlays .................................................................................... .................... ....................

2009 est.

6,872
6,872

2007 actual

2008 est.

2009 est.

The legislative proposals include provisions to introduce an
option available to all States to participate in an alternative
financing system for child welfare that will better meet the
needs of each State’s foster care population. States choosing
to participate face far fewer administrative burdens and will
receive funds in the form of flexible grants. There is also
a proposal to increase the match rate for the District of Columbia to align with the match rate used in the Medicaid
program.
f

17
14

ADMINISTRATION ON AGING
Federal Funds

Total:
Budget Authority .....................................................................
Outlays ....................................................................................

6,855
6,563

6,877
6,670

6,889
6,886

Foster care.—The proposed level will support eligible lowincome children who must be placed outside the home. An
average of 203,200 children per month will be served in 2009.
Adoption assistance.—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 430,400 children per
month will be served in 2009.
Object Classification (in millions of dollars)

AGING SERVICES PROGRAMS
For carrying out, to the extent not otherwise provided, the Older
Americans Act of 1965, as amended øand section 398 of the Public
Health Service Act, $1,438,567,000, of which $5,500,000 shall be
available for activities regarding medication management, screening,
and education to prevent incorrect medication and adverse drug reactions: Provided, That $6,431,000 shall be available for the projects
and in the amounts specified in the explanatory statement described
in section 4 (in the matter preceding division A of this consolidated
Act)¿, $1,381,384,000. (Department of Health and Human Services
Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–1545–0–1–609

2007 actual

2008 est.

2009 est.
Identification code 75–0142–0–1–506

1
6,751

1
6,865

1
6,860

99.9

6,770

6,877

6,872

25.1
25.3

Total new obligations ................................................

Employment Summary
Identification code 75–1545–0–1–609

2007 actual

2008 est.

2009 est.

Frm 00040

Fmt 3616

Direct:
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

PO 00000

2007 actual

Obligations by program activity:
01.01 Home and community-based supportive services .........
01.02 Preventive health services .............................................
01.03 National family caregiver support program ..................
01.04 Native American caregiver support program ................
01.05 Congregate nutrition services ........................................
01.06 Home-delivered nutrition services .................................
01.07 Nutrition services incentive program ............................
01.08 Native American nutrition and supportive services ......
01.09 Program innovations ......................................................
01.10 Aging network support activities ...................................
01.11 Long-term care ombudsmen program ...........................
Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

351
21
156
6
400
188
148
26
24
13
15

2008 est.

2009 est.

351
351
21 ...................
153
153
6
6
411
411
194
194
151
153
27
27
15
33
32
13
16
16

DEPARTMENTAL MANAGEMENT
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
01.12
01.13
01.14
01.15

Prevention of elder abuse and neglect .........................
Alzheimer’s disease demonstration grants ...................
Program administration .................................................
White House Conference on Aging ................................

5
5
5
12
11 ...................
18
18
19
1 ................... ...................

02.00
09.01

Total, direct program ................................................
Reimbursable program ..................................................

1,384
6

1,411
4

1,381
4

10.00

Total new obligations ................................................

1,390

1,415

1,385

22.00
22.10

1,389

1,415

1,385

23.90
23.95
24.40

Total budgetary resources available for obligation
Total new obligations ....................................................

1 ................... ...................
1,390
¥1,390

1,415
¥1,415

1,385
¥1,385

1,439
1,381
¥25 ...................
¥3 ...................

43.00

1,383

1,411

1,381

58.00
58.10
58.90
70.00

Total new budget authority (gross) ..........................

1,389

1,415

1,385

541
560
582
1,390
1,415
1,385
¥1,363
¥1,393
¥1,393
¥13 ................... ...................
¥1 ................... ...................
¥5 ................... ...................
11 ................... ...................

74.40

Obligated balance, end of year ................................

560

582

574

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

897
466

912
481

899
494

87.00

Total outlays (gross) .................................................

1,363

1,393

¥4

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥5 ................... ...................
3 ................... ...................

1,383
1,359

1,411
1,389

1,381
1,389

Note.—The reimbursable program (HCFAC) in the Administration on Aging (AoA) reflects
the estimated distribution of the allocation account for 2008 and 2009. Actual 2008 and
2009 distributions will be determined by the Secretary of HHS and the Attorney General.

Administration on Aging.—The proposed level will provide
continued funding for core formula grant programs that provide nutrition, supportive services and caregiver support services through the aging network. These programs are part
of a comprehensive system of home and community-based
support for older people and their families.
The Budget will fund the Choices for Independence demonstration which aims to help older individuals and their
families conserve and extend their personal resources through
the use of low-cost, community-based alternatives in longterm care.
VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

2008 est.

2009 est.

10
2
2
9

11
2
2
8

12
2
2
10

41.0

7
1,354

5
1,383

8
1,347

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

1,384
6

1,411
4

1,381
4

99.9

Total new obligations ................................................

1,390

1,415

1,385

11.1
12.1
23.1
25.1
25.3

Employment Summary
2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................
Reimbursable:
2001 Civilian full-time equivalent employment .....................

2008 est.

2009 est.

101

105

109

DEPARTMENTAL MANAGEMENT
Federal Funds

2007 actual

Direct obligations:
Personnel compensation: Full-time permanent ........
Civilian personnel benefits .......................................
Rental payments to GSA ...........................................
Advisory and assistance services .............................
Other purchases of goods and services from Government accounts .................................................
Grants, subsidies, and contributions ........................

5 ................... ...................
6

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–0142–0–1–506

Spending authority from offsetting collections
(total discretionary) ..........................................

72.40
73.10
73.20
73.40
73.45
74.00

89.00
90.00

Object Classification (in millions of dollars)

Unobligated balance carried forward, end of year ................... ................... ...................

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
1,383
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
41.00
Transferred to other accounts ................................... ...................

463

PO 00000

Frm 00041

Fmt 3616

GENERAL DEPARTMENTAL MANAGEMENT
(INCLUDING TRANSFER OF FUNDS)

For necessary expenses, not otherwise provided, for general departmental management, including hire of six sedans, and for carrying
out titles III, XVII, XX, and XXI of the Public Health Service Act,
the United States-Mexico Border Health Commission Act, and research studies under section 1110 of the Social Security Act,
ø$355,518,000¿ $374,013,000, together with ø$5,792,000¿ $5,851,000
to be transferred and expended as authorized by section 201(g)(1)
of the Social Security Act from the Federal Hospital Insurance Trust
Fund and the øSupplemental¿ Federal Supplementary Medical Insurance Trust Fund, and $46,756,000 from the amounts available under
section 241 of the Public Health Service Act to carry out national
health or human services research and evaluation activities: Provided,
That of the funds made available under this heading for carrying
out title XX of the Public Health Service Act, $13,120,000 shall be
for activities specified under section 2003(b)(2), all of which shall
be for prevention service demonstration grants under section 510(b)(2)
of title V of the Social Security Act, as amended, without application
of the limitation of section 2010(c) of said title XX: Provided further,
That of this amount, $51,891,000 shall be for minority AIDS prevention and treatment activities; and ø$5,892,000¿ $5,789,000 shall be
to assist Afghanistan in the development of maternal and child health
clinics, consistent with section 103(a)(4)(H) of the Afghanistan Freedom Support Act of 2002; and ø$1,000,000 shall be transferred, not
later than 30 days after enactment of this Act, to the National Institute of Mental Health to administer the Interagency Autism Coordinating Committee: Provided further, That specific information requests from the chairmen and ranking members of the Subcommittees on Labor, Health and Human Services, and Education, and Related Agencies, on scientific research or any other matter, shall be
transmitted to the Committees on Appropriations in a prompt, professional manner and within the time frame specified in the request:
Provided further, That scientific information, including such information provided in congressional testimony, requested by the Committees on Appropriations and prepared by government researchers and
scientists shall be transmitted to the Committees on Appropriations,
uncensored and without delay: Provided further, That funds provided
in this Act for embryo adoption activities may be used to provide,
to individuals adopting embryos, through grants and other mechanisms, medical and administrative services deemed necessary for such
adoptions: Provided further, That such services shall be provided
consistent with 42 CFR 59.5(a)(4): Provided further, That $4,138,000
shall be available for the projects and in the amounts specified in
the explanatory statement described in section 4 (in the matter preceding division A of this consolidated Act)¿ $3,545,000 shall be for
a Health Diplomacy Initiative and may be used to carry out health
diplomacy activities such as health training, services, education, and
Sfmt 3616

E:\BUDGET\HHS.XXX

HHS

464

DEPARTMENTAL MANAGEMENT—Continued
Federal Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009

GENERAL DEPARTMENTAL MANAGEMENT—Continued
(INCLUDING TRANSFER OF FUNDS)—Continued

program evaluation provided directly, through grants, or through contracts. (Department of Health and Human Services Appropriations
Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–9912–0–1–551

2007 actual

2009 est.

355
168
5
40

348
183
6
47

374
193
6
47

10.00

Total new obligations ................................................

568

584

620

21.40
22.00

Budgetary resources available for obligation:
Unobligated balance carried forward, start of year
New budget authority (gross) ........................................

2
568

1
584

1
620

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

570
585
621
¥568
¥584
¥620
¥1 ................... ...................
1

58.00
58.10
58.90
70.00

350

348

374

236

246

11.9
12.1
12.2
21.0
23.1
23.3

236

246

Total new budget authority (gross) ..........................

568

584

620

51 ................... ...................

74.40

Obligated balance, end of year ................................

247

298

317

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

294
200

410
123

433
168

87.00

Total outlays (gross) .................................................

494

533

601

cprice-sewell on PROD1PC71 with BUDGET PAG

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥119

¥236

¥246

36 ................... ...................

350
375

348
297

374
355

General Departmental Management (GDM) funds activities
that provide leadership, policy, legal, and administrative guidance to HHS components, and support research to develop
policy initiatives and improve existing HHS programs. GDM
16:43 Jan 24, 2008

Jkt 214754

93
3
2
5

96
3
2
15

101
23
2
2
20

103
23
2
2
20

116
24
3
2
21
2
1
1
35

25.4
25.7
26.0
31.0
41.0

36
3
2
1
1
125

34
3
2
1
1
120

37
3
2
1
1
125

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

355
213

348
236

374
246

99.9

Total new obligations ................................................

568

584

620

Employment Summary
2007 actual

2008 est.

2009 est.

878
104

882
209

315

OFFICE

FOR

CIVIL RIGHTS

For expenses necessary for the Office for Civil Rights,
ø$31,628,000¿ $36,785,000, together with not to exceed ø$3,281,000¿
$3,314,000 to be transferred and expended as authorized by section
201(g)(1) of the Social Security Act from the Federal Hospital Insurance Trust Fund and the Federal øSupplemental¿ Supplementary
Medical Insurance Trust Fund. (Department of Health and Human
Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Direct program activity ..................................................
09.01 Reimbursable program ..................................................

31
4

37
4

10.00

Total new obligations ................................................

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

36
¥35

35
¥35

41
¥41

¥135 ................... ...................

Note.—The reimbursable HCFAC program in General Departmental Management reflects
the estimated distribution from the allocation account for 2008 and 2009.

VerDate Aug 31 2005

91
3
2
5

2
1
1
33

Identification code 75–0135–0–1–751

2009 est.

2
1
1
35

24.0
25.1
25.2
25.3

282
247
298
568
584
620
¥494
¥533
¥601
¥25 ................... ...................
¥135 ................... ...................

2008 est.

Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Travel and transportation of persons .......................
Rental payments to GSA ...........................................
Communications, utilities, and miscellaneous
charges .................................................................
Printing and reproduction .........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Operation and maintenance of facilities ..................
Operation and maintenance of equipment ...............
Supplies and materials .............................................
Equipment .................................................................
Grants, subsidies, and contributions ........................

Identification code 75–9912–0–1–551

218

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................

2007 actual

135 ................... ...................

Spending authority from offsetting collections
(total discretionary) ..........................................

72.40
73.10
73.20
73.40
74.00

11.1
11.3
11.5
11.7

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
351
355
374
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
¥6 ...................
40.35
Appropriation permanently reduced ..........................
¥1 ................... ...................
41.00
Transferred to other accounts ................................... ...................
¥1 ...................
43.00

Object Classification (in millions of dollars)
Identification code 75–9912–0–1–551

2008 est.

Obligations by program activity:
00.01 General departmental management ..............................
09.01 Reimbursable program ..................................................
09.02 Reimbursable program (HCFAC) ....................................
09.03 Reimbursable program: PHS Evaluation .......................

also includes the activities of the Office of Public Health and
Science, including adolescent family life, disease prevention
and health promotion, physical fitness and sports, minority
health, research integrity, and women’s health.

PO 00000

Frm 00042

Fmt 3616

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
32
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
43.00
58.00
70.00
Sfmt 3643

32
37
¥1 ...................

Appropriation (total discretionary) ........................
Spending authority from offsetting collections: Offsetting collections (cash) .....................................

Total new budget authority (gross) ..........................

E:\BUDGET\HHS.XXX

HHS

DEPARTMENTAL MANAGEMENT—Continued
Federal Funds—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES

72.40
73.10
73.20
73.40

74.40

Obligated balance, end of year ................................

11
12
11
35
35
41
¥32
¥36
¥40
¥2 ................... ...................
12

Outlays (gross), detail:
86.90 Outlays from new discretionary authority .....................
86.93 Outlays from discretionary balances .............................
87.00

29
3

Total outlays (gross) .................................................

30
6

35
5
40

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

¥4

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

32
28

31
32

37
36

89.00
90.00

The Office for Civil Rights funds activities that carry out
the Department’s civil rights nondiscrimination and health
information privacy compliance programs.
Object Classification (in millions of dollars)
Identification code 75–0135–0–1–751

11.1
12.1
23.1
25.2
26.0

2007 actual

2008 est.

2009 est.

17
18
5
5
3
3
5
5
1 ...................

20
6
3
7
1

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

31
4

37
4

99.9

Total new obligations ................................................

Employment Summary
Identification code 75–0135–0–1–751

2007 actual

Direct:
Civilian full-time equivalent employment .....................
Reimbursable:
2001 Civilian full-time equivalent employment .....................
1001

2008 est.

2009 est.

236

251

OFFICE

OF THE

NATIONAL COORDINATOR
TECHNOLOGY

FOR

HEALTH INFORMATION

For expenses necessary for the Office of the National Coordinator
for Health Information Technology, including grants, contracts and
cooperative agreements for the development and advancement of øan¿
interoperable ønational¿ health information technology øinfrastructure, $42,402,000¿, $18,151,000: Provided, That in addition to
amounts provided herein, ø$18,900,000¿ $48,000,000 shall be available from amounts available under section 241 of the Public Health
Service Act øto carry out health information technology network development¿. (Department of Health and Human Services Appropriations Act, 2008.)

40.00
40.33

Appropriation .............................................................
42
Appropriation permanently reduced (P.L. 110–161) ...................

43.00

58.00
58.10

465
43
18
¥1 ...................

25 ................... ...................

58.90

Spending authority from offsetting collections
(total discretionary) ..........................................

70.00

Total new budget authority (gross) ..........................

72.40
73.10
73.20
73.40
74.00

74.40

Obligated balance, end of year ................................

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

12
32

41
14

62
25

87.00

Total outlays (gross) .................................................

¥1

¥26

¥56

27
21
34
68
68
74
¥44
¥55
¥87
¥5 ................... ...................
¥25 ................... ...................

89.00
90.00

¥25 ................... ...................

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

42
43

42
29

18
31

This program supports coordination, leadership, and development of Federal health information technology activities
and Federal initiatives for the nationwide advancement of
interoperable health information technology, in cooperation
with participants in the health sector. The Office of the National Coordinator for Health Information Technology was created by Executive Order 13335, for the purpose of addressing
strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and
private adoption of health information technology.
Through this program, activities related to and supporting
the President’s Health Information Technology Initiative are
coordinated across several HHS organizations, as shown in
the following consolidated table.
Health Information Technology Funding
[Program level—Dollars in millions]
2007 actual

Distribution of funding by account:
National Coordinator for Health Information Technology
General Departmental Management ..................................
Agency for Healthcare Research and Quality ....................
HIT Initiative Total ..............................................................
Federal Health Architecture ................................................

61
2
50
113
7

2008 est.

61
3
45
109
7

2009 est.

66
3
45
114
8

Program and Financing (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–0130–0–1–551

2007 actual

2008 est.

00.01
09.01
09.02

Obligations by program activity:
Health information technology .......................................
Reimbursable program ..................................................
Reimbursable program: PHS evaluation ........................

42
7
19

18
8
48

10.00

Total new obligations ................................................

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

68
¥68

74
¥74

16:43 Jan 24, 2008

Identification code 75–0130–0–1–551

11.1
12.1
23.1
25.1
25.2
25.3
99.0
99.0

New budget authority (gross), detail:
Discretionary:
VerDate Aug 31 2005

Object Classification (in millions of dollars)

2009 est.

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2007 actual

Direct obligations:
Personnel compensation: Full-time permanent ........
Civilian personnel benefits .......................................
Rental payments to GSA ...........................................
Advisory and assistance services .............................
Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Direct obligations ..................................................
Reimbursable obligations ..............................................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

2008 est.

2009 est.

2
1
1
1
22

3
1
2
2
21

3
1
2
2
5

42
26

18
56

DEPARTMENTAL MANAGEMENT—Continued
Federal Funds—Continued

466
OFFICE

OF THE

THE BUDGET FOR FISCAL YEAR 2009

NATIONAL COORDINATOR FOR HEALTH INFORMATION
TECHNOLOGY—Continued

Object Classification (in millions of dollars)—Continued
Identification code 75–0130–0–1–551

99.9

2007 actual

Total new obligations ................................................

2008 est.

2009 est.

Employment Summary
Identification code 75–0130–0–1–551

1001
1101

2007 actual

Direct:
Civilian full-time equivalent employment .....................
Military full-time equivalent employment .....................

2008 est.

22
1

27
1

2009 est.

27
1

11.1
11.5

Personnel compensation:
Full-time permanent ..................................................
Other personnel compensation ..................................

30
1

31
8
5
2
6
2

31
8
7
2
6
2

31
8
7
2
7
2

25.4
26.0

Total personnel compensation ..............................
Civilian personnel benefits ............................................
Rental payments to GSA ................................................
Communications, utilities, and miscellaneous charges
Advisory and assistance services ..................................
Other services ................................................................
Other purchases of goods and services from Government accounts ...........................................................
Operation and maintenance of facilities ......................
Supplies and materials .................................................

4
1
1

6
1
1

99.9

Total new obligations ................................................

11.9
12.1
23.1
23.3
25.1
25.2
25.3

Employment Summary

OFFICE

MEDICARE HEARINGS

AND

Identification code 75–0139–0–1–551

APPEALS

For expenses necessary for administrative law judges responsible
for hearing cases under title XVIII of the Social Security Act (and
related provisions of title XI of such Act), ø$65,000,000¿ $65,344,000,
to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance
Trust øFunds¿ Fund. (Department of Health and Human Services
Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–0139–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Direct program activity ..................................................

10.00

Total new obligations ................................................

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

60
¥60

64
¥64

65
¥65

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

72.40
73.10
73.20

29
60
¥54

35
64
¥64

35
65
¥65

74.40

Obligated balance, end of year ................................

86.90
86.93

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

87.00

Total outlays (gross) .................................................

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

¥60

¥64

¥65

38
64
65
16 ................... ...................

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

cprice-sewell on PROD1PC71 with BUDGET PAG

This activity funds the Office of Medicare Hearings and
Appeals (OMHA), as directed by the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003. OMHA
provides the basic mechanisms through which individuals and
organizations who are dissatisfied with Medicare determinations affecting their rights to, or their participation in, the
Medicare program may administratively appeal those determinations, in accordance with the requirements of the Administrative Procedures Act and the Social Security Act.
Object Classification (in millions of dollars)
2007 actual

2008 est.

2009 est.

Frm 00044

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Direct obligations:
16:43 Jan 24, 2008

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374

PUBLIC HEALTH

AND

SOCIAL SERVICES EMERGENCY FUND

(INCLUDING

TRANSFER)

For expenses necessary to support activities related to countering
potential biological, ødisease,¿ nuclear, radiological and chemical
threats to civilian populations, and for other public health emergencies, ø$666,087,000¿ $810,740,000, of which not to exceed
ø$21,804,000¿ $22,360,000, to remain available until September 30,
ø2009¿ 2010, is to pay the costs described in section 319F–2(c)(7)(B)
of the Public Health Service Act, and of which ø$103,921,000 shall
be used¿ $275,000,000, to remain available until September 30, 2010,
is to support advanced research and development of medical countermeasures and ancillary products, consistent with section 319L of
the Public Health Service Act.
For expenses necessary to prepare for and respond to an influenza
pandemic, ø$76,139,000¿ $585,091,000, of which $507,000,000 shall
be available until expended, for activities including the development
and purchase of vaccine, antivirals, necessary medical supplies,
diagnostics, and other surveillance tools: Provided, That products purchased with these funds may, at the discretion of the Secretary, be
deposited in the Strategic National Stockpile: Provided further, That
notwithstanding section 496(b) of the Public Health Service Act, funds
may be used for the construction or renovation of privately owned
facilities for the production of pandemic influenza vaccines and other
biologics, where the Secretary finds such a contract necessary to secure
sufficient supplies of such vaccines or biologics: Provided further, That
funds appropriated herein may be transferred to other appropriation
accounts of the Department of Health and Human Services, as determined by the Secretary to be appropriate, to be used for the purposes
specified in this sentence. (Department of Health and Human Services
Appropriations Act, 2008.)

Identification code 75–0140–0–1–551

VerDate Aug 31 2005

2009 est.

Program and Financing (in millions of dollars)

Net budget authority and outlays:
89.00 Budget authority ............................................................ ................... ................... ...................
90.00 Outlays ...........................................................................
¥6 ................... ...................

Identification code 75–0139–0–1–551

356

2008 est.

PO 00000

2007 actual

2008 est.

2009 est.

00.01
09.01

Obligations by program activity:
Public Health and Social Services Emergency Fund
Reimbursable program ..................................................

2,001
17

2,807
19

1,396
19

10.00

Total new obligations ................................................

2,018

2,826

1,415

3,279
713

2,088
748

10
1,415

23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year
New budget authority (gross), detail:
Discretionary:

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

87 ................... ...................
30 ................... ...................
4,109
2,836
1,425
¥2,018
¥2,826
¥1,415
¥3 ................... ...................
2,088

PROGRAM SUPPORT CENTER
Federal Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
40.00
40.33
41.00
42.00

Appropriation .............................................................
160
742
1,396
Appropriation permanently reduced (P.L. 110–161) ...................
¥13 ...................
Transferred to other accounts ...................................
¥100 ................... ...................
Transferred from other accounts ..............................
634 ................... ...................

43.00

Appropriation (total discretionary) ........................
694
729
1,396
Spending authority from offsetting collections:
Offsetting collections (cash) ................................ ...................
19
19
Change in uncollected customer payments from
Federal sources (unexpired) .............................
19 ................... ...................

58.00
58.10
58.90
70.00

Spending authority from offsetting collections
(total discretionary) ..........................................

Total new budget authority (gross) ..........................

713

748

1,415

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Obligated balance transferred from other accounts
Adjustments in expired accounts (net) .........................
Recoveries of prior year obligations ..............................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
72.40
73.10
73.20
73.32
73.40
73.45
74.00

74.40

Obligated balance, end of year ................................

3,259

3,911

2,939

92
2,082

159
2,228

87.00

Total outlays (gross) .................................................

2,087

2,174

2,387

¥47

¥19

¥19 ................... ...................
47 ................... ...................

694
2,040

729
2,155

1,396
2,368

The Public Health and Social Services Emergency Fund
(PHSSEF) provides resources to support a comprehensive program to prepare for the health and medical consequences
of bioterrorism or other public health emergencies. This account includes funding for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized
by the Pandemic and All-Hazards Preparedness Act. Funds
will be used for the advanced development of pandemic and
biodefense countermeasures, hospital preparedness and other
emergency preparedness activities including the National Disaster Medical System that was transferred to HHS from the
Department of Homeland Security in January 2007. The
PHSSEF also includes funding for activities to support the
detection and control of pandemic influenza.
Object Classification (in millions of dollars)

cprice-sewell on PROD1PC71 with BUDGET PAG

Identification code 75–0140–0–1–551

11.1
11.3
11.5
11.7
11.9
12.1
12.2
21.0
23.1
23.2
23.3

2007 actual

Direct obligations:
Personnel compensation:
Full-time permanent .............................................
Other than full-time permanent ...........................
Other personnel compensation .............................
Military personnel .................................................
Total personnel compensation ..............................
Civilian personnel benefits .......................................
Military personnel benefits ........................................
Travel and transportation of persons .......................
Rental payments to GSA ...........................................
Rental payments to others ........................................
Communications, utilities, and miscellaneous
charges .................................................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

Jkt 214754

50
468
753
2
661

114
1,277
516
3
795

115
250
513
3
381

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

2,001
17

2,807
19

1,396
19

99.9

Total new obligations ................................................

2,018

2,826

1,415

Employment Summary

2008 est.

2009 est.

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................
1101 Military full-time equivalent employment .....................

2008 est.

219
94

2009 est.

346
94

422
94

NONRECURRING EXPENSES FUND
Program and Financing (in millions of dollars)

918 ................... ...................

118
1,969

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

¥19 ................... ...................

Outlays (gross), detail:
Outlays from new discretionary authority .....................
Outlays from discretionary balances .............................

89.00
90.00

25.5
26.0
31.0
41.0

Other services ............................................................
Other purchases of goods and services from Government accounts .................................................
Research and development contracts .......................
Supplies and materials .............................................
Equipment .................................................................
Grants, subsidies, and contributions ........................

Identification code 75–0140–0–1–551

3,375
3,259
3,911
2,018
2,826
1,415
¥2,087
¥2,174
¥2,387
18 ................... ...................
¥877 ................... ...................
¥87 ................... ...................

86.90
86.93

25.2
25.3

467

Identification code 75–0125–0–1–551

2007 actual

2008 est.

2009 est.

Budgetary resources available for obligation:
22.30 Expired unobligated balance transfer to unexpired account .......................................................................... ................... ................... ...................
New budget authority (gross), detail:
Discretionary:
40.00
Appropriation ............................................................. ................... ................... ...................

89.00
90.00

Net budget authority and outlays:
Budget authority ........................................................ ................... ................... ...................
Outlays ....................................................................... ................... ................... ...................

The Nonrecurring Expenses Fund is a no-year account that
captures expired unobligated balances from discretionary accounts prior to cancellation. The Fund will be used for nonrecurring expenses that are difficult to accomodate or arise
outside of the normal budget process. Beginning with 2008
appropriations, transfers will occur up to five years after expiration, when it is certain that original obligations have been
fully paid and closed out. Advance notification of a proposed
use of the Fund will be submitted to the relevant Committees
on Appropriations of the House of Representatives and the
Senate, with justification for the proposed areas/projects.
f

PROGRAM SUPPORT CENTER
Federal Funds
RETIREMENT PAY

AND

MEDICAL BENEFITS
OFFICERS

FOR

COMMISSIONED

For retirement pay and medical benefits of Public Health Service
Commissioned Officers as authorized by law, for payments under
the Retired Serviceman’s Family Protection Plan and Survivor Benefit
Plan, for medical care of dependents and retired personnel under
the Dependents’ Medical Care Act (10 U.S.C. chapter 55), such
amounts as may be required during the current fiscal year. (Department of Health and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)

16
5
1
12

35
5
1
13

45
5
1
17

34
5
5
4
4
1

54
8
6
5
8
2

68
9
8
6
10
2

Frm 00045

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PO 00000

Identification code 75–0379–0–1–551

2007 actual

2008 est.

2009 est.

00.01
00.02
00.03

Obligations by program activity:
Retirement payments .....................................................
Survivors’ benefits .........................................................
Medical care ..................................................................

287
18
66

312
19
67

339
19
76

10.00

Total new obligations ................................................

371

398

434

22.00
23.95

Budgetary resources available for obligation:
New budget authority (gross) ........................................
Total new obligations ....................................................

371
¥371

397
¥398

435
¥434

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

468

PROGRAM SUPPORT CENTER—Continued
Federal Funds—Continued

RETIREMENT PAY

THE BUDGET FOR FISCAL YEAR 2009

MEDICAL BENEFITS
OFFICERS—Continued

AND

FOR

COMMISSIONED

Program and Financing (in millions of dollars)—Continued
Identification code 75–0379–0–1–551

2007 actual

New budget authority (gross), detail:
Mandatory:
60.00
Appropriation .............................................................
Change in obligated balances:
72.40 Obligated balance, start of year ...................................
73.10 Total new obligations ....................................................
73.20 Total outlays (gross) ......................................................
73.40 Adjustments in expired accounts (net) .........................

2008 est.

371

40.00

Appropriation .............................................................

73.10
73.20

Change in obligated balances:
Total new obligations ....................................................
Total outlays (gross) ......................................................

36
¥36

37
¥37

35
¥35

86.90

Outlays (gross), detail:
Outlays from new discretionary authority .....................

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

36
36

37
37

35
35

2009 est.

397

435

31
34
37
371
398
434
¥365
¥395
¥432
¥3 ................... ...................

74.40

Obligated balance, end of year ................................

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

340
25

361
34

396
36

87.00

Total outlays (gross) .................................................

365

395

432

The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense MedicareEligible Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for
a discretionary appropriation of the annual accrual payment
into this fund (P.L. No. 108–375, section 725).
f

HEALTH ACTIVITIES FUNDS
Net budget authority and outlays:
89.00 Budget authority ............................................................
90.00 Outlays ...........................................................................

371
365

397
395

Program and Financing (in millions of dollars)

435
432

Identification code 75–9913–0–1–552

The number of beneficiaries using the Commissioned Corps
system is estimated as follows:

2007 actual

2008 est.

2009 est.

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

74.40

Obligated balance, end of year ................................

Retirement Pay Eligible Beneficiaries
FY 2007

Active Duty:
HHS .........................................................................................
DOJ, BOP .................................................................................
Homeland Security ..................................................................
EPA ..........................................................................................
All Other ..................................................................................
Total Active Duty .........................................................................
Retirees & Survivors:
Retirees ........................................................................................
Retiree family members and survivors .......................................
Total Retirement Pay ...................................................................
Total Beneficiaries (active duty, retirees, survivors) ..................

FY 2008

FY 2009

4,968
630
191
78
90
5,957

4,710
630
467
73
270
6,150

4,815
630
467
73
270
6,255

4,839
890
5,729
11,686

5,149
900
6,049
12,199

5,408
910
6,318
12,573

This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
medical benefits for active duty PHS commissioned officers,
retirees, and dependents of member and retirees of the PHS
Commissioned Corps.
Object Classification (in millions of dollars)
Identification code 75–0379–0–1–551

2007 actual

2008 est.

2009 est.

Direct obligations:
13.0 Benefits for former personnel ........................................
25.6 Medical care ..................................................................

305
66

331
67

358
76

99.9

371

398

434

Total new obligations ................................................
f

HHS ACCRUAL CONTRIBUTION TO THE UNIFORMED SERVICES
RETIREE HEALTH CARE FUND

cprice-sewell on PROD1PC71 with BUDGET PAG

Program and Financing (in millions of dollars)
Identification code 75–0170–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Medicare eligible accruals .............................................

10.00

Total new obligations (object class 12.2) ................

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

36
¥36

37
¥37

35
¥35

New budget authority (gross), detail:
Discretionary:
VerDate Aug 31 2005

16:43 Jan 24, 2008

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89.00
90.00

This display shows activities in support of St. Elizabeths
Hospital and scientific activities overseas that were supported
by foreign currencies by the United States abroad.
f

HHS SERVICE

AND

SUPPLY FUND

Program and Financing (in millions of dollars)
Identification code 75–9941–0–4–551

2007 actual

2008 est.

2009 est.

09.01
09.02

Obligations by program activity:
Program support center .................................................
OS activities ...................................................................

583
77

642
49

699
50

10.00

Total new obligations ................................................

660

691

749

21.40
22.00
22.10

98
662

111
691

111
749

11 ................... ...................

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

771
¥660

802
¥691

860
¥749

24.40

Unobligated balance carried forward, end of year

111

529

691

749

New budget authority (gross), detail:
Mandatory:
Spending authority from offsetting collections:
69.00
Offsetting collections (cash) ................................
69.10
Change in uncollected customer payments from
Federal sources (unexpired) .............................
69.90

72.40
73.10
73.20
73.45
74.00

Spending authority from offsetting collections
(total mandatory) .............................................
Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Recoveries of prior year obligations ..............................
Change in uncollected customer payments from Federal sources (unexpired) ............................................

Sfmt 3643

E:\BUDGET\HHS.XXX

HHS

133 ................... ...................
662

691

749

23
¥38
¥38
660
691
749
¥577
¥691
¥749
¥11 ................... ...................
¥133 ................... ...................

PROGRAM SUPPORT CENTER—Continued
Trust Funds

DEPARTMENT OF HEALTH AND HUMAN SERVICES
74.40

¥38

Obligated balance, end of year ................................

¥38

469

¥38

Trust Funds
Outlays (gross), detail:
86.97 Outlays from new mandatory authority .........................

577

749

Special and Trust Fund Receipts (in millions of dollars)

89.00
90.00

691

MISCELLANEOUS TRUST FUNDS

¥529

¥691

¥749

Identification code 75–9971–0–7–551

01.00
¥133 ................... ...................

Object Classification (in millions of dollars)
Identification code 75–9941–0–4–551

11.1
11.3
11.5
11.7

Reimbursable obligations:
Personnel compensation:
Full-time permanent ..................................................
Other than full-time permanent ...............................
Other personnel compensation ..................................
Military personnel ......................................................

2008 est.

2009 est.

88
5
2
9

100
5
3
9

102
5
3
9

104
28
5
3
3
17
36
1
30
259

117
32
5
4
3
17
42
1
37
244

119
32
5
4
4
19
46
1
41
269

25.4
25.6
25.7
26.0
31.0

Total personnel compensation ..............................
Civilian personnel benefits ............................................
Military personnel benefits ............................................
Travel and transportation of persons ............................
Transportation of things ................................................
Rental payments to GSA ................................................
Communications, utilities, and miscellaneous charges
Printing and reproduction ..............................................
Advisory and assistance services ..................................
Other services ................................................................
Other purchases of goods and services from Government accounts ...........................................................
Operation and maintenance of facilities ......................
Medical care ..................................................................
Operation and maintenance of equipment ...................
Supplies and materials .................................................
Equipment ......................................................................

69
16
23
30
33
3

41
25
37
18
65
3

45
28
41
20
72
3

99.9

Total new obligations ................................................

660

691

749

11.9
12.1
12.2
21.0
22.0
23.1
23.3
24.0
25.1
25.2
25.3

cprice-sewell on PROD1PC71 with BUDGET PAG

2007 actual

2008 est.

2009 est.

Balance, start of year ....................................................
Receipts:
02.00 Interest, Miscellaneous Trust Funds ..............................
02.20 Contributions, Indian Health Facilities ..........................
02.60 Gifts and Contributions, Miscellaneous Trust Funds

1
29
53

01.99

02.99

HHS Service and Supply Fund (SSF) provides a wide range
of logistical and support services to components of the Department and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support,
information technology, financial management operations, and
administrative services, including acquisitions management,
building and property management, telecommunication services, medical supplies repackaging and distribution services,
and the Federal Occupational Health Service. The Office of
Secretary activities include the fund manager, departmental
contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration
and modernization, small business, grants tracking, and competitive sourcing.
Most Commissioned Corps officers work for agencies in the
Department of Health and Human Services and are reflected
in the agencies’ personnel summaries. However, some officers
are assigned to other Federal agencies. The allocation account
section in the following personnel summary shows officers
assigned to other agencies, which are paid directly by that
agency, either through an allocation account or by directly
citing that agency’s appropriation.

2007 actual

Balance, start of year ....................................................

Total receipts and collections ...................................

Total: Balances and collections ....................................
Appropriations:
05.00 Miscellaneous Trust Funds ............................................

115

114

113

¥84

04.00

07.99

Balance, end of year .....................................................

Program and Financing (in millions of dollars)
Identification code 75–9971–0–7–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.02 Gifts ...............................................................................
00.03 Contributions, Indian health facilities ..........................

47
47

55
29

10.00

Total new obligations ................................................

21.40
22.00
22.10

110
84

101
84

1 ................... ...................

23.90
23.95

Total budgetary resources available for obligation
Total new obligations ....................................................

195
¥94

185
¥84

24.40

Unobligated balance carried forward, end of year

101

New budget authority (gross), detail:
Mandatory:
60.26
Appropriation (trust fund) .........................................

72.40
73.10
73.20
73.45

74.40

Obligated balance, end of year ................................

174

177

179

86.97
86.98

Outlays (gross), detail:
Outlays from new mandatory authority .........................
Outlays from mandatory balances ................................

18
49

8
73

8
74

87.00

Total outlays (gross) .................................................

89.00
90.00

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

84
67

84
81

84
82

148
174
177
94
84
84
¥67
¥81
¥82
¥1 ................... ...................

[Dollars in millions]

Employment Summary
Identification code 75–9941–0–4–551

Reimbursable:
2001 Civilian full-time equivalent employment
2101 Military full-time equivalent employment
Allocation account:
3101 Military full-time equivalent employment
3101 Military full-time equivalent employment
VerDate Aug 31 2005

16:43 Jan 24, 2008

2007
2007 actual

2008 est.

2009 est.

.....................
.....................

1,179
58

1,271
58

1,300
58

.....................
.....................

630
281

630
570

Frm 00047

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Distribution of budget authority by account:
Gifts ........................................................................................
Contributions, Indian health facilities ...................................
Distribution of outlays by account:
Gifts ........................................................................................
Contributions, Indian health facilities ...................................

2008

2009

55
29

44
23

53
28

54
28

Gifts to the Public Health Service are for the benefit of
patients and for research. Contributions are made for the
Sfmt 3616

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HHS

470

PROGRAM SUPPORT CENTER—Continued
Trust Funds—Continued

THE BUDGET FOR FISCAL YEAR 2009
58.10

MISCELLANEOUS TRUST FUNDS—Continued

construction, improvement, extension, and provision of sanitation facilities.

60.00

Object Classification (in millions of dollars)
Identification code 75–9971–0–7–551

2007 actual

Direct obligations:
Personnel compensation:
11.1
Full-time permanent ..................................................
11.3
Other than full-time permanent ...............................
11.8
Special personal services payments .........................

2008 est.

69.00
69.10

2009 est.

1
2
2

5
1
1
5
39

5
1
1
4
34

25.4
25.5
25.6
26.0
31.0
32.0
41.0

Total personnel compensation ..............................
Civilian personnel benefits ............................................
Travel and transportation of persons ............................
Advisory and assistance services ..................................
Other services ................................................................
Other purchases of goods and services from Government accounts ...........................................................
Operation and maintenance of facilities ......................
Research and development contracts ...........................
Medical care ..................................................................
Supplies and materials .................................................
Equipment ......................................................................
Land and structures ......................................................
Grants, subsidies, and contributions ............................

1
2
15
1
3
2
1
18

1
2
13
1
3
2
1
16

99.9

Total new obligations ................................................

11.9
12.1
21.0
25.1
25.2
25.3

Employment Summary
Identification code 75–9971–0–7–551

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................

2008 est.

58.90

2009 est.

OFFICE

Spending authority from offsetting collections
(total discretionary) ..........................................
Mandatory:
Appropriation .............................................................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................
Change in uncollected customer payments from
Federal sources (unexpired) .............................

69.90
70.00

104

179

70 ................... ...................
174

179

Total new budget authority (gross) ..........................

260

265

287

Change in obligated balances:
Obligated balance, start of year ...................................
Total new obligations ....................................................
Total outlays (gross) ......................................................
Adjustments in expired accounts (net) .........................
Change in uncollected customer payments from Federal sources (unexpired) ............................................
74.10 Change in uncollected customer payments from Federal sources (expired) ................................................
74.40

Obligated balance, end of year ................................

86.90
86.93
86.97
86.98

87.00

Total outlays (gross) .................................................

89.00
90.00

3 ................... ...................

Spending authority from offsetting collections
(total mandatory) .............................................

72.40
73.10
73.20
73.40
74.00

OFFICE OF THE INSPECTOR GENERAL
Federal Funds

Change in uncollected customer payments from
Federal sources (unexpired) .............................

Net budget authority and outlays:
Budget authority ............................................................
Outlays ...........................................................................

38
¥8
27
259
273
294
¥231
¥238
¥295
¥2 ................... ...................
¥73 ................... ...................
1 ................... ...................
¥8

58
35
48 ...................
101
189
24
14

55
24
189
27

231

238

295

¥119

¥197

¥216

¥73 ................... ...................

68
112

68
41

71
79

INSPECTOR GENERAL

For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations, in carrying
out the provisions of the Inspector General Act of 1978, ø$44,000,000¿
$46,058,000: Provided, That of such amount, necessary sums are
available for providing protective services to the Secretary and investigating non-payment of child support cases for which non-payment
is a Federal offense under 18 U.S.C. 228. (Department of Health
and Human Services Appropriations Act, 2008.)
Program and Financing (in millions of dollars)
Identification code 75–0128–0–1–551

2007 actual

2008 est.

2009 est.

Obligations by program activity:
00.01 Direct program ...............................................................
09.01 HCFAC reimbursable program .......................................
09.02 Reimbursable program ..................................................

65
172
22

73
183
17

72
204
18

10.00

259

273

294

Total new obligations ................................................

The Office of Inspector General (OIG) identifies and recommends actions to correct fraud, waste, and abuse in HHS
administered and assisted programs and operations through
audits, evaluations, and investigations.
In addition to the discretionary resources appropriated to
the OIG, the Health Insurance Portability and Accountability
Act of 1996 (HIPAA) and the Deficit Reduction Act of 2005
(DRA) make available mandatory funding for use by the OIG.
These funds are used to combat Medicare, Medicaid, and
State Children’s Health Insurance Program (SCHIP) fraud,
waste, and abuse through a coordinated health care fraud
and abuse control (HCFAC) program with the Department
of Justice, and to establish a Medicaid Integrity Program
under DRA. The following table shows total funding resources
for the OIG:
(In millions of dollars)

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Budgetary resources available for obligation:
21.40 Unobligated balance carried forward, start of year
22.00 New budget authority (gross) ........................................
23.90
23.95
23.98

Total budgetary resources available for obligation
Total new obligations ....................................................
Unobligated balance expiring or withdrawn .................

24.40

Unobligated balance carried forward, end of year

25
260

58.00

Appropriation (total discretionary) ........................
Spending authority from offsetting collections:
Offsetting collections (cash) ................................

VerDate Aug 31 2005

16:43 Jan 24, 2008

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16
287

285
289
303
¥259
¥273
¥294
¥2 ................... ...................
24

New budget authority (gross), detail:
Discretionary:
40.00
Appropriation .............................................................
40
40.33
Appropriation permanently reduced (P.L. 110–161) ...................
43.00

24
265

2008 est.

2009 est.

40
0
166
25
10
3

43
0
173
25
10
0

46
19
175
25
10
0

Total ....................................................................................

244

251

275

Note.—-The reimbursable HCFAC program in the Office of Inspector General reflects
the estimated distribution of the allocation account for 2008 and 2009.

44
46
¥1 ...................

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2007 actual

Discretionary appropriation .....................................................
Discretionary caps proposal ...................................................
Mandatory (HCFAC) .................................................................
Medicaid Integrity Program ....................................................
Audit and investigations reimbursements .............................
Never Events ...........................................................................

Object Classification (in millions of dollars)
Identification code 75–0128–0–1–551

2007 actual

Direct obligations:
Sfmt 3643

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HHS

2008 est.

2009 est.

GENERAL PROVISIONS

DEPARTMENT OF HEALTH AND HUMAN SERVICES
11.1
12.1
21.0
23.1
23.3

40
12
3
3

40
12
3
5

40
12
3
4

31.0

Personnel compensation: Full-time permanent ........
Civilian personnel benefits .......................................
Travel and transportation of persons .......................
Rental payments to GSA ...........................................
Communications, utilities, and miscellaneous
charges .................................................................
Other purchases of goods and services from Government accounts .................................................
Equipment .................................................................

5
1

11
1

99.0
99.0

Direct obligations ..................................................
Reimbursable obligations ..............................................

65
194

73
200

72
222

99.9

Total new obligations ................................................

259

273

294

25.3

Employment Summary
Identification code 75–0128–0–1–551

2007 actual

Direct:
1001 Civilian full-time equivalent employment .....................
Reimbursable:
2001 Civilian full-time equivalent employment .....................

2008 est.

FROM

øSEC. 205. None of the funds appropriated in this Act may be
expended pursuant to section 241 of the Public Health Service Act,
except for funds specifically provided for in this Act, or for other
taps and assessments made by any office located in the Department
of Health and Human Services, prior to the preparation and submission of a report by the Secretary of Health and Human Services
to the Committees on Appropriations of the House of Representatives
and the Senate detailing the planned uses of such funds.¿
SEC. ø206¿ 205. Notwithstanding section 241(a) of the Public
Health Service Act, such portion as the Secretary of Health and
Human Services shall determine, but not more than 2.4 percent,
of any amounts appropriated for programs authorized under such
Act shall be made available for the evaluation (directly, or by grants
or contracts) of the implementation and effectiveness of such programs.
(TRANSFER OF FUNDS)

2009 est.

444

450

1,069

1,120

1,212

ALLOCATIONS RECEIVED

OTHER ACCOUNTS

Note.—Obligations incurred under allocations from other accounts are included in the
schedules of the parent appropriations as follows: Centers for Medicare and Medicaid Services ‘‘Health Care Fraud and Abuse Control Account.’’
f

GENERAL FUND RECEIPT ACCOUNTS

SEC. ø207¿ 206. Not to exceed 1 percent of any discretionary funds
(pursuant to the Balanced Budget and Emergency Deficit Control
Act of 1985) which are appropriated for the current fiscal year for
the Department of Health and Human Services in this Act may
be transferred between øa program, project, or activity¿ appropriations, but no such øprogram, project, or activity¿ appropriation shall
be increased by more than 3 percent by any such transfer: Provided,
That øthe transfer authority granted by this section shall be available
only to meet emergency needs and shall not be used to create any
new program or to fund any project or activity for which no funds
are provided in this Act:¿ an appropriation may be increased by
up to an additional 2 percent after notification of the House and
Senate Committees on Appropriations: Provided further, That the
Committees on Appropriations of the House of Representatives and
the Senate are notified at least 15 days in advance of any transfer.

(in millions of dollars)

(TRANSFER OF FUNDS)
2007 actual

2008 est.

2009 est.

Offsetting receipts from the public:
75–143500 General Fund Proprietary Interest Receipts,
not Otherwise Classified ....................................................
92
92
92
75–274530 Health Education Assistance Loans, Downward Reestimates of Subsidies .........................................
34
44 ...................
75–275830 Downward Reestimates of Subsidies, Health
Centers ............................................................................... ...................
1 ...................
75–310700 Federal Share of Child Support Collections
1,023
1,013
936
Legislative proposal, subject to PAYGO ...................................... ................... ...................
1
75–322000 All Other General Fund Proprietary Receipts
Including Budget Clearing Accounts .................................
143
143
143
General Fund Offsetting receipts from the public .....................
1,292
1,293
1,172
Intragovernmental payments: ......................................................
75–330500 Transfer of Excess Receipts to the General
Fund, Trust Fund Payments ............................................... ...................
75–388500 Undistributed Intragovernmental Payments
and Receivables from Cancelled Accounts ........................
62

General Fund Intragovernmental payments ................................

cprice-sewell on PROD1PC71 with BUDGET PAG

GENERAL PROVISIONS
SEC. 201. Funds appropriated in this title shall be available for
not to exceed $50,000 for official reception and representation expenses when specifically approved by the Secretary of Health and
Human Services.
SEC. 202. The Secretary shall make available through assignment
not more than 60 employees of the Public Health Service to assist
in child survival activities and to work in AIDS programs through
and with funds provided by the Agency for International Development, the United Nations International Children’s Emergency Fund
or the World Health Organization.
SEC. 203. None of the funds appropriated in this Act for the National Institutes of Health, the Agency for Healthcare Research and
Quality, and the Substance Abuse and Mental Health Services Administration shall be used to pay the salary of an individual, through
a grant or other extramural mechanism, at a rate in excess of Executive Level I I.
SEC. 204. None of the funds appropriated in this title for Head
Start shall be used to pay the compensation of an individual, either
as direct costs or any proration as an indirect cost, at a rate in
excess of Executive Level II.
VerDate Aug 31 2005

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SEC. ø208¿ 207. The Director of the National Institutes of Health,
jointly with the Director of the Office of AIDS Research, may transfer
up to 3 percent among institutes and centers from the total amounts
identified by these two Directors as funding for research pertaining
to the human immunodeficiency virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are promptly notified øat least 15 days in advance¿ of øany¿
the transfer.
(TRANSFER OF FUNDS)

SEC. ø209¿ 208. Of the amounts made available in this Act for
the National Institutes of Health, the amount for research related
to the human immunodeficiency virus, as jointly determined by the
Director of the National Institutes of Health and the Director of
the Office of AIDS Research, shall be made available to the ‘‘Office
of AIDS Research’’ account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary to carry
out section 2353(d)(3) of the Public Health Service Act.
SEC. ø210¿ 209. None of the funds appropriated in this Act may
be made available to any entity under title X of the Public Health
Service Act unless the applicant for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling
to minors on how to resist attempts to coerce minors into engaging
in sexual activities.
SEC. ø211¿ 210. Notwithstanding any other provision of law, no
provider of services under title X of the Public Health Service Act
shall be exempt from any State law requiring notification or the
reporting of child abuse, child molestation, sexual abuse, rape, or
incest.
SEC. ø212¿ 211. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry
out the Medicare Advantage program if the Secretary of Health and
Human Services denies participation in such program to an otherwise
eligible entity (including a Provider Sponsored Organization) because
the entity informs the Secretary that it will not provide, pay for,
provide coverage of, or provide referrals for abortions: Provided, That
the Secretary shall make appropriate prospective adjustments to the
capitation payment to such an entity (based on an actuarially sound
estimate of the expected costs of providing the service to such entity’s
enrollees): Provided further, That nothing in this section shall be
construed to change the Medicare program’s coverage for such services and a Medicare Advantage organization described in this section
shall be responsible for informing enrollees where to obtain information about all Medicare covered services.
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HHS

cprice-sewell on PROD1PC71 with BUDGET PAG

472

GENERAL PROVISIONS—Continued

THE BUDGET FOR FISCAL YEAR 2009

SEC. ø213¿ 212. (a) Except as provided by subsection (e) none
of the funds appropriated by this Act may be used to withhold substance abuse funding from a State pursuant to section 1926 of the
Public Health Service Act (42 U.S.C. 300x–26) if such State certifies
to the Secretary of Health and Human Services by May 1, ø2008¿
2009, that the State will commit additional State funds, in accordance
with subsection (b), to ensure compliance with State laws prohibiting
the sale of tobacco products to individuals under 18 years of age.
(b) The amount of funds to be committed by a State under subsection (a) shall be equal to 1 percent of such State’s substance
abuse block grant allocation for each percentage point by which the
State misses the retailer compliance rate goal established by the
Secretary of Health and Human Services under section 1926 of such
Act.
(c) The State is to maintain State expenditures in fiscal year
ø2008¿ 2009 for tobacco prevention programs and for compliance
activities at a level that is not less than the level of such expenditures
maintained by the State for fiscal year ø2007¿ 2008, and adding
to that level the additional funds for tobacco compliance activities
required under subsection (a). The State is to submit a report to
the Secretary on all fiscal year ø2007¿ 2008 State expenditures and
all fiscal year ø2008¿ 2009 obligations for tobacco prevention and
compliance activities by program activity by July 31, ø2008¿ 2009.
(d) The Secretary shall exercise discretion in enforcing the timing
of the State obligation of the additional funds required by the certification described in subsection (a) as late as July 31, ø2008¿ 2009.
(e) None of the funds appropriated by this Act may be used to
withhold substance abuse funding pursuant to section 1926 of the
Public Health Service Act from a territory that receives less than
$1,000,000.
SEC. ø214¿ 213. In order for the øCenters for Disease Control
and Prevention¿ Department of Health and Human Services to carry
out international health activities, including HIV/AIDS and other
infectious disease, chronic and environmental disease, and other
health activities abroad during fiscal year ø2008¿ 2009:
(1) The Secretary of Health and Human Services (in this section
referred to as the ‘‘Secretary of HHS’’) may exercise authority
equivalent to that available to the Secretary of State in section
2(c) of the State Department Basic Authorities Act of 1956 (22
U.S.C. 2669(c)). The Secretary of HHS shall consult with the Secretary of State and relevant Chief of Mission to ensure that the
authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act of 1980 (22
U.S.C. 3927) and other applicable statutes administered by the
Department of State.
(2) The Secretary of HHS is authorized to provide such funds
by advance or reimbursement to the Secretary of State as may
be necessary to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
for the use of the Department of Health and Human Services.
The Department of State shall cooperate fully with the Secretary
of HHS to ensure that the Department of Health and Human
Services has secure, safe, functional facilities that comply with
applicable regulation governing location, setback, and other facilities requirements and serve the purposes established by this Act.
The Secretary of HHS is authorized, in consultation with the Secretary of State, through grant or cooperative agreement, to make
available to public or nonprofit private institutions or agencies in
participating foreign countries, funds to acquire, lease, alter, or
renovate facilities in those countries as necessary to conduct programs of assistance for international health activities, including
activities relating to HIV/AIDS and other infectious diseases, chronic and environmental diseases, and other health activities abroad.
SEC. ø215¿ 214. (a) AUTHORITY.—Notwithstanding any other provision of law, the Director of the National Institutes of Health (in
this section referred to as the ‘‘Director of NIH’’) may use funds
available under section 402(b)(7) or 402(b)(12) of the Public Health
Service Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry out research identified pursuant
to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described in such section 402(b)(12).
(b) PEER REVIEW.—In entering into transactions under subsection
(a), the Director of the NIH may utilize such peer review procedures
(including consultation with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific
and technical merit. Such procedures shall apply to such transactions
in lieu of the peer review and advisory council review procedures
that would otherwise be required under sections 301(a)(3),
VerDate Aug 31 2005

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405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the Public Health
Service Act.
øSEC. 216. Funds which are available for Individual Learning Accounts for employees of the Centers for Disease Control and Prevention (‘‘CDC’’) and the Agency for Toxic Substances and Disease Registry (‘‘ATSDR’’) may be transferred to ‘‘Disease Control, Research,
and Training’’, to be available only for Individual Learning Accounts:
Provided, That such funds may be used for any individual full-time
equivalent employee while such employee is employed either by CDC
or ATSDR.¿
øSEC. 217. Notwithstanding any other provisions of law, funds
made available in this Act may be used to continue operating the
Council on Graduate Medical Education established by section 301
of Public Law 102–408.¿
øSEC. 218. The Director of the National Institutes of Health shall
require that all investigators funded by the NIH submit or have
submitted for them to the National Library of Medicine’s PubMed
Central an electronic version of their final, peer-reviewed manuscripts
upon acceptance for publication, to be made publicly available no
later than 12 months after the official date of publication: Provided,
That the NIH shall implement the public access policy in a manner
consistent with copyright law.¿
øSEC. 219. (a) The Secretary of Health and Human Services is
authorized to award a grant to the Delta Health Alliance, a nonprofit
alliance of academic institutions in the Mississippi Delta region that
has as its primary purposes addressing longstanding, unmet health
needs and catalyzing economic development in the Mississippi Delta.
(b) To be eligible to receive a grant under subsection (a), the Delta
Health Alliance shall solicit and fund proposals from local governments, hospitals, health care clinics, academic institutions, and rural
public health-related entities and organizations for research development, educational programs, health care services, job training, and
planning, construction, and equipment of public health-related facilities in the Mississippi Delta region.
(c) With respect to the use of grant funds under this section for
construction or major alteration of property, the Federal interest in
the property involved shall last for a period of 1 year following the
completion of the project or until such time that the Federal Government is compensated for its proportionate interest in the property
if the property use changes or the property is transferred or sold,
whichever time period is less. At the conclusion of such period, the
Notice of Federal Interest in such property shall be removed.
(d) There are authorized to be appropriated such sums as may
be necessary to carry out this section in fiscal year 2008 and in
each of the five succeeding fiscal years.¿
SEC. ø220¿ 215. Not to exceed $35,000,000 of funds appropriated
by this Act to the institutes and centers of the National Institutes
of Health may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the activities
authorized herein, at not to exceed $2,500,000 per project.
(TRANSFER OF FUNDS)

SEC. ø221¿ 216. Of the amounts made available øin this Act¿
for the National Institutes of Health, 1 percent of the amount made
available for National Research Service Awards (NRSA) shall be
made available to the Administrator of the Health Resources and
Services Administration to make NRSA awards for research in primary medical care to individuals affiliated with entities who have
received grants or contracts under section 747 of the Public Health
Service Act, and 1 percent of the amount made available for NRSA
shall be made available to the Director of the Agency for Healthcare
Research and Quality to make NRSA awards for health service research.
SEC. 217. Of the unobligated balances available under the heading;
Health Resources and Services Administration, the amounts made
available to the Health Centers Loan Guarantee Program authorized
under section 330 (d) of the Public Health Service Act and Title
II of P.L. 104–208 are cancelled.
SEC. 218. Notwithstanding section 835 of title VIII and subpart
II of title VII of the Public Health Service Act, an institution of
higher education with a student loan revolving fund established under
these authorities shall, no later than September 30, 2009, pay to
the Secretary of Health and Human Services the Federal portion of
all the liquid assets of such fund, as determined by the Secretary
on June 30, 2009: Provided, That amounts collected under the
preceeding provision are cancelled: Provided further, That the institution shall not make any new loans under these authorities until the
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GENERAL PROVISIONS—Continued

DEPARTMENT OF HEALTH AND HUMAN SERVICES
amount equal to that Federal portion determined on June 30, 2009,
has been paid to the Secretary.
SEC. 219. NONRECURRING EXPENSES FUND. Section 223 of
the Department of Health and Human Services Appropriations Act,
2008 (Division G of Public Law 110–161), is amended in its first
proviso by inserting ‘‘, with respect to this or any succeeding fiscal
year,’’ after ‘‘by this or any other Act’’.
øSEC. 222. None of the funds made available in this Act may
be used—
(1) for the Ombudsman Program of the Centers for Disease Control and Prevention; and
(2) by the Centers for Disease Control and Prevention to provide
additional rotating pastel lights, zero-gravity chairs, or dry-heat
saunas for its fitness center.¿
øSEC. 223. There is hereby established in the Treasury of the
United States a fund to be known as the ‘‘Nonrecurring expenses
fund’’ (the Fund): Provided, That unobligated balances of expired
discretionary funds appropriated for this or any succeeding fiscal
year from the General Fund of the Treasury to the Department
of Health and Human Services by this or any other Act may be
transferred (not later than the end of the fifth fiscal year after the
last fiscal year for which such funds are available for the purposes
for which appropriated) into the Fund: Provided further, That
amounts deposited in the Fund shall be available until expended,
and in addition to such other funds as may be available for such
purposes, for capital acquisition necessary for the operation of the
Department, including facilities infrastructure and information technology infrastructure, subject to approval by the Office of Management and Budget: Provided further, That amounts in the Fund may
be obligated only after the Committees on Appropriations of the
House of Representatives and the Senate are notified at least 15
days in advance of the planned use of funds.¿
ø(RESCISSION

OF FUNDS)¿

cprice-sewell on PROD1PC71 with BUDGET PAG

øSEC. 224. Of the funds available within the Health Professions
Student Loan program authorized in subpart II, Federally-Supported
Student Loan Funds, of title VII of the Public Health Service Act,
$15,000,000 are rescinded.¿
øSEC. 225. (a) CONTINUATION OF AVAILABILITY OF PERMITTED NUMBER OF MEDICAL RESIDENCY POSITIONS UNDER THE MEDICARE PROGRAM.—Section 1886(h)(4)(H) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(H)) is amended by adding at the end the following:
‘‘(v) SPECIAL PROVIDER AGREEMENT.—If an entity enters
into a provider agreement pursuant to section 1866(a) to
provide hospital services on the same physical site previously
used by Medicare Provider No. 05–0578—
‘‘(I) the limitation on the number of total full time equivalent residents under subparagraph (F) and clauses (v) and (vi)(I) of subsection
(d)(5)(B) applicable to such provider shall be equal to the limitation
applicable under such provisions to Provider No. 05–0578 for its
cost reporting period ending on June 30, 2006; and
‘‘(II) the provisions of subparagraph (G) and subsection
(d)(5)(B)(vi)(II) shall not be applicable to such provider for the first

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three cost reporting years in which such provider trains residents
under any approved medical residency training program.’’.
(b) TECHNICAL CORRECTION OF SECTION 422 OF MMA.—
(1) IN GENERAL.—Section 1886(h)(7) of the Social Security Act
(42 U.S.C. 1395ww(h)(7)) is amended—
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following new subparagraph:
‘‘(D) ADJUSTMENT BASED ON SETTLED COST REPORT.—In the
case of a hospital with a dual accredited osteopathic and
allopathic family practice program for which—
‘‘(i) the otherwise applicable resident limit was reduced
under subparagraph (A)(i)(I); and
‘‘(ii) such reduction was based on a reference resident level
that was determined using a cost report and where a revised
or corrected notice of program reimbursement was issued
for such cost report between September 1, 2006 and September 15, 2006, whether as a result of an appeal or otherwise, and the reference resident level under such settled
cost report is higher than the level used for the reduction
under subparagraph (A)(i)(I);
the Secretary shall apply subparagraph (A)(i)(I) using the
higher resident reference level and make any necessary adjustments to such reduction. Any such necessary adjustments shall
be effective for portions of cost reporting periods occurring on
or after July 1, 2005.’’.
(2) EFFECTIVE DATE.—Subject to paragraph (3), the amendments
made by paragraph (1) shall take effect as if included in the enactment of section 422 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173).
(c) OFFSETTING COSTS.—
(1) IN GENERAL.—The amount of funds available to the Physician
Assistance and Quality Initiative Fund for expenditures—
(A) under the first sentence of section 1848(l)(2)(A) of the Social
Security Act (42 U.S.C. 1395w–4(l)(2)(A)) is reduced by $500,000;
and
(B) under the first amount in the second sentence of such
section is reduced by $24,500,000.
(2) CONFORMING AMENDMENTS.—Section 1848(l)(2)(A) of the Social Security Act (42 U.S.C. 1395w–4(l)(2)(A)) is amended—
(A) in the first sentence, by inserting after ‘‘$1,350,000,000’’
the following: ‘‘, as reduced by section 524 and section 225(c)(1)(A)
of the Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act, 2008 (division G of the Consolidated Appropriations Act, 2008)’’; and
(B) in the second sentence, by inserting after ‘‘$325,000,000’’
the following: ‘‘, as reduced by section 225(c)(1)(B) of such Act,’’.¿
(Department of Health and Human Services Appropriations Act,
2008.)

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