Centers for Disease Control and Prevention
Changes in Obligations and Activities before and after Fiscal Year 2005 Budget Reorganization Gao ID: GAO-08-328R February 25, 2008Congress asked us to examine issues regarding changes in obligations for administrative activities--generally conducted in CDC's leadership and management levels--and public health programs--generally conducted in CDC's division level--before and after the organizational restructuring and budget reorganization. GAO examined the following questions: 1. How were obligations distributed between CDC's division level and CDC's leadership and management levels from fiscal years 2003 through 2006? 2. How have obligations and activities at CDC's leadership and management levels--including shared business services in the CDC Office of the Director--changed from fiscal year 2003 through fiscal year 2006? 3. How have obligations and activities at CDC's division level changed from fiscal years 2003 through 2006?The Centers for Disease Control and Prevention's (CDC) mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. In fiscal year 2005, CDC, an agency within the Department of Health and Human Services (HHS), completed its first major organizational restructuring in more than 25 years, known as the Futures Initiative, as part of its efforts to prioritize its strategies, programs, resources, and needs. In accordance with the conference report accompanying its 2005 appropriation, CDC also implemented a new internal budget reporting structure that specifically identifies funding obligated for leadership and management activities. However, questions have been raised concerning whether changing the budget reporting structure has made it difficult to compare obligations over time for leadership and management activities and for public health program activities. Prior to the fiscal year 2005 organizational restructuring, CDC consisted of an Office of the Director and national centers that housed CDC's public health programs, including programs to reduce or prevent infectious diseases, cancer, birth defects, injuries, and other health problems. CDC had two organizational levels that were primarily responsible for leadership and management: the CDC Office of the Director and the national center directors' offices. In fiscal year 2005, CDC added two national centers. CDC also added a new leadership and management organizational level, which consists of six coordinating centers designed to better integrate the work of the national centers. Four of the six coordinating centers each manage the work of two or more specific national centers, while the other two coordinating centers each manage agencywide issues related to global health and terrorism preparedness and emergency response. Adding coordinating centers to CDC's structure was consistent with our 2004 recommendation that CDC oversee the national centers' programmatic work at a level below that of the CDC Director. In addition to its leadership and management levels, CDC has one organizational level--consisting of the national center divisions, branches, and other units--that is primarily responsible for operating public health programs. In this report, we refer to this level as CDC's division level. You asked us to examine issues regarding changes in obligations for administrative activities--generally conducted in CDC's leadership and management levels--and public health programs--generally conducted in CDC's division level--before and after the organizational restructuring and budget reorganization.
The distribution of obligations between CDC's division level, which is primarily responsible for carrying out public health programs, and its leadership and management levels remained relatively stable from fiscal year 2003 through fiscal year 2006. Obligations at CDC's division level accounted for between 87 and 89 percent of CDC's obligations in each year, while obligations at CDC's leadership and management levels accounted for between 8 and 9 percent of CDC obligations. Obligations for buildings and facilities, which are not considered part of CDC's division level or CDC's leadership and management levels because they generally consist of onetime capital expenses, accounted for the remaining portion of CDC obligations. Overall, CDC's obligations increased from $6.05 billion in fiscal year 2003 to $6.14 billion in fiscal year 2006. Obligations at leadership and management levels fluctuated from about $483 million in fiscal year 2003 to a high of about $592 million in fiscal year 2004, before ending at $516 million in fiscal year 2006, as obligations and activities such as shared business services were consolidated in the CDC Office of the Director. Obligations at CDC's division level remained between about $5.4 billion and about $5.6 billion, despite the movement of some activities to the division level from leadership and management levels and the movement of some administrative activities from the division level to the leadership and management levels. However, after adjusting for inflation, from fiscal year 2003 to fiscal year 2006, obligations declined at the division level to a greater extent than at the leadership and management levels. We received written comments on a draft of this report from HHS. In its comments, HHS interpreted our findings to suggest that its 2005 organizational restructuring has had limited or no impact on funding available for public health program activities. However, because it is difficult to separate the effects of the organizational restructuring, inflation, or other factors on obligations for public health program activities, we did not draw this conclusion. We did note that, after adjusting for inflation, obligations at CDC's division level declined more than obligations at CDC's leadership and management levels from fiscal year 2003 to fiscal year 2006.
GAO-08-328R, Centers for Disease Control and Prevention: Changes in Obligations and Activities before and after Fiscal Year 2005 Budget Reorganization
This is the accessible text file for GAO report number GAO-08-328R
entitled 'Centers for Disease Control and Prevention: Changes in
Obligations and Activities before and after Fiscal Year 2006 Budget
Reorganization' which was released on March 14, 2008.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
February 25, 2008:
The Honorable Henry A. Waxman:
Chairman:
Committee on Oversight and Government Reform:
House of Representatives:
Subject: Centers for Disease Control and Prevention: Changes in
Obligations and Activities before and after Fiscal Year 2005 Budget
Reorganization:
Dear Mr. Chairman:
The Centers for Disease Control and Prevention's (CDC) mission is to
promote health and quality of life by preventing and controlling
disease, injury, and disability. In fiscal year 2005, CDC, an agency
within the Department of Health and Human Services (HHS), completed its
first major organizational restructuring in more than 25 years, known
as the Futures Initiative, as part of its efforts to prioritize its
strategies, programs, resources, and needs.[Footnote 1] In accordance
with the conference report accompanying its 2005 appropriation, CDC
also implemented a new internal budget reporting structure that
specifically identifies funding obligated for leadership and management
activities. However, questions have been raised concerning whether
changing the budget reporting structure has made it difficult to
compare obligations over time for leadership and management activities
and for public health program activities.[Footnote 2]
Prior to the fiscal year 2005 organizational restructuring, CDC
consisted of an Office of the Director and national centers that housed
CDC's public health programs, including programs to reduce or prevent
infectious diseases, cancer, birth defects, injuries, and other health
problems.[Footnote 3] CDC had two organizational levels that were
primarily responsible for leadership and management:[Footnote 4] the
CDC Office of the Director and the national center directors' offices.
In fiscal year 2005, CDC added two national centers. CDC also added a
new leadership and management organizational level, which consists of
six coordinating centers designed to better integrate the work of the
national centers.[Footnote 5] Four of the six coordinating centers each
manage the work of two or more specific national centers, while the
other two coordinating centers each manage agencywide issues related to
global health and terrorism preparedness and emergency response. Adding
coordinating centers to CDC's structure was consistent with our 2004
recommendation that CDC oversee the national centers' programmatic work
at a level below that of the CDC Director.[Footnote 6] In addition to
its leadership and management levels, CDC has one organizational level-
-consisting of the national center divisions, branches, and other
units--that is primarily responsible for operating public health
programs. In this report, we refer to this level as CDC's division
level. (See table 1.)
Table 1: CDC's Organizational Levels:
Prior to fiscal year 2005: Leadership and management levels: CDC Office
of the Director: * Immediate Office of the Director[A];
* CDC-wide shared business services[B];
National center directors' offices.
Beginning in fiscal year 2005: Leadership and management levels: CDC
Office of the Director: * Immediate Office of the Director[A];
* CDC-wide shared business services[B];
Coordinating centers;
National center directors' offices[C].
Prior to fiscal year 2005: Division level: National center divisions,
branches, and other units.
Beginning in fiscal year 2005: Division level: National center
divisions, branches, and other units[C].
Source: GAO analysis of information from CDC.
[A] The immediate Office of the Director consists of the offices that
report to the CDC director.
[B] Shared business services are agencywide administrative services,
such as rent, utilities, security, maintenance, contract and grants
administration, financial management, information technology, human
resources, telecommunications, and postage.
[C] In fiscal year 2005, CDC established two additional national
centers.
[End of table]
Under CDC's new budget reporting structure, the agency began allocating
funding for staff and activities at its leadership and management
levels under two new elements within CDC's Disease Control, Research,
and Training account, titled "Public Health Improvement and Leadership"
and "Business Services Support." Each of these elements is a Program,
Project, or Activity (PPA).[Footnote 7] Under the previous structure in
effect through fiscal year 2004, funds for CDC's leadership and
management levels, including shared business services[Footnote 8] in
the CDC Office of the Director, were derived from a combination of
CDC's "Office of the Director"
PPA and indirect cost allocations[Footnote 9] against other CDC units,
primarily from the division level. The "Office of the Director" PPA and
the indirect cost allocations were eliminated as part of the budget
reorganization.
You asked us to examine issues regarding changes in obligations for
administrative activities--generally conducted in CDC's leadership and
management levels--and public health programs--generally conducted in
CDC's division level--before and after the organizational restructuring
and budget reorganization. In response to your request, we examined the
following questions:
1. How were obligations distributed between CDC's division level and
CDC's leadership and management levels from fiscal years 2003 through
2006?
2. How have obligations and activities at CDC's leadership and
management levels--including shared business services in the CDC Office
of the Director--changed from fiscal year 2003 through fiscal year
2006?
3. How have obligations and activities at CDC's division level changed
from fiscal years 2003 through 2006?
To address these questions about CDC's implementation of its budget
reorganization in fiscal year 2005, we obtained and analyzed
obligations data at CDC's leadership and management levels and at CDC's
division level from fiscal year 2003 through fiscal year 2006.[Footnote
10] Our work was limited to CDC's discretionary budget, which
constituted about 77 percent of CDC's total budget in fiscal year
2006.[Footnote 11] We reviewed documents, including those related to
relevant legislation and CDC's budget and obligations, and interviewed
officials from CDC's Financial Management Office and from CDC's
leadership and management levels to understand changes in obligations.
Although administrative activities are generally conducted at
leadership and management levels and public health programs are
generally conducted at the division level, some administrative and
public health activities are conducted at each CDC level. Therefore, we
also examined the types of activities conducted at each level. In
addition, to examine obligations at CDC's national centers in greater
detail, we selected five national centers and their related funding
sources, based on changes in obligations from fiscal year:
2003 through fiscal year 2006.[Footnote 12] Specifically, we selected
the two national centers' PPAs or their subcategories with the largest
increases in obligations, the two with the largest decreases, and one
with a small overall change. To better understand changes in
obligations over time, we also adjusted CDC obligations data from
fiscal year 2003 through fiscal year 2006 for inflation using the Gross
Domestic Product (GDP) price index. We compared the adjusted
obligations data to the unadjusted obligations data, particularly for
the division level, because the effect of inflation was greater there
than at the leadership and management levels. Throughout this report,
we present unadjusted obligations data, unless otherwise noted. To
assess the reliability of the obligations data provided by CDC, we (1)
performed electronic testing for obvious errors in accuracy and
completeness, (2) reviewed related documentation, including contractor
reports concerning the data, and (3) worked closely with agency
officials to reconcile questions about the data before conducting our
analyses. We did not find any errors, and therefore we determined that
the data were sufficiently reliable for the purposes of our report. Our
review focused on how obligations and activities shifted among CDC's
organizational levels over time and not whether these changes resulted
in improved efficiency or effectiveness. We conducted our work from May
2007 to January 2008 in accordance with generally accepted government
auditing standards. For more information on our scope and methodology,
see enclosure III.
Results in Brief:
The distribution of obligations between CDC's division level, which is
primarily responsible for carrying out public health programs, and its
leadership and management levels remained relatively stable from fiscal
year 2003 through fiscal year 2006. Obligations at CDC's division level
accounted for between 87 and 89 percent of CDC's obligations in each
year, while obligations at CDC's leadership and management levels
accounted for between 8 and 9 percent of CDC obligations. Obligations
for buildings and facilities, which are not considered part of CDC's
division level or CDC's leadership and management levels because they
generally consist of onetime capital expenses, accounted for the
remaining portion of CDC obligations. Overall, CDC's obligations
increased from $6.05 billion in fiscal year 2003 to $6.14 billion in
fiscal year 2006. Obligations at leadership and management levels
fluctuated from about $483 million in fiscal year 2003 to a high of
about $592 million in fiscal year 2004, before ending at $516 million
in fiscal year 2006, as obligations and activities such as shared
business services were consolidated in the CDC Office of the Director.
Obligations at CDC's division level remained between about $5.4 billion
and about $5.6 billion, despite the movement of some activities to the
division level from leadership and management levels and the movement
of some administrative activities from the division level to the
leadership and management levels. However, after adjusting for
inflation, from fiscal year 2003 to fiscal year 2006, obligations
declined at the division level to a greater extent than at the
leadership and management levels.
We received written comments on a draft of this report from HHS. In its
comments, HHS interpreted our findings to suggest that its 2005
organizational restructuring has had limited or no impact on funding
available for public health program activities. However, because it is
difficult to separate the effects of the organizational restructuring,
inflation, or other factors on obligations for public health program
activities, we did not draw this conclusion. We did note that, after
adjusting for inflation, obligations at CDC's division level declined
more than obligations at CDC's leadership and management levels from
fiscal year 2003 to fiscal year 2006. HHS's written comments are
reprinted in enclosure IV. HHS also provided technical comments, which
we incorporated as appropriate.
Background:
Under CDC's new structure, the agency's organization consists of the
CDC Office of the Director, coordinating centers, and national centers.
The coordinating centers include the Coordinating Office for Global
Health, the Coordinating Office for Terrorism Preparedness and
Emergency Response, the Coordinating Center for Environmental Health
and Injury Prevention, the Coordinating Center for Health Information
and Service, the Coordinating Center for Health Promotion, and the
Coordinating Center for Infectious Diseases. Coordinating centers are
intended to allow CDC's scientists to collaborate and innovate across
organizational boundaries, improve efficiency, and improve the internal
services that support and develop CDC staff. Four of these coordinating
centers oversee the activities at multiple national centers. In
addition to establishing coordinating centers, CDC added two new
national centers, the National Center for Public Health Informatics and
the National Center for Health Marketing. (Encl. I contains CDC's
organizational chart.)
For fiscal year 2005, CDC restructured the 13 PPAs in its Disease
Control, Research, and Training budget account into 10 PPAs to
correspond with its new organizational structure and, in accordance
with language in the Senate and conference reports accompanying its
2005 appropriation, to separate actual program costs from management
and administrative costs.[Footnote 13] The new Public Health
Improvement and Leadership PPA includes obligations for staff and
activities at each of CDC's three leadership and management
organizational levels.[Footnote 14] The new Business Services Support
PPA includes obligations in the CDC Office of the Director on shared
business services that benefit the entire agency. In addition, CDC
consolidated the PPAs that it uses to track funding for its public
health programs, creating new PPAs and subcategories to correspond with
the newly created coordinating centers. (See encl. II for a list of
PPAs and their subcategories before and after CDC's budget
reorganization.)
The Distribution of Obligations between CDC's Division Level and Its
Leadership and Management Levels Remained Relatively Stable:
The distribution of obligations between CDC's division level, primarily
responsible for operating CDC's public health programs, and its
leadership and management levels remained relatively stable from fiscal
year 2003 through fiscal year 2006. CDC's total obligations were about
$6.05 billion in fiscal year 2003, $6.24 billion in fiscal year 2004,
$6.28 billion in fiscal year 2005, and $6.14 billion in fiscal year
2006. Obligations at CDC's division level accounted for between 87 and
89 percent of CDC's total obligations in each year. Obligations at
CDC's leadership and management levels accounted for between 8 and 9
percent of its total obligations in each year. The remaining 2 to 3
percent of CDC's obligations were for the purchase and construction of
buildings and facilities, which are not considered part of CDC's
division level or CDC's leadership and management levels because they
generally consist of onetime capital expenses. Figure 1 indicates CDC's
total obligations from fiscal year 2003 through fiscal year 2006,
broken out according to obligations at the division level, obligations
at leadership and management levels, and obligations for buildings and
facilities.
Figure 1: CDC's Obligations by Level, Fiscal Year 2003 through Fiscal
Year 2006:
This figure is a combination bar graph showing CDC's obligations by
level, fiscal year 2003 through fiscal year 2006. The X axis represents
the fiscal year, and the Y axis represents dollars (in millions). The
bars represent total buildings and facilities obligations, total-
leadership-and management-level obligations, and total division-level
obligations.
[See PDF for image]
Source: GAO analysis of CDC data.
Note: CDC's division level consists of the national center divisions,
branches, and other units. In fiscal year 2003 and fiscal year 2004,
CDC's leadership and management levels consisted of the CDC Office of
the Director and the national center directors' offices. As of fiscal
year 2005, CDC's leadership and management levels also include the
coordinating centers.
[End of figure]
Obligations within CDC's Leadership and Management Levels Have
Increased, and Obligations and Activities Have Been Consolidated in the
CDC Office of the Director:
Total obligations at CDC's leadership and management levels, which
include the CDC Office of the Director, coordinating centers, and
national center directors' offices, have fluctuated and increased
overall, from $483 million in fiscal year 2003 to $516 million in
fiscal year 2006. During this time, obligations and activities within
the leadership and management levels were consolidated in the CDC
Office of the Director. Obligations and activities at national center
directors' offices have decreased, while obligations and activities at
the CDC Office of the Director have increased as a result of the
consolidation. Several activities previously performed in national
center directors' offices were consolidated in the CDC Office of the
Director, moved to the division level, or discontinued, thereby
affecting obligations at these levels. Obligations for some public
health program activities were part of the CDC Office of the Director
from fiscal year 2003 through fiscal year 2006. In addition,
obligations for shared business services within the CDC Office of the
Director, which include the majority of obligations at CDC's leadership
and management levels, have fluctuated and increased overall as new
services, including information technology services, have been
consolidated from other components throughout CDC.
Overall Obligations within CDC's Leadership and Management Levels Have
Increased, and Obligations Have Been Consolidated in the CDC Office of
the Director:
Obligations at leadership and management levels from fiscal year 2003
through fiscal year 2006 have fluctuated but increased overall by about
6.9 percent. This increase is greater than the increase in CDC's total
obligations, which rose by about 1.5 percent over the same period. It
is also greater than the increase in obligations at CDC's division
level, which rose by about 1.9 percent over the same period.
Specifically, obligations at leadership and management levels increased
from about $483 million in fiscal year 2003 to about $592 million in
fiscal year 2004, but then decreased to about $530 million in fiscal
year 2005 and about $516 million in fiscal year 2006. Figure 2 shows
the obligations at CDC's three leadership and management levels from
fiscal year 2003 through fiscal year 2006.
Figure 2: CDC Obligations at Leadership and Management Levels, Fiscal
Years 2003 through 2006:
This figure is a combination bar graph showing CDC obligations at
leadership and management levels, fiscal year 2003 through 2006. The X
axis represents the fiscal year, and the Y axis represents dollars (in
millions).
CDC Office of the Director: Fiscal year 2003: 328;
CDC Office of the Director: Fiscal year 2004: 402;
CDC Office of the Director: Fiscal year 2005: 389;
CDC Office of the Director: Fiscal year 2006: 408.
Coordinating centers: Fiscal year 2003: [Empty];
Coordinating centers: Fiscal year 2004: [Empty];
Coordinating centers: Fiscal year 2005: 19;
Coordinating centers: Fiscal year 2006: 28.
National center directors' offices: Fiscal year 2003: 155;
National center directors' offices: Fiscal year 2004: 190;
National center directors' offices: Fiscal year 2005: 122;
National center directors' offices: Fiscal year 2006: 80.
[See PDF for image]
Note: CDC's coordinating centers were established in fiscal year 2005.
[End of figure]
As shown in figure 2, obligations within CDC's leadership and
management levels increased at the CDC Office of the Director and at
coordinating centers but decreased at national center directors'
offices. The portion of CDC's total leadership-and management-level
obligations in the CDC Office of the Director increased from 68 percent
in fiscal year 2003 to 79 percent in fiscal year 2006. This percentage
increase corresponded to an increase in CDC Office of the Director
obligations from $328 million in fiscal year 2003 to $408 million in
fiscal year 2006. The portion of CDC's total leadership-and management-
level obligations that was part of CDC national center directors'
offices decreased from 32 percent in fiscal year 2003 to 15 percent in
fiscal year 2006. This decrease corresponded with a decline in
obligations at national center directors' offices from $155 million in
fiscal year 2003 to $80 million in fiscal year 2006. The portion of
leadership and management level obligations in coordinating centers,
which were established in fiscal year 2005, was 4 percent or $19
million in fiscal year 2005 and 5 percent or $28 million in fiscal year
2006.
Obligations at national center directors' offices decreased for four of
the five PPAs that we examined in detail. (See fig. 3.) The decreases
in these four PPAs ranged from about 42 percent or $4 million for Birth
Defects, Developmental Disabilities, Disability and Health to about 68
percent or $24 million for Chronic Disease Prevention and Health
Promotion from fiscal year 2003 through fiscal year 2006.
Figure 3: Leadership-and Management-Level Obligations at National
Center Directors' Offices for Selected PPAs, Fiscal Years 2003 through
2006:
This figure is a combination of five bar graphs. The X axis represents
the fiscal year, and the Y axis represents dollars in millions.
HIV/AIDS, STD, and TB Prevention(Funding for the National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally reported
under this PPA.)
Fiscal year 2003: $21.7;
Fiscal year 2004: $17.8;
Fiscal year 2005: $9.1;
Fiscal year 2006: $6.9.
Infectious Disease Control(Funding for the National Center for
Preparedness, Detection, and Control of Infectious Diseases is
generally reported under this PPA.)
Fiscal year 2003: $28.3;
Fiscal year 2004: $25.1;
Fiscal year 2005: $23.8;
Fiscal year 2006: $11.3.
Chronic Disease Prevention and Health Promotion (Funding for the
National Center for Chronic Disease Prevention and Health Promotion is
generally reported under this PPA.)
Fiscal year 2003: $35.6;
Fiscal year 2004: $44.2;
Fiscal year 2005: $33.5;
Fiscal year 2006: $11.5.
Birth Defects, Develop-mental Disabilities, Disability and
Health(Funding for the National Center on Birth Defects and
Developmental Disabilities is generally reported under this PPA.)
Fiscal year 2003: $9.6;
Fiscal year 2004: $11.8;
Fiscal year 2005: $9.1;
Fiscal year 2006: $5.6.
Occupational Safety and Health(Funding for the National Center for
Occupational Safety and Health is generally reported under this PPA.)
Fiscal year 2003: $5.3;
Fiscal year 2004: $5.6;
Fiscal year 2005: $9.8;
Fiscal year 2006: $7.1.
[See PDF for image]
Source: GAO analysis of CDC data.
Note: With the exception of Occupational Safety and Health, these PPAs
became subcategories of newly established broader PPAs in fiscal year
2005 due to the reorganization of CDC's budget. See enclosure II for
the full list of changes to CDC's PPAs.
[End of figure]
Several Activities Previously Performed in National Center Directors'
Offices Have Moved or Been Discontinued:
Some administrative activities and public health program functions
previously performed in national center directors' offices have been
consolidated in the CDC Office of the Director, moved to the division
level, or discontinued. CDC officials told us that it was common for
public health program functions to be placed in national center
directors' offices in fiscal year 2003 and fiscal year 2004 because
these offices had funding available to them that could be utilized for
program functions. It has become less common for program functions to
be placed in national center directors' offices as funding levels for
national center directors' offices have declined, leading to program
functions being moved or discontinued. CDC officials provided the
following examples of these changes in activities.
Consolidated in the CDC Office of the Director--CDC officials indicated
that some administrative activities that were previously performed in
national center directors' offices were consolidated into the CDC
Office of the Director. For example, budget analysts had been
distributed throughout CDC, including the national center directors'
offices. CDC consolidated its budget analysts in the CDC Office of the
Director as part of the Financial Management Office in fiscal year
2005, contributing to an increase in financial management obligations
at the CDC Office of the Director level from about $17 million in
fiscal year 2004 to about $34 million in fiscal year 2005.
Moved from National Center Directors' Offices--CDC officials in five
national centers also provided examples of public health program
functions that were moved from national center directors' offices to
the division level in fiscal year 2005 and fiscal year 2006, including
the following:
* Antimicrobial Resistance Program functions, previously housed in the
director's office of the National Center for Infectious Diseases, were
moved to the Division of Healthcare Quality Promotion in fiscal years
2005 and 2006. Obligations for these program functions totaled $7.7
million in fiscal year 2004 and decreased to $3.1 million in fiscal
year 2006.
* Functions of the Emerging Infections Office/Program, which were
previously located in the director's office of the National Center for
Infectious Diseases, were moved to the Division of Emerging Infections
and Surveillance Services in fiscal years 2005 and 2006. Obligations
for these program functions totaled $33 million in fiscal year 2004 and
decreased to $22 million in fiscal year 2006.
* The National AIDS Clearing House, which was previously located in the
director's office of the National Center for HIV, STD, and TB
Prevention,[Footnote 15] was moved to the National Center for Health
Marketing in fiscal year 2005. Obligations for this program function
totaled $9.5 million in fiscal year 2004 and remained at the same level
for fiscal year 2006.
Discontinued Activities That Had Been in National Center Directors'
Offices--Other activities were discontinued from national center
directors' offices. For example, the alcohol activity grant and global
health evaluation projects were located in the director's office of the
National Center for Chronic Disease Prevention and Health Promotion. In
fiscal year 2004, obligations for these programs totaled $100,000 and
$205,000, respectively. These activities were discontinued in fiscal
year 2006. CDC officials stated that CDC does not keep data on the
total amount of obligations for public health programs in national
center directors' offices. However, the amount of obligations for
grants--one type of program obligations--in national center directors'
offices decreased from about $28.8 million in fiscal year 2004 to $1.1
million in fiscal year 2006. CDC officials told us that most of this
decrease was due to programs being moved to divisions or discontinued,
but that some program-related activities were moved to the CDC Office
of the Director. An additional $700,000 in obligations for grants
occurred at the coordinating centers in fiscal year 2006, and
obligations for grants at the CDC Office of the Director increased from
about $1.2 million in fiscal year 2004 to about $3.8 million in fiscal
year 2006. As a result, the net decrease in obligations for grants at
CDC's leadership and management levels was about 81 percent from fiscal
years 2004 to 2006.
Some Additional Obligations for Public Health Program Activities Were
Part of the CDC Office of the Director in Fiscal Years 2005 and 2006:
In addition to obligations for grants, some other public health program
obligations became part of the CDC Office of the Director in fiscal
years 2005 and 2006. About $2.2 million of the director's discretionary
fund was used to finance public heath programs concerning influenza and
obesity in fiscal year 2005, and about $3.3 million was used to finance
public health programs concerning infant mortality and other issues in
fiscal year 2006. Furthermore, $19.6 million in fiscal year 2005 and
$18.5 million in fiscal year 2006 from the Office of Workforce and
Career Development, part of the CDC Office of the Director, were used
for workforce and career development activities within CDC's public
health programs. These amounts constitute a relatively small percentage
of overall obligations for the CDC Office of the Director, which were
$389 million in fiscal year 2005 and $408 million in 2006.
Obligations for Shared Business Services within the CDC Office of the
Director Have Fluctuated and Increased Overall as New Services Have
Been Consolidated:
Obligations for shared business services within the CDC Office of the
Director--which included between 58 and 62 percent of the obligations
at CDC's leadership and management levels--have fluctuated and
increased overall as new services, particularly information technology
services, have been moved from other components within CDC and
consolidated in that office. From fiscal year 2003 through fiscal year
2006, obligations on shared business services have fluctuated from
about $278 million, or 4.6 percent of CDC's total obligations in fiscal
year 2003, to about $353 million, or 5.7 percent of CDC's total
obligations in fiscal year 2004. Obligations for shared business
services peaked in fiscal year 2004 and have since declined to about
$318 million in fiscal year 2006. (See fig. 4.)
Figure 4: Obligations on Shared Business Services in the CDC Office of
the Director, Fiscal Year 2003 through Fiscal Year 2006:
This figure is a combination bar graph showing obligations on shared
business services in the CDC Office of the Director, fiscal year 2003
through fiscal year 2006. The X axis represents the fiscal year, and
the Y axis represents dollars (in millions). The bars represent
information technology services; telecommunications; HHS assessments
and support costs, postage; General Services Administration vehicles;
General Services Administration rental payments, lease purchases,
maintenance costs, utilities, and security; and all other shared
business services.
[See PDF for image]
Source: GAO analysis of CDC data.
[End of figure]
Shared business services were centrally located as part of the CDC
Office of the Director in each year from fiscal year 2003 through
fiscal year 2006 even though the method for funding them changed in
fiscal year 2005. Beginning in that year, CDC started using its newly
created Business Services Support PPA to allocate funding for these
services.[Footnote 16] Although shared business services have been part
of the CDC Office of the Director in each year, the types of services
and the amount of obligations for shared business services have changed
over time, in part due to functions moving between the CDC Office of
the Director and the national centers. As shown in figure 4, the
largest fluctuations in obligations on shared business services from
fiscal years 2003 through 2006 were for CDC's information technology
services. However, the CDC information technology offices included
within CDC's shared business services have changed from year to year,
and CDC officials told us that changes in services provided by these
offices were largely responsible for the fluctuations in obligations.
The information technology offices that were part of shared business
services during this period were the Information Resource Management
Office (IRMO), the Information Technology Service Office (ITSO), the
Office of the Chief Information Officer (OCIO), and the Management
Information Systems Office (MISO). See table 2 for the offices that CDC
included in its shared business services in each fiscal year and how
the corresponding obligations have fluctuated.
Table 2: Information Technology Offices Included in CDC's Shared
Business Services and Corresponding Obligation Levels, Fiscal Year 2003
through Fiscal Year 2006:
Information technology offices included in CDC's shared business
services;
Fiscal year 2003:
* Information Resource Management Office (IRMO);
Fiscal year 2004:
* IRMO;
* Information Technology Service Office (ITSO);
* Office of the Chief Information Officer (OCIO);
Fiscal year 2005:
* ITSO;
* OCIO;
* Management Information Systems Office (MISO);
Fiscal year 2006:
* ITSO;
* OCIO;
* MISO.
CDC obligations for these offices;
Fiscal year 2003: $34.5 million;
Fiscal year 2004: $89.3 million;
Fiscal year 2005: $65.1 million;
Fiscal year 2006: $59.1 million.
Source: GAO analysis of CDC data.
Note: In fiscal year 2005, IRMO was eliminated. Its functions were
moved into ITSO, OCIO, MISO, and the National Center for Public Health
Informatics.
[End of table]
Information technology personnel were moved from other components
within CDC and consolidated into the newly created ITSO in fiscal year
2004, contributing to the increase in obligations in CDC's information
technology offices from about $35 million in fiscal year 2003 to about
$89 million in fiscal year 2004. Although IRMO was CDC's primary
centralized information technology organization in fiscal year 2003,
the majority of information technology obligations, approximately $57
million, were outside of the CDC Office of the Director in the division
level and directors' offices of national centers. In fiscal year 2004
when ITSO was formed within the CDC Office of the Director, these
decentralized information technology obligations were consolidated to
form ITSO and several related functions within IRMO. IRMO was
eliminated for fiscal year 2005 and its functions were moved into ITSO,
OCIO, and MISO. About an additional $21 million was moved out of the
CDC Office of the Director to the National Center for Public Health
Informatics, contributing to the decrease in shared business services
information technology obligations from about $89 million in fiscal
year 2004 to about $65 million in fiscal year 2005.
Obligations at CDC's Division Level Remained Generally Stable from
Fiscal Year 2003 through Fiscal Year 2006 but Have Declined When
Adjusted for Inflation:
Obligations at CDC's division level, which includes most CDC public
health programs, remained generally stable from fiscal year 2003
through fiscal year 2006. Division level obligations increased by 1.9
percent from fiscal year 2003 through fiscal year 2006, from about $5.4
billion to about $5.5 billion. This increase is similar to the increase
in CDC's total obligations, which rose 1.5 percent over the same
period. However, after adjusting for inflation, from fiscal year 2003
through fiscal year 2006, obligations declined.
Without adjusting for inflation, obligations at the division level for
the PPAs we selected have remained generally stable. Division level
obligations declined for two of the selected PPAs and increased
slightly for three of the selected PPAs. (See fig. 5.)
Figure 5: CDC Division-Level Obligations for Selected PPAs, Fiscal
Years 2003 through 2006:
This figure is a combination of four graphs showing CDC division-level
obligations for selected PPAs, fiscal 2003 through 2006. The X axis
represents the fiscal year, and the Y axis represents dollars in
millions.
HIV/AIDS, STD, and TB Prevention(Funding for the National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally reported
under this PPA.)
Fiscal year 2003: $940;
Fiscal year 2004: $931;
Fiscal year 2005: $960;
Fiscal year 2006: $913.
Infectious Disease Control(Funding for the National Center for
Preparedness, Detection, and Control of Infectious Diseases is
generally reported under this PPA.)
Fiscal year 2003: $250;
Fiscal year 2004: $237;
Fiscal year 2005: $228;
Fiscal year 2006: $217.
Chronic Disease Prevention and Health Promotion (Funding for the
National Center for Chronic Disease Prevention and Health Promotion is
generally reported under this PPA.)
Fiscal year 2003: $761;
Fiscal year 2004: $818;
Fiscal year 2005: $897;
Fiscal year 2006: $808.
Birth Defects, Develop-mental Disabilities, Disability and
Health(Funding for the National Center on Birth Defects and
Developmental Disabilities is generally reported under this PPA.)
Fiscal year 2003: $106;
Fiscal year 2004: $115;
Fiscal year 2005: $124;
Fiscal year 2006: $121.
Occupational Safety and Health(Funding for the National Center for
Occupational Safety and Health is generally reported under this PPA.)
Fiscal year 2003: $233;
Fiscal year 2004: $228;
Fiscal year 2005: $230;
Fiscal year 2006: $242.
[See PDF for image]
Source: GAO analysis of CDC data.
[See PDF for image]
Note: With the exception of Occupational Safety and Health, these PPAs
became subcategories of newly established broader PPAs in fiscal year
2005 due to the reorganization of CDC's budget. See enclosure II for
the full list of changes to CDC's PPAs.
[End of figure]
The shifting of obligations and activities between CDC's leadership and
management levels and CDC's division level had varying effects at CDC's
division level. Program functions that were moved to divisions from
national center directors' offices, such as Antimicrobial Resistance
Program functions in fiscal years 2005 and 2006, expanded the
responsibilities of the division level. Officials from a CDC national
center director's office told us that these new program functions often
had to be absorbed by the divisions without any overall increase in
obligations. Alternatively, divisions no longer had to fund
administrative activities and personnel that were consolidated into
CDC's leadership and management levels, such as budget analysts or
information technology personnel who were moved to the CDC Office of
the Director in fiscal year 2005.
After adjusting for inflation, division-level obligations declined from
fiscal year 2003 to fiscal year 2006.[Footnote 17] Obligations at CDC's
leadership and management levels also declined during this period after
adjusting for inflation, but the decline was smaller than at the
division level. (See fig. 6.) To have kept pace with inflation,
obligations at CDC's division level would have had to increase by
almost 9 percent from fiscal year 2003 to fiscal year 2006, but they
increased less than 2 percent. Figure 6 shows how obligations at CDC's
division level and leadership and management levels compare with the
respective inflation-adjusted obligation amounts.[Footnote 18] The fact
that obligations declined after adjusting for inflation is not unique
to CDC; obligations at many other federal agencies also did not keep
pace with inflation during this period.
Figure 6: Comparative Unadjusted and Adjusted Obligations at CDC
Leadership and Management Levels and Division Level, Fiscal Year 2003
through Fiscal Year 2006:
This figure is a combination of two bar graphs showing comparative
unadjusted and adjusted obligations at CDC leadership and management
levels and division level, fiscal year 2003 through fiscal year 2006.
The X axis represents the fiscal year, and the Y axis represents the
dollars in millions.
Division-level obligations:
Fiscal year 2003: $5,384;
Fiscal year 2004: $5,431;
Fiscal year 2005: $5,562;
Fiscal year 2006: $5,486.
Leadership-and management-level obligations:
Fiscal year 2003: $483;
Fiscal year 2004: $592;
Fiscal year 2005: $530;
Fiscal year 2006: $516.
[See PDF for image]
Source: GAO analysis of CDC data.
Note: CDC's division level consists of the national center divisions,
branches, and other units. In fiscal year 2003 and fiscal year 2004,
CDC's leadership and management levels consisted of the CDC Office of
the Director and the national center directors' offices. As of fiscal
year 2005, CDC's leadership and management levels also include the
coordinating centers.
[End of figure]
Agency Comments and Our Evaluation:
We received written comments on a draft of this report from HHS. In its
comments, HHS provided information on CDC's mission, goals, and the
rationale for its current organizational structure. In regard to this
report, HHS interpreted our findings to suggest that its 2005
organizational restructuring has had limited or no impact on funding
available for public health program activities. However, because it is
difficult to separate the effects of the organizational restructuring,
inflation, or other factors on obligations for public health program
activities, we did not draw this conclusion. We did note that, after
adjusting for inflation, obligations at CDC's division level declined
more than obligations at CDC's leadership and management levels from
fiscal year 2003 to fiscal year 2006. HHS's written comments are
reprinted in enclosure IV. HHS also provided technical comments, which
we incorporated as appropriate.
As we agreed with your office, unless you publicly announce the
contents of this report earlier, we plan no further distribution of
this report until 30 days after the date of this letter. At that time,
we will send copies to the Secretary of Health and Human Services and
other interested parties. We will also make copies available to others
on request. In addition, the report will be available at no charge on
GAO's Web site at [hyperlink, http://www.gao.gov].
If you or your staff have any questions about this report, please
contact me at (202) 512-7114 or bascettac@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. Key contributors to this report were
Sheila Avruch, Assistant Director; Linda Kohn, Assistant Director;
Timothy Cunningham; Roseanne Price; William Simerl; and Michael Zose.
Sincerely yours,
Signed by:
Cynthia Bascetta:
Director, Health Care:
[End of section]
Enclosures - 4:
Figure: Centers for Disease Control and Prevention (CDC) Organizational
Chart (effective March 22, 2007):
This figure is a layout showing centers for disease control and
prevention (CDC) organizational chart (effective March 22, 2007).
[See PDF for image]
Source: GAO analysis of CDC data.
Note: The national centers in this chart include both their respective
directors' office and their divisions, branches, and other units, which
we refer to collectively as CDC's division level in this report. We use
the term national center to refer to the 11 national centers listed
above, the National Office of Public Health Genomics, and the National
Institute for Occupational Safety and Health. This organizational chart
reflects some changes that CDC made to its structure after the fiscal
year 2005 organizational restructuring.
[End of figure]
Programs, Projects, or Activities for the Centers for Disease Control
and Prevention's (CDC) Disease Control, Research, and Training Account:
Programs, Projects, or Activities (PPA) are elements within an agency's
budget or appropriations accounts intended to provide a meaningful
representation of the operations financed by those accounts.[Footnote
19] This enclosure lists the PPAs for the CDC's Disease Control,
Research, and Training account.
CDC restructured the PPAs within the Disease Control, Research, and
Training account for fiscal year 2005 to correspond with its new
organizational structure and to separate funding for programs from
funding for management and administrative services. For fiscal year
2004, Disease Control, Research, and Training included the following 13
PPAs:
* Birth Defects, Developmental Disabilities, Disability and Health:
* Chronic Disease Prevention and Health Promotion:
* Environmental Health:
* Epidemic Services and Response:
* Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency
Syndrome (AIDS), Sexually Transmitted Diseases (STD) and Tuberculosis
(TB) Prevention:
* Immunization:
* Infectious Disease Control:
* Injury Prevention and Control:
* Occupational Safety and Health:
* Preventive Health and Health Service Block Grant:
* Public Health Improvement:
* Building and Facilities:
* Office of the Director:
For fiscal year 2005, Disease Control, Research, and Training included
the following 10 PPAs:
* Infectious Diseases:
* Health Promotion:
* Health Information and Service:
* Environmental Health and Injury:
* Occupational Safety and Health:
* Global Health:
* Public Health Improvement and Leadership:
* Preventive Health and Health Service Block Grant:
* Buildings and Facilities:
* Business Services Support:
Scope and Methodology:
To examine (1) the distribution of obligations between the Centers for
Disease Control and Prevention's (CDC) division level and CDC's
leadership and management levels, (2) obligations and activities at
CDC's leadership and management levels, including shared business
services within the CDC Office of the Director, and (3) obligations and
activities at CDC's division level, we obtained and reviewed
obligations data at CDC's leadership and management levels and at CDC's
division level from fiscal year 2003 through fiscal year 2006.[Footnote
20] Although administrative activities are generally conducted at
leadership and management levels and public health programs are
generally conducted at the division level, some administrative and
public health activities are conducted at each CDC level. Therefore, we
also examined the types of activities conducted at each level. Our work
was limited to CDC's discretionary obligations, which comprise about 77
percent of CDC's overall obligations in fiscal year 2006. We also
reviewed documents, including those related to relevant appropriations
legislation and CDC's budget and obligations, and interviewed officials
from CDC's Financial Management Office and from CDC's leadership and
management levels. We did not review CDC's Vaccines for Children
program, which is not a discretionary program and comprised most of the
remaining 23 percent of CDC's overall obligations in that year.
We compared obligations at CDC's division level and at CDC's leadership
and management levels, which include the CDC Office of the Director,
coordinating centers, and national centers directors' offices, from
fiscal year 2003 through fiscal year 2006.[Footnote 21] For this
comparison, we included the following items that constitute obligations
at the CDC Office of the Director level: (1) obligations from CDC's
Programs, Projects, or Activities (PPA) dedicated to the Office of the
Director and the offices included in it; (2) obligations from indirect
cost allocations[Footnote 22] against CDC components for shared
business services in the CDC Office of the Director in fiscal year 2003
and fiscal year 2004; (3) obligations dedicated to leadership and
management that CDC attributed to the Office of the Director in fiscal
year 2005 and fiscal year 2006; and (4) obligations from indirect cost
allocations against the National Institute for Occupational Safety and
Health (NIOSH) by the CDC Office of the Director in fiscal year 2005
and fiscal year 2006. For the coordinating centers, we included
obligations dedicated to leadership and management that CDC attributed
to the coordinating centers in fiscal year 2005 and fiscal year 2006.
For the national center directors' offices, we included (1) obligations
from indirect cost allocations for the division level by national
centers for the national center directors' offices in fiscal year 2003
and fiscal year 2004, (2) obligations dedicated to leadership and
management that CDC attributed to national center directors' offices in
fiscal year 2005 and fiscal year 2006, and (3) the portion of the NIOSH
appropriation obligated at the NIOSH director's office. For the
division level, which is primarily responsible for operating public
health programs, we included obligations at divisions and other units
within national centers. CDC officials reviewed our analysis and
confirmed that the way we had grouped the obligations was appropriate.
We did not consider buildings and facilities obligations to be a part
of obligations at CDC's division level or at CDC's leadership and
management levels because in each year they generally consist of
onetime capital expenses. Other building-related expenses, such as
maintenance or rent, are included as part of obligations at CDC's
leadership and management levels in the shared business services
category.
To specifically address changes in shared business services in the CDC
Office of the Director--part of CDC's leadership and management levels-
-we obtained and reviewed CDC data on obligations for shared business
services from fiscal years 2003 through 2006. We also determined the
obligations for subcategories in shared business services, interviewed
CDC officials, and reviewed documentation provided by them to determine
how changes in CDC's PPAs have affected obligations levels for shared
business services over time.
Funding for each of CDC's national centers is generally reported under
one of CDC's PPAs or subcategories within CDC's budget. We selected
five of these national centers and their related PPAs or subcategories
for additional analysis based on changes in obligations from fiscal
year 2003 through fiscal year 2006. We selected the two national
centers' PPAs or subcategories with the largest increases in
obligations, the two with the largest decreases, and one with a small
overall change. The PPAs or their subcategories with the largest
increase in obligations are Chronic Disease Prevention and Health
Promotion, under which funding for the National Center for Chronic
Disease Prevention and Health Promotion is generally reported; and
Birth Defects, Developmental Disabilities, Disability and Health, under
which funding for the National Center on Birth Defects and
Developmental Disabilities is generally reported. The PPAs or their
subcategories with the largest decrease in obligations are HIV/AIDS,
STD, and TB Prevention, under which funding for the National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is generally
reported; and Infectious Disease Control, under which funding for the
National Center for Preparedness, Detection, and Control of Infectious
Diseases is generally reported. The PPA with a small overall change in
obligations is Occupational Safety and Health, under which funding for
NIOSH is generally reported. In fiscal years 2003 and 2004, all five of
these components of CDC's budget were PPAs. Starting in fiscal year
2005, only Occupational Safety and Health remained a PPA, while the
other components became subcategories of newly established PPAs. For
each of the selected national centers, we reviewed obligations data
from their PPAs or subcategories and interviewed the corresponding
national center and coordinating center leadership and management
officials.
As part of our analysis of CDC obligations data, we adjusted CDC
obligations data from fiscal year 2003 through fiscal year 2006 for
inflation using the Gross Domestic Product (GDP) price index and
compared it to the unadjusted obligations data. While CDC officials
told us that they preferred to use the Bureau of Economic Analysis's
Biomedical Research and Development Price Index (BRDPI) to measure
inflation, which generally results in a larger adjustment than the GDP
price index, we chose the more conservative GDP price index over the
BRDPI. Both indexes show that obligations have declined after making
the adjustment. Given that the choice of index does not affect our
findings, we chose the more conservative index.
We compared the adjusted obligations data to the unadjusted obligations
data, particularly for the division level, because the effects of
inflation were greater there than at the leadership and management
levels. Throughout this report, we present unadjusted obligations data,
unless otherwise noted. To assess the reliability of the obligations
data provided by CDC, we (1) performed electronic testing for obvious
errors in accuracy and completeness, (2) reviewed related
documentation, including contractor reports concerning the data, and
(3) worked closely with agency officials to reconcile questions about
the data before conducting our analyses. We did not find any errors,
and therefore we determined that the data were sufficiently reliable
for our purposes, although we did not independently verify it.
We conducted our work from May 2007 to January 2008 in accordance with
generally accepted government auditing standards.
[End of section]
Comments from the Department of Health and Human Services:
Footnotes:
[1] See GAO, Centers for Disease Control and Prevention: Agency
Leadership Taking Steps to Improve Management and Planning, but
Challenges Remain, GAO-04-219 (Washington, D.C.: Jan. 30, 2004).
[2] Obligations generally are commitments that create a legal liability
of the government to pay for goods or services.
[3] We use the term national centers to refer to CDC's National
Centers, such as the National Center for Immunization and Respiratory
Diseases, as well as the National Institute for Occupational Safety and
Health and the National Office of Public Health Genomics. For an
overview of CDC's current organizational structure, see encl. I.
[4] We refer to the CDC Office of the Director, the coordinating
centers, and the national center directors' offices collectively as
CDC's leadership and management levels.
[5] We use the term coordinating centers to refer to CDC's four
coordinating centers and two coordinating offices. For an overview of
CDC's current organizational structure, see encl. I.
[6] GAO-04-219.
[7] PPAs are elements within an agency's budget or appropriations
accounts intended to provide a meaningful representation of the
operations financed by that account.
[8] Shared business services are agencywide administrative services,
such as rent, utilities, security, maintenance, contract and grants
administration, financial management, information technology, human
resources, telecommunications, and postage.
[9] CDC used two different types of indirect cost allocations. One type
was for shared business services. The other type was used within CDC's
national centers for the operation of the national center directors'
offices. Methods for determining the amount of these allocations varied
among national centers.
[10] We included the Agency for Toxic Substances and Disease Registry
(ATSDR) in our analysis because CDC's budget includes obligations for
it. ATSDR is an agency of HHS; its administrative and management
functions are consolidated with CDC's National Center for Environmental
Health. In addition, the director of the CDC is also the administrator
of ATSDR.
[11] CDC's Vaccines for Children program, which is administered by the
National Center for Immunization and Respiratory Diseases, is not a
discretionary program and is not included in our analysis. It comprised
most of the remaining 23 percent of CDC's overall obligations in fiscal
year 2006.
[12] Obligations for the National Center for Human Immunodeficiency
Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS), Viral
Hepatitis, Sexually Transmitted Diseases (STD), and Tuberculosis (TB)
Prevention are generally reported under the HIV/AIDS, STD, and TB
Prevention PPA. Obligations for the National Center for Preparedness,
Detection, and Control of Infectious Diseases are generally reported
under the Infectious Disease Control PPA. Obligations for the National
Center for Chronic Disease Prevention and Health Promotion are
generally reported under the Chronic Disease Prevention and Health
Promotion PPA. Obligations for the National Center on Birth Defects and
Developmental Disabilities are generally reported under the Birth
Defects, Developmental Disabilities, Disability and Health PPA.
Obligations for the National Institute for Occupational Safety and
Health are generally reported under the Occupational Safety and Health
PPA. In fiscal years 2003 and 2004, all five of these components of
CDC‘s budget were PPAs. Starting in fiscal year 2005, only Occupational
Safety and Health remained a PPA, while the other components became
subcategories of newly established PPAs. (For more information, see
encl. II.)
[13] S. Rep. No. 108-345, at 65 (2004); H. Rep. No. 108-792 at 1157
(Conf. Rep.)
[14] The Public Health Improvement and Leadership PPA has a subcategory
called Leadership and Management, which includes funding for
coordinating center and national center directors' offices.
[15] The National Center for HIV, STD, and TB Prevention was renamed
the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention in March 2007 to reflect the addition of CDC's Viral
Hepatitis program.
[16] A portion of obligations for shared business services in fiscal
year 2005 was accounted for by one of CDC's national centers, the
National Institute for Occupational Safety and Health (NIOSH). These
obligations were not part of CDC's Business Services Support PPA.
Beginning in fiscal year 2006, a corresponding amount of obligations
was included in the Business Services Support PPA. In addition, in
fiscal year 2006, NIOSH also accounted for a smaller, additional amount
of obligations for CDC's shared business services. We included these
additional amounts in our calculation of business services support
obligations in fiscal years 2005 and 2006.
[17] See encl. III for more information about our methodology,
including our use of the Gross Domestic Product (GDP) price index to
adjust for inflation.
[18] See also Centers for Disease Control and Prevention Professional
Judgment for Fiscal Year 2008, April 20, 2007, for CDC's analysis of
the effects of inflation. In this statement, CDC noted that the loss of
purchasing power due to inflation has led to the erosion of core
funding for non-terrorism-related research and noninfluenza, non-
emerging infectious disease science.
[19] For annually appropriated accounts, the Office of Management and
Budget (OMB) and agencies identify PPAs by reference to congressional
committee reports and agency budget justifications. For permanent
appropriations, OMB and agencies identify PPAs by the program and
financing schedules that the President provides in the "Detailed Budget
Estimates" in the budget submission for the relevant fiscal year.
Program activity structures are intended to provide a meaningful
representation of the operations financed by a specific budget account-
-usually by project, activity, or organization. See GAO, A Glossary of
Terms Used in the Federal Budget Process, GAO-05-734SP (Washington,
D.C.: September 2005), at 80.
[20] Obligations generally are commitments that create a legal
liability of the government to pay for goods or services.
[21] Our review focused on how obligations and activities shifted among
CDC's organizational levels over time and not whether these changes
resulted in improved efficiency or effectiveness.
[22] CDC used two different types of indirect cost allocations. One
type was for shared business services, which are services such as rent,
utilities, security, and administrative infrastructure that benefit all
CDC components. The other type was used within CDC's national centers
for the operation of the national center directors' offices. Methods
for determining the amount of these allocations varied among national
centers.
GAO's Mission:
The Government Accountability Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site [hyperlink, http://www.gao.gov]. Each
weekday, GAO posts newly released reports, testimony, and
correspondence on its Web site. To have GAO e-mail you a list of newly
posted products every afternoon, go to [hyperlink, http://www.gao.gov]
and select "Subscribe to Updates."
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office:
441 G Street NW, Room LM:
Washington, D.C. 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]:
E-mail: fraudnet@gao.gov:
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Ralph Dawn, Managing Director, dawnr@gao.gov:
(202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, D.C. 20548:
Public Affairs:
Chuck Young, Managing Director, youngc1@gao.gov:
(202) 512-4800:
U.S. Government Accountability Office:
441 G Street NW, Room 7149:
Washington, D.C. 20548:
