

Centers for Disease Control and Prevention (CDC)

CDC works 24/7 to protect America from health, safety and security threats, both foreign and domestic. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and protects Americans.

CDC Budget Overview

(Dollars in millions)

Programs/Funds 2013 2014 2015 2015

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2014 Immunization and Respiratory Diseases 718 785 748 -36 ACA Prevention Fund (non-add) 91 160 127 -33 Balances from P.L. 111-32 Pandemic Flu (non-add) 12 -- -- -- Vaccines For Children 3,607 3,562 4,077 +514 HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention 1,095 1,121 1,128 +7 ACA Prevention Fund (non-add) -- -- -- -- Emerging and Zoonotic Infectious Diseases /1 341 390 445 +55 ACA Prevention Fund (non-add) 44 52 52 -- Chronic Disease Prevention and Health Promotion 1,003 1,188 1,078 -110 ACA Prevention Fund (non-add) 233 446 470 +24 Birth Defects, Developmental Disabilities, Disability and Health 134 132 132 -- ACA Prevention Fund (non-add) -- -- 71 +71 Environmental Health 142 180 169 -11 ACA Prevention Fund (non-add) 21 13 37 +24 Injury Prevention and Control 139 151 194 +43 Public Health Scientific Services 493 483 526 +43 ACA Prevention Fund (non-add) 52 -- 53 +53 Occupational Safety and Health 323 333 281 -52 World Trade Center Health Program 231 268 282 +14 Energy Employee Occupational Illness Compensation Program 51 50 55 +5 Global Health /2 363 417 464 +48 Public Health Preparedness and Response 1,279 1,371 1,317 -54 CDC-Wide Activities and Program Support 251 299 124 -175 ACA Prevention Fund (non-add) 23 160 -- -160 Agency for Toxic Substances and Disease Registry 72 75 75 -- ACA Mandatory funds (non-add) -- -- 20 +20 User Fees 2 2 2 -- Subtotal, Program Level 10,243 10,806 11,117 +311





CDC Budget Totals – Less Funds From Mandatory Sources 2013 2014 2015 2015

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2014 Vaccines for Children -3,607 -3,562 -4,077 -514 Energy Employee Occupational Injury Compensation Prog. -51 -50 -55 -5 World Trade Center Health Program -231 -268 -282 -14 ATSDR ACA Mandatory Funds -- -- -20 -20 ACA Prevention Fund -463 -831 -810 -22 User Fees -2 -2 -2 -- Total, Discretionary Program Level 5,890 6,092 5,872 -221





CDC Budget Totals – Less Funds From Other Sources 2013 2014 2015 2015

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2014 PHS Evaluation Fund Transfers -375 -211 -397 +187 Balances from P.L. 111-32 Pandemic Flu 12 -- -- -- Total, Discretionary Budget Authority 5,503 5,882 5,474 -407





Full Time Equivalents

2013: 11,134

2014: 11,134

2015: 11,134

2015 +/- 2014: +150

1/ The FY 2013 amounts have been made comparable to FY 2014 and FY 2015 to reflect both the distribution of Business Support Services resources to other program budget lines and the transfer of the Paralysis Resource Center to the Administration for Community Living.

2/ FY 2013 and FY 2014 have been made comparable to FY 2015 to account for the 2013 Center for Global Health reorganization.

CDC Programs and Services

The Centers for Disease Control and Prevention (CDC) works to keep America safe from health, safety, and security threats, both foreign and domestic. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, come from human error or deliberate attack, CDC fights disease, and supports communities and citizens to do the same. CDC is the nation’s health protection agency — saving lives, protecting people from health threats, and saving money through prevention. The FY 2015 Budget request for CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) is $11.1 billion. This total includes $810 million of the $1 billion available from the Prevention and Public Health Fund (Prevention Fund).

The Budget includes increases for a new antibiotic resistance initiative, global health security, prescription drug overdose, the Now is the Time initiative, food safety, and polio eradication to continue to advance CDC’s core public health mission. In addition, the Budget includes targeted reductions to the

317 Immunization program, preparedness and response activities, chronic disease prevention programs, occupational health activities, and direct medical services that are covered through insurance. A few of these targeted decreases, as well as some redirection of resources within programs, reflect expected increases in the availability of preventive and direct health care services due to the implementation of the Affordable Care Act.

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Emerging and Zoonotic Infectious Disease

CDC’s experts and laboratories detect and track a range of microbes, respond to outbreaks, like the 2012 fungal meningitis outbreak, and serve as an early warning system to rapidly identify new infectious disease threats. The Budget includes $445 million for Emerging and Zoonotic Infectious Disease activities, a $55 million increase over FY 2014. The FY 2015 Budget will allow CDC to further reduce healthcare-associated infections, improve food safety, modernize public health microbiology and bioinformatics capabilities, and invest in a new antibiotic resistance detection and response initiative. This domestic initiative establishes a robust infrastructure that can “detect” antibiotic resistant threats and “protect” patients and communities, resulting in appreciable benefits in deaths prevented and money saved. The initiative will also limit the future spread of the most potentially deadly and costly antibiotic resistance pathogens. Relatedly, through data collection of healthcare associated infections (HAIs) and antibiotic use, CDC will accelerate HAI prevention across the spectrum of care. In order to target prevention efforts, CDC will use data to find problem areas in highuse Medicaid facilities.

The Budget includes $50 million for CDC’s food safety activities, an increase of $10 million. This funding will support the implementation of CDC’s provisions of the Food Safety Modernization Act. For instance, CDC will support and improve PulseNet in all 50 states, which is responsible for detecting about 150 potential outbreaks each year. CDC will modernize PulseNet laboratories and take advantage of tools for analyzing DNA developed by the Advanced Molecular Detection initiative.



NEW INITIATIVE -- Detect and Protect Against Antibiotic Resistance

The Budget includes an increase of $30 million for the Detect and Protect Against Antibiotic Resistance initiative, to enhance surveillance and laboratory capacity to detect antibiotic resistance threats and protect patients from imminent danger.



Antibiotic resistance (AR) is a rapidly growing threat that undermines the successful delivery of most clinical interventions nationally and globally. Without an effective response to this threat, not only are current treatment options for infectious diseases jeopardized, but the effectiveness of new interventions, surgeries, treatments, and effective ICU care are put at risk. For some infections, it is already a post-antibiotic world.



The Detect and Protect Against Antibiotic Resistance initiative enhances surveillance and laboratory capacity at local, state, and national levels to characterize domestic AR threats and protect patients from imminent danger. Most critically, the initiative will invest in direct action by implementing proven, evidence-based interventions that reduce the emergence and spread of AR pathogens and improve appropriate antibiotic use. Over five years, this initiative can reduce the national incidence of C. difficile by 50 percent, preventing at least 20,000 deaths, 150,000 hospitalizations, and over $1 billion in healthcare costs and possibly as much as $2 billion.

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HIV/AIDS, Viral Hepatitis, STI and TB Prevention

The Budget includes $1.1 billion for Domestic HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis, an increase of $7 million over FY 2014. The Budget will improve the timeliness, quality, and efficiency of the collection of HIV population data; as well as provide an additional $3 million for evaluation of CDC’s school HIV health prevention activities. CDC will also invest $8 million to help HIV prevention grantees increase their capacity to seek reimbursement for covered services. The Budget focuses HIV resources on implementing effective, scalable and sustainable prevention strategies for persons living with HIV and populations at highest risk for HIV.

The Affordable Care Act will improve the prevention and control of HIV/AIDS, viral hepatitis, Sexually Transmitted Infections, and Tuberculosis in the United States due to expected increases in the proportion of the population with health insurance coverage, increased emphasis on preventive services, and prohibitions on denial of coverage to persons with pre-existing conditions. Decreasing illness and death due to these infections remains dependent upon CDC support of critical public health services at the state and local levels.

CDC and its public health partners provide these critical services, including surveillance, monitoring, partner services and contact investigations, laboratory services, provider training, operational research, and outreach to populations unlikely to access clinical care. Where direct services, such as screening, are provided by public health agencies, they are often provided in outreach settings in order to reach populations that would not otherwise access these services. CDC continues to work with public health agencies to build the infrastructure and capacity that state public health departments and community-based organizations will need to bill private insurers for infectious disease testing and treatment.

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Immunization and Respiratory Diseases

In the United States, most vaccine-preventable diseases are at or near record lows, with a majority showing a 90 percent or greater decline in reported cases when compared with the pre-vaccine era. CDC's $4.8 billion immunization program has two components: the mandatory Vaccines for Children (VFC) program and the discretionary Section 317 program.

In FY 2015, the Section 317 Immunization Program will continue to provide federally purchased vaccines to protect uninsured Americans from preventable diseases —and thus protect communities from the dangers of low vaccination rates. CDC estimates that although it is expected that these populations will begin to decrease with the implementation of expanded health insurance coverage provisions, there will continue to be a need for Section 317-purchased vaccines to serve uninsured adults and to provide rapid vaccination response to disease outbreaks or for non-VFC-eligible populations. In 2012, these resources were used to respond to the pertussis outbreak in the State of Washington. Pertussis, or whooping cough, can transmit from unvaccinated adolescents and adults to infants too young to be vaccinated. Washington was able to direct some of its Section 317 vaccine to targeted vaccination of pregnant women and adult caregivers of young infants—an important strategy to protect vulnerable infants from serious complications, and in some cases, death.

In FY 2015, CDC will work collaboratively with its awardees and partners to sustain record-high childhood immunization coverage rates and increase immunization coverage rates for children and adults by improving access to immunizations. Specifically, CDC will work to establish access points at complementary venues such as schools, pharmacies, and retail-based clinics; expand the network of VFC providers through recruitment efforts; purchase and deliver vaccine for at-risk populations; and ensure those with insurance have access to immunization services.

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NEW INITIATIVE -- Global Health Security

Epidemic threats to national security arise at unpredictable intervals and from unexpected sources. Because these threats do not recognize national borders, the health of people overseas directly affects America’s safety and prosperity, with far-reaching implications for economic security, trade, stability of foreign governments, and the well-being of U.S. citizens at home. In 2013 alone, the world was confronted with highly concerning and unpredictable epidemic threats from influenza A (H7N9) and the novel Middle East Respiratory Syndrome coronavirus.



CDC’s Global Health Security program will accelerate sustainable capacity of countries around the world to prevent infectious diseases and detect and respond quickly and effectively. CDC will use the increase of $45 million to expand currently successful efforts, such as training field epidemiologists, deploying diagnostic tests, increasing pathogens detection, enhancing public health emergency management capacity, and supporting disease outbreak responses. CDC anticipates partnering with up to 10 countries to create a sustainable program to achieve early threat detection, effective response, and prevention of avoidable catastrophes.

Global Health

CDC engages internationally to protect the health of the American people and save lives worldwide. CDC supports efforts around the globe to detect epidemic threats earlier, respond more effectively, and prevent more avoidable catastrophes—protecting Americans by intervening before these threats reach our borders. The Budget provides $464 million for CDC’s global health activities, an increase of $48 million above FY 2014. With the increase, CDC will accelerate progress to prevent the introduction and spread of global health threats.

With scientists and health experts embedded in countries around the globe, CDC works with partners to translate and adapt scientific evidence into policies and public health actions—strengthening public health capacity and impact in partner countries. CDC builds strong national programs and sustainable public health systems that can effectively respond to the global HIV/AIDS epidemic and to other diseases that threaten the health and prosperity of the global community. In addition, the FY 2015 Budget includes an increase of $45 million for global health security activities. CDC’s Global Health Security program will accelerate and expand efforts to improve detection of and response to global epidemics.

CDC’s global immunization program protects the health of Americans and global citizens by preventing disease, disability, and death from vaccine-preventable diseases. Polio cases have dropped by more than 99 percent since 1988, measles deaths declined by 74 percent from 2000 through 2010, and more than 2.5 million vaccinepreventable disease deaths are prevented each year through routine immunization. The Budget includes $161 million, an increase of $10 million above FY 2014 to support the eradication of polio, which is endemic to three remaining countries and is within reach of total eradication.

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Chronic Disease Prevention and Health Promotion

Chronic diseases are among the most prevalent, costly, and deadly of all health problems—and the most preventable. CDC leads the nation’s efforts to prevent and control chronic diseases and associated risk factors by funding programs in states, tribes, territories, and local communities. CDC’s chronic disease prevention and health promotion efforts contribute to CDC’s overarching goal of preventing the leading causes of disease, disability, and death. The Budget includes $1.1 billion for chronic disease prevention and health promotion activities, $110 million below FY 2014.

CDC will continue the Partnerships to Improve Community Health program created in FY 2014, at the same funding level of $80 million. This program reaches Americans where they live, work, and play to reduce the burden of chronic diseases. In FY 2015, CDC will also continue to fund the State Public Health Approaches to Chronic Disease Prevention program, which supports states to implement crosscutting strategies to promote health and prevent and control chronic diseases and their risk factors. The coordinated approach is comprised of the Diabetes, Heart Disease and Stroke Prevention, School Health, and Nutrition, Physical Activity, and Obesity state programs. Collectively, these programs support a set of complementary activities and intervention strategies in four domains: epidemiology and surveillance, supportive environments, improvements in health systems, and communityclinical linkages. Coordinating these efforts into a single effort encourages states to implement a cohesive set of evidence and practice-based interventions that address four inter-related chronic diseases and risk factors and allows for increased efficiencies. These interventions are implemented in multiple settings, such as child care, schools, communities, healthcare, and work sites.

PROGRAM HIGHLIGHT -- Tips from Former Smokers Education Campaign

CDC launched the Tips from Former Smokers national tobacco education campaign in FY 2012 and introduced new ad content in FY 2013 and FY 2014. Research shows that educational efforts like this one provide an excellent return on investment, saving lives and lowering health care costs. The Tips campaigns serve as an important counter to the more than $900,000 that the tobacco industry spends each hour—more than $22 million a day—on cigarette advertising and promotion. The Tips campaign that ran in 2012 cost less than the tobacco industry spends in 3 days on marketing and promotion.



Smokers who want to quit have responded dramatically to the Tips campaigns. A study of the 2012 campaign was published in the medical journal, The Lancet. It reported that more than 1.6 million Americans tried to quit smoking because of the campaign and over 100,000 smokers are expected to stay quit for good.



In FY 2015, CDC will expand the national mass-media campaign to raise awareness of the health effects of tobacco use and prompt smokers to quit, as well as increase tobacco cessation quitline capacity to respond to smokers seeking help to quit. CDC estimates that the campaign will prompt an additional 750,000 quit attempts, resulting in 50,000 to 64,000 successful attempts to quit smoking permanently.

In addition, the Budget eliminates the REACH program and the Preventive Health and Health Services Block Grant; other CDC activities address the goals of these programs through the State Public Health Approaches to Chronic Disease Prevention program and the community chronic disease prevention grant program.

The Budget also proposes targeted reductions to select direct health care programs such as cancer screenings. In 2014, the Affordable Care Act’s consumer protections and Medicaid expansion will promote coverage and use of new preventive services, such as screenings for populations formerly served through CDC grant programs. The Budget includes $10 million for a new demonstration to transition from the existing Breast and Cervical and Colorectal screening programs to a more population based model supporting innovative strategies to increase screening for all recommended populations and link people to care.

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Birth Defects and Developmental Disabilities

CDC’s mission includes preventing birth defects and developmental disabilities and improving long-term health outcomes for people who have them. The Budget includes $132 million for Birth Defects and Developmental Disabilities, the same as FY 2014. CDC’s core child health and development activities focus on surveillance, public health research, and prevention.

In addition, CDC’s Human Development and Disability program works to prevent disease and promote equity in health and development of adults with disabilities and children with hearing loss, complex disabling conditions, and mental, emotional, or behavioral disorders. These activities represent the nation’s primary public health commitment to supporting populations with disabilities.

CDC protects people who have blood disorders from complications and improves long-term outcomes by gathering data on the impacts of bleeding, clotting, and red blood cell disorders and translating the information into action. CDC works with partners to identify how often and in which settings blood disorders occur to better understand who is at risk, identify effective strategies that prevent and reduce complications, and develop and promote education and awareness materials and activities.

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Public Health Scientific Services

CDC provides most of the information available to the public, health care providers, and policy makers on the status of health in the United States. CDC’s public health scientific support services provide expertise in health statistics, surveillance systems, epidemiologic analysis, informatics, public health workforce development, and laboratory policy and practice. Public health scientific services are the foundation of CDC’s efforts to protect the public’s health by supporting CDC’s goal of monitoring health and ensuring laboratory excellence. The Budget includes $526 million, a $43 million increase over FY 2014, for public health scientific support services.

Without reliable, timely and constant health information and data, efforts to protect the nation's public health may be compromised. CDC strengthens these efforts through various surveillance systems, utilizing external sources of information, and sharing best practices in collecting, managing, and using information among CDC programs and the public health community. In FY 2015, analyses of data from the National Vital Statistics System will provide key information to measure the health of the United States population, including the infant mortality rate, life expectancy at birth, and the leading causes of death.

A well-trained public health workforce is critical to ensuring the highest level of efficiency and effectiveness in protecting population health—a responsibility that only public health systems ensure. The Budget includes an increase of $15 million to support fellowship programs that provide robust experiential learning while filling critical gaps in the public health workforce, as well as maintaining capacity to provide continuing education and training for the existing public health workforce. The Budget also includes $5 million to support public health systems research to identify the economic and budgetary impacts of public health interventions and healthcare delivery systems.

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Environmental Health

CDC prevents illnesses, disabilities, and early death related to the environment. Knowledge about problems caused by the environment helps CDC respond to public health threats, natural disasters, and intentional or unintentional releases of chemicals and radiation. CDC’s environmental health programs help all Americans, especially those who are more likely to be affected by the environment, such as children and older Americans. The Budget includes $169 million for these activities, $11 million below FY 2014.

CDC’s Environmental Health Laboratory is recognized globally as the most advanced, state-of-the-art environmental public health laboratory. The lab standardizes biomarker measurements to assure their quality (accuracy and precision) and has more than 50 years of success in laboratory standardization programs. CDC’s Chronic Disease Biomarkers Standardization program builds on this established role and infrastructure to develop reference methods and materials for additional cardiovascular and breast cancer disease biomarker measurements that need improvement in accuracy and precision. Ensuring the quality of these laboratory measurements helps clinicians better determine risk for and diagnose heart disease, reduces costs associated with repeated laboratory testing, and improves the diagnosis and treatment of breast cancer.

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Injury Prevention and Control

CDC is the lead federal agency focusing on preventing unintentional and intentional injuries that occur outside of the workplace. The Budget includes $194 million for injury prevention and control activities, an increase of $43 million above FY 2014. Prevention activities address a wide range of topics including intimate partner violence, sexual violence, teen dating violence, youth violence, suicidal behavior, child maltreatment, motor vehicle crashes, falls, prescription drug overdoses, traumatic brain injuries, and sportsrelated injuries. To prevent these injuries or mitigate their consequences, CDC collects and disseminates key public health data, identifies risk factors and injury prevention strategies, and translates scientific findings into effective community programs.

The Budget includes $5 million to fund evaluation activities with the goal of generating findings to improve sexual violence prevention nationwide. The Budget also includes $34 million for the Now is the Time initiative. This amount includes $10 million to conduct research on the causes and prevention of gun violence, including investigating links between video games, media images, and violence. The Budget also includes $24 million to expand the National Violent Death Report System, which reports anonymous data on all types of violent deaths, to all 50 states during FY 2015.

Prescription opioid overdose deaths have increased four-fold between 1999 and 2010, and now outnumber deaths from all illicit drugs—including cocaine and heroin—combined. The Budget includes an increase of $16 million to expand the existing State Core Violence and Injury Prevention Program to additional States with a high burden of prescription drug overdose. CDC and SAMHSA will collaborate in their efforts to reduce prescription drug overdose.

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Occupational Safety and Health

The mission of CDC's National Institute for Occupational Safety and Health (NIOSH) is to generate new knowledge in the field of occupational safety and health through collaborations with diverse partners, and to transfer that knowledge into workplace practice to prevent workrelated injury, illness, and death. This work is a core element of CDC’s goal to keep Americans safe from environmental and work-related hazards. The FY 2015 Budget provides $281 million for Occupational Safety and Health programs, $52 million below FY 2014. The Budget proposes targeted reductions to programs such as the Agriculture, Forestry, and Fishing program and Education Research Centers within the National Occupational Research Agenda. One of the emerging issues that CDC will address with FY 2015 funds is worker exposure to nanoparticles and nanomaterials. CDC’s Nanotechnology Research Center will work with private sector partners to conduct eight field investigations that will provide evidence of effective interventions to control worker exposure, with specific prevention recommendations for employers that will support sustainable economic growth and job creation through increased investments in nanotechnology.

The Budget includes an increase of $14 million above FY 2014 in mandatory funding for the World Trade Center Health Program, for the addition of certain cancers to the list of related conditions, and the program inclusion of responders from the Shanksville, Pennsylvania, and Pentagon sites.

Within the total for NIOSH, the Budget also includes $55 million in mandatory funding to continue CDC’s role in the Energy Employees Occupational Illness Compensation Program.

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Public Health Preparedness and Response

CDC operates 24-hours a day, seven days a week, to promote the security, safety, and health of Americans from intentional and naturally occurring threats. The FY 2015 Budget provides $1.3 billion for biodefense and emergency preparedness activities in CDC, a decrease of $54 million below FY 2014. Of this total, $617 million is requested for Public Health and Emergency Preparedness (PHEP) grants, $28 million below FY 2014. The PHEP program has provided approximately $7 billion in funding over the last decade to state and local entities to support preparedness efforts. Grants support local public health preparedness through enhanced laboratory capacity, health surveillance, and disaster response planning. The PHEP cooperative agreements are coordinated closely with the Hospital Preparedness program, administered by the Assistant Secretary for Preparedness and Response (ASPR). This collaboration extends to the program objectives, which are aligned around 15 core public health preparedness capabilities, of which 8 are also healthcare preparedness capabilities. These cross-cutting capabilities help to ensure that communities assess their readiness across the full spectrum of stakeholders.

In FY 2015, $158 million will support CDC’s direct efforts to provide rapid responses to emerging public health threats, the same as FY 2014. This investment includes funding for the CDC Emergency Operations Center, which operates 24 hours a day to support emergency management for public health threats and provides technical assistance to hospitals, health departments, international agencies and the general public.

Additionally, $543 million is requested to support the purchase and maintenance of medical countermeasures and other material in the Strategic National Stockpile, $8 million below FY 2014. Funds also support public health departments through preparedness training and direct technical assistance provided by subject matter experts.

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Managing CDC Infrastructure and Human Capital

The Budget includes $124 million in administrative and infrastructure activities to support CDC’s mission critical efforts.

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

Public Health Leadership and Support : The Budget includes $114 million to support CDC’s Office of the Director, urgent and emergent public health response activities, and offices that provide agency-wide support and leadership for the US public health system. These funds are essential to CDC's ability to manage with efficiency, transparency, and accountability. In addition, these funds are used to directly support health organizations and officials across the United States.

Buildings and Facilities: The Budget includes $10 million in repairs and improvements projects to conduct all necessary repairs and improvements to existing buildings.

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Agency for Toxic Substances and Disease Registry (ATSDR)

Managed as part of CDC, ATSDR supports healthy, sustainable environments in communities by identifying chemical exposures, educating the public and health care providers on how to prevent harmful exposures, and using the latest science to better characterize these exposures. The Budget provides $96 million for ATSDR, of which $20 million is mandatory funding for the early detection of medical conditions related to environmental hazards for the period of FY 2015–2019. ATSDR serves a critical role in supporting local, state, and federal efforts to protect human health from environmental threats. ATSDR’s work in communities includes investigating hazards in towns with a legacy of industrial pollution to responding to environmental public health emergencies like acute chemical spills. ATSDR also uses environmental health surveillance and registries to track harmful exposures and adverse health outcomes. In FY 2015, ATSDR expects to address 2,000 technical requests, respond to 50 emergency events, and investigate exposures at 500 communities.

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