United States Government Accountability Office

Washington, DC 20548 

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.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.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.3

 CDC had two organizational levels that were primarily responsible for leadership 

and management: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 

 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. 

GAO-08-328R Changes in CDC Obligations and Activities 
better integrate the work of the national centers.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.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 Beginning in fiscal year 2005

CDC Office of the Director CDC Office of the Director 

• Immediate Office of the 

Directora

• Immediate Office of the Directora

Leadership and

management 

levels 

• CDC-wide shared business 

servicesb

 

Leadership and

management levels 

• CDC-wide shared business 

servicesb

National center directors’ 

offices 

Coordinating centers

National center directors’ officesc

Division level National center divisions, 

branches, and other units 

Division level National center divisions, branches, 

and other unitsc

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. 

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 Progam, Project, or 

Activity (PPA).7

 Under the previous structure in effect through fiscal year 2004, funds for 

CDC’s leadership and management levels, including shared business services8

 in the CDC 

Office of the Director, were derived from a combination of CDC’s “Office of the Director” 

 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. 

2 GAO-08-328R Changes in CDC Obligations and Activities
PPA and indirect cost allocations9

 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.

10 Our work 

was limited to CDC’s discretionary budget, which constituted about 77 percent of CDC’s total 

budget in fiscal year 2006.

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 

 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. 

10We 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. 

11CDC’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. 

3 GAO-08-328R Changes in CDC Obligations and Activities
2003 through fiscal year 2006.

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. 

 12Obligations 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.) 

4 GAO-08-328R Changes in CDC Obligations and Activities
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.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.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.) 

 13S. Rep. No. 108-345, at 65 (2004); H. Rep. No. 108-792 at 1157 (Conf. Rep.). 

14The Public Health Improvement and Leadership PPA has a subcategory called Leadership and 

Management, which includes funding for coordinating center and national center directors’ offices.

5 GAO-08-328R Changes in CDC Obligations and Activities
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 

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Total buildings and facilities obligations

Total leadership- and management-level obligations

Total division-level obligations

2003 2004 2005 2006 

Dollars (in millions)

Fiscal year

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. 

6 GAO-08-328R Changes in CDC Obligations and Activities
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. 

7 GAO-08-328R Changes in CDC Obligations and Activities
Figure 2: CDC Obligations at Leadership and Management Levels, Fiscal Years 2003 through 2006 

0

100

200

300

400

500

600

CDC Office of the Director

Coordinating centers

National center directors’ offices

2003 2004 2005 2006 

Dollars (in millions)

Fiscal year

Source: GAO analysis of CDC data.

328

402

389

408

155

190

122

80

19

28

Note: CDC’s coordinating centers were established in fiscal year 2005. 

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. 

8 GAO-08-328R Changes in CDC Obligations and Activities
Figure 3: Leadership- and Management-Level Obligations at National Center Directors’ Offices for 

Selected PPAs, Fiscal Years 2003 through 2006 

Source: GAO analysis of CDC data.

0

10

20

30

40

50

2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006

Fiscal Year

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.)

Infectious Disease 

Control

(Funding for the National 

Center for Preparedness, 

Detection, and Control of 

Infectious Diseases is 

generally reported under 

this PPA.)

Chronic Disease 

Prevention and 

Health Promotion 

(Funding for the National 

Center for Chronic Disease 

Prevention and Health 

Promotion is generally 

reported under this PPA.)

Birth Defects, Developmental Disabilities, 

Disability and Health

(Funding for the National 

Center on Birth Defects and 

Developmental Disabilities

is generally reported under 

this PPA.)

Occupational 

Safety and Health

(Funding for the National 

Center for Occupational 

Safety and Health is 

generally reported under 

this PPA.)

$21.7

$17.8

$6.9

$9.1

$9.6

$11.8

$5.6

$9.1

$5.3

$5.6

$7.1

$9.8

$28.3

$25.1

$11.3

$23.8

$35.6

$44.2

$11.5

$33.5

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. 

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. 

9 GAO-08-328R Changes in CDC Obligations and Activities
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,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 programrelated 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 

 15The 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. 

10 GAO-08-328R Changes in CDC Obligations and Activities
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 

0

50

100

150

200

250

300

350

400

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

All other shared business services

2003 2004 2005 2006 

Dollars (in millions)

Fiscal year

Source: GAO analysis of CDC data.

11 GAO-08-328R Changes in CDC Obligations and Activities
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.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 

Fiscal year 2003 Fiscal year 2004 Fiscal year 2005 Fiscal year 2006 

Information technology

offices included in

CDC’s shared business 

services 

• Information 

Resource

Management 

Office (IRMO) 

• IRMO 

• Information 

Technology 

Service Office 

(ITSO) 

• Office of the Chief 

Information 

Officer (OCIO)

• ITSO 

• OCIO 

• Management 

Information 

Systems 

Office (MISO) 

• ITSO 

• OCIO 

• MISO 

CDC obligations for 

these offices 

$34.5 million $89.3 million $65.1 million $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. 

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 

 16A 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. 

12 GAO-08-328R Changes in CDC Obligations and Activities
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 

Source: GAO analysis of CDC data.

0

200

400

600

800

1,000

2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006 2003 2004 2005 2006

Fiscal Year

Dollars

(in millions)

$940

$931

$913

$960

$106

$115

$124

$121

$233

$228

$2

$242

30

$250

$237

$228

$217

$761

$818

$808

$897

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.)

Infectious Disease 

Control

(Funding for the National 

Center for Preparedness, 

Detection, and Control of 

Infectious Diseases is 

generally reported under 

this PPA.)

Chronic Disease 

Prevention and 

Health Promotion 

(Funding for the National 

Center for Chronic Disease 

Prevention and Health 

Promotion is generally 

reported under this PPA.)

Birth Defects, Developmental Disabilities, 

Disability and Health

(Funding for the National 

Center on Birth Defects and 

Developmental Disabilities

is generally reported under 

this PPA.)

Occupational 

Safety and Health

(Funding for the National 

Center for Occupational 

Safety and Health is 

generally reported under 

this PPA.)

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. 

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 

13 GAO-08-328R Changes in CDC Obligations and Activities
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 2006.17 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.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. 

 17See encl. III for more information about our methodology, including our use of the Gross Domestic

Product (GDP) price index to adjust for inflation. 

18See 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. 

14 GAO-08-328R Changes in CDC Obligations and Activities
Figure 6: Comparative Unadjusted and Adjusted Obligations at CDC Leadership and Management Levels 

and Division Level, Fiscal Year 2003 through Fiscal Year 2006 

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. 

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 

15 GAO-08-328R Changes in CDC Obligations and Activities
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 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, 

Cynthia Bascetta 

Director, Health Care 

Enclosures – 4 

16 GAO-08-328R Changes in CDC Obligations and Activities
Enclosure I 

Centers for Disease Control and Prevention (CDC) Organizational Chart 

(effective March 22, 2007) 

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. 

Office of the

Director

Office of Chief

Science Officer

Office of Chief of

Public Health 

Practice

Office of Chief

Operating Officer

CDC Washington 

Office

Office of Strategy 

and Innovation

Office of Workforce 

and Career 

Development

Office of 

Enterprise 

Communication

Office of

Chief of Staff

Office of Dispute 

Resolution & 

Equal Employment 

Opportunity

Coordinating Office 

for Global Health

Coordinating Office 

for Terrorism 

Preparedness & 

Emergency 

Response

Coordinating Center 

for Environmental 

Health and Injury 

Prevention

Coordinating Center 

for Health 

Information and 

Service

Coordinating Center 

for Health Promotion

Coordinating Center 

for Infectious

Diseases

National Institute for 

Occupational Safety 

and Health

National Center for 

Environmental 

Health/Agency for 

Toxic Substances & 

Disease Registry 

National Center for 

Health Marketing

National Center on 

Birth Defects and 

Developmental 

Disabilities

National Center for 

Immunization & 

Respiratory 

Diseases

National Center for 

Injury Prevention 

and Control

National Center for 

Health Statistics

National Center for 

Chronic Disease 

Prevention and 

Health Promotion

National Center for 

Zoonotic, 

Vector-Borne, & 

Enteric Diseases

National Center for 

Public Health 

Informatics

National Office of 

Public Health 

Genomics

National Center for 

HIV/Viral Hepatitis, 

STD, & TB 

Prevention

National Center for 

Preparedness, 

Detection, & Control 

of Infectious 

Diseases

Source: GAO analysis of CDC data.

17 GAO-08-328R Changes in CDC Obligations and Activities 
Enclosure II 

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.1

 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 

 1

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.

18 GAO-08-328R Changes in CDC Obligations and Activities 
Enclosure III 

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 2006.1

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.

2

 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 allocations3

 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 

 1

Obligations generally are commitments that create a legal liability of the government to pay for goods 

or services. 

2

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. 

3

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.

19 GAO-08-328R Changes in CDC Obligations and Activities 
Enclosure III 

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, 

20 GAO-08-328R Changes in CDC Obligations and Activities
Enclosure III 

(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. 

21 GAO-08-328R Changes in CDC Obligations and Activities
Enclosure IV 

Comments from the Department of Health and Human Services 

22 GAO-08-328R Changes in CDC Obligations and Activities 
Enclosure IV 

23 GAO-08-328R Changes in CDC Obligations and Activities
Enclosure IV 

(290633) 

24 GAO-08-328R Changes in CDC Obligations and Activities
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