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‘‘TITLE V—ASSISTANCE FOR OR-
PHANS AND OTHER VULNER-
ABLE CHILDREN 
‘‘SEC. 241. FINDINGS; DECLARATION OF POLICY. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) By 2010, HIV/AIDS will orphan more 
than 25,000,000 children worldwide. 
‘‘(2) Ongoing conflicts and civil wars in devel-
oping countries are adversely affecting children in 
these countries, the vast majority of whom currently 
do not receive humanitarian assistance or other sup-
port from the United States Government. 
‘‘(3) The United States Government currently 
administers assistance programs for orphans and 
other vulnerable children in developing countries. 
When requested by the Committee on International 
Relations of the House of Representatives to provide 
information on the overall number of orphans and 
other vulnerable children receiving assistance from 
the United States Agency for International Develop-
ment in fiscal year 2002, the Agency was only able 
to report on its HIV/AIDS assistance program, 
under which the Agency provided assistance to 
462,000 such orphans and other vulnerable children.
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‘‘(4) The United States Government should in-
crease its efforts to provide assistance for orphans 
and other vulnerable children in developing coun-
tries, especially those children affected by HIV/AIDS 
or conflict. 
‘‘(5) The United States Agency for Inter-
national Development should establish improved ca-
pacity to deliver assistance to orphans and other vul-
nerable children in developing countries through 
partnerships with private voluntary organizations, 
including faith-based organizations. 
‘‘(6) Further, the United States Agency for 
International Development should be the primary 
United States Government agency responsible for 
identifying and assisting orphans and other vulner-
able children in developing countries. 
‘‘(b) DECLARATION OF POLICY.—Congress, recog-
nizing that prompt and appropriate action by the United 
States to assist orphans and other vulnerable children in 
developing countries is an important expression of the hu-
manitarian concern and tradition of the people of the 
United States, affirms the willingness of the United States 
to assist such orphans and other vulnerable children—
‘‘(1) by providing assistance for the purpose of 
improving the health, nutritional, shelter, edu-
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cational, economic, and psychological status of or-
phans and other vulnerable children in such coun-
tries; and 
‘‘(2) by providing humanitarian and protection 
assistance to such orphans and other vulnerable chil-
dren affected by conflict or civil strife. 
‘‘SEC. 242. ASSISTANCE TO PROVIDE BASIC CARE. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) The need for individuals and local organi-
zations in developing countries to assist households 
headed by children is necessary due to the increase 
in the number of such households. Millions of chil-
dren in these types of households lack basic care, 
such as access to food and shelter. 
‘‘(2) Although families and extended families 
serve as the primary providers of care for these chil-
dren, when these family care networks break down, 
and when communities are responsible for raising 
orphans, these children are cared for in a rich and 
nurturing environment and remain connected to the 
traditions and rituals of families and the community. 
‘‘(3) As the number of these children increases, 
the ability of communities to provide basic care for 
such children is limited. Assistance to support the 
provision of such basic care is therefore necessary in
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and of itself and also to facilitate the provision of 
other types of assistance for such children under this 
title. 
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for programs in developing 
countries to provide basic care for orphans and other 
vulnerable children. 
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used—
‘‘(A) to support individuals and local orga-
nizations, including teachers, social workers, 
and representatives from religious institutions 
and nongovernmental organizations, to mobilize 
their own resources through the strengthening 
of community care coalitions, networks, or sup-
port groups to provide basic care for orphans 
and other vulnerable children, including day 
care, food assistance, protection assistance, and 
home visits; 
‘‘(B) to increase the capacity of the com-
munity care groups described in subparagraph 
(A) to meet on a regular basis to identify or-
phans and other vulnerable children and to fa-
cilitate the provision of services; and
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‘‘(C) to ensure that the activities of com-
munity care groups described in subparagraph 
(A) include appropriate monitoring and super-
vision components. 
‘‘(3) DEFINITION.—In this subsection, the term 
‘protection assistance’ means all appropriate meas-
ures to promote the physical and psychological secu-
rity of an individual, provide equal access to basic 
services for the individual, and safeguard the legal 
and human rights and dignity of the individual. 
‘‘SEC. 243. ASSISTANCE TO PROVIDE TREATMENT TO OR-
PHANS AND OTHER VULNERABLE CHILDREN 
WITH HIV/AIDS. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) Approximately 2,500,000 children under 
the age of 15 worldwide have HIV/AIDS. Every day 
another 2,000 children under the age of 15 are in-
fected with HIV. 
‘‘(2) In 2002, approximately 2,500,000 children 
were at risk for infection with HIV through mother-
to-child transmission, which includes transmission at 
any point during pregnancy, labor, delivery, or 
breastfeeding. 
‘‘(3) To date, more than 4,000,000 children 
worldwide are estimated to have died from AIDS,
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primarily contracted through mother-to-child trans-
mission. Every year, approximately 700,000 babies 
are infected with HIV, of which the majority are liv-
ing in Africa. 
‘‘(4) In southern Africa HIV/AIDS is now the 
leading cause of death among young children, ac-
counting for almost half of such deaths. 
‘‘(5) Research has shown conclusively that initi-
ation in a timely manner of antiretroviral therapy 
for infants or young children with HIV/AIDS can 
preserve or restore their immune functions, promote 
normal growth and development, and prolong life. 
‘‘(6) Few international development programs 
specifically target the treatment of children with 
HIV/AIDS in developing countries. Reasons for this 
include the perceived low priority of pediatric treat-
ment, a lack of pediatric health care professionals, 
lack of expertise and experience in pediatric drug 
dosing and monitoring, the perceived complexity of 
pediatric treatment, and mistaken beliefs regarding 
the risks and benefits of pediatric treatment. 
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for the treatment of or-
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phans and other vulnerable children with HIV/AIDS 
in developing countries. 
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used to carry 
out the following activities: 
‘‘(A) The treatment of orphans and other 
vulnerable children with HIV/AIDS through the 
provision of pharmaceuticals, including high-
quality, low-cost antiretrovirals and other thera-
pies, including generically manufactured phar-
maceuticals where appropriate. 
‘‘(B)(i) The recruitment and training of in-
dividuals to provide the treatment described in 
subparagraph (A), including the recruitment 
and training of appropriate support personnel. 
‘‘(ii) Such training should include appro-
priate methodologies relating to initial diag-
nosis, appropriate dosages of pharmaceuticals, 
monitoring, medication adherence techniques, 
treatment for any complications resulting from 
such pharmaceuticals, and psychosocial support 
for vulnerable children and their caregivers. 
‘‘(C) Activities of medical laboratories re-
lating to the treatment described in subpara-
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graph (A), including assistance for the purchase 
of necessary equipment. 
‘‘SEC. 244. ASSISTANCE TO PROVIDE PSYCHOSOCIAL SUP-
PORT TO ORPHANS AND OTHER VULNER-
ABLE CHILDREN AFFECTED BY HIV/AIDS. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) Many children who are orphaned as a re-
sult of AIDS blame themselves for the death of a 
parent and many children are separated from sib-
lings, sometimes for life. 
‘‘(2) The trauma that results from the loss of 
a parent as a result of AIDS can trigger behavior 
problems of aggression or emotional withdrawal and 
negatively affect a child’s performance in school and 
the child’s social relations. 
‘‘(3) Children living in families affected by 
HIV/AIDS are often stigmatized, teased, and ostra-
cized by peers. 
‘‘(4) Children living in families affected by 
HIV/AIDS who are most vulnerable are those chil-
dren in households headed by children. In these 
households, trained community volunteers can play a 
major role through home visits. 
‘‘(5) In many African countries, religious lead-
ers are mobilizing individuals and local organizations
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within the community to identify and respond to the 
psychosocial needs of those children affected by 
AIDS. 
‘‘(b) ASSISTANCE.—The President is authorized to 
provide assistance for programs in developing countries to 
provide culturally appropriate mental health services and 
psychosocial support for orphans and other vulnerable 
children, and their caregivers. 
‘‘SEC. 245. ASSISTANCE FOR SCHOOL FOOD PROGRAMS. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) In 2004, it is estimated that 125,000,000 
children worldwide do not attend school, in part be-
cause of hunger and malnutrition, and the vast ma-
jority of these children are young girls. 
‘‘(2) School food programs, including take-home 
rations, in developing countries provide strong incen-
tives for parents to send their children to school and 
ensure that they continue with their education. 
School food programs may reduce short-term hun-
ger, improve cognitive functions, and enhance learn-
ing, behavior, and achievement. 
‘‘(3) In 2004, more than 8,000,000 children in 
sub-Saharan Africa are underweight compared to 
1994. Malnutrition enhances the risk that orphans 
and other vulnerable children will be at risk for ill-
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ness and infections, especially if these children are 
also infected with HIV. 
‘‘(4) Healthy members of families affected by 
HIV/AIDS in developing countries often leave the 
workforce to care for those family members with 
HIV/AIDS, which compounds the problem of access 
to food for the family. Food consumption has been 
shown to drop by as much as 40 percent in these 
families. 
‘‘(5)(A) Although a number of organizations 
seek to meet the needs of children who are orphaned 
or vulnerable as a result of HIV/AIDS, immediate 
and extended families continue to be the primary 
providers of care and support for these children, and 
they need direct assistance urgently. 
‘‘(B) According to a survey by the United 
States Agency for International Development, or-
phans and other vulnerable children relied on rel-
atives for food support 74 percent of the time and 
on friends for food support 19 percent of the time. 
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for school food programs 
for orphans and vulnerable children in developing
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countries, especially in such countries heavily af-
fected by HIV/AIDS. 
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used to pur-
chase local or regional foodstuffs, where appropriate, 
for school food programs. 
‘‘SEC. 246. ASSISTANCE TO INCREASE EDUCATIONAL OP-
PORTUNITIES AND PROVIDE EMPLOYMENT 
TRAINING. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) The lack of financial resources in families 
affected by HIV/AIDS prevents many orphans and 
other vulnerable children in developing countries 
from attending school because of the requirement to 
pay school fees and other costs of education. 
‘‘(2) Such children, in particular young girls, 
are often forced to miss school in order to serve as 
caregivers to relatives with HIV/AIDS or assume 
adult responsibilities for providing for the family. 
Younger children who lose a parent also lose the op-
portunity to learn skills that they will need to sup-
port themselves as they grow older. 
‘‘(3) According to the International Labor Or-
ganization (ILO), approximately 250,000,000 chil-
dren and adolescents ages 5 to 14 in developing
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countries are working part-time and approximately 
120,000,000 children and adolescents ages 5 to 14 
in developing countries are working full-time. 
‘‘(4) In many regions of Africa and other devel-
oping countries, non-formal education plays an im-
portant role to provide children who are unable to 
attend school with the employment and related life 
skills training such children need to survive. 
‘‘(5) Many organizations in Africa, including 
faith-based organizations, provide employment and 
related life skills training for older children to better 
prepare them to serve as caregivers for younger sib-
lings. 
‘‘(6) Organizations that provide non-formal 
education can assist the thousands of children in de-
veloping countries who are not currently being as-
sisted by families or communities and are struggling 
to survive. 
‘‘(b) ASSISTANCE.—
‘‘(1) EDUCATION ASSISTANCE.—The President 
is authorized to provide assistance for programs in 
developing countries to decrease barriers to public 
primary school enrollment by eliminating school fees 
and other costs of education, especially in developing
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countries heavily affected by HIV/AIDS. Amounts 
made available to carry out this paragraph—
‘‘(A) are authorized to be made available 
to the President for assistance or contributions 
to nongovernmental organizations and inter-
national organizations to achieve the purposes 
of this paragraph; and 
‘‘(B) shall not be used to pay school fees. 
‘‘(2) EMPLOYMENT
TRAINING
ASSISTANCE.—
The President is authorized to provide assistance for 
programs in developing countries to provide employ-
ment training and related services for orphans and 
other vulnerable children who are of legal working 
age, especially for programs in developing countries 
heavily affected by HIV/AIDS. 
‘‘SEC. 247. ASSISTANCE TO PROTECT AND PROMOTE INHER-
ITANCE RIGHTS. 
‘‘(a) FINDING.—Congress finds that orphans and 
other vulnerable children in developing countries, particu-
larly children who are orphaned as a result of AIDS, are 
routinely denied their inheritance or encounter difficulties 
in claiming the land and other property which they have 
inherited. 
‘‘(b) ASSISTANCE.—The President is authorized to 
provide assistance in support of programs in developing
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countries to protect and promote the inheritance rights of 
orphans and other vulnerable children, particularly young 
girls and children who are orphaned as a result of AIDS. 
‘‘SEC. 248. ADMINISTRATION OF ASSISTANCE. 
‘‘(a) OFFICE FOR ORPHANS AND OTHER VULNER-
ABLE CHILDREN.—
‘‘(1) ESTABLISHMENT.—There is established 
within the United States Agency for International 
Development an Office for Orphans and Other Vul-
nerable Children (hereafter in this title referred to 
as the ‘Office’), which shall be headed by a Director 
who shall be appointed by the Administrator of the 
Agency. 
‘‘(2) DUTIES.—The Office shall be responsible 
for carrying out this title. 
‘‘(b) APPROVAL OF APPLICATIONS.—Subject to the 
requirements of subsection (e), the Director of the Office 
shall be responsible for reviewing or approving all applica-
tions submitted to the United States Agency for Inter-
national Development for assistance under this title, in-
cluding applications submitted to field missions of the 
Agency. 
‘‘(c) PRIORITY.—In providing assistance under this 
title, priority should be given to assistance for developing 
countries in which the rate of HIV infection, as reported
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in the most recent epidemiological data for that country 
compiled by the United Nations Joint Programme on 
HIV/AIDS (UNAIDS), is at least 5 percent among women 
attending prenatal clinics or more than 15 percent among 
individuals in groups with high-risk behavior. 
‘‘(d) FORM OF ASSISTANCE.—Assistance under this 
title shall be provided in the form of—
‘‘(1) grants, cooperative agreements, or con-
tracts; 
‘‘(2) contributions to international organiza-
tions; or 
‘‘(3) assistance to the governments of devel-
oping countries. 
‘‘(e) COORDINATION.—The provision of assistance 
under this title for children who are orphaned as a result 
of HIV/AIDS, or are children with HIV/AIDS, shall be 
undertaken in accordance with section 104A of this Act 
and assistance relating to HIV/AIDS authorized under the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (Public Law 108–25), 
including section 102 of such Act concerning the coordina-
tion of HIV/AIDS programs. 
‘‘(f) OTHER ASSISTANCE.—
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‘‘(1) REVIEW OR APPROVAL OF OTHER USAID 
ASSISTANCE.—The Director of the Office shall be re-
sponsible for reviewing or approving—
‘‘(A) each component of the annual plan of 
a mission, bureau, or other office of the United 
States Agency for International Development as 
the component relates to assistance for orphans 
or other vulnerable children in developing coun-
tries; and 
‘‘(B) each program, project, or activity re-
lating to such assistance. 
‘‘(2) COORDINATION OF ALL U.S. GOVERNMENT 
ASSISTANCE.—The Director of the Office shall be re-
sponsible for ensuring coordination of all United 
States Government programs to provide assistance 
for orphans and other vulnerable children in devel-
oping countries. 
‘‘SEC. 249. MONITORING SYSTEM. 
‘‘(a) ESTABLISHMENT.—In order to maximize the 
sustainable development impact of assistance authorized 
under this title, the President shall establish a monitoring 
system that meets the requirements of subsection (b). 
‘‘(b) REQUIREMENTS.—The requirements referred to 
in subsection (a) are the following:
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‘‘(1) The monitoring system establishes per-
formance goals for the assistance and expresses such 
goals in an objective and quantifiable form, to the 
extent feasible. 
‘‘(2) The monitoring system establishes per-
formance indicators to be used in measuring or as-
sessing the achievement of the performance goals de-
scribed in paragraph (1). 
‘‘(3) The monitoring system provides a basis for 
recommendations for adjustments to the assistance 
to enhance the impact of the assistance. 
‘‘SEC. 250. REPORT. 
‘‘(a) REPORT.—Not later than December 31, 2005, 
and each December 31 thereafter, the President shall 
transmit to Congress a report that contains a detailed de-
scription of the implementation of this title for the pre-
vious fiscal year. 
‘‘(b) CONTENTS.—The report shall contain the fol-
lowing information: 
‘‘(1) For each grant, cooperative agreement, 
contract, contribution, or other form of assistance 
awarded or entered into under this title—
‘‘(A) the amount of the grant, cooperative 
agreement, contract, contribution, or other form 
of assistance, the name of each recipient and
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each developing country with respect to which 
projects or activities under the grant, coopera-
tive agreement, contract, contribution, or other 
form of assistance were carried out, and the ap-
proximate number of orphans and other vulner-
able children who received direct or indirect as-
sistance under the projects or activities; and 
‘‘(B) the results of the monitoring system 
with respect to the grant, cooperative agree-
ment, contract, contribution, or other form of 
assistance. 
‘‘(2) For each grant, cooperative agreement, 
contract, contribution, or other form of assistance 
awarded or entered into under any provision of law 
other than this title for assistance for orphans and 
other vulnerable children in developing countries, the 
information described in paragraph (1)(A). 
‘‘(3) Of the total amounts of assistance made 
available in each such fiscal year for orphans and 
other vulnerable children, the percentage of assist-
ance provided in support of orphans or other vulner-
able children affected by HIV/AIDS. 
‘‘(4) Any other appropriate information relating 
to the needs of orphans and other vulnerable chil-
dren in developing countries that could be addressed
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through the provision of assistance under this title 
or under any other provision of law. 
‘‘SEC. 251. AUTHORIZATION OF APPROPRIATIONS; ADDI-
TIONAL PROVISIONS. 
‘‘(a) AUTHORIZATION OF APPROPRIATION.—
‘‘(1) IN
GENERAL.—Of the amounts made 
available to carry out the provisions of law described 
in paragraph (2), there are authorized to be appro-
priated to the President to carry out this title such 
sums as may be necessary for each of the fiscal 
years 2005 and 2006. 
‘‘(2) PROVISIONS OF LAW.—The provisions of 
law referred to in paragraph (1) are the following: 
‘‘(A) 
The 
United 
States 
Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (Public Law 108–25) and the 
amendments made by that Act. 
‘‘(B) Any other provision of law under 
which assistance is authorized for orphans and 
other vulnerable children in developing coun-
tries. 
‘‘(b) ADDITIONAL PROVISIONS.—
‘‘(1) 
AVAILABILITY.—Amounts 
appropriated 
pursuant to the authorization of appropriations 
under subsection (a) are authorized to remain avail-
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able until expended and are in addition to amounts 
otherwise available for such purposes. 
‘‘(2) MINIMUM FUNDING REQUIREMENT.—Not 
less than 60 percent of amounts appropriated pursu-
ant to the authorization of appropriations under 
subsection (a) for a fiscal year (other than amounts 
made available for assistance to eliminate school fees 
and other costs of education pursuant to section 
246) shall be provided through United States or in-
digenous private voluntary organizations that imple-
ment programs on the community level. Amounts 
provided by for-profit entities to not-for-profit enti-
ties from assistance under this title shall not be con-
sidered for purposes of satisfying the requirement of 
this paragraph. 
‘‘(3) ASSISTANCE
UNDER
OTHER
PROVISIONS 
OF LAW.—
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of law, amounts made available 
for assistance for orphans or other vulnerable 
children in developing countries under any pro-
vision of law other than this title may be pro-
vided to further the purposes of this title. 
‘‘(B) REPORT.—To the extent assistance 
described in subparagraph (A) is provided in
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accordance with such subparagraph, the Presi-
dent shall include, as part of the report re-
quired under section 250, a detailed description 
of such assistance and, to the extent applicable, 
the 
information 
required 
by 
subsection 
(b)(1)(A) of such section with respect to such 
assistance. 
‘‘(4) ADMINISTRATIVE
EXPENSES.—Notwith-
standing any other provision of law, amounts made 
available for assistance for orphans or other vulner-
able children in developing countries under this title, 
or under any provision of law other than this title, 
may be made available for administrative expenses 
incurred in carrying out this title for a fiscal year 
in an amount not to exceed 7 percent of amounts 
made available for such fiscal year for such purpose 
under this title, or under such other provision of 
law, as the case may be. 
‘‘SEC. 252. DEFINITIONS. 
‘‘In this title: 
‘‘(1) AIDS.—The term ‘AIDS’ has the meaning 
given the term in section 104A(g)(1) of this Act. 
‘‘(2) CHILDREN.—The term ‘children’ means 
persons who have not attained the age of 18.
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‘‘(3) HIV.—The term ‘HIV’ has the meaning 
given the term in section 104A(g)(2) of this Act. 
‘‘(4) HIV/AIDS.—The term ‘HIV/AIDS’ has 
the meaning given the term in section 104A(g)(3) of 
this Act. 
‘‘(5) ORPHAN.—The term ‘orphan’ means a 
child deprived by death of one or both parents. 
‘‘(6) PSYCHOSOCIAL SUPPORT.—The term ‘psy-
chosocial support’ includes care that addresses the 
ongoing psychological and social problems that affect 
individuals, their partners, families, and caregivers 
in order to alleviate suffering, strengthen social ties 
and integration, provide emotional support, and pro-
mote coping strategies. 
‘‘(7) VULNERABLE CHILDREN.—The term ‘vul-
nerable children’ includes children who are ne-
glected, destitute, abandoned, homeless, disabled, 
suffering from malnutrition, are sexually exploited or 
abused, or are displaced or otherwise adversely af-
fected by armed conflict.’’.
Passed the House of Representatives June 14, 2004. 
Attest: 
JEFF TRANDAHL, 
Clerk.