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| section_id ▼ | title_number | title_name | chapter | subchapter | part_number | part_name | subpart | subpart_name | section_number | section_heading | agency | authority | source_citation | amendment_citations | full_text |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 14:14:4.0.2.8.4.0.24.1 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.1 Scope. | FAA | [Doc. No. FAA-2016-6761, Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | This part establishes procedures for issuing regulations and for filing a petition for waiver or petition for rulemaking to the Associate Administrator for Commercial Space Transportation. | |||||
| 14:14:4.0.2.8.4.0.24.10 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.19 Hearings. | FAA | [53 FR 11013, Apr. 4, 1988, as amended by Amdt. 404-2, 68 FR 35289, June 13, 2003] | (a) Sections 556 and 557 of Title 5, United States Code, do not apply to hearings held under this part. As a fact-finding forum, each hearing held under this part is nonadversarial and there are no formal pleadings or adverse parties. Any rule issued in a proceeding in which a hearing is held is not based exclusively on the record of the hearing, but on the entire record of the rulemaking proceeding. (b) The Associate Administrator designates a representative to conduct any hearing held under this part. The FAA Chief Counsel designates a legal officer for the hearing. | |||||
| 14:14:4.0.2.8.4.0.24.2 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.3 General. | FAA | [Doc. No. FAA-2005-21234, 71 FR 51971, Aug. 31, 2006, as amended at 72 FR 68475, Dec. 5, 2007; Doc. No. FAA-2016-6761; Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | (a) Any person may petition the Associate Administrator to: (1) Issue, amend, or repeal a regulation to eliminate as a requirement for a license or permit any requirement of Federal law applicable to commercial space launch and reentry activities and the operation of launch and reentry sites; (2) Waive any such requirement in the context of a specific application for a license or permit; or (3) Waive the requirement for a license, except as provided in § 404.7(b). (b) A petition filed under this section may request, under § 413.9 of this chapter, that the Associate Administrator withhold certain trade secrets or proprietary commercial or financial data from public disclosure. (c) Each petitioner filing under this section must: (1) For electronic submission, send one copy of the petition by email to the Office of Commercial Space Transportation at ASTpetition@faa.gov; or (2) For paper submission, send one copy of the petition to the Office of Commercial Space Transportation, Federal Aviation Administration, 800 Independence Avenue SW, Room 331, Washington, DC 20591. (d) Each petition filed under this section must include the petitioner's name, mailing address, telephone number and any other contact information, such as an email address or a fax number. (e) Notification. When the Associate Administrator determines that a petition should be granted or denied, the Associate Administrator notifies the petitioner of the Associate Administrator's action and the reasons supporting the action. (f) Reconsideration. Any person may petition the FAA to reconsider a denial of a petition the person filed. The petitioner must send a request for reconsideration within 60 days after being notified of the denial to the same address to which the original petition was filed. For the FAA to accept the reconsideration request, the petitioner must show— (1) There is a significant additional fact and the reason it was not included in the original petition; (2) The FAA made an important factual error in its denial of the… | |||||
| 14:14:4.0.2.8.4.0.24.3 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.5 Filing a petition for waiver. | FAA | [Doc. No. FAA-2019-0229, Amdt. 404-7, 85 FR 79709, Dec. 10, 2020] | (a) A petition for waiver must be submitted at least 60 days before the proposed effective date of the waiver, unless the Administrator agrees to a different time frame in accordance with § 404.15. (b) The petition for waiver must include: (1) The specific section or sections of 14 CFR chapter III from which the petitioner seeks relief; (2) The extent of the relief sought and the reason the relief is being sought; (3) The reason why granting the request for relief is in the public interest and will not jeopardize the public health and safety, safety of property, and national security and foreign policy interests of the United States; and (4) Any additional facts, views, and data available to the petitioner to support the waiver request. | |||||
| 14:14:4.0.2.8.4.0.24.4 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.7 Action on a petition for waiver. | FAA | [Doc. No. FAA-2016-6761, Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | (a) Grant of waiver. The Associate Administrator may grant a waiver, except as provided in paragraph (b) of this section, if the Associate Administrator determines that the waiver is in the public interest and will not jeopardize public health and safety, the safety of property, or any national security or foreign policy interest of the United States. (b) Waiver ineligibility. The FAA may not grant a waiver that would permit the launch or reentry of a launch vehicle or a reentry vehicle without a license or permit if a human being will be on board. (c) Denial of waiver. If the Associate Administrator determines that the petition does not justify granting a waiver, the Associate Administrator denies the petition. | |||||
| 14:14:4.0.2.8.4.0.24.5 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.9 Filing a petition for rulemaking. | FAA | [Doc. No. FAA-2016-6761, Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | A petition for rulemaking filed under this part must be made in accordance with 14 CFR 11.71. | |||||
| 14:14:4.0.2.8.4.0.24.6 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.11 Action on a petition for rulemaking. | FAA | [Doc. No. FAA-2016-6761, Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | The FAA will process petitions for rulemaking under this part in accordance with 14 CFR 11.73. | |||||
| 14:14:4.0.2.8.4.0.24.7 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.13 Rulemaking. | FAA | [Doc. No. FAA-2016-6761, Amdt. No. 404-6, 83 FR 28534, June 20, 2018] | (a) The FAA's rulemaking procedures are located in subpart A of part 11 of this title, under the General, Written Comments, and Public Meetings and Other Proceedings headings. (b) In addition to the rulemaking procedures referenced in paragraph (a) of this section, the provisions of §§ 404.17 and 404.19 also apply. | |||||
| 14:14:4.0.2.8.4.0.24.8 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.15 Alternative Time Frames. | FAA | [Doc. No. FAA-2019-0229, Amdt. 404-7, 85 FR 79710, Dec. 10, 2020] | (a) General. Unless otherwise approved by the Administrator, an applicant, a licensee, a permittee, or a safety element approval holder must meet the time frames set forth in this chapter. (b) Request to change a time frame. An applicant, a licensee, a permittee, or a safety element approval holder may file a written request to the FAA to propose an alternative time frame to any of the time frames included in the chapter III sections listed in Appendix A to part 404. The request must be— (1) Emailed to ASTApplications@faa.gov in accordance with § 413.7; or (2) Mailed to the Federal Aviation Administration, Associate Administrator for Commercial Space Transportation, Room 331, 800 Independence Avenue SW, Washington, DC 20591. Attention: Alternative Time Frame Request. (c) Administrator review. The Administrator will review and make a decision or grant a request for an alternative time frame as follows: (1) The FAA will conduct its review on a case-by-case basis, taking into account the complexity of the request, the timeliness of the request, and whether the requested alternative allows sufficient time for the FAA to conduct its review and make the requisite public health and safety, safety of property, and national security and foreign policy findings; (2) The FAA will provide its decision in writing; and (3) The FAA may grant the request, deny the request, or grant an alternative time frame that differs from what was requested. | |||||
| 14:14:4.0.2.8.4.0.24.9 | 14 | Aeronautics and Space | III | B | 404 | PART 404—PETITION AND RULEMAKING PROCEDURES | § 404.17 Additional rulemaking proceedings. | FAA | [Doc. No. FAA-2006-24197, 72 FR 17016, Apr. 6, 2007] | The FAA may initiate other rulemaking proceedings, if necessary or desirable. For example, it may invite interested people to present oral arguments, participate in conferences, appear at informal hearings, or participate in any other proceedings. | |||||
| 17:17:5.0.2.1.5.0.43.1 | 17 | Commodity and Securities Exchanges | IV | A | 404 | PART 404—RECORDKEEPING AND PRESERVATION OF RECORDS | § 404.1 Application of part to registered brokers and dealers. | SEC | [71 FR 54411, Sept. 15, 2006] | Compliance by a registered broker or dealer with § 240.17a-3 of this title (pertaining to records to be made), § 240.17a-4 of this title (pertaining to preservation of records), § 240.17a-13 of this title (pertaining to quarterly securities counts) and § 240.17a-7 of this title (pertaining to records of non-resident brokers or dealers), including provisions in those rules relating to OTC derivatives dealers, constitutes compliance with this part. | |||||
| 17:17:5.0.2.1.5.0.43.2 | 17 | Commodity and Securities Exchanges | IV | A | 404 | PART 404—RECORDKEEPING AND PRESERVATION OF RECORDS | § 404.2 Records to be made and kept current by registered government securities brokers and dealers; records of non-resident registered government securities brokers and dealers. | SEC | [52 FR 27952, July 24, 1987, as amended at 60 FR 11026, Mar. 1, 1995; 60 FR 20399, Apr. 26, 1995; 83 FR 66616, Dec. 27, 2018] | (a) Every registered government securities broker or dealer shall comply with the requirements of § 240.17a-3 of this title (SEC Rule 17a-3), with the following modifications: (1) References to “broker or dealer” and “broker or dealer registered pursuant to Section 15 of the Act” include registered government securities brokers or dealers. (2) References to §§ 240.17a-3, 240.17a-4, 240.17a-5, and 240.17a-13 mean such sections as modified by this part and part 405 of this chapter. (3) (i) Except in the case of a government securities interdealer broker who is subject to the financial responsibility rules of § 402.1(e) of this chapter and a registered government securities broker or dealer that is a futures commission merchant registered with the CFTC, paragraph 240.17a-3(a)(1l) is modified to read as follows: “(11) A record of the proof of money balances of all ledger accounts in the form of trial balances, and a record of the computation of liquid capital and total haircuts, as of the trial date, determined as provided in § 402.2 of this title; provided however, that such computation need not be made by any registered government securities broker or dealer unconditionally exempt from part 402 of this title. Such trial balances and computations shall be prepared current1y at least once a month.”. “(11) A record of the proof of money balances of all ledger accounts in the form of trial balances, and a record of the computation of liquid capital and total haircuts, as of the trial date, determined as provided in § 402.2 of this title; provided however, that such computation need not be made by any registered government securities broker or dealer unconditionally exempt from part 402 of this title. Such trial balances and computations shall be prepared current1y at least once a month.”. (ii) For a government securities interdealer broker who is subject to the financial responsibility rules of § 402.1(e) of this chapter, references to § 240.15c3-1 include modifications contained in § 402.1(e) of this chapter… | |||||
| 17:17:5.0.2.1.5.0.43.3 | 17 | Commodity and Securities Exchanges | IV | A | 404 | PART 404—RECORDKEEPING AND PRESERVATION OF RECORDS | § 404.3 Records to be preserved by registered government securities brokers and dealers. | SEC | [52 FR 27952, July 24, 1987, as amended at 60 FR 11026, Mar. 1, 1995] | (a) Every registered government securities broker or dealer, except a government securities interdealer broker subject to the financial responsibility rules of § 402.1(e) and a registered government securities broker or dealer that is also a futures commission merchant registered with the CFTC, shall comply with the requirements of § 240.17a-4 of this title (SEC Rule 17a-4), with the following modifications: (1) References to “broker or dealer” and “broker and dealer registered pursuant to Section 15 of the Act” include registered government securities brokers or dealers. (2) References to §§ 240.17a-3, .17a-4, and .17a-5 mean such sections as modified by this part and part 405 of this chapter. (3) References to § 240.15c3-1, relating to net capital, and “Computation for Net Capital” thereunder mean § 402.2 of this chapter and the computation of the ratio of liquid capital to total haircuts required thereunder. (4) References to § 240.15c3-3, relating to possession or control of customer securities and balances, mean § 403.4 of this chapter. (5) References to Form X-17A-5 mean Form G-405 (§ 449.5 of this chapter). (6) The computation described in § 240.17a-4(b)(8)(x) is not required. (b) A government securities interdealer broker subject to the financial responsibility rules of § 402.1(e) and a registered government securities broker or dealer that is also a futures commission merchant registered with the CFTC, shall comply with the requirements of § 240.17a-4 of this title (SEC Rule 17a-4), with the following modifications: (1) References to “broker or dealer” and “broker and dealer” include registered government securities brokers or dealers. (2) References to §§ 240.17a-3, 240.17a-4, and 240.17a-5 mean such sections as modified by this part and part 405 of this chapter. (3) With respect to a government securities interdealer broker subject to the financial responsibility rules of § 402.1(e) of this chapter, references to § 240.15c3-1, relating to net capital, and “Computation for Net Capital” thereun… | |||||
| 17:17:5.0.2.1.5.0.43.4 | 17 | Commodity and Securities Exchanges | IV | A | 404 | PART 404—RECORDKEEPING AND PRESERVATION OF RECORDS | § 404.4 Records to be made and preserved by government securities brokers and dealers that are financial institutions. | SEC | [52 FR 27952, July 24, 1987, as amended at 53 FR 28987, Aug. 1, 1988; 60 FR 11026, Mar. 1, 1995; 62 FR 7155, Feb. 18, 1997; 72 FR 54411, Sept. 15, 2006] | (a) Records to be made and kept. Every financial institution that is a government securities broker or dealer and that is not exempt from this part pursuant to part 401 of this chapter shall comply with the requirements of §§ 404.2 and 404.3 unless such financial institution: (1) Is subject to 12 CFR part 12 (relating to national banks), 12 CFR part 208 (relating to state member banks of the Federal Reserve System) or 12 CFR part 344 (relating to state banks that are not members of the Federal Reserve System), or is a United States branch or agency of a foreign bank and complies with 12 CFR part 12 (for federally licensed branches and agencies of foreign banks) or 12 CFR part 208 (for uninsured state-licensed branches and agencies of foreign banks) or 12 CFR part 344 (for insured state licensed branches and agencies of foreign banks); (2) Complies with the recordkeeping requirements of § 450.4(c), (d) and (f) of this chapter; and (3) Makes and keeps current: (i)(A) A securities record or ledger reflecting separately for each government security as of the settlement dates all “long” or “short” positions (including government securities that are the subjects of repurchase or reverse repurchase agreements) carried by such financial institution for its own account or for the account of its customers or others (except securities held in a fiduciary capacity) and showing the location of all government securities long and the offsetting position to all government securities short, including long security count differences and short security count differences classified by the date of the count and verification in which they were discovered, and in all cases the name or designation of the account in which each position is carried; (B) A complete and current Form G-FIN-4 (§ 449.3 of this chapter) or Form U-4 (promulgated by a self-regulatory organization) or Form MSD-4 (as required for associated persons of bank municipal securities dealers) for each associated person as defined in § 400.3 of this chapter; (C) A F… | |||||
| 17:17:5.0.2.1.5.0.43.5 | 17 | Commodity and Securities Exchanges | IV | A | 404 | PART 404—RECORDKEEPING AND PRESERVATION OF RECORDS | § 404.5 Securities counts by registered government securities brokers and dealers. | SEC | [52 FR 27952, July 24, 1987, as amended at 60 FR 11026, Mar. 1, 1995] | (a) Securities counts. Every registered government securities broker or dealer shall comply with the requirements of § 240.17a-13 of this title (Commission Rule 17a-13), with the modification that references to “broker or dealer” and “broker and dealer registered pursuant to Section 15 of the Act” include registered government securities brokers or dealers. (b) Effective date. This section shall be effective on October 31, 1987. | |||||
| 20:20:2.0.1.1.5.1.109.1 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | A | Subpart A—Introduction, General Provisions and Definitions | § 404.1 Introduction. | SSA | [26 FR 7054, Aug. 5, 1961; 26 FR 7760, Aug. 19, 1961, as amended at 27 FR 4513, May 11, 1962; 28 FR 14492, Dec. 31, 1963; 51 FR 11718, Apr. 7, 1986; 62 FR 38450, July 18, 1997; 83 FR 62456, Dec. 4, 2018] | The regulations in this part 404 (Regulations No. 4 of the Social Security Administration) relate to the provisions of title II of the Social Security Act as amended on August 28, 1950, and as further amended thereafter. The regulations in this part are divided into 22 subparts: (a) Subpart A contains provisions relating to general definitions and use of terms. (b) Subpart B relates to quarters of coverage and insured status requirements. (c) Subpart C relates to the computation and recomputation of the primary insurance amount. (d) Subpart D relates to the requirements for entitlement to monthly benefits and to the lump-sum death payment duration of entitlement and benefit rates. (e) Subpart E contains provisions relating to the reduction and increase of insurance benefits and to deductions from benefits and lump-sum death payments. (f) Subpart F relates to overpayments, underpayments, waiver of adjustment or recovery of overpayments and liability of certifying officers. (g) Subpart G relates to filing of applications and other forms. (h) Subpart H relates to evidentiary requirements for establishing an initial and continuing right to monthly benefits and for establishing a right to lump-sum death payment. (Evidentiary requirements relating to disability are contained in subpart P.) (i) Subpart I relates to maintenance and revision of records of wages and self-employment income. (j) Subpart J relates to initial determinations, the administrative review process, and reopening of determinations and decisions. (k) Subpart K relates to employment, wages, self-employment and self-employment income. (l) Subpart L is reserved. (m) Subpart M relates to coverage of employees of State and local Governments. (n) Subpart N relates to benefits in cases involving veterans. (o) Subpart O relates to the interrelationship of the old-age, survivors and disability insurance program with the railroad retirement program. (p) Subpart P relates to the determination of disability or blindness. (q) Subpart Q relates to … | ||||
| 20:20:2.0.1.1.5.1.109.2 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | A | Subpart A—Introduction, General Provisions and Definitions | § 404.2 General definitions and use of terms. | SSA | [26 FR 7055, Aug. 5, 1961; 26 FR 7760, Aug. 19, 1961, as amended at 28 FR 1037, Feb. 2, 1963; 28 FR 14492, Dec. 31, 1963; 29 FR 15509, Nov. 19, 1964; 41 FR 32886, Aug. 6, 1976; 51 FR 11718, Apr. 7, 1986; 61 FR 41330, Aug. 8, 1996; 62 FR 38450, July 18, 1997; 69 FR 51555, Aug. 20, 2004; 79 FR 33684, June 12, 2014; 83 FR 21708, May 10, 2018; 85 FR 73156, Nov. 16, 2020] | (a) Terms relating to the Act and regulations. (1) The Act means the Social Security Act, as amended (42 U.S.C. Chapter 7). (2) Section means a section of the regulations in part 404 of this chapter unless the context indicates otherwise. (b) Commissioner; Appeals Council; Administrative Law Judge; Administrative Appeals Judge defined —(1) Commissioner means the Commissioner of Social Security. (2) Appeals Council means the Appeals Council of the Office of Analytics, Review, and Oversight in the Social Security Administration or such member or members thereof as may be designated by the Chair of the Appeals Council. (3) Administrative Law Judge means an Administrative Law Judge in the Office of Hearings Operations in the Social Security Administration. (4) Administrative Appeals Judge means an Administrative Appeals Judge serving as a member of the Appeals Council. (c) Miscellaneous. (1) Certify, when used in connection with the duty imposed on the Commissioner by section 205(i) of the act, means that action taken by the Administration in the form of a written statement addressed to the Managing Trustee, setting forth the name and address of the person to whom payment of a benefit or lump sum, or any part thereof, is to be made, the amount to be paid, and the time at which payment should be made. (2) Benefit means an old-age insurance benefit, disability insurance benefit, wife's insurance benefit, husband's insurance benefit, child's insurance benefit, widow's insurance benefit, widower's insurance benefit, mother's insurance benefit, father's insurance benefit, or parent's insurance benefit under Title II of the Act. (Lump sums, which are death payments under title II of the Act, are excluded from the term benefit as defined in this part to permit greater clarity in the regulations.) (3) Lump sum means a lump-sum death payment under title II of the act or any person's share of such a payment. (4) Attainment of age. An individual attains a given age on the first moment of the da… | ||||
| 20:20:2.0.1.1.5.1.109.3 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | A | Subpart A—Introduction, General Provisions and Definitions | § 404.3 General provisions. | SSA | [26 FR 7055, Aug. 5, 1961, as amended at 29 FR 15509, Nov. 19, 1964; 51 FR 11718, Apr. 7, 1986; 61 FR 41330, Aug. 8, 1996; 62 FR 38450, July 18, 1997] | (a) Effect of cross references. The cross references in the regulations in this part 404 to other portions of the regulations, when the word see is used, are made only for convenience and shall be given no legal effect. (b) Periods of limitation ending on nonwork days. Pursuant to the provisions of section 216(j) of the act, effective September 13, 1960, where any provision of title II, or any provision of another law of the United States (other than the Internal Revenue Code of 1954) relating to or changing the effect of title II, or any regulation of the Commissioner issued under title II, provides for a period within which an act is required to be done which affects eligibility for or the amount of any benefit or payment under this title or is necessary to establish or protect any rights under this title, and such period ends on a Saturday, Sunday or Federal legal holiday or on any other day all or part of which is declared to be a nonwork day for Federal employees by statute or Executive Order, then such act shall be considered as done within such period if it is done on the first day thereafter which is not a Saturday, Sunday, or legal holiday or any other day all or part of which is declared to be a nonwork day for Federal employees either by statute or Executive Order. For purposes of this paragraph, the day on which a period ends shall include the final day of any extended period where such extension is authorized by law or by the Commissioner pursuant to law. Such extension of any period of limitation does not apply to periods during which benefits may be paid for months prior to the month an application for such benefits is filed pursuant to § 404.621, or to periods during which an application for benefits may be accepted as such pursuant to § 404.620. | ||||
| 20:20:2.0.1.1.5.10.145.1 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.900 Introduction. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 300, Jan. 3, 1986; 51 FR 8808, Mar. 14, 1986; 52 FR 4004, Feb. 9, 1987; 78 FR 57259, Sept. 18, 2013; 80 FR 14835, Mar. 20, 2015; 81 FR 90992, Dec. 16, 2016] | (a) Explanation of the administrative review process. This subpart explains the procedures we follow in determining your rights under title II of the Social Security Act. The regulations describe the process of administrative review and explain your right to judicial review after you have taken all the necessary administrative steps. These procedures apply also to persons claiming certain benefits under title XVIII of the Act (Medicare); see 42 CFR 405.904(a)(1). The administrative review process consists of several steps, which usually must be requested within certain time periods and in the following order: (1) Initial determination. This is a determination we make about your entitlement or your continuing entitlement to benefits or about any other matter, as discussed in § 404.902, that gives you a right to further review. (2) Reconsideration. If you are dissatisfied with an initial determination, you may ask us to reconsider it. (3) Hearing before an administrative law judge. If you are dissatisfied with the reconsideration determination, you may request a hearing before an administrative law judge. (4) Appeals Council review. If you are dissatisfied with the decision of the administrative law judge, you may request that the Appeals Council review the decision. (5) Federal court review. When you have completed the steps of the administrative review process listed in paragraphs (a)(1) through (a)(4) of this section, we will have made our final decision. If you are dissatisfied with our final decision, you may request judicial review by filing an action in a Federal district court. (6) Expedited appeals process. At some time after your initial determination has been reviewed, if you have no dispute with our findings of fact and our application and interpretation of the controlling laws, but you believe that a part of the law is unconstitutional, you may use the expedited appeals process. This process permits you to go directly to a Federal district court so that the constitutional issue may … | ||||
| 20:20:2.0.1.1.5.10.145.2 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.901 Definitions. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 73 FR 76943, Dec. 18, 2008] | As used in this subpart: Date you receive notice means 5 days after the date on the notice, unless you show us that you did not receive it within the 5-day period. Decision means the decision made by an administrative law judge or the Appeals Council. Determination means the initial determination or the reconsidered determination. Preponderance of the evidence means such relevant evidence that as a whole shows that the existence of the fact to be proven is more likely than not. Remand means to return a case for further review. Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Vacate means to set aside a previous action. Waive means to give up a right knowingly and voluntarily. We, us, or our refers to the Social Security Administration. You or your refers to any person claiming a right under the old age, disability, dependents' or survivors' benefits program. | ||||
| 20:20:2.0.1.1.5.10.145.3 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.902 Administrative actions that are initial determinations. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 47 FR 4988, Feb. 3, 1982; 47 FR 31543, July 21, 1982; 49 FR 22272, May 29, 1984; 50 FR 20902, May 21, 1985; 56 FR 41790, Aug. 23, 1991; 59 FR 44925, Aug. 31, 1994; 60 FR 8147, Feb. 10, 1995; 68 FR 40123, July 7, 2003; 69 FR 60232, Oct. 7, 2004; 70 FR 36507, June 24, 2005; 73 FR 76943, Dec. 18, 2008] | Initial determinations are the determinations we make that are subject to administrative and judicial review. We will base our initial determination on the preponderance of the evidence. We will state the important facts and give the reasons for our conclusions in the initial determination. In the old age, survivors' and disability insurance programs, initial determinations include, but are not limited to, determinations about— (a) Your entitlement or your continuing entitlement to benefits; (b) Your reentitlement to benefits; (c) The amount of your benefit; (d) A recomputation of your benefit; (e) A reduction in your disability benefits because you also receive benefits under a workmen's compensation law; (f) A deduction from your benefits on account of work; (g) [Reserved] (h) Termination of your benefits; (i) Penalty deductions imposed because you failed to report certain events; (j) Any overpayment or underpayment of your benefits; (k) Whether an overpayment of benefits must be repaid to us; (l) How an underpayment of benefits due a deceased person will be paid; (m) The establishment or termination of a period of disability; (n) A revision of your earnings record; (o) Whether the payment of your benefits will be made, on your behalf, to a representative payee; (p) Your drug addiction or alcoholism; (q) Who will act as your payee if we determine that representative payment will be made; (r) An offset of your benefits under § 404.408b because you previously received supplemental security income payments for the same period; (s) Whether your completion of, or continuation for a specified period of time in, an appropriate program of vocational rehabilitation services, employment services, or other support services will increase the likelihood that you will not have to return to the disability benefit rolls, and thus, whether your benefits may be continued even though you are not disabled; (t) Nonpayment of your benefits under § 404.468 because of your confinement in a jail, prison, or other pe… | ||||
| 20:20:2.0.1.1.5.10.145.4 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.903 Administrative actions that are not initial determinations. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 8808, Mar. 14, 1986; 55 FR 1018, Jan. 11, 1990; 56 FR 52469, Oct. 21, 1991; 57 FR 23057, June 1, 1992; 59 FR 44925, Aug. 31, 1994; 62 FR 6120, Feb. 11, 1997; 62 FR 64278, Dec. 5, 1997; 68 FR 74183, Dec. 23, 2003; 70 FR 57142, Sept. 30, 2005; 71 FR 16443, Mar. 31, 2006; 71 FR 66853, 66866, Nov. 17, 2006; 72 FR 51177, Sept. 6, 2007; 76 FR 45192, July 28, 2011; 76 FR 80245, Dec. 23, 2011; 80 FR 400, Jan. 6, 2015] | Administrative actions that are not initial determinations may be reviewed by us, but they are not subject to the administrative review process provided by this subpart, and they are not subject to judicial review. These actions include, but are not limited to, an action— (a) Suspending benefits pending an investigation and determination of any factual issue relating to a deduction on account of work; (b) Suspending benefits pending an investigation to determine if your disability has ceased; (c) Denying a request to be made a representative payee; (d) Certifying two or more family members for joint payment of benefits; (e) Withholding less than the full amount of your monthly benefit to recover an overpayment; (f) Determining the fee that may be charged or received by a person who has represented you in connection with a proceeding before us; (g) Refusing to recognize, disqualifying, or suspending a person from acting as your representative in a proceeding before us (see §§ 404.1705 and 404.1745); (h) Compromising, suspending or terminating collection of an overpayment under the Federal Claims Collection Act; (i) Extending or not extending the time to file a report of earnings; (j) Denying your request to extend the time period for requesting review of a determination or a decision; (k) Denying your request to use the expedited appeals process; (l) Denying your request to reopen a determination or a decision; (m) Withholding temporarily benefits based on a wage earner's estimate of earnings to avoid creating an overpayment; (n) Determining whether (and the amount of) travel expenses incurred are reimbursable in connection with proceedings before us; (o) Denying your request to readjudicate your claim and apply an Acquiescence Ruling; (p) Findings on whether we can collect an overpayment by using the Federal income tax refund offset procedure (see § 404.523); (q) Determining whether an organization may collect a fee from you for expenses it incurred in serving as your representative payee (see § … | ||||
| 20:20:2.0.1.1.5.10.145.5 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.904 Notice of the initial determination. | SSA | [72 FR 51177, Sept. 6, 2007] | We will mail a written notice of our initial determination to you at your last known address. The written notice will explain in simple and clear language what we have determined and the reasons for and the effect of our determination. If our determination involves a determination of disability that is in whole or in part unfavorable to you, our written notice also will contain in understandable language a statement of the case setting forth the evidence on which our determination is based. The notice also will inform you of your right to reconsideration. We will not mail a notice if the beneficiary's entitlement to benefits has ended because of his or her death. | ||||
| 20:20:2.0.1.1.5.10.145.6 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.905 Effect of an initial determination. | SSA | [51 FR 300, Jan. 3, 1986] | An initial determination is binding unless you request a reconsideration within the stated time period, or we revise the initial determination. | ||||
| 20:20:2.0.1.1.5.10.145.7 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.906 Testing modifications to the disability determination procedures. | SSA | [60 FR 20026, Apr. 24, 1995, as amended at 73 FR 2415, Jan. 15, 2008; 76 FR 24806, May 3, 2011; 82 FR 5863, Jan. 18, 2017] | (a) Applicability and scope. Notwithstanding any other provision in this part or part 422 of this chapter, we are establishing the procedures set out in this section to test modifications to our disability determination process. These modifications will enable us to test, either individually or in one or more combinations, the effect of: having disability claim managers assume primary responsibility for processing an application for disability benefits; providing persons who have applied for benefits based on disability with the opportunity for an interview with a decisionmaker when the decisionmaker finds that the evidence in the file is insufficient to make a fully favorable determination or requires an initial determination denying the claim; having a single decisionmaker make the initial determination with assistance from medical consultants, where appropriate; and eliminating the reconsideration step in the administrative review process and having a claimant who is dissatisfied with the initial determination request a hearing before an administrative law judge. The model procedures we test will be designed to provide us with information regarding the effect of these procedural modifications and enable us to decide whether and to what degree the disability determination process would be improved if they were implemented on a national level. (b) Procedures for cases included in the tests. Prior to commencing each test or group of tests in selected site(s), we will publish a notice in the Federal Register. The notice will describe which model or combinations of models we intend to test, where the specific test site(s) will be, and the duration of the test(s). The individuals who participate in the test(s) will be randomly assigned to a test group in each site where the tests are conducted. Paragraphs (b) (1) through (4) of this section lists descriptions of each model. (1) In the disability claim manager model, when you file an application for benefits based on disability, a disability claim manager wil… | ||||
| 20:20:2.0.1.1.5.10.146.10 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.909 How to request reconsideration. | SSA | (a) We shall reconsider an initial determination if you or any other party to the reconsideration files a written request— (1) Within 60 days after the date you receive notice of the initial determination (or within the extended time period if we extend the time as provided in paragraph (b) of this section); (2) At one of our offices, the Veterans Administration Regional Office in the Philippines, or an office of the Railroad Retirement Board if you have 10 or more years of service in the railroad industry. (b) Extension of time to request a reconsideration. If you want a reconsideration of the initial determination but do not request one in time, you may ask us for more time to request a reconsideration. Your request for an extension of time must be in writing and must give the reasons why the request for reconsideration was not filed within the stated time period. If you show us that you had good cause for missing the deadline, we will extend the time period. To determine whether good cause exists, we use the standards explained in § 404.911. | |||||
| 20:20:2.0.1.1.5.10.146.11 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.911 Good cause for missing the deadline to request review. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 59 FR 1634, Jan. 12, 1994] | (a) In determining whether you have shown that you had good cause for missing a deadline to request review we consider— (1) What circumstances kept you from making the request on time; (2) Whether our action misled you; (3) Whether you did not understand the requirements of the Act resulting from amendments to the Act, other legislation, or court decisions; and (4) Whether you had any physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) which prevented you from filing a timely request or from understanding or knowing about the need to file a timely request for review. (b) Examples of circumstances where good cause may exist include, but are not limited to, the following situations: (1) You were seriously ill and were prevented from contacting us in person, in writing, or through a friend, relative, or other person. (2) There was a death or serious illness in your immediate family. (3) Important records were destroyed or damaged by fire or other accidental cause. (4) You were trying very hard to find necessary information to support your claim but did not find the information within the stated time periods. (5) You asked us for additional information explaining our action within the time limit, and within 60 days of receiving the explanation you requested reconsideration or a hearing, or within 30 days of receiving the explanation you requested Appeal Council review or filed a civil suit. (6) We gave you incorrect or incomplete information about when and how to request administrative review or to file a civil suit. (7) You did not receive notice of the determination or decision. (8) You sent the request to another Government agency in good faith within the time limit and the request did not reach us until after the time period had expired. (9) Unusual or unavoidable circumstances exist, including the circumstances described in paragraph (a)(4) of this section, which show that you could not have known of the need to file timely, or which p… | ||||
| 20:20:2.0.1.1.5.10.146.12 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.913 Reconsideration procedures. | SSA | [51 FR 300, Jan. 3, 1986] | (a) Case review. With the exception of the type of case described in paragraph (b) of this section, the reconsideration process consists of a case review. Under a case review procedure, we will give you and the other parties to the reconsideration an opportunity to present additional evidence to us. The official who reviews your case will then make a reconsidered determination based on all of this evidence. (b) Disability hearing. If you have been receiving benefits based on disability and you request reconsideration of an initial or revised determination that, based on medical factors, you are not now disabled, we will give you and the other parties to the reconsideration an opportunity for a disability hearing. (See §§ 404.914 through 404.918.) | ||||
| 20:20:2.0.1.1.5.10.146.13 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.914 Disability hearing—general. | SSA | [51 FR 300, Jan. 3, 1986, as amended at 51 FR 8808, Mar. 14, 1986; 71 FR 10427, Mar. 1, 2006] | (a) Availability. We will provide you with an opportunity for a disability hearing if: (1) You have been receiving benefits based on a medical impairment that renders you disabled; (2) We have made an initial or revised determination based on medical factors that you are not now disabled because your impairment: (i) Has ceased; (ii) Did not exist; or (iii) Is no longer disabling; and (3) You make a timely request for reconsideration of the initial or revised determination. (b) Scope. The disability hearing will address only the initial or revised determination, based on medical factors, that you are not now disabled. Any other issues which arise in connection with your request for reconsideration will be reviewed in accordance with the reconsideration procedures described in § 404.913(a). (c) Time and place —(1) General. Either the State agency or the Associate Commissioner for Disability Determinations or his or her delegate, as appropriate, will set the time and place of your disability hearing. We will send you a notice of the time and place of your disability hearing at least 20 days before the date of the hearing. You may be expected to travel to your disability hearing. (See §§ 404.999a-404.999d regarding reimbursement for travel expenses.) (2) Change of time or place. If you are unable to travel or have some other reason why you cannot attend your disability hearing at the scheduled time or place, you should request at the earliest possible date that the time or place of your hearing be changed. We will change the time or place if there is good cause for doing so under the standards in § 404.936 (c) and (d). (d) Combined issues. If a disability hearing is available to you under paragraph (a) of this section, and you file a new application for benefits while your request for reconsideration is still pending, we may combine the issues on both claims for the purpose of the disability hearing and issue a combined initial/reconsidered determination which is binding with respect to the commo… | ||||
| 20:20:2.0.1.1.5.10.146.14 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.915 Disability hearing—disability hearing officers. | SSA | [51 FR 301, Jan. 3, 1986, as amended at 71 FR 10428, Mar. 1, 2006] | (a) General. Your disability hearing will be conducted by a disability hearing officer who was not involved in making the determination you are appealing. The disability hearing officer will be an experienced disability examiner, regardless of whether he or she is appointed by a State agency or by the Associate Commissioner for Disability Determinations or his or her delegate, as described in paragraphs (b) and (c) of this section. (b) State agency hearing officers —(1) Appointment of State agency hearing officers. If a State agency made the initial or revised determination that you are appealing, the disability hearing officer who conducts your disability hearing may be appointed by a State agency. If the disability hearing officer is appointed by a State agency, that individual will be employed by an adjudicatory unit of the State agency other than the adjudicatory unit which made the determination you are appealing. (2) State agency defined. For purposes of this subpart, State agency means the adjudicatory component in the State which issues disability determinations. (c) Federal hearing officers. The disability hearing officer who conducts your disability hearing will be appointed by the Associate Commissioner for Disability Determinations or his or her delegate if: (1) A component of our office other than a State agency made the determination you are appealing; or (2) The State agency does not appoint a disability hearing officer to conduct your disability hearing under paragraph (b) of this section. | ||||
| 20:20:2.0.1.1.5.10.146.15 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.916 Disability hearing—procedures. | SSA | [51 FR 301, Jan. 3, 1986] | (a) General. The disability hearing will enable you to introduce evidence and present your views to a disability hearing officer if you are dissatisfied with an initial or revised initial determination, based on medical factors, that you are not now disabled as described in § 404.914(a)(2). (b) Your procedural rights. We will advise you that you have the following procedural rights in connection with the disability hearing process: (1) You may request that we assist you in obtaining pertinent evidence for your disability hearing and, if necessary, that we issue a subpoena to compel the production of certain evidence or testimony. We will follow subpoena procedures similar to those described in § 404.950(d) for the administrative law judge hearing process; (2) You may have a representative at the hearing appointed under subpart R of this part, or you may represent yourself; (3) You or your representative may review the evidence in your case file, either on the date of your hearing or at an earlier time at your request, and present additional evidence; (4) You may present witnesses and question any witnesses at the hearing; (5) You may waive your right to appear at the hearing. If you do not appear at the hearing, the disability hearing officer will prepare and issue a written reconsidered determination based on the information in your case file. (c) Case preparation. After you request reconsideration, your case file will be reviewed and prepared for the hearing. This review will be conducted in the component of our office (including a State agency) that made the initial or revised determination, by personnel who were not involved in making the initial or revised determination. Any new evidence you submit in connection with your request for reconsideration will be included in this review. If necessary, further development of the evidence, including arrangements for medical examinations, will be undertaken by this component. After the case file is prepared for the hearing, it will be forwarded by this c… | ||||
| 20:20:2.0.1.1.5.10.146.16 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.917 Disability hearing—disability hearing officer's reconsidered determination. | SSA | [51 FR 302, Jan. 3, 1986, as amended at 71 FR 10428, Mar. 1, 2006; 73 FR 76943, Dec. 18, 2008] | (a) General. The disability hearing officer who conducts your disability hearing will prepare and will also issue a written reconsidered determination, unless: (1) The disability hearing officer sends the case back for additional development by the component that prepared the case for the hearing, and that component issues a favorable determination, as permitted by § 404.916(c); (2) It is determined that you are engaging in substantial gainful activity and that you are therefore not disabled; or (3) The reconsidered determination prepared by the disability hearing officer is reviewed under § 404.918. (b) Content. The disability hearing officer's reconsidered determination will give the findings of fact and the reasons for the reconsidered determination. The disability hearing officer must base the reconsidered determination on the preponderance of the evidence offered at the disability hearing or otherwise included in your case file. (c) Notice. We will mail you and the other parties a notice of reconsidered determination in accordance with § 404.922. (d) Effect. The disability hearing officer's reconsidered determination, or, if it is changed under § 404.918, the reconsidered determination that is issued by the Associate Commissioner for Disability Determinations or his or her delegate, is binding in accordance with § 404.921, subject to the exceptions specified in that section. | ||||
| 20:20:2.0.1.1.5.10.146.17 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.918 Disability hearing—review of the disability hearing officer's reconsidered determination before it is issued. | SSA | [71 FR 10428, Mar. 1, 2006] | (a) General. The Associate Commissioner for Disability Determinations or his or her delegate may select a sample of disability hearing officers' reconsidered determinations, before they are issued, and review any such case to determine its correctness on any grounds he or she deems appropriate. The Associate Commissioner or his or her delegate shall review any case within the sample if: (1) There appears to be an abuse of discretion by the hearing officer; (2) There is an error of law; or (3) The action, findings or conclusions of the disability hearing officer are not supported by substantial evidence. If the review indicates that the reconsidered determination prepared by the disability hearing officer is correct, it will be dated and issued immediately upon completion of the review. If the reconsidered determination prepared by the disability hearing officer is found by the Associate Commissioner or his or her delegate to be deficient, it will be changed as described in paragraph (b) of this section. (b) Methods of correcting deficiencies in the disability hearing officer's reconsidered determination. If the reconsidered determination prepared by the disability hearing officer is found by the Associate Commissioner for Disability Determinations or his or her delegate to be deficient, the Associate Commissioner or his or her delegate will take appropriate action to assure that the deficiency is corrected before a reconsidered determination is issued. The action taken by the Associate Commissioner or his or her delegate will take one of two forms: (1) The Associate Commissioner or his or her delegate may return the case file either to the component responsible for preparing the case for hearing or to the disability hearing officer, for appropriate further action; or (2) The Associate Commissioner or his or her delegate may issue a written reconsidered determination which corrects the deficiency. (c) Further action on your case if it is sent back by the Associate Commissioner for Disability Determina… | ||||
| 20:20:2.0.1.1.5.10.146.18 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.919 Notice of another person's request for reconsideration. | SSA | [45 FR 52081, Aug. 5, 1980. Redesignated at 51 FR 302, Jan. 3, 1986] | If any other person files a request for reconsideration of the initial determination in your case, we shall notify you at your last known address before we reconsider the initial determination. We shall also give you an opportunity to present any evidence you think helpful to the reconsidered determination. | ||||
| 20:20:2.0.1.1.5.10.146.19 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.920 Reconsidered determination. | SSA | [73 FR 76943, Dec. 18, 2008] | After you or another person requests a reconsideration, we will review the evidence we considered in making the initial determination and any other evidence we receive. We will make our determination based on the preponderance of the evidence. | ||||
| 20:20:2.0.1.1.5.10.146.20 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.921 Effect of a reconsidered determination. | SSA | [51 FR 302, Jan. 3, 1986] | The reconsidered determination is binding unless— (a) You or any other party to the reconsideration requests a hearing before an administrative law judge within the stated time period and a decision is made; (b) The expedited appeals process is used; or (c) The reconsidered determination is revised. | ||||
| 20:20:2.0.1.1.5.10.146.21 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.922 Notice of a reconsidered determination. | SSA | [45 FR 52081, Aug. 5, 1980. Redesignated at 51 FR 302, Jan. 3, 1986] | We shall mail a written notice of the reconsidered determination to the parties at their last known address. We shall state the specific reasons for the determination and tell you and any other parties of the right to a hearing. If it is appropriate, we will also tell you and any other parties how to use the expedited appeals process. | ||||
| 20:20:2.0.1.1.5.10.146.8 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.907 Reconsideration—general. | SSA | [61 FR 56132, Oct. 31, 1996] | If you are dissatisfied with the initial determination, reconsideration is the first step in the administrative review process that we provide, except that we provide the opportunity for a hearing before an administrative law judge as the first step for those situations described in §§ 404.930 (a)(6) and (a)(7), where you appeal an initial determination denying your request for waiver of adjustment or recovery of an overpayment (see § 404.506). If you are dissatisfied with our reconsidered determination, you may request a hearing before an administrative law judge. | ||||
| 20:20:2.0.1.1.5.10.146.9 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.908 Parties to a reconsideration. | SSA | (a) Who may request a reconsideration. If you are dissatisfied with the initial determination, you may request that we reconsider it. In addition, a person who shows in writing that his or her rights may be adversely affected by the initial determination may request a reconsideration. (b) Who are parties to a reconsideration. After a request for the reconsideration, you and any person who shows in writing that his or her rights are adversely affected by the initial determination will be parties to the reconsideration. | |||||
| 20:20:2.0.1.1.5.10.147.22 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.923 Expedited appeals process—general. | SSA | By using the expedited appeals process you may go directly to a Federal district court without first completing the administrative review process that is generally required before the court will hear your case. | |||||
| 20:20:2.0.1.1.5.10.147.23 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.924 When the expedited appeals process may be used. | SSA | You may use the expedited appeals process if all of the following requirements are met: (a) We have made an initial and a reconsidered determination; an administrative law judge has made a hearing decision; or Appeals Council review has been requested, but a final decision has not been issued. (b) You are a party to the reconsidered determination or the hearing decision. (c) You have submitted a written request for the expedited appeals process. (d) You have claimed, and we agree, that the only factor preventing a favorable determination or decision is a provision in the law that you believe is unconstitutional. (e) If you are not the only party, all parties to the determination or decision agree to request the expedited appeals process. | |||||
| 20:20:2.0.1.1.5.10.147.24 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.925 How to request expedited appeals process. | SSA | (a) Time of filing request. You may request the expedited appeals process— (1) Within 60 days after the date you receive notice of the reconsidered determination (or within the extended time period if we extend the time as provided in paragraph (c) of this section); (2) At any time after you have filed a timely request for a hearing but before you receive notice of the administrative law judge's decision; (3) Within 60 days after the date you receive a notice of the administrative law judge's decision or dismissal (or within the extended time period if we extend the time as provided in paragraph (c) of this section); or (4) At any time after you have filed a timely request for Appeals Council review, but before you receive notice of the Appeals Council's action. (b) Place of filing request. You may file a written request for the expedited appeals process at one of our offices, the Veterans Administration Regional Office in the Philippines, or an office of the Railroad Retirement Board if you have 10 or more years of service in the railroad industry. (c) Extension of time to request expedited appeals process. If you want to use the expedited appeals process but do not request it within the stated time period, you may ask for more time to submit your request. Your request for an extension of time must be in writing and must give the reasons why the request for the expedited appeals process was not filed within the stated time period. If you show that you had good cause for missing the deadline, the time period will be extended. To determine whether good cause exists, we use the standards explained in § 404.911. | |||||
| 20:20:2.0.1.1.5.10.147.25 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.926 Agreement in expedited appeals process. | SSA | If you meet all the requirements necessary for the use of the expedited appeals process, our authorized representative shall prepare an agreement. The agreement must be signed by you, by every other party to the determination or decision and by our authorized representative. The agreement must provide that— (a) The facts in your claim are not in dispute; (b) The sole issue in dispute is whether a provision of the Act that applies to your case is unconstitutional; (c) Except for your belief that a provision of the Act is unconstitutional, you agree with our interpretation of the law; (d) If the provision of the Act that you believe is unconstitutional were not applied to your case, your claim would be allowed; and (e) Our determination or the decision is final for the purpose of seeking judicial review. | |||||
| 20:20:2.0.1.1.5.10.147.26 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.927 Effect of expedited appeals process agreement. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 49 FR 46369, Nov. 26, 1984] | After an expedited appeals process agreement is signed, you will not need to complete the remaining steps of the administrative review process. Instead, you may file an action in a Federal district court within 60 days after the date you receive notice (a signed copy of the agreement will be mailed to you and will constitute notice) that the agreement has been signed by our authorized representative. | ||||
| 20:20:2.0.1.1.5.10.147.27 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.928 Expedited appeals process request that does not result in agreement. | SSA | If you do not meet all of the requirements necessary to use the expedited appeals process, we shall tell you that your request to use this process is denied and that your request will be considered as a request for a hearing or Appeals Council review, whichever is appropriate. | |||||
| 20:20:2.0.1.1.5.10.148.28 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.929 Hearing before an administrative law judge—general. | SSA | [89 FR 68360, Aug. 26, 2024] | If you are dissatisfied with one of the determinations or decisions listed in § 404.930, you may request a hearing. Subject to § 404.956, the Deputy Commissioner for Hearings Operations, or their delegate, will appoint an administrative law judge to conduct the hearing. If circumstances warrant, the Deputy Commissioner for Hearings Operations, or their delegate, may assign your case to another administrative law judge. We will schedule you to appear by audio, agency video, online video, or in person as set forth in § 404.936. Audio means telephone or similar audio-based technology in a private location you choose. Agency video means video, with audio functionality, using our equipment in one of our offices. Online video means video, with audio functionality, using a personal electronic device in a private location you choose. When we determine your manner of appearance, we consider the factors described in § 404.936(c)(1)(i) through (ii). You may submit new evidence (subject to the provisions of § 404.935), examine the evidence used in making the determination or decision under review, and present and question witnesses. The administrative law judge who conducts the hearing may ask you questions. The administrative law judge will issue a decision based on the preponderance of the evidence in the hearing record. If you waive your right to appear at the hearing, the administrative law judge will make a decision based on the preponderance of the evidence that is in the file and, subject to the provisions of § 404.935, any new evidence that may have been submitted for consideration. | ||||
| 20:20:2.0.1.1.5.10.148.29 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.930 Availability of a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 61 FR 56132, Oct. 31, 1996; 73 FR 2415, Jan. 15, 2008; 76 FR 24806, May 3, 2011] | (a) You or another party may request a hearing before an administrative law judge if we have made— (1) A reconsidered determination; (2) A revised determination of an initial determination, unless the revised determination concerns the issue of whether, based on medical factors, you are disabled; (3) A reconsideration of a revised initial determination concerning the issue of whether, based on medical factors, you are disabled; (4) A revised reconsidered determination; (5) A revised decision based on evidence not included in the record on which the prior decision was based; (6) An initial determination denying waiver of adjustment or recovery of an overpayment based on a personal conference (see § 404.506); or (7) An initial determination denying waiver of adjustment or recovery of an overpayment based on a review of the written evidence of record (see § 404.506), and the determination was made concurrent with, or subsequent to, our reconsideration determination regarding the underlying overpayment but before an administrative law judge holds a hearing. (b) We will hold a hearing only if you or another party to the hearing file a written request for a hearing. | ||||
| 20:20:2.0.1.1.5.10.148.30 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.932 Parties to a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 75 FR 39160, July 8, 2010] | (a) Who may request a hearing. You may request a hearing if a hearing is available under § 404.930. In addition, a person who shows in writing that his or her rights may be adversely affected by the decision may request a hearing. (b) Who are parties to a hearing. After a request for a hearing is made, you, the other parties to the initial, reconsidered, or revised determination, and any other person who shows in writing that his or her rights may be adversely affected by the hearing, are parties to the hearing. In addition, any other person may be made a party to the hearing if his or her rights may be adversely affected by the decision, and we notify the person to appear at the hearing or to present evidence supporting his or her interest. | ||||
| 20:20:2.0.1.1.5.10.148.31 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.933 How to request a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986] | (a) Written request. You may request a hearing by filing a written request. You should include in your request— (1) The name and social security number of the wage earner; (2) The reasons you disagree with the previous determination or decision; (3) A statement of additional evidence to be submitted and the date you will submit it; and (4) The name and address of any designated representative. (b) When and where to file. The request must be filed— (1) Within 60 days after the date you receive notice of the previous determination or decision (or within the extended time period if we extend the time as provided in paragraph (c) of this section); (2) At one of our offices, the Veterans Administration Regional Office in the Philippines, or an office of the Railroad Retirement Board for persons having 10 or more years of service in the railroad industry. (c) Extension of time to request a hearing. If you have a right to a hearing but do not request one in time, you may ask for more time to make your request. The request for an extension of time must be in writing and it must give the reasons why the request for a hearing was not filed within the stated time period. You may file your request for an extension of time at one of our offices. If you show that you had good cause for missing the deadline, the time period will be extended. To determine whether good cause exists, we use the standards explained in § 404.911. | ||||
| 20:20:2.0.1.1.5.10.148.32 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.935 Submitting written evidence to an administrative law judge. | SSA | [81 FR 90993, Dec. 16, 2016] | (a) When you submit your request for hearing, you should also submit information or evidence as required by § 404.1512 or any summary of the evidence to the administrative law judge. Each party must make every effort to ensure that the administrative law judge receives all of the evidence and must inform us about or submit any written evidence, as required in § 404.1512, no later than 5 business days before the date of the scheduled hearing. If you do not comply with this requirement, the administrative law judge may decline to consider or obtain the evidence, unless the circumstances described in paragraph (b) of this section apply. (b) If you have evidence required under § 404.1512 but you have missed the deadline described in paragraph (a) of this section, the administrative law judge will accept the evidence if he or she has not yet issued a decision and you did not inform us about or submit the evidence before the deadline because: (1) Our action misled you; (2) You had a physical, mental, educational, or linguistic limitation(s) that prevented you from informing us about or submitting the evidence earlier; or (3) Some other unusual, unexpected, or unavoidable circumstance beyond your control prevented you from informing us about or submitting the evidence earlier. Examples include, but are not limited to: (i) You were seriously ill, and your illness prevented you from contacting us in person, in writing, or through a friend, relative, or other person; (ii) There was a death or serious illness in your immediate family; (iii) Important records were destroyed or damaged by fire or other accidental cause; or (iv) You actively and diligently sought evidence from a source and the evidence was not received or was received less than 5 business days prior to the hearing. | ||||
| 20:20:2.0.1.1.5.10.148.33 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.936 Time, place, and manner of appearance for a hearing before an administrative law judge. | SSA | [84 FR 69305, Dec. 18, 2019, as amended at 89 FR 68360, Aug. 26, 2024] | (a) General. We set the time and manner(s) of appearance for any hearing. We will set the place of a hearing when we schedule you and any other parties to the hearing to appear in person or by agency video. We may change the time, manner(s) of appearance, or place, if it is necessary. After sending you reasonable notice of the proposed action, the administrative law judge may adjourn or postpone the hearing or reopen it to receive additional evidence any time before the administrative law judge notifies you of a hearing decision. (b) Place of hearing. If we set the place of the hearing, it can be in the 50 States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the United States Virgin Islands. The “place” of the hearing is the hearing office or other site(s) at which you and any other parties to the hearing are located when you make your appearance(s) before the administrative law judge by agency video or in person. A party to a hearing may only appear from the geographic areas, noted in this subsection, in which we hold hearings. (c) Determining manner of appearance to schedule. We will schedule you or any other party to the hearing to appear by audio, agency video, online video, or in person. We may schedule you to appear by online video only if you agree to appear in that manner. (1) When we determine your manner of appearance at the hearing, we consider the following factors: (i) Which manner of appearance would be the most efficient for conducting the hearing; and (ii) Any facts in your particular case that provide a good reason to schedule your appearance by audio, agency video, online video, or in person. (2) We will generally direct any person we call as a witness, other than you or any other party to the hearing, to appear by audio, by agency video, or by online video. Witnesses include medical experts and vocational experts. Witnesses you call will appear at the hearing pursuant to § 404.950(e). If they are unable to appear… | ||||
| 20:20:2.0.1.1.5.10.148.34 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.937 Protecting the safety of the public and our employees in our hearing process. | SSA | [76 FR 13508, Mar. 14, 2011, as amended at 77 FR 10658, Feb. 23, 2012; 89 FR 68361, Aug. 26, 2024] | (a) Notwithstanding any other provision in this part or part 422 of this chapter, we are establishing the procedures set out in this section to ensure the safety of the public and our employees in our hearing process. (b)(1) At the request of any hearing office employee, the Hearing Office Chief Administrative Law Judge will determine, after consultation with the presiding administrative law judge, whether a claimant or other individual poses a reasonable threat to the safety of our employees or other participants in the hearing. The Hearing Office Chief Administrative Law Judge will find that a claimant or other individual poses a threat to the safety of our employees or other participants in the hearing when he or she determines that the individual has made a threat and there is a reasonable likelihood that the claimant or other individual could act on the threat or when evidence suggests that a claimant or other individual poses a threat. In making a finding under this paragraph, the Hearing Office Chief Administrative Law Judge will consider all relevant evidence, including any information we have in the claimant's record and any information we have regarding the claimant's or other individual's past conduct. (2) If the Hearing Office Chief Administrative Law Judge determines that the claimant or other individual poses a reasonable threat to the safety of our employees or other participants in the hearing, the Hearing Office Chief Administrative Law Judge will either: (i) Require the presence of a security guard at the hearing; or (ii) Require that the hearing be conducted by audio, notwithstanding any objection to appearing by audio, or, if the claimant agrees, by online video. (c) If we have banned a claimant from any of our facilities, we will provide the claimant with the opportunity for a hearing that will be conducted by audio, notwithstanding any objection to appearing by audio, or, if the claimant agrees, by online video. (d) The actions of the Hearing Office Chief Administrative Law Judge taken… | ||||
| 20:20:2.0.1.1.5.10.148.35 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.938 Notice of a hearing before an administrative law judge. | SSA | [68 FR 5219, Feb. 3, 2003, as amended at 75 FR 39160, July 8, 2010; 78 FR 29627, May 21, 2013; 79 FR 35932, June 25, 2014; 81 FR 90993, Dec. 16, 2016; 84 FR 69306, Dec. 18, 2019; 89 FR 68362, Aug. 26, 2024] | (a) Issuing the notice. After we set the time and place of the hearing, we will mail notice of the hearing to you at your last known address, or give the notice to you by personal service, unless you have indicated in writing that you do not wish to receive this notice. We will mail or serve the notice at least 75 days before the date of the hearing. (b) Notice information. The notice of hearing will tell you: (1) The specific issues to be decided in your case; (2) That you may designate a person to represent you during the proceedings; (3) How to request that we change the time or place of your hearing; (4) That your hearing may be dismissed if neither you nor the person you designate to act as your representative appears at your scheduled hearing without good reason under § 404.957; (5) The time and manner(s) in which you, or any other party or witness, will appear. If we schedule you to appear in person or by agency video, as set forth in § 404.936, the notice of hearing will tell you the place of the hearing. (6) That you must make every effort to inform us about or submit all written evidence that is not already in the record no later than 5 business days before the date of the scheduled hearing, unless you show that your circumstances meet the conditions described in § 404.935(b); and (7) Any other information about the scheduling and conduct of your hearing. (c) Acknowledging the notice of hearing. The notice of hearing will ask you to return a form to let us know that you received the notice. If you or your representative do not acknowledge receipt of the notice of hearing, we will attempt to contact you for an explanation. If you tell us that you did not receive the notice of hearing, an amended notice will be sent to you by certified mail. (d) Amended notice of hearing or notice of supplemental hearing. If we need to send you an amended notice of hearing, we will mail or serve the notice at least 20 days before the date of the hearing. Similarly, if we schedule a supplemental hearing, … | ||||
| 20:20:2.0.1.1.5.10.148.36 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.939 Objections to the issues. | SSA | [81 FR 90993, Dec. 16, 2016] | If you object to the issues to be decided at the hearing, you must notify the administrative law judge in writing at the earliest possible opportunity, but no later than 5 business days before the date set for the hearing, unless you show that your circumstances meet the conditions described in § 404.935(b). You must state the reason(s) for your objection(s). The administrative law judge will make a decision on your objection(s) either at the hearing or in writing before the hearing. | ||||
| 20:20:2.0.1.1.5.10.148.37 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.940 Disqualification of the administrative law judge. | SSA | An administrative law judge shall not conduct a hearing if he or she is prejudiced or partial with respect to any party or has any interest in the matter pending for decision. If you object to the administrative law judge who will conduct the hearing, you must notify the administrative law judge at your earliest opportunity. The administrative law judge shall consider your objections and shall decide whether to proceed with the hearing or withdraw. If he or she withdraws, the Associate Commissioner for Hearings and Appeals, or his or her delegate, will appoint another administrative law judge to conduct the hearing. If the administrative law judge does not withdraw, you may, after the hearing, present your objections to the Appeals Council as reasons why the hearing decision should be revised or a new hearing held before another administrative law judge. | |||||
| 20:20:2.0.1.1.5.10.148.38 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.941 Prehearing case review. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 73 FR 76943, Dec. 18, 2008; 75 FR 33168, June 11, 2010; 76 FR 65369, Oct. 21, 2011] | (a) General. After a hearing is requested but before it is held, we may, for the purposes of a prehearing case review, forward the case to the component of our office (including a State agency) that issued the determination being reviewed. That component will decide whether it should revise the determination based on the preponderance of the evidence. A revised determination may be fully or partially favorable to you. A prehearing case review will not delay the scheduling of a hearing unless you agree to continue the review and delay the hearing. If the prehearing case review is not completed before the date of the hearing, the case will be sent to the administrative law judge unless a favorable revised determination is in process or you and the other parties to the hearing agree in writing to delay the hearing until the review is completed. (b) When a prehearing case review may be conducted. We may conduct a prehearing case review if— (1) Additional evidence is submitted; (2) There is an indication that additional evidence is available; (3) There is a change in the law or regulation; or (4) There is an error in the file or some other indication that the prior determination may be revised. (c) Notice of a prehearing revised determination. If we revise the determination in a prehearing case review, we will mail a written notice of the revised determination to all parties at their last known addresses. We will state the basis for the revised determination and advise all parties of the effect of the revised determination on the request for a hearing. (d) Effect of a fully favorable revised determination. If the revised determination is fully favorable to you, we will tell you in the notice that an administrative law judge will dismiss the request for a hearing. We will also tell you that you or another party to the hearing may request that the administrative law judge vacate the dismissal and reinstate the request for a hearing if you or another party to the hearing disagrees with the revised determin… | ||||
| 20:20:2.0.1.1.5.10.148.39 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.942 Prehearing proceedings and decisions by attorney advisors. | SSA | [60 FR 34131, June 30, 1995, as amended at 63 FR 35516, June 30, 1998; 64 FR 13678, Mar. 22, 1999; 64 FR 51893, Sept. 27, 1999; 72 FR 44765, Aug. 9, 2007; 73 FR 76944, Dec. 18, 2008; 74 FR 33328, July 13, 2009; 76 FR 18384, Apr. 4, 2011; 76 FR 65370, Oct. 21, 2011; 78 FR 45460, July 29, 2013; 80 FR 31991, June 5, 2015; 82 FR 5863, Jan. 18, 2017; 83 FR 712, Jan. 8, 2018; 83 FR 40453, Aug. 15, 2018] | (a) General. After a hearing is requested but before it is held, an attorney advisor may conduct prehearing proceedings as set out in paragraph (c) of this section. If after the completion of these proceedings we can make a decision that is fully favorable to you and all other parties based on the preponderance of the evidence, an attorney advisor, instead of an administrative law judge, may issue the decision. The conduct of the prehearing proceedings by the attorney advisor will not delay the scheduling of a hearing. If the prehearing proceedings are not completed before the date of the hearing, the case will be sent to the administrative law judge unless a fully favorable decision is in process or you and all other parties to the hearing agree in writing to delay the hearing until the proceedings are completed. (b) When prehearing proceedings may be conducted by an attorney advisor. An attorney advisor may conduct prehearing proceedings if you have filed a claim for benefits based on disability and— (1) New and material evidence is submitted; (2) There is an indication that additional evidence is available; (3) There is a change in the law or regulations; or (4) There is an error in the file or some other indication that a fully favorable decision may be issued. (c) Nature of the prehearing proceedings that may be conducted by an attorney advisor. As part of the prehearing proceedings, the attorney advisor, in addition to reviewing the existing record, may— (1) Request additional evidence that may be relevant to the claim, including medical evidence; and (2) If necessary to clarify the record for the purpose of determining if a fully favorable decision is warranted, schedule a conference with the parties. (d) Notice of a decision by an attorney advisor. If an attorney advisor issues a fully favorable decision under this section, we will mail a written notice of the decision to all parties at their last known addresses. We will state the basis for the decision and advise all parties that they m… | ||||
| 20:20:2.0.1.1.5.10.148.40 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.943 Responsibilities of the adjudication officer. | SSA | [60 FR 47475, Sept. 13, 1995, as amended at 75 FR 33168, June 11, 2010] | (a)(1) General. Under the procedures set out in this section we will test modifications to the procedures we follow when you file a request for a hearing before an administrative law judge in connection with a claim for benefits based on disability where the question of whether you are under a disability as defined in § 404.1505 is at issue. These modifications will enable us to test the effect of having an adjudication officer be your primary point of contact after you file a hearing request and before you have a hearing with an administrative law judge. The tests may be conducted alone, or in combination with the tests of the modifications to the disability determination procedures which we conduct under § 404.906. The adjudication officer, working with you and your representative, if any, will identify issues in dispute, develop evidence, conduct informal conferences, and conduct any other prehearing proceeding as may be necessary. The adjudication officer has the authority to make a decision fully favorable to you if the evidence so warrants. If the adjudication officer does not make a decision on your claim, your hearing request will be assigned to an administrative law judge for further proceedings. (2) Procedures for cases included in the tests. Prior to commencing tests of the adjudication officer position in selected site(s), we will publish a notice in the Federal Register. The notice will describe where the specific test site(s) will be and the duration of the test(s). We will also state whether the tests of the adjudication officer position in each site will be conducted alone, or in combination with the tests of the modifications to the disability determination procedures which we conduct under § 404.906. The individuals who participate in the test(s) will be assigned randomly to a test group in each site where the tests are conducted. (b)(1) Prehearing procedures conducted by an Adjudication Officer. When you file a request for a hearing before an administrative law judge in connection wit… | ||||
| 20:20:2.0.1.1.5.10.149.41 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.944 Administrative law judge hearing procedures—general. | SSA | [89 FR 68362, Aug. 26, 2024] | A hearing is open to the parties and to other persons the administrative law judge considers necessary and proper. At the hearing, the administrative law judge looks fully into the issues, questions you and the other witnesses, and, subject to the provisions of § 404.935, accepts as evidence any documents that are material to the issues; may stop the hearing temporarily and continue it at a later date if the administrative law judge finds that there is material evidence missing at the hearing or one or more variables outside of our control, such as audio quality or video quality, materially affects the hearing; and may reopen the hearing at any time before the administrative law judge mails a notice of the decision in order to receive new and material evidence. For purposes of this section, materially affects means prevents the hearing from proceeding. The administrative law judge may decide when the evidence will be presented and when the issues will be discussed. | ||||
| 20:20:2.0.1.1.5.10.149.42 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.946 Issues before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986] | (a) General. The issues before the administrative law judge include all the issues brought out in the initial, reconsidered or revised determination that were not decided entirely in your favor. However, if evidence presented before or during the hearing causes the administrative law judge to question a fully favorable determination, he or she will notify you and will consider it an issue at the hearing. (b) New issues —(1) General. The administrative law judge may consider a new issue at the hearing if he or she notifies you and all the parties about the new issue any time after receiving the hearing request and before mailing notice of the hearing decision. The administrative law judge or any party may raise a new issue; an issue may be raised even though it arose after the request for a hearing and even though it has not been considered in an initial or reconsidered determination. However, it may not be raised if it involves a claim that is within the jurisdiction of a State agency under a Federal-State agreement concerning the determination of disability. (2) Notice of a new issue. The administrative law judge shall notify you and any other party if he or she will consider any new issue. Notice of the time and place of the hearing on any new issues will be given in the manner described in § 404.938, unless you have indicated in writing that you do not wish to receive the notice. | ||||
| 20:20:2.0.1.1.5.10.149.43 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.948 Deciding a case without an oral hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 73 FR 76944, Dec. 18, 2008; 75 FR 33168, June 11, 2010; 76 FR 65370, Oct. 21, 2011] | (a) Decision fully favorable. If the evidence in the hearing record supports a finding in favor of you and all the parties on every issue, the administrative law judge may issue a hearing decision based on a preponderance of the evidence without holding an oral hearing. The notice of the decision will state that you have the right to an oral hearing and to examine the evidence on which the administrative law judge based the decision. (b) Parties do not wish to appear. (1) The administrative law judge may decide a case on the record and not conduct an oral hearing if— (i) You and all the parties indicate in writing that you do not wish to appear before the administrative law judge at an oral hearing; or (ii) You live outside the United States, you do not inform us that you wish to appear, and there are no other parties who wish to appear. (2) When an oral hearing is not held, the administrative law judge shall make a record of the material evidence. The record will include the applications, written statements, certificates, reports, affidavits, and other documents that were used in making the determination under review and any additional evidence you or any other party to the hearing present in writing. The decision of the administrative law judge must be based on this record. (c) Case remanded for a revised determination. (1) The administrative law judge may remand a case to the appropriate component of our office for a revised determination if there is reason to believe that the revised determination would be fully favorable to you. This could happen if the administrative law judge receives new and material evidence or if there is a change in the law that permits the favorable determination. (2) Unless you request the remand, the administrative law judge shall notify you that your case has been remanded and tell you that if you object, you must notify him or her of your objections within 10 days of the date the case is remanded or we will assume that you agree to the remand. If you object to the rema… | ||||
| 20:20:2.0.1.1.5.10.149.44 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.949 Presenting written statements and oral arguments. | SSA | [81 FR 90993, Dec. 16, 2016 | You or a person you designate to act as your representative may appear before the administrative law judge to state your case, present a written summary of your case, or enter written statements about the facts and law material to your case in the record. If presenting written statements prior to hearing, you must provide a copy of your written statements for each party no later than 5 business days before the date set for the hearing, unless you show that your circumstances meet the conditions described in § 404.935(b). | ||||
| 20:20:2.0.1.1.5.10.149.45 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.950 Presenting evidence at a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 68 FR 5219, Feb. 3, 2003; 75 FR 39160, July 8, 2010; 78 FR 29627, May 21, 2013; 81 FR 90993, Dec. 16, 2016; 84 FR 69306, Dec. 18, 2019; 89 FR 68362, Aug. 26, 2024] | (a) The right to appear and present evidence. Any party to a hearing has a right to appear before the administrative law judge, in the manner set forth in § 404.936, to present evidence and to state their position. A party may also make their appearance by means of a designated representative, who may make their appearance in the manner set forth in § 404.936. (b) Waiver of the right to appear. You may send the administrative law judge a waiver or a written statement indicating that you do not wish to appear at the hearing. You may withdraw this waiver any time before a notice of the hearing decision is mailed to you. Even if all of the parties waive their right to appear at a hearing, we may notify them of a time and a place for an oral hearing, if the administrative law judge believes that a personal appearance and testimony by you or any other party is necessary to decide the case. (c) Admissible evidence. Subject to the provisions of § 404.935, the administrative law judge may receive any evidence at the hearing that he or she believes is material to the issues, even though the evidence would not be admissible in court under the rules of evidence used by the court. (d) Subpoenas. (1) When it is reasonably necessary for the full presentation of a case, an administrative law judge or a member of the Appeals Council may, on his or her own initiative or at the request of a party, issue subpoenas for the appearance and testimony of witnesses and for the production of books, records, correspondence, papers, or other documents that are material to an issue at the hearing. (2) Parties to a hearing who wish to subpoena documents or witnesses must file a written request for the issuance of a subpoena with the administrative law judge or at one of our offices at least 10 business days before the hearing date, unless you show that your circumstances meet the conditions described in § 404.935(b). The written request must give the names of the witnesses or documents to be produced; describe the address or locat… | ||||
| 20:20:2.0.1.1.5.10.149.46 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.951 Official record. | SSA | [81 FR 90994, Dec. 16, 2016 | (a) Hearing recording. All hearings will be recorded. The hearing recording will be prepared as a typed copy of the proceedings if— (1) The case is sent to the Appeals Council without a decision or with a recommended decision by the administrative law judge; (2) You seek judicial review of your case by filing an action in a Federal district court within the stated time period, unless we request the court to remand the case; or (3) An administrative law judge or the Appeals Council asks for a written record of the proceedings. (b) Contents of the official record. All evidence upon which the administrative law judge relies for the decision must be contained in the record, either directly or by appropriate reference. The official record will include the applications, written statements, certificates, reports, affidavits, medical records, and other documents that were used in making the decision under review and any additional evidence or written statements that the administrative law judge admits into the record under §§ 404.929 and 404.935. All exhibits introduced as evidence must be marked for identification and incorporated into the record. The official record of your claim will contain all of the marked exhibits and a verbatim recording of all testimony offered at the hearing. It also will include any prior initial determinations or decisions on your claim. | ||||
| 20:20:2.0.1.1.5.10.149.47 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.952 Consolidated hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986] | (a) General. (1) A consolidated hearing may be held if— (i) You have requested a hearing to decide your benefit rights under title II of the Act and you have also requested a hearing to decide your rights under another law we administer; and (ii) One or more of the issues to be considered at the hearing you requested are the same issues that are involved in another claim you have pending before us. (2) If the administrative law judge decides to hold the hearing on both claims, he or she decides both claims, even if we have not yet made an initial or reconsidered determination on the other claim. (b) Record, evidence, and decision. There will be a single record at a consolidated hearing. This means that the evidence introduced in one case becomes evidence in the other(s). The administrative law judge may make either a separate or consolidated decision. | ||||
| 20:20:2.0.1.1.5.10.149.48 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.953 The decision of an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 54 FR 37792, Sept. 13, 1989; 69 FR 61597, Oct. 20, 2004; 73 FR 76944, Dec. 18, 2008; 75 FR 33168, June 11, 2010] | (a) General. The administrative law judge shall issue a written decision that gives the findings of fact and the reasons for the decision. The administrative law judge must base the decision on the preponderance of the evidence offered at the hearing or otherwise included in the record. The administrative law judge shall mail a copy of the decision to all the parties at their last known address. The Appeals Council may also receive a copy of the decision. (b) Fully favorable oral decision entered into the record at the hearing. The administrative law judge may enter a fully favorable oral decision based on the preponderance of the evidence into the record of the hearing proceedings. If the administrative law judge enters a fully favorable oral decision into the record of the hearing proceedings, the administrative law judge may issue a written decision that incorporates the oral decision by reference. The administrative law judge may use this procedure only in those categories of cases that we identify in advance. The administrative law judge may only use this procedure in those cases where the administrative law judge determines that no changes are required in the findings of fact or the reasons for the decision as stated at the hearing. If a fully favorable decision is entered into the record at the hearing, the administrative law judge will also include in the record, as an exhibit entered into the record at the hearing, a document that sets forth the key data, findings of fact, and narrative rationale for the decision. If the decision incorporates by reference the findings and the reasons stated in an oral decision at the hearing, the parties shall also be provided, upon written request, a record of the oral decision. (c) Recommended decision. Although an administrative law judge will usually make a decision, the administrative law judge may send the case to the Appeals Council with a recommended decision based on a preponderance of the evidence when appropriate. The administrative law judge will mail… | ||||
| 20:20:2.0.1.1.5.10.149.49 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.955 The effect of a hearing decision. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986; 54 FR 37792, Sept. 13, 1989; 85 FR 73157, Nov. 16, 2020] | The decision of the administrative law judge is binding on all parties to the hearing unless— (a) You or another party request a review of the decision by the Appeals Council within the stated time period, and the Appeals Council reviews your case; (b) You or another party requests a review of the decision by the Appeals Council within the stated time period, the Appeals Council denies your request for review, and you seek judicial review of your case by filing an action in a Federal district court; (c) The Appeals Council decides on its own motion to review the decision under the procedures in § 404.969; (d) The decision is revised by an administrative law judge or the Appeals Council under the procedures explained in § 404.987; (e) The expedited appeals process is used; (f) The decision is a recommended decision directed to the Appeals Council; or (g) In a case remanded by a Federal court, the Appeals Council assumes jurisdiction under the procedures in § 404.984. | ||||
| 20:20:2.0.1.1.5.10.149.50 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.956 Removal of a hearing request(s) to the Appeals Council. | SSA | [85 FR 73157, Nov. 16, 2020] | (a) Removal. The Appeals Council may assume responsibility for a hearing request(s) pending at the hearing level of the administrative review process. (b) Notice. We will mail a notice to all parties at their last known address telling them that the Appeals Council has assumed responsibility for the case(s). (c) Procedures applied. If the Appeals Council assumes responsibility for a hearing request(s), it shall conduct all proceedings in accordance with the rules set forth in §§ 404.929 through 404.961, as applicable. (d) Appeals Council review. If the Appeals Council assumes responsibility for your hearing request under this section and you or any other party is dissatisfied with the hearing decision or with the dismissal of a hearing request, you may request that the Appeals Council review that action following the procedures in §§ 404.967 through 404.982. The Appeals Council may also decide on its own motion to review the action that was taken in your case under § 404.969. The administrative appeals judge who conducted a hearing, issued a hearing decision in your case, or dismissed your hearing request will not participate in any action associated with your request for Appeals Council review of that case. (e) Ancillary provisions. For the purposes of the procedures authorized by this section, the regulations of part 404 shall apply to authorize a member of the Appeals Council to exercise the functions performed by an administrative law judge under subpart J of part 404. | ||||
| 20:20:2.0.1.1.5.10.149.51 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.957 Dismissal of a request for a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 50 FR 21438, May 24, 1985; 51 FR 303, Jan. 3, 1986; 59 FR 1634, Jan. 12, 1994] | An administrative law judge may dismiss a request for a hearing under any of the following conditions: (a) At any time before notice of the hearing decision is mailed, you or the party or parties that requested the hearing ask to withdraw the request. This request may be submitted in writing to the administrative law judge or made orally at the hearing. (b)(1)(i) Neither you nor the person you designate to act as your representative appears at the time and place set for the hearing and you have been notified before the time set for the hearing that your request for hearing may be dismissed without further notice if you did not appear at the time and place of hearing, and good cause has not been found by the administrative law judge for your failure to appear; or (ii) Neither you nor the person you designate to act as your representative appears at the time and place set for the hearing and within 10 days after the administrative law judge mails you a notice asking why you did not appear, you do not give a good reason for the failure to appear. (2) In determining good cause or good reason under this paragraph, we will consider any physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) which you may have. (c) The administrative law judge decides that there is cause to dismiss a hearing request entirely or to refuse to consider any one or more of the issues because— (1) The doctrine of res judicata applies in that we have made a previous determination or decision under this subpart about your rights on the same facts and on the same issue or issues, and this previous determination or decision has become final by either administrative or judicial action; (2) The person requesting a hearing has no right to it under § 404.930; (3) You did not request a hearing within the stated time period and we have not extended the time for requesting a hearing under § 404.933(c); or (4) You die, there are no other parties, and we have no information to show tha… | ||||
| 20:20:2.0.1.1.5.10.149.52 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.958 Notice of dismissal of a request for a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986] | We shall mail a written notice of the dismissal of the hearing request to all parties at their last known address. The notice will state that there is a right to request that the Appeals Council vacate the dismissal action. | ||||
| 20:20:2.0.1.1.5.10.149.53 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.959 Effect of dismissal of a request for a hearing before an administrative law judge. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 51 FR 303, Jan. 3, 1986] | The dismissal of a request for a hearing is binding, unless it is vacated by an administrative law judge or the Appeals Council. | ||||
| 20:20:2.0.1.1.5.10.149.54 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.960 Vacating a dismissal of a request for a hearing before an administrative law judge. | SSA | [76 FR 65370, Oct. 21, 2011] | (a) Except as provided in paragraph (b) of this section, an administrative law judge or the Appeals Council may vacate a dismissal of a request for a hearing if you request that we vacate the dismissal. If you or another party wish to make this request, you must do so within 60 days of the date you receive notice of the dismissal, and you must state why our dismissal of your request for a hearing was erroneous. The administrative law judge or Appeals Council will inform you in writing of the action taken on your request. The Appeals Council may also vacate a dismissal of a request for a hearing on its own motion. If the Appeals Council decides to vacate a dismissal on its own motion, it will do so within 60 days of the date we mail the notice of dismissal and will inform you in writing that it vacated the dismissal. (b) If you wish to proceed with a hearing after you received a fully favorable revised determination under the prehearing case review process in § 404.941, you must follow the procedures in § 404.941(d) to request that an administrative law judge vacate his or her order dismissing your request for a hearing. | ||||
| 20:20:2.0.1.1.5.10.149.55 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.961 Prehearing and posthearing conferences. | SSA | The administrative law judge may decide on his or her own, or at the request of any party to the hearing, to hold a prehearing or posthearing conference to facilitate the hearing or the hearing decision. The administrative law judge shall tell the parties of the time, place and purpose of the conference at least seven days before the conference date, unless the parties have indicated in writing that they do not wish to receive a written notice of the conference. At the conference, the administrative law judge may consider matters in addition to those stated in the notice, if the parties consent in writing. A record of the conference will be made. The administrative law judge shall issue an order stating all agreements and actions resulting from the conference. If the parties do not object, the agreements and actions become part of the hearing record and are binding on all parties. | |||||
| 20:20:2.0.1.1.5.10.149.56 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.965 [Reserved] | SSA | ||||||
| 20:20:2.0.1.1.5.10.150.57 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.966 [Reserved] | SSA | ||||||
| 20:20:2.0.1.1.5.10.150.58 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.967 Appeals Council review—general. | SSA | If you or any other party is dissatisfied with the hearing decision or with the dismissal of a hearing request, you may request that the Appeals Council review that action. The Appeals Council may deny or dismiss the request for review, or it may grant the request and either issue a decision or remand the case to an administrative law judge. The Appeals Council shall notify the parties at their last known address of the action it takes. | |||||
| 20:20:2.0.1.1.5.10.150.59 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.968 How to request Appeals Council review. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 81 FR 90993, Dec. 16, 2016] | (a) Time and place to request Appeals Council review. You may request Appeals Council review by filing a written request. You should submit any evidence you wish to have considered by the Appeals Council with your request for review, and the Appeals Council will consider the evidence in accordance with § 404.970. You may file your request— (1) Within 60 days after the date you receive notice of the hearing decision or dismissal (or within the extended time period if we extend the time as provided in paragraph (b) of this section); (2) At one of our offices, the Veterans Administration Regional Office in the Philippines, or an office of the Railroad Retirement Board if you have 10 or more years of service in the railroad industry. (b) Extension of time to request review. You or any party to a hearing decision may ask that the time for filing a request for the review be extended. The request for an extension of time must be in writing. It must be filed with the Appeals Council, and it must give the reasons why the request for review was not filed within the stated time period. If you show that you had good cause for missing the deadline, the time period will be extended. To determine whether good cause exists, we use the standards explained in § 404.911. | ||||
| 20:20:2.0.1.1.5.10.150.60 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.969 Appeals Council initiates review. | SSA | [63 FR 36570, July 7, 1998, as amended at 75 FR 33168, June 11, 2010] | (a) General. Anytime within 60 days after the date of a decision or dismissal that is subject to review under this section, the Appeals Council may decide on its own motion to review the action that was taken in your case. We may refer your case to the Appeals Council for it to consider reviewing under this authority. (b) Identification of cases. We will identify a case for referral to the Appeals Council for possible review under its own-motion authority before we effectuate a decision in the case. We will identify cases for referral to the Appeals Council through random and selective sampling techniques, which we may use in association with examination of the cases identified by sampling. We will also identify cases for referral to the Appeals Council through the evaluation of cases we conduct in order to effectuate decisions. (1) Random and selective sampling and case examinations. We may use random and selective sampling to identify cases involving any type of action ( i.e. , fully or partially favorable decisions, unfavorable decisions, or dismissals) and any type of benefits ( i.e. , benefits based on disability and benefits not based on disability). We will use selective sampling to identify cases that exhibit problematic issues or fact patterns that increase the likelihood of error. Neither our random sampling procedures nor our selective sampling procedures will identify cases based on the identity of the decisionmaker or the identity of the office issuing the decision. We may examine cases that have been identified through random or selective sampling to refine the identification of cases that may meet the criteria for review by the Appeals Council. (2) Identification as a result of the effectuation process. We may refer a case requiring effectuation to the Appeals Council if, in the view of the effectuating component, the decision cannot be effectuated because it contains a clerical error affecting the outcome of the claim; the decision is clearly inconsistent with the Social Security Act, t… | ||||
| 20:20:2.0.1.1.5.10.150.61 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.970 Cases the Appeals Council will review. | SSA | [81 FR 90994, Dec. 16, 2016, as amended at 85 FR 73157, Nov. 16, 2020] | (a) The Appeals Council will review a case at a party's request or on its own motion if— (1) There appears to be an abuse of discretion by the administrative law judge or administrative appeals judge who heard the case; (2) There is an error of law; (3) The action, findings or conclusions in the hearing decision or dismissal order are not supported by substantial evidence; (4) There is a broad policy or procedural issue that may affect the general public interest; or (5) Subject to paragraph (b) of this section, the Appeals Council receives additional evidence that is new, material, and relates to the period on or before the date of the hearing decision, and there is a reasonable probability that the additional evidence would change the outcome of the decision. (b) The Appeals Council will only consider additional evidence under paragraph (a)(5) of this section if you show good cause for not informing us about or submitting the evidence as described in § 404.935 because: (1) Our action misled you; (2) You had a physical, mental, educational, or linguistic limitation(s) that prevented you from informing us about or submitting the evidence earlier; or (3) Some other unusual, unexpected, or unavoidable circumstance beyond your control prevented you from informing us about or submitting the evidence earlier. Examples include, but are not limited to: (i) You were seriously ill, and your illness prevented you from contacting us in person, in writing, or through a friend, relative, or other person; (ii) There was a death or serious illness in your immediate family; (iii) Important records were destroyed or damaged by fire or other accidental cause; (iv) You actively and diligently sought evidence from a source and the evidence was not received or was received less than 5 business days prior to the hearing; or (v) You received a hearing level decision on the record and the Appeals Council reviewed your decision. (c) If you submit additional evidence that does not relate to the period on or before the date … | ||||
| 20:20:2.0.1.1.5.10.150.62 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.971 Dismissal by Appeals Council. | SSA | The Appeals Council will dismiss your request for review if you did not file your request within the stated period of time and the time for filing has not been extended. The Appeals Council may also dismiss any proceedings before it if— (a) You and any other party to the proceedings files a written request for dismissal; or (b) You or any other party to the proceedings dies and the record clearly shows that dismissal will not adversely affect any other person who wishes to continue the action. | |||||
| 20:20:2.0.1.1.5.10.150.63 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.972 Effect of dismissal of request for Appeals Council review. | SSA | The dismissal of a request for Appeals Council review is binding and not subject to further review. | |||||
| 20:20:2.0.1.1.5.10.150.64 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.973 Notice of Appeals Council review. | SSA | [85 FR 73157, Nov. 16, 2020] | When the Appeals Council decides to review a case, it shall mail a prior notice to all parties at their last known address stating the reasons for the review and the issues to be considered. However, when the Appeals Council plans to issue a decision that is fully favorable to all parties, plans to remand the case for further proceedings, or plans to issue a decision that is favorable in part and remand the remaining issues for further proceedings, it may send the notice of Appeals Council review to all parties with the decision or remand order. | ||||
| 20:20:2.0.1.1.5.10.150.65 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.974 Obtaining evidence from Appeals Council. | SSA | You may request and receive copies or a statement of the documents or other written evidence upon which the hearing decision or dismissal was based and a copy or summary of the transcript of oral evidence. However, you will be asked to pay the costs of providing these copies unless there is a good reason why you should not pay. | |||||
| 20:20:2.0.1.1.5.10.150.66 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.975 Filing briefs with the Appeals Council. | SSA | Upon request, the Appeals Council shall give you and all other parties a reasonable opportunity to file briefs or other written statements about the facts and law relevant to the case. A copy of each brief or statement should be filed for each party. | |||||
| 20:20:2.0.1.1.5.10.150.67 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.976 Procedures before the Appeals Council. | SSA | [81 FR 90994, Dec. 16, 2016, as amended at 84 FR 69306, Dec. 18, 2019; 85 FR 73157, Nov. 16, 2020; 89 FR 68362, Aug. 26, 2024] | (a) Limitation of issues. The Appeals Council may limit the issues it considers if it notifies you and the other parties of the issues it will review. (b) Evidence the Appeals Council will exhibit. The Appeals Council will evaluate all additional evidence it receives, but will only mark as an exhibit and make part of the official record additional evidence that it determines meets the requirements of § 404.970(a)(5) and (b). If we need to file a certified administrative record in Federal court, we will include in that record all additional evidence the Appeals Council received during the administrative review process, including additional evidence that the Appeals Council received but did not exhibit or make part of the official record. (c) Oral argument. You may request to appear before the Appeals Council to present oral argument in support of your request for review. The Appeals Council will grant your request if it decides that your case raises an important question of law or policy or that oral argument would help to reach a proper decision. If your request to appear is granted, the Appeals Council will tell you the time and place of the oral argument at least 10 business days before the scheduled date. The Appeals Council will determine whether your appearance will be by audio, agency video, online video, or in person as set forth in § 404.936. The Appeals Council will determine whether any other person relevant to the proceeding will appear by audio, agency video, online video, or in person as set forth in § 404.936(c)(2). | ||||
| 20:20:2.0.1.1.5.10.150.68 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.977 Case remanded by Appeals Council. | SSA | (a) When the Appeals Council may remand a case. The Appeals Council may remand a case to an administrative law judge so that he or she may hold a hearing and issue a decision or a recommended decision. The Appeals Council may also remand a case in which additional evidence is needed or additional action by the administrative law judge is required. (b) Action by administrative law judge on remand. The administrative law judge shall take any action that is ordered by the Appeals Council and may take any additional action that is not inconsistent with the Appeals Council's remand order. (c) Notice when case is returned with a recommended decision. When the administrative law judge sends a case to the Appeals Council with a recommended decision, a notice is mailed to the parties at their last known address. The notice tells them that the case has been sent to the Appeals Council, explains the rules for filing briefs or other written statements with the Appeals Council, and includes a copy of the recommended decision. (d) Filing briefs with and obtaining evidence from the Appeals Council. (1) You may file briefs or other written statements about the facts and law relevant to your case with the Appeals Council within 20 days of the date that the recommended decision is mailed to you. Any party may ask the Appeals Council for additional time to file briefs or statements. The Appeals Council will extend this period, as appropriate, if you show that you had good cause for missing the deadline. (2) All other rules for filing briefs with and obtaining evidence from the Appeals Council follow the procedures explained in this subpart. (e) Procedures before the Appeals Council. (1) The Appeals Council, after receiving a recommended decision, will conduct its proceedings and issue its decision according to the procedures explain in this subpart. (2) If the Appeals Council believes that more evidence is required, it may again remand the case to an administrative law judge for further inquiry into the issues, rehe… | |||||
| 20:20:2.0.1.1.5.10.150.69 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.979 Decision of Appeals Council. | SSA | [52 FR 4004, Feb. 9, 1987, as amended at 73 FR 76944, Dec. 18, 2008; 81 FR 90994, Dec. 16, 2016] | After it has reviewed all the evidence in the administrative law judge hearing record and any additional evidence received, subject to the limitations on Appeals Council consideration of additional evidence in § 404.970, the Appeals Council will make a decision or remand the case to an administrative law judge. The Appeals Council may affirm, modify or reverse the administrative law judge hearing decision or it may adopt, modify or reject a recommended decision. If the Appeals Council issues its own decision, it will base its decision on the preponderance of the evidence. A copy of the Appeals Council's decision will be mailed to the parties at their last known address. | ||||
| 20:20:2.0.1.1.5.10.150.70 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.981 Effect of Appeals Council's decision or denial of review. | SSA | The Appeals Council may deny a party's request for review or it may decide to review a case and make a decision. The Appeals Council's decision, or the decision of the administrative law judge if the request for review is denied, is binding unless you or another party file an action in Federal district court, or the decision is revised. You may file an action in a Federal district court within 60 days after the date you receive notice of the Appeals Council's action. | |||||
| 20:20:2.0.1.1.5.10.150.71 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.982 Extension of time to file action in Federal district court. | SSA | Any party to the Appeals Council's decision or denial of review, or to an expedited appeals process agreement, may request that the time for filing an action in a Federal district court be extended. The request must be in writing and it must give the reasons why the action was not filed within the stated time period. The request must be filed with the Appeals Council, or if it concerns an expedited appeals process agreement, with one of our offices. If you show that you had good cause for missing the deadline, the time period will be extended. To determine whether good cause exists, we use the standards explained in § 404.911. | |||||
| 20:20:2.0.1.1.5.10.151.72 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.983 Case remanded by a Federal court. | SSA | [85 FR 73157, Nov. 16, 2020] | (a) General rule. When a Federal court remands a case to the Commissioner for further consideration, the Appeals Council, acting on behalf of the Commissioner, may make a decision following the provisions in paragraph (b) or (c) of this section, dismiss the proceedings, except as provided in paragraph (d) of this section, or remand the case to an administrative law judge following the provisions in paragraph (e) of this section with instructions to take action and issue a decision or return the case to the Appeals Council with a recommended decision. Any issues relating to the claim(s) may be considered by the Appeals Council or administrative law judge whether or not they were raised in the administrative proceedings leading to the final decision in the case. (b) Appeals Council decision without a hearing. If the Appeals Council assumes responsibility under paragraph (a) of this section for issuing a decision without a hearing, it will follow the procedures explained in §§ 404.973 and 404.979. (c) Administrative appeals judge decision after holding a hearing. If the Appeals Council assumes responsibility for issuing a decision and a hearing is necessary to complete adjudication of the claim(s), an administrative appeals judge will hold a hearing using the procedures set forth in §§ 404.929 through 404.961, as applicable. (d) Appeals Council dismissal. After a Federal court remands a case to the Commissioner for further consideration, the Appeals Council may dismiss the proceedings before it for any reason that an administrative law judge may dismiss a request for a hearing under § 404.957. The Appeals Council will not dismiss the proceedings in a claim where we are otherwise required by law or a judicial order to file the Commissioner's additional and modified findings of fact and decision with a court. (e) Appeals Council remand. If the Appeals Council remands a case under paragraph (a) of this section, it will follow the procedures explained in § 404.977. | ||||
| 20:20:2.0.1.1.5.10.151.73 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.984 Appeals Council review of hearing decision in a case remanded by a Federal court. | SSA | [85 FR 73185, Nov. 16, 2020] | (a) General. In accordance with § 404.983, when a case is remanded by a Federal court for further consideration and the Appeals Council remands the case to an administrative law judge, or an administrative appeals judge issues a decision pursuant to § 404.983(c), the decision of the administrative law judge or administrative appeals judge will become the final decision of the Commissioner after remand on your case unless the Appeals Council assumes jurisdiction of the case. The Appeals Council may assume jurisdiction, using the standard set forth in § 404.970, based on written exceptions to the decision which you file with the Appeals Council or based on its authority pursuant to paragraph (c) of this section. If the Appeals Council assumes jurisdiction of the case, it will not dismiss the request for a hearing where we are otherwise required by law or a judicial order to file the Commissioner's additional and modified findings of fact and decision with a court. (b) You file exceptions disagreeing with the hearing decision. (1) If you disagree with the hearing decision, in whole or in part, you may file exceptions to the decision with the Appeals Council. Exceptions may be filed by submitting a written statement to the Appeals Council setting forth your reasons for disagreeing with the decision of the administrative law judge or administrative appeals judge. The exceptions must be filed within 30 days of the date you receive the hearing decision or an extension of time in which to submit exceptions must be requested in writing within the 30-day period. A timely request for a 30-day extension will be granted by the Appeals Council. A request for an extension of more than 30 days should include a statement of reasons as to why you need the additional time. (2) If written exceptions are timely filed, the Appeals Council will consider your reasons for disagreeing with the hearing decision and all the issues presented by your case. If the Appeals Council concludes that there is no reason to change the hearing de… | ||||
| 20:20:2.0.1.1.5.10.151.74 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.985 Application of circuit court law. | SSA | [63 FR 24932, May 6, 1998] | The procedures which follow apply to administrative determinations or decisions on claims involving the application of circuit court law. (a) General. We will apply a holding in a United States Court of Appeals decision that we determine conflicts with our interpretation of a provision of the Social Security Act or regulations unless the Government seeks further judicial review of that decision or we relitigate the issue presented in the decision in accordance with paragraphs (c) and (d) of this section. We will apply the holding to claims at all levels of the administrative review process within the applicable circuit unless the holding, by its nature, applies only at certain levels of adjudication. (b) Issuance of an Acquiescence Ruling. When we determine that a United States Court of Appeals holding conflicts with our interpretation of a provision of the Social Security Act or regulations and the Government does not seek further judicial review or is unsuccessful on further review, we will issue a Social Security Acquiescence Ruling. The Acquiescence Ruling will describe the administrative case and the court decision, identify the issue(s) involved, and explain how we will apply the holding, including, as necessary, how the holding relates to other decisions within the applicable circuit. These Acquiescence Rulings will generally be effective on the date of their publication in the Federal Register and will apply to all determinations and decisions made on or after that date unless an Acquiescence Ruling is rescinded as stated in paragraph (e) of this section. The process we will use when issuing an Acquiescence Ruling follows: (1) We will release an Acquiescence Ruling for publication in the Federal Register for any precedential circuit court decision that we determine contains a holding that conflicts with our interpretation of a provision of the Social Security Act or regulations no later than 120 days from the receipt of the court's decision. This timeframe will not apply when we decide to seek … | ||||
| 20:20:2.0.1.1.5.10.152.75 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.987 Reopening and revising determinations and decisions. | SSA | [59 FR 8535, Feb. 23, 1994] | (a) General. Generally, if you are dissatisfied with a determination or decision made in the administrative review process, but do not request further review within the stated time period, you lose your right to further review and that determination or decision becomes final. However, a determination or a decision made in your case which is otherwise final and binding may be reopened and revised by us. (b) Procedure for reopening and revision. We may reopen a final determination or decision on our own initiative, or you may ask that a final determination or a decision to which you were a party be reopened. In either instance, if we reopen the determination or decision, we may revise that determination or decision. The conditions under which we may reopen a previous determination or decision, either on our own initiative or at your request, are explained in § 404.988. | ||||
| 20:20:2.0.1.1.5.10.152.76 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.988 Conditions for reopening. | SSA | [45 FR 52081, Aug. 5, 1980, as amended at 49 FR 46369, Nov. 26, 1984; 51 FR 18313, May 19, 1986; 59 FR 1635, Jan. 12, 1994; 60 FR 19165, Apr. 17, 1995; 75 FR 33168, June 11, 2010] | A determination, revised determination, decision, or revised decision may be reopened— (a) Within 12 months of the date of the notice of the initial determination, for any reason; (b) Within four years of the date of the notice of the initial determination if we find good cause, as defined in § 404.989, to reopen the case; or (c) At any time if— (1) It was obtained by fraud or similar fault (see § 416.1488(c) of this chapter for factors which we take into account in determining fraud or similar fault); (2) Another person files a claim on the same earnings record and allowance of the claim adversely affects your claim; (3) A person previously determined to be dead, and on whose earnings record your entitlement is based, is later found to be alive; (4) Your claim was denied because you did not prove that a person died, and the death is later established— (i) By a presumption of death under § 404.721(b); or (ii) By location or identification of his or her body; (5) The Railroad Retirement Board has awarded duplicate benefits on the same earnings record; (6) It either— (i) Denies the person on whose earnings record your claim is based gratuitous wage credits for military or naval service because another Federal agency (other than the Veterans Administration) has erroneously certified that it has awarded benefits based on the service; or (ii) Credits the earnings record of the person on which your claim is based with gratuitous wage credits and another Federal agency (other than the Veterans Administration) certifies that it has awarded a benefit based on the period of service for which the wage credits were granted; (7) It finds that the claimant did not have insured status, but earnings were later credited to his or her earnings record to correct errors apparent on the face of the earnings record (section 205(c)(5)(C) of the Act), to enter items transferred by the Railroad Retirement Board, which were credited under the Railroad Retirement Act when they should have been credited to the claimant's Socia… | ||||
| 20:20:2.0.1.1.5.10.152.77 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.989 Good cause for reopening. | SSA | (a) We will find that there is good cause to reopen a determination or decision if— (1) New and material evidence is furnished; (2) A clerical error in the computation or recomputation of benefits was made; or (3) The evidence that was considered in making the determination or decision clearly shows on its face that an error was made. (b) We will not find good cause to reopen your case if the only reason for reopening is a change of legal interpretation or administrative ruling upon which the determination or decision was made. | |||||
| 20:20:2.0.1.1.5.10.152.78 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.990 Finality of determinations and decisions on revision of an earnings record. | SSA | A determination or a decision on a revision of an earnings record may be reopened only within the time period and under the conditions provided in section 205(c) (4) or (5) of the Act, or within 60 days after the date you receive notice of the determination or decision, whichever is later. | |||||
| 20:20:2.0.1.1.5.10.152.79 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.991 Finality of determinations and decisions to suspend benefit payments for entire taxable year because of earnings. | SSA | A determination or decision to suspend benefit payments for an entire taxable year because of earnings may be reopened only within the time period and under the conditions provided in section 203(h)(1)(B) of the Act. | |||||
| 20:20:2.0.1.1.5.10.152.80 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.991a Late completion of timely investigation. | SSA | [49 FR 46369, Nov. 26, 1984; 49 FR 48036, Dec. 10, 1984] | We may revise a determination or decision after the applicable time period in § 404.988(a) or § 404.988(b) expires if we begin an investigation into whether to revise the determination or decision before the applicable time period expires. We may begin the investigation either based on a request by you or by an action on our part. The investigation is a process of gathering facts after a determination or decision has been reopened to determine if a revision of the determination or decision is applicable. (a) If we have diligently pursued the investigation to its conclusion, we may revise the determination or decision. The revision may be favorable or unfavorable to you. “Diligently pursued” means that in light of the facts and circumstances of a particular case, the necessary action was undertaken and carried out as promptly as the circumstances permitted. Diligent pursuit will be presumed to have been met if we conclude the investigation and if necessary, revise the determination or decision within 6 months from the date we began the investigation. (b) If we have not diligently pursued the investigation to its conclusion, we will revise the determination or decision if a revision is applicable and if it will be favorable to you. We will not revise the determination or decision if it will be unfavorable to you. | ||||
| 20:20:2.0.1.1.5.10.152.81 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.992 Notice of revised determination or decision. | SSA | [51 FR 303, Jan. 3, 1986] | (a) When a determination or decision is revised, notice of the revision will be mailed to the parties at their last known address. The notice will state the basis for the revised determination or decision and the effect of the revision. The notice will also inform the parties of the right to further review. (b) If a reconsidered determination that you are disabled, based on medical factors, is reopened for the purpose of being revised, you will be notified, in writing, of the proposed revision and of your right to request that a disability hearing be held before a revised reconsidered determination is issued. If a revised reconsidered determination is issued, you may request a hearing before an administrative law judge. (c) If an administrative law judge or the Appeals Council proposes to revise a decision, and the revision would be based on evidence not included in the record on which the prior decision was based, you and any other parties to the decision will be notified, in writing, of the proposed action and of your right to request that a hearing be held before any further action is taken. If a revised decision is issued by an administrative law judge, you and any other party may request that it be reviewed by the Appeals Council, or the Appeals Council may review the decision on its own initiative. (d) If an administrative law judge or the Appeals Council proposes to revise a decision, and the revision would be based only on evidence included in the record on which the prior decision was based, you and any other parties to the decision will be notified, in writing, of the proposed action. If a revised decision is issued by an administrative law judge, you and any other party may request that it be reviewed by the Appeals Council, or the Appeals Council may review the decision on its own initiative. | ||||
| 20:20:2.0.1.1.5.10.152.82 | 20 | Employees' Benefits | III | 404 | PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) | J | Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions | § 404.993 Effect of revised determination or decision. | SSA | [51 FR 303, Jan. 3, 1986] | A revised determination or decision is binding unless— (a) You or another party to the revised determination file a written request for reconsideration or a hearing before an administrative law judge, as appropriate; (b) You or another party to the revised decision file, as appropriate, a request for review by the Appeals Council or a hearing before an administrative law judge; (c) The Appeals Council reviews the revised decision; or (d) The revised determination or decision is further revised. |
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